Nursing students' experience of moral distress in clinical settings: A phenomenological study.

AIM: To explore nursing students' moral distress (MD) experiences in clinical settings. DESIGN: An interpretative phenomenological analysis (IPA) design was employed. METHODS: Purposive sampling was used. In-depth semi-structured face-to-face interviews were conducted from December 2020 to June 2021 with nursing students who were taking the internship course in clinical settings. Data analysis was conducted following Dickman et al.'s (1989) method. RESULTS: Ten nursing students participated in this study. Three main themes were identified, including (1) negative learning environments, (2) internal disgust and (3) threats to professional identity. CONCLUSION: Findings showed that value conflict, lack of knowledge of ethical standards and its application, and unprofessional approaches result in negative environmental learning perceptions from the nursing students. Therefore, due to being unable to change the situation, they start to feel guilt and shame and, as a result, decide to escape the problem instead of managing it. These feelings lead to internal disgust. This issue indicates the importance of improving the knowledge and perception of these situations. Thus, nursing students must be prepared for the real world, where their ideals are constantly challenged. MDs were experienced as threats to dignity, inequality, distrust, and change of mentality towards nursing, characterised as threats to professional identity. It is suggested to inquire about the process of nursing students' resiliency in morally disturbing situations to deduce the suitable approach for clinical education.

Living with Mental Distress, Social Anger, and In-Group Commitment among Working Children: A Qualitative Study.

Background: Working as a child can have various effects on all aspects of children's health. Investigating and identifying issues related to the health of working children can be useful in promoting their health. Therefore, in this qualitative study, we examined issues related to the mental health and behavior of working children. Materials and Methods: This qualitative study was conducted in Tehran, Iran, in 2021 with the contractual content analysis approach. The main participants (N = 32) in this study were working children aged 10 to 18 years. To collect data, in-depth and semi-structured interviews were conducted with working children, their parents, and the center officials. In addition to the interview, some field notes were also taken from interactions between working children. After each interview, they were transcribed and coded. After 27 interviews, the data were saturated, no new code was extracted, and further interviews were conducted to ensure data saturation. Data analysis was performed based on the proposed method of Lundman and Graneheim. Results: The results revealed the three main categories of mental distress (fear and anxiety, depression, loneliness and isolation, decreased self-confidence, and decentralized mind), social anger (negative social role modeling, harassment and harm of others, reprehensible and antisocial behavior, disregard for the property of others, disrupted relationships, and violence), and in-group commitment (self-censorship outside the group, individual independence and group cohesion, and caring for the group). Conclusions: Most working children suffer from various forms of mental and behavioral issues, which, if not taken care of, can have irreparable consequences.

Self-management interventions for people with multiple sclerosis: A systematic review and meta-analysis protocol.

Background and Aims: Educational self-management interventions (SMI) have an important role in improving symptom management, preventing relapse of multiple sclerosis (MS) and promoting quality of life (QoL) of these patients; since there is little knowledge about overall effectiveness of MS self-management programs and which types of SMI improves the outcomes, this research aims to assess the efficacy of structured SMI in improving health outcomes in people with MS (PwMS) by synthesizing and compare outcomes from related randomized controlled trials. Methods: In the present systematic review protocol, the keywords related to self-management and MS will be searched in electronic databases including (PubMed, Web of Science, Scopus, EMBASE, Cochrane Central Register of Controlled Trials [CENTRAL]), gray literature resources and key journals from 2000 to July 2023. Research-related articles will be collected and after removing duplicate articles, will be included in the study. In the screening step, titles and abstracts of articles will be reviewed and after deleting irrelevant articles, the full text of related articles will be evaluated independently by two researchers and data will be extracted from final articles and the findings will be categorized in an extraction table. Risk of bias will be assessed by using the Cochrane collaboration's tool. If possible, the data will be analyzed using random effect models and the statistical analysis will be performed using STATA software (version 14.2) developed by StataCorp. Discussion: Comparative effectiveness of SMI is currently unknown. We will analyze outcome measures used to assess effectiveness of self-management education in improving QoL, depression, self-efficacy, pain, and fatigue. These findings will help identify the most promising components of SMIs, guiding targeted interventions for specific subpopulations, and facilitating the design of better interventions.

Strategies to improve hidden curriculum in nursing and medical education: a scoping review.

