Children's perspective of hope in living with leukemia: A qualitative study using drawing.

PURPOSE: This study aimed to explore children's perspective of hope in living with leukemia through the utilization of drawing-based interview technique. DESIGN AND METHODS: This qualitative study was conducted at the Children's Medical Center in Tehran with the participation of children aged 6 to 12 diagnosed with leukemia. The children were asked to prepare a drawing about hope then interviews were conducted face-to-face with each child after completing the drawing. Data analysis was conducted using the qualitative content analysis. RESULTS: In the collection of a total of 20 drawings from school-age children with leukemia, each drawings has different metaphors symbolizing hope. Five themes emerged including positive thinking, embracing the sanctuary of maternal affection and collective caring, the ethereal glow of joy, the melody of resilient soul, and navigating the way back to home. CONCLUSION: Hope from the child's perspective can be achieved in simple, possible and accessible ways, making it easier for the family, community and healthcare system to inspire hope in their lives with Leukemia. PRACTICE IMPLICATION: Health providers in pediatric oncology can integrate hope-based care interventions related to the factors influencing children's perspectives.

The effect of spiritual support on life satisfaction in Iranian patients with gastrointestinal cancer.

Background: The diagnosis and treatment of gastrointestinal cancer not only impose significant physical challenges but also deeply affect patients emotionally and psychologically, significantly influencing their overall quality of life. Among the various factors that can positively impact life satisfaction in individuals facing gastrointestinal cancer, spirituality emerges as a crucial aspect. This study aimed to determine the effect of a spiritual intervention on life satisfaction in patients with gastrointestinal cancer. Methods: This quasi-experimental study was conducted with two groups of 85 gastrointestinal cancer patients from two major hospitals in Tehran. The intervention group received spiritual support through social media for six sessions over three weeks to learn how to effectively improve their spiritual state. The control group received routine medical visits and care. The Satisfaction with Life Scale (SWLS) was used before and after the spiritual support in both the intervention and control groups. The research was approved by the institutional ethics committee. Results: In the pre-test stage, there was no significant difference in average life satisfaction between the intervention and control groups (t = 1.887, d = 0.30, p > 0.05). However, positive changes occurred in the post-test stage. Notably, the disparity in average life satisfaction between the intervention and control groups was significant in the post-test stage (t = 13.118, d = 0.95, p < 0.01). Furthermore, the result showed that the changes in life satisfaction in the intervention group were statistically significant (t = 11.854, d = 0.84, p < 0.001). Changes in life satisfaction in the control group were not statistically significant in the pre-test stage compared to the post-test stage (t = 1.113, d = 0.10, p > 0.05). Conclusion: The results can guide health care providers in dealing with the problems of cancer patients. Assessing patients' spiritual needs and empowering them to promote their spiritual recovery and find meaning in their suffering can lead to improved quality of life and satisfaction with holistic care.

Reflection on near-peer shadowing program: impact on operating room student's perception of their future profession.

BACKGROUND: Reflection is a key element in learning from observation and experience of future profession's roles and responsibilities in clinical encounters. Moreover, reflection helps students cope with the challenges, complexities, and uncertainties of professional development. Students' written reflections on clinical exposure offer valuable information, and their analysis provides instructors with invaluable insight into students' experiences. This study evaluated Operating Room students' written reflections on their first clinical exposure experiences towards their future profession through the shadowing program. METHODS: This study was a qualitative analysis on Operating Room freshmen's reflections in the undergraduate program of Zahedan and Zabol University of Medical Sciences in Iran. After the shadowing program, all participants were asked to write an unstructured written reflection, and these fifty written reflections were de-identified and independently analyzed using the thematic analysis approach. RESULTS: Qualitative analysis extracted 10 subthemes and four main themes including (i) Moving towards the guiding realities of future profession, (ii) Discovering milestones of realizing professional identity, (iii) Managing the emotions affecting the perception of future profession's desirability, and (iv) Excellence in professional growth and development. CONCLUSION: Reflecting on the experience of the shadowing program, the participants described being in the OR environment as a stimulating and valuable learning opportunity. Moreover, this experience helped improve their perception of future profession's realities, as well as initiate realization of professional identity and planning for professional developments.

Symbols of Hope on Pediatric Oncology Ward: Children's Perspective Using Photovoice.

