Physical and psychosocial challenges of people with gender dysphoria: a content analysis study.

BACKGROUND: The mismatch between the gender experienced by a person and the gender attributed to him/her leads to gender dysphoria. It seems that people's perception of gender dysphoria is affected by individual, cultural, and sociological factors and these factors affect different aspects of their biological, psychological, and social health. To this end, this qualitative study aimed to identify the physical, psychological, and social challenges of people with gender dysphoria referring to the Department of forensic medicine in Iran. METHODS: This qualitative study was conducted using conventional content analysis on 9 individuals who were selected through purposive sampling. A total of 16 interviews were conducted with 9 participants. Each interview lasted 60-90 min. The participants' gender dysphoria was confirmed by the Department of forensic medicine. The data were collected through face-to-face semi-structured interviews with the participants. RESULTS: The data revealed 3 main categories and 10 subcategories. The main categories were living in agony, confusion, and social concerns. The subcategories were annoying physical characteristics, mental suffering, disturbing sexual changes, concerns about public reaction, helplessness, surrender, the final solution, retreating to isolation, stressful family conditions, and lack of public recognition. CONCLUSION: The findings showed that people with gender dysphoria suffer from some problems including living in agony, confusion, and social concerns. Each of these problems is associated with several challenges. It seems that most of the challenges faced by people with gender dysphoria are caused by unawareness of their conditions by the family and the public, which in turn is caused by the failure of related organizations and experts in this field to provide adequate information about the conditions of these people. Thus, the findings of the present study can have some implications for resolving the challenges faced by people with gender dysphoria.

The Effect of Cognitive-Emotional Training on Post-traumatic Growth in Women with Breast Cancer in Middle East.

Overcoming distresses and negative consequences of serious crises such as cancers can lead to perception of positive changes in the patients. It is necessary to design and test the psychological interventions that can improve post-traumatic growth. The objective of this study was to determine the effect of cognitive-emotional training on post-traumatic growth in women with breast cancer referred to the department of chemotherapy. This is a quasi-experimental study and it was performed on 85 patients with breast cancer who referred to an educational hospital in southeastern of Iran in 2017. The eligible patients were selected through convenience method sampling among the patients and they randomly allocated into intervention and control groups. The intervention group received five sessions of emotional-cognitive training in two sessions per week. Each session lasted 60-90 min. The posttest data were collected by post-traumatic growth inventory (PTGI) 20 weeks after the end of the last intervention session. Collected data were analyzed by SPSS software version 21.00 using independent t test, paired t test, and Chi-square tests for demographic analysis. The results indicated that there is no significant difference in both groups in terms of individual variables such as age, marriage, duration of disease, and degree progression of cancer. Although the mean of PTG scores in posttest and the mean of variations in the PTG scores in the intervention group were 77.48 ± 11.18 and 25.81 ± 12.24, respectively, and it was significantly higher than the control group, 53.95 ± 14.86 and 7.69 ± 9, respectively (mean scores of PTG: p < .0001; mean changes of PTG: p < .001). According to the results of this study, cognitive-behavioral intervention had a positive and significant effect on post-traumatic growth in women with breast cancer. If intervention is found to be effective, cognitive and emotional strategies of such interventions could be integrated into daily clinical practice as a way to promote PTG in women who are being treated for breast cancer.

The Effect of Group Counseling Based on Quality of Life Therapy on Stress and Life Satisfaction in Family Caregivers of Individuals with Substance Use Problem: A Randomized Controlled Trial.