BACKGROUND: The importance of hidden curriculum cannot be neglected in education. Despite much research in the field, there have been limited studies on HC improvement in nursing and medical education. This scoping review aimed to determine the scope of strategies to improve HC in nursing and medical education. METHOD: PubMed, EBSCO/Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Web of Science, Proquest and Persian-language databases of Magiran and SID were searched in January 2023 without a time filter. According to the PRISMA flow diagram, two independent reviewers selected the records that fit the inclusion and exclusion criteria via title and abstract screening. Next, the reviewers studied the full texts of the related articles. The data extracted from the selected articles were tabulated and ultimately synthesized. FINDINGS: Out of the eight examined studies, published from 2017 to 2022, only one was in the field of nursing and seven were in medicine. The central strategies were implementing new curricula to replace the previous ones, utilizing team-based clinical clerkship, proposing a HC improvement model, implementation a case-based faculty development workshop, implementation longitudinal and comprehensive educational courses, and incorporating an educational activity into a small group program. CONCLUSION: Students and faculty members familiarization on the topic of HC, implementing new curricula, utilizing team-based clerkship, and using comprehensive models were among the HC improvement strategies. Focusing on upgrading the learning environment, particularly the clinical settings, can also be helpful in HC improvement.

Nurses' bereavement experiences of a deceased colleague due to COVID-19: A phenomenological study.

AIM: Healthcare workers have little time to mourn due to the intensification of the COVID-19 pandemic. Although grief is a normal part of life and death, the circumstances surrounding the death can affect the grieving process. So far, the nurses' experience in mourn for a deceased colleague in the COVID-19 pandemic has not been determined. Identifying these experiences can provide opportunities to formulate appropriate strategies to functionally adapt to death and promote mental health and well-being during this crisis. This study aimed to understand the nurses' experiences in mourning for a deceased colleague due to COVID-19. DESIGN: This was an interpretive phenomenological study. METHOD: Participants included 10 nurses with the bereavement experience following the death of a colleague due to COVID-19, who were selected through purposive sampling, and the data were collected through in-depth and semi-structured interviews and analysed using Diekelmann et al.'s (1989) approach. RESULTS: The nurses' bereavement experiences were in the form of eight themes: disbelief and amazement, acceptance with grief, lasting sadness, unsung laments, bringing back memories, impulse to leave the service, a professional myth and holy death. For nurses, mourning for the death of a colleague due to COVID-19 is like a lasting sadness that begins with disbelief and amazement and changes to acceptance with sadness. From the fellow nurses' point of view, this type of death was perceived as a holy death, which along with countless unsung laments and memories brought to us the association of a professional legend, and that such a fate would be inevitable for us as well, it was a push to leave the service. PUBLIC CONTRIBUTION: Crisis managers and policymakers need to add protocols and training programs for resilience skills and healthy mourning.

Explaining the process of formation of ageism among the iranian older adults.

BACKGROUND: Ageism is considered as one of the consequences of the industrialization of societies, which appears in various forms in different cultures. This study aimed to explain the process of formation of ageism among the older adults people. METHODS: The research was conducted using grounded theory method. Data were collected from 28 participants using in-depth semi-structured interviews and field notes. Data were analyzed using open, axial, and selective coding. RESULTS: Fear of loneliness and rejection striving to tackle ageism "was identified as the core category of the study. Concepts such as "family context" and "cultural context" were relevant. After identifying the strategies used by the older adults in response to the context ("maintaining integrity", "socio-cultural care" and "proper health care", "striving to tackle ageism") was the most important process in ageism by the Iranian older adults. CONCLUSION: Findings of this study indicated that individual, family and social factors play an important role in the process of ageism among the older adults. These factors sometimes exacerbate or moderate the process of ageism. By recognizing these factors, various social institutions and organizations (including the health care system and the national media (radio and television)) can help the older adults achieve successful aging by emphasizing the issues related to the social aspect.

Transformational leadership in development of transformative education in nursing: a qualitative study.