Background Hope nurtures confidence and enhances positivity. It is known to be a critical factor in illness, recovery and healing. This study aimed to identify the views of hospitalized children with cancer about the circumstances and factors that create hope for them in the oncology ward. Methods: This qualitative study explored children's experiences using Photovoice, which is an arts-based approach. Twenty children aged 6-12 years diagnosed with various cancers at a Pediatric Hospital in Tehran, Iran, participated in this study. Participants were requested to take photographs of objects, circumstances, or anything that gave them hope or represented a sign of hope in the oncology ward. The photographs were then used to facilitate face-to-face interviews with these children. Data were analyzed using thematic analysis. Results: Data analysis revealed six main themes: emotional connectedness with nursing staff; the playroom as a means to soften the hospital space; the presence of a parent; symbols of recovery; a touch of nature in the hospital setting; and escaping the hospital cage. Discussion: Hopefulness among children can emanate from diverse events and circumstances within the hospital environment. Nurses and physicians need an understanding of children's perspectives to design interventions to improve hopefulness among hospitalized children with cancer.

War on Two Fronts: Experience of Children with Cancer and Their Family During COVID-19 Pandemic in Iran.

INTRODUCTION: The COVID-19 pandemic affects all age groups and presents differently in children from adults. Children who contract the virus while suffering from cancer may face unique health challenges than their counterparts. This study aimed to investigate the perspectives of children with cancer and their family in this era of the COVID-19 pandemic. METHODS: In this qualitative study, a total of 21 participants were interviewed. They include five children, thirteen mothers, a father and three pediatric oncology nurses. The study setting was a Pediatric Hospital in Tehran, Iran. RESULTS: Three main themes were identified through thematic analysis. 1) Swinging on the path of fear to adaptation, 2) Left-alone at emotional distances, 3) Care system confusion, and decreased quality of care. CONCLUSIONS: The COVID-19 pandemic has burdened children living with cancer and their families in varying ways. Their experiences show a new insight on how to improve their quality of life during these difficult times.

Comparative evaluation of sedative and clinical effects of dexmedetomidine and xylazine in dromedary calves (Camelus dromedarius).

OBJECTIVE: To compare the sedative and clinical effects of intravenous (IV) administration of dexmedetomidine and xylazine in dromedary calves. STUDY DESIGN: Experimental, crossover, randomized, blinded study. ANIMALS: A total of seven healthy male dromedary calves aged 14 ± 2 weeks and weighing 95 ± 5.5 kg. METHODS: Calves were assigned three IV treatments: treatment XYL, xylazine (0.2 mg kg-1); treatment DEX, dexmedetomidine (5 µg kg-1); and control treatment, normal saline (0.01 mL kg-1). Sedation scores, heart rate (HR), respiratory rate (fR), rectal temperature (RT) and ruminal motility were recorded before (baseline) and after drug administration. Sedation signs were scored using a 4-point scale. One-way anova and Mann-Whitney U tests were used for data analysis. RESULTS: Calves in treatments XYL and DEX were sedated at 5-60 minutes. Sedation had waned in XYL calves, but not DEX calves, at 60 minutes (p = 0.037). Sedation was not present in calves of any treatment at 90 minutes. HR decreased from baseline in XYL and DEX at 5-90 minutes after drug administration and was lower in DEX than XYL at 5 minutes (p = 0.017). HR was lower in DEX (p = 0.001) and XYL (p = 0.013) than in control treatment at 90 minutes. fR decreased from baseline in XYL and DEX at 5-60 minutes after drug administration and was lower in DEX than XYL at 5 minutes (p = 0.013). RT was unchanged in any treatment over 120 minutes. Ruminal motility was decreased in XYL at 5, 90 and 120 minutes and absent at 10-60 minutes. Motility was decreased in DEX at 5, 10 and 120 minutes and was absent at 15-90 minutes. CONCLUSION AND CLINICAL RELEVANCE: The duration of sedation from dexmedetomidine (5 µg kg-1) and xylazine (0.2 mg kg-1) was similar in dromedary calves.

Challenges and facilitators of professional socialization: A systematic review.

AIMS: This current study aimed to present a review of the challenges and facilitators of professional socialization among undergraduate nursing students. DESIGN: Systematic review. METHODS: A literature search was conducted in Embase, Google Scholar, PubMed and Scopus in April and May 2018 for studies published in the English language. Four thousand three hundred fifty-two articles were retrieved. We conducted further screening for full-text articles after discarding duplicates and irrelevant studies. Finally, eight studies were included. The Joanna Briggs appraisal tools were used to appraise and evaluate study quality. The PRISMA guidelines were followed and a narrative synthesis used for data analysis. RESULTS: Challenges and facilitators of professional socialization were identified and categorized into two major themes. Under each theme, results were grouped into three sub-themes: professional, personal and educational challenges/facilitators.

Children's description of pain through drawings and dialogs: A concept analysis.

AIM: To present a concept analysis of pain in children's drawings and dialogs. INTRODUCTION: The complexity and subjectivity of the concept of pain in children remain ambiguous. As a result, children are exposed to inappropriate diagnosis and inadequate treatment. Children can describe or draw their painful experiences. Analysing the concept of pain based on children's experiences can help identify, assess and properly manage and treat pain in children. DESIGN: Concept analysis. METHODS: Walker and Avant's framework for concept analysis was used in this current study. RESULTS: Major aspects of pain revealed in this concept analysis are affected by children's different concerns about pain. The description of pain in children with chronic diseases or chronic pain is completely different from that in healthy children. Children perceive pain to be internal, external and emotional. Pain in children is associated with poor psychological and emotional conditions, which add new features and aspects to the concept of pain. Children's descriptions and drawings of pain indicate different concepts of pain in their minds. From the perspective of children, pain has an identity that is formed based on reality. CONCLUSION: When developing pain evaluation tools, it is necessary to address the characteristics of pain. In the case of chronic pain, emotional effects of pain on children's psyche need extra attention. Child-based pain management guidelines can then be formulated with the results of relevant concept analyses. Pain assessment is a major part of pain management in children. By considering the characteristics of the concept of pain, the efficiency and usefulness of developed tools can be enhanced to create advancement in paediatric pain management.

Suggesting a Practical Theory to Oncology Nurses: Case Report of a Child in Discomfort.

PURPOSE: Children with cancer are faced with many challenges related to their disease that disturbs their comfort. The aim of this study was to apply Kolcaba's comfort theory for a child with cancer. DESIGN: A case study design was used. METHODS: We applied Kolcaba's comfort theory for a young boy with cancer who was sad and in discomfort because of intravenous access procedures. Following Kolcaba's taxonomy of needs for comfort in the spiritual and mental level, we designed a new intervention. FINDINGS: Kolcaba's comfort theory is an appropriate approach which not only helps to assess and evaluate comfort holistically but also assists in performing innovative interventions to provide comfort for children with cancer. CONCLUSIONS: Kolcaba's comfort theory is a practical theory for oncology nurses. CLINICAL RELEVANCE: Nursing theories can improve the quality of clinical care.

Modified Use of Team-Based Learning to Teach Nursing Documentation.

INTRODUCTION: Nursing documentation is one of the main parts of clinical documentation. Poor knowledge of nurses in documentation methods could bring about problems for patients and nurses. It is very important to promote nurses' knowledge and skills in this regard through effective teaching methods. The aim of this study was to use Team-Based Learning (TBL) to teach nursing documentation for nurses. METHODS: TBL was implemented for 20 nurses participating in a nursing documentation workshop in Qazvin, Iran, in 2015. TBL consists of three main stages. The first stage is the learners' reading about the subject matter. The second stage is measuring the learners' knowledge about the subject matter they have studied using the Individual Readiness Assurance Test (IRAT). In the third stage, more profound learning is achieved by forming small groups and performing teamwork. Finally, participants' views and experiences about TBL were investigated using observations and interviews. RESULTS: The results showed that TBL method increases transfer of information and improves intrapersonal relationships and collaboration. All nurses were satisfied with the educational content and the TBL method. The strong points of this workshop included obtaining the viewpoints of the nurses, step-by-step integration of the contents of teamwork, consultation and active participation of all participants, high learning motivation, and creating a sense of competition. The nurses viewed TBL as a useful method to improve their reporting skills. CONCLUSION: Using new teaching methods based on teamwork could bring about achievements, including improvement of intrapersonal relationships and teamwork, which are requisites of nursing in addition to facilitating the learning of educational content. It is suggested that the TBL method be used to improve teaching and to increase nurses' skills and knowledge.