BACKGROUND: Regarding the dynamic and increasing needs of communities, changes in the education system are essential to train competent healthcare professionals. The study aimed to explore the experience of educational directors, teachers, and students to gain insight into the implementation of educational transformative programs. METHOD: A qualitative approach with the grounded theory method was applied in this study. Twenty-four participants were selected by using a purposive and theoretical sampling method. The data were collected from April 2019 to May 2020 in nursing schools of Tehran, through in-depth semi-structured individual face-to-face interviews and field notes. Collected data were analyzed by Corbin and Strauss's (2015) approach. RESULTS: In this study, transformational leadership was extracted as the core concept. The core concept emerged from four sub-concepts including transformative management; educational policy requirements; providing a platform and community-centered education. CONCLUSIONS: Nurse educational directors need to achieve some competencies and capabilities for implementing transformative education in nursing schools. Also, achieving a transformative perspective by educational directors is essential.

Diabetes Experiences of Transition from Childhood to Adulthood Care.

AIM: The present study was conducted to explain the perception of diabetic people about the transition of diabetes care from childhood to adulthood. METHOD: This study with the hermeneutic phenomenology approach was conducted on 10 young people with type 1 diabetes with a history of childhood diabetes. They were selected through purposive sampling. Data were collected by semi-structured interviews until data saturation was reached. Then, data analysis was performed according to Dickelman's method. COREQ criteria for reporting qualitative research were used. RESULTS: Three main themes of tedious marathons (laborious transition, constant do's and don'ts), unprepared transition (insufficient education, emotional exhaustion), and green sugar motivation (friendship with diabetes, beyond care, peer-seeking, freedom from dependencies) resulted from data analysis. CONCLUSION: The findings of this study indicated the importance and necessity of planning and preparing patients with type 1 diabetes for the transition of care from childhood to adulthood, and the importance of emotional support during this transition.

Effective factors and challenges of forming transformational education in the nursing education system: a qualitative study.

OBJECTIVES: In the nursing education system, evolution is required to train qualified and professionally competent nurses who can face workplace challenges and evolving needs of societies. This study aimed to explore effective factors and challenges of the formation of transformational education in the nursing education system. METHODS: This was a qualitative study with a grounded theory approach. Twenty-four individuals participated through purposive and theoretical sampling. The authors collected data using semi-structured interviews and analyzed them by Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Los Angeles: Sage Publication grounded-theory method. RESULTS: Findings showed the process of formation of transformational education which encompasses four concepts including, "transformational leadership", "effective learning", "necessity of foresight in education", and "inhibitors of educational transformation". Transformational education is a complex and multidimensional education. CONCLUSIONS: Implementation of this education requires preparing transformational leaders, planning to empower faculty members and students, and preparing for the challenges facing the education system.

Coping with suicide' burning scar's disfigurement among Kurdish women in Iraq (Kurdistan).

BACKGROUND: Suicide is one of the most important causes of death in the world. A critical problem that Iraqi women in Kurdistan are facing is self-immolation. Deformity caused by burn can have many psychological effects on the individuals, including self-image disorder, loss of quality of life, low self-confidence, and disturbances in social interactions. METHODS: A qualitative research method with a grounded theory approach was used to achieve the research objectives. Sampling started purposefully and continued with theoretical sampling until access to sufficient knowledge about the phenomenon under investigation. In this study, 22 in-depth interviews were carried out with 19 women participants who had committed self-immolation. FINDINGS: After the data analysis, six main categories were formed, including; 1- Facing the inevitable harsh reality. 2- Experiencing negative reactions from others 3- Drowning in the vicious cycle of hopelessness and regret. 4- A bitter journey into the whirlpool of fear and uncertainty. 5- Germination of the hope buds. 6- Re-building weakened self-esteem. "Stepping on the rugged path of distorted image reconstruction" was the core variable in the study. CONCLUSION: Although people take some steps to adapt to the situation and deformity, they do not achieve full acceptance of the present circumstances. In this process, the person hopes to regain the lost beauty and does not effortlessly accept the deformity. Instead, she will try everything to get rid of deformity and restore the lost beauty. During the adaptation process, nurses and health care providers, the family and the community have a unique role in accelerating or slowing the process of adaptation.

The stakeholders' perceptions of the requirements of implementing innovative educational approaches in nursing: a qualitative content analysis study.

BACKGROUND: Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing. METHODS: In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical saturation in extracted categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method. RESULTS: Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were 'novel educational policymaking', 'Innovative education-oriented platform', and 'managing barriers of innovative educational approaches'. CONCLUSIONS: Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial.