Effect of Playing Interactive Computer Game on Distress of Insulin Injection Among Type 1 Diabetic Children.

BACKGROUND: Diabetic children and their families experience high level stress because of daily insulin injection. OBJECTIVES: This study was conducted to investigate the impact of an interactive computer game on behavioral distress due to insulin injection among diabetic children. PATIENTS AND METHODS: In this clinical trial, thirty children (3-12 years) with type 1 diabetes who needed daily insulin injection were recruited and allocated randomly into two groups. Children in intervention groups received an interactive computer game and asked to play at home for a week. No special intervention was done for control group. The behavioral distress of groups was assessed before, during and after the intervention by Observational Scale of Behavioral Distress-Revised (OSBD-R). RESULTS: Repeated measure ANOVA test showed no significantly difference of OSBD-R over time for control group (P = 0.08), but this changes is signification in the study group (P = 0.001). Comparison mean score of distress were significantly different between two groups (P = 0.03). CONCLUSIONS: According to the findings, playing interactive computer game can decrease behavioral distress induced by insulin injection in type 1 diabetic children. It seems this game can be beneficial to be used alongside other interventions.

The design and development of a computer game on insulin injection.

BACKGROUND: Insulin therapy is of high importance in glycemic control and prevention of complications in type 1 diabetes in children. However, this treatment is unpleasant and stressful for many children, and it is difficult for them to accept. The purpose of the study was to design and develop an educational computer game for diabetic children to familiarize them with insulin injections. METHODS: After a review of the literature and the collection of basic information, we discussed the purpose of this research with some diabetic children, their parents, and nurses. The findings that we acquired from the discussion were considered in designing and developing the game. Then, following the principles associated with the development of computer games, we developed seven different games that related to insulin injections, and the games were evaluated in a pilot study. RESULTS: The games developed through the design and programming environment of Adobe Flash Player and stored on a computer disk (CD). The seven games were a pairs game, a puzzle game, a question and answer game, an insulin kit game, a drawing room game, a story game, and an insulin injection-room game). The idea was that diabetic children could become acquainted with insulin injections and the injection toolkit by playing a variety of entertaining and fun games. They also learned about some of the issues associated with insulin and experienced insulin injection in a simulated environment. CONCLUSIONS: It seems that the use of new technologies, such as computer games, can influence diabetic children's acquaintance with the correct method of insulin injection, psychological readiness to initiate insulin therapy, reduction in stress, anxiety, and fear of insulin injection.

Factors effective on medication errors: A nursing view.

OBJECTIVE: Medication errors are the most common medical errors, which may result in some complications for patients. This study was carried out to investigate what influence medication errors by nurses from their viewpoint. METHODS: In this descriptive study, 150 nurses who were working in Qazvin Medical University teaching hospitals were selected by proportional random sampling, and data were collected by means of a researcher-made questionnaire including demographic attributes (age, gender, working experience,…), and contributing factors in medication errors (in three categories including nurse-related, management-related, and environment-related factors). FINDINGS: The mean age of the participant nurses was 30.7 ± 6.5 years. Most of them (87.1%) were female with a Bachelor of Sciences degree (86.7%) in nursing. The mean of their overtime working was 64.8 ± 38 h/month. The results showed that the nurse-related factors are the most effective factors (55.44 ± 9.14) while the factors related to the management system (52.84 ± 11.24) and the ward environment (44.0 ± 10.89) are respectively less effective. The difference between these three groups was significant (P = 0.000). In each aforementioned category, the most effective factor on medication error (ranked from the most effective to the least effective) were as follow: The nurse's inadequate attention (98.7%), the errors occurring in the transfer of medication orders from the patient's file to kardex (96.6%) and the ward's heavy workload (86.7%). CONCLUSION: In this study nurse-related factors were the most effective factors on medication errors, but nurses are one of the members of health-care providing team, so their performance must be considered in the context of the health-care system like work force condition, rules and regulations, drug manufacturing that might impact nurses performance, so it could not be possible to prevent medication errors without paying attention to our health-care system in a holistic approach.