How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study.

BACKGROUND: Nurses require a great deal of knowledge to provide a comprehensive and effective nursing care. A number of patterns have been put into place to help nurses acquire this knowledge. The aim of this study was to describe the core variable in the process of using patterns of knowing by nurses in clinical practice. METHODS: The study was conducted in qualitative and grounded theory approach, between April 2018 and January 2020. Semi-structured interviews were used for data collection. All the interviews were transcribed verbatim. Nineteen clinical nurses were interviewed, and eight observation sessions were conducted in different hospital departments. Participants were first selected through purposeful and then theoretical sampling. Data were analyzed and interpreted using constant comparison analysis approach. RESULTS: The findings of the study indicated that nurses apply the patterns of knowing in three ways in their clinical practice: "cohesion of patterns of knowing", "domination of some patterns of knowing" and "elimination of some patterns of knowing". The core variable of this process is cohesion of patterns of knowing in the domain of flexibility. CONCLUSION: The findings of the present study indicate that application of patterns of knowing is practiced in a range of nurse flexibility in clinical settings.

A qualitative study of Ghanaian pediatric oncology nurses' care practice challenges.

BACKGROUND: Pediatric cancer is a global problem, and some studies have emphasized that nurses caring for these children experience work-related challenges. This has caused many children diagnosed with cancer to have a prolonged hospital stay and suffer unnecessary pain. However, there is insufficient documentary evidence on this issue. This study aims to explore and understand the challenges faced by pediatric oncology nurses in caring for children in Ghana. METHODS: An exploratory qualitative research design study was conducted from August 2019 to April 2020. The study was conducted at the pediatric oncology unit which is located at the Tamale Teaching Hospital (TTH), Ghana. The study was conducted among 14 Ghanaian pediatric oncology nurses who were purposively sampled. A semi-structured interview guide was used to collect data. The interviews were recorded, transcribed verbatim, and analyzed inductively using Elo and Kyngas content analysis approach. The criteria proposed by Guba and Lincoln were used to ensure the validity of the study. RESULTS: From the analysis of participants transcripts, eight subcategories emerged from two major categories. The subcategories were; time-consuming care, low job motivations, inadequate logistics, work stress, reduced labour force, low knowledge level, lack of teamwork and the perception of contracting cancer. CONCLUSIONS: The results point to several organizational and personal constraints experienced by the nurses who work at the pediatric oncology ward. It is hoped that by addressing these challenges, it would lead to further improvement in the care that is provided to children with cancer. There is the need for the administrative managers of hospitals, government and other stakeholders to invest in human, material and financial resources for delivering childhood cancer care services.

Behavioural changes in medication safety: Consequent to an action research intervention.

AIM: To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff. BACKGROUND: Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes. METHOD: Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles. RESULTS: The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate. CONCLUSIONS: Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours. IMPLICATION FOR NURSING MANAGEMENT: This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety.

Striving to reduce suffering: A Phenomenological Study of nurses experience in caring for children with cancer in Ghana.

Aim: To provide insights into nurses lived experiences in caring for children with cancer. Background: Little is known about the paediatric oncology nurses shared practices of caring for children with cancer in Ghana. Design: A hermeneutic phenomenological qualitative study. Methods: A semi-structured interview with 14 purposely sampled Ghanaian paediatric oncology nurses. Findings were analysed using Diekelman, Allen and Tanner's approach. Results: The theme "Striving to reduce suffering" and three relational subthemes: "knowing children's needs," "Rendering a hopeful fight" and "Ensuring continuity and coordination of care" emerged. Increased awareness of this phenomenon for the nurses who care for these children is vital to ensure quality and holistic care that is meaningful and satisfying by nurses for children with cancer. Paediatric oncology nurses can use the result of the study to evaluate their caring practice and as an avenue to develop better caring practice.

Exploring the process of turning back to professional nursing practice in Iran: A grounded theory.

BACKGROUND: The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost-effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice. MATERIALS AND METHODS: This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi-structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method. RESULTS: In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The "transformed competence" as the core concept and the four main concepts of "feeling alienated with the new environment," "getting prepared for restart," "gradual maturity in clinical practice," and "components of organizational culture" were extracted from the data analysis process. CONCLUSION: The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

Marriage, a way to achieve relaxing evolution: A grounded theory investigation.

BACKGROUND: Marital satisfaction is a complex of feelings, which includes pleasure, satisfaction, and pleasure experienced by the husband or wife in all aspects of marriage, and it is an important part of individual health, especially mental health. This qualitative study was conducted to understand marital satisfaction using grounded theory on couples. MATERIALS AND METHODS: This qualitative study was implemented using grounded theory based on Corbin and Strauss, 2008, to investigate the process of marital satisfaction formation among couples from 2014 to 2016. The sampling was started as purposeful and continued as theoretical. The data were obtained using semi-structured interviews. 28 interviews were taken from 25 participants; MAXQDA software was used to facilitate the organization of classes and subclasses. RESULTS: The central variable of this study was called "toward a relaxing evolution." On that account, the main classes included "supportive companionship" and "responsible love," and variables of "personality traits," "interactive relationships," "economic status," "passage of time," and "present resources in society" provided the basis for the formation of marital satisfaction. CONCLUSION: To achieve marital satisfaction, couples should set their family's ultimate goal toward achieving a relaxing evolution for the entire family, and they should accompany each other in order to achieve that goal. This sometimes requires sacrifice and forgiveness to achieve the ultimate goal of the family.

Factors Moderating the Influence of Intergenerational Contact on Ageism: A Systematic Review.

The authors conducted a systematic review of factors that moderate the influence of intergenerational contact on ageism. MEDLINE (using PubMed), EMBASE, Scopus, Web of Science, and Proquest databases were searched, using terms and keywords including intergenerational conflict, intergenerational relation, intergeneration gap, and ageism, and no date restrictions. The search yielded a total of 247 articles, of which 23 met eligibility criteria for the review. Findings revealed that the experience of ageism for older adults is widespread and highly prevalent in Western and Eastern countries. In addition, culture, age, and gender played important roles in young people's decisions to contact older adults. These factors were important moderators of intergenerational relationships and ageism. Robust, trans-disciplinary research is needed to examine factors related to intergenerational relations, particularly with older adults in clinical populations. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 48-55.].

Designing a truth-based communication model in patient ethical care process.

INTRODUCTION: Providing information based on truth is very important in patients' treatment-related decisions and reduces emotional and physical sufferings as well as patient costs. The aim of this study was to design a model that is based on the culture and health-care context of Iran in order to establish a truth-based communication and provide accurate information to patient. MATERIALS AND METHODS: This qualitative study was conducted in 2019. Data were collected through semi-structured interviews with 18 nurses who had been selected by purposeful sampling method. Data analysis was performed in two steps. In the first step, the participants' experiences were determined using the grounded theory approach. In the next step, using Walker and Evant's (2011) method, the concepts and statements were combined and presented in a central concept. RESULTS: The central concept in this study was "an attempt to establish a truth-based communication with patient," and then, a truth-based communication model was presented. The components of the model were presented in three parts: improving patient communication skills, managing the situation in which the truth is presented, and the patient's participation in decision-making. CONCLUSION: To present the truth of the treatment, which can sometimes be unpleasant and bitter, it is very important to improve communication skills and choose an effective communication strategy. To establish a truth-based communication, it is necessary to create a suitable ground for communication, which should be provided in clinical setting and community.

The presence of the child, the opportunity or a threat to marital satisfaction: A qualitative study.

BACKGROUND: The aim of this qualitative study was to explore if the presence of a child in the family was an opportunity or threat to the marital life. METHODS: In this common qualitative content analysis, semi-structured interviews with 20 participants were conducted. All of the interviews were recorded and then transcribed. The data were categorized, and the main themes and sub-themes were extracted. RESULTS: Twenty transcription were analysed. The data analysis led to the development of the first theme of "feeling evolution" with the category of "flourishing the motherhood sense," and the second theme of "strengthening the marital life" with the two categories of "the marital life stabilization" and "efforts for a common goal." CONCLUSIONS: The presence of the child can lead to the feeling of development and stabilizing the marital life. Furthermore, the presence of the child can facilitate or hinder marital satisfaction. Given the challenges due to a lack of preparation of parents for childbirth, consultation and support by family members or the society can help with adaptation with this life period and increasing the positive effects of the presence of the child on parents' relationships and marital satisfaction.