Family caregivers of people with substance abuse are exposed to psychological problems that diminish their life quality and satisfaction. The purpose of this study was to diagnose the efficacy of quality-of-life intervention on stress and life satisfaction of family caregivers of individuals with substance use problem. This is a randomized controlled trial conducted on 80 family caregivers of individuals with substance use problem in the process of withdrawal who were referred to a psychiatric center in southeastern Iran (2018). The intervention group received seven sessions of quality-of-life group counseling every other day based on predetermined content. Twelve weeks post-intervention, data were collected from the control and intervention groups using the Depression Anxiety and Stress Scales (DASS-21) and the Satisfaction with Life Scale (SWLS). The results were analyzed through statistical tests. After group counseling based on quality of life, the mean stress score in the family caregivers of the intervention group (11.50 ± 4.36) was significantly lower than in those of the control group (14.67 ± 4.93) (p = 0.003). Also, in the posttest, the mean score of life satisfaction in the intervention group (24.75 ± 4.28) was significantly higher than that of the control group (19.57 ± 7.33) (p = 0.001). Group counseling based on quality of life exerted a significantly positive impact on reducing the severity of stress and improving life satisfaction among family caregivers of individuals with substance use problem. Therefore, it is highly recommended that healthcare service providers incorporate this counseling approach in substance use withdrawal programs so as to increase the well-being and mental health of family caregivers.

Effect of a Couples' Relationship Enrichment Program on the Quality of Marital Relationships from the Perspective of Spouses of Patients with Multiple Sclerosis.

A relationship enrichment program involves family therapy with psychosocial training to improve relationship skills. This study was conducted to determine the effect of a couples' relationship enrichment program on marital relationship quality. This quasi-experimental study was conducted in 2016 with 80 spouses of patients, all members of the Multiple Sclerosis (MS) Center in Zahedan, Iran. The participants were randomly assigned to two groups: an intervention and a control group, each of which comprised 40 participants. The Perceived Relationship Quality Components questionnaire was used to collect the required data. After five-session couples' relationship enrichment program, the mean total marital relationship quality score and all the subscale scores except the love subscale score in the intervention group were significantly greater than those in the control group. Application of the program is recommended to increase the quality of marital relationships for spouses of patients with MS, as they are the most important sources of support for patients with MS.

Fordyce happiness training program on the competence of mothers of premature infants admitted to the NICU from Middle East: A quasi-experimental study.

The purpose of this study was to determine the effect of the Fordyce Happiness Training Program on the parental competence of mothers of premature infants admitted to the neonatal intensive care unit (NICU). This quasi-experimental study was performed on 80 mothers of premature infants who were admitted to a NICU in Iran. Mean Parenting Sense of Competence Scale (PSOC) scores of participants in the intervention group before and after training were 61.32 ± 6.44 and 68.52 ± 2.52. Mean PSOC scores for those in the control group before and after the intervention were 64.47 ± 11.08 and 65.30 ± 6.90, respectively. The two groups showed significant differences in terms of parental competence after the happiness training program (p = 0.0001). NICU admission of a premature baby not only has a negative effect on the mother's emotional state but it can also adversely affect the parental sense of competence. Therefore, considering the psychological needs of mothers of premature infants, it is worth considering implementation of programs such as Fordyce Happiness Training, to promote and maintain the mental health of mothers.

Nurses' effort for providing end-of-life care in paediatric oncology: a phenomenological study.

BACKGROUND: Many children with cancer are hospitalised before the end of life and need special care. To improve the delivery of care for children, it is necessary to understand the insights, emotions and feelings of nurses. AIM: This study aimed to explore the lived experiences of nurses providing end-of-life care for children with cancer. METHODS: A phenomenological hermeneutic approach was used to analyse the experience of 14 oncology nurses working in a children's hospital who were caring for children with cancer. FINDINGS: Three themes and seven subthemes emerged from the analysis. The three main themes were: pain management (relieving physical pain and reducing the mental pain of the child and family); respect-based care (for the values and beliefs of the child and family and honesty in providing information to them); and negative reflections of care (psychological trauma, cultural challenges and futile care). CONCLUSION: The results of the present study showed that, despite the problems experienced by the nurses, they were still trying to provide life-sustaining care for children with cancer.

A Qualitative Study of the Health-Related Perceptions of Married Iranian Women Who Have Experienced Domestic Violence.

INTRODUCTION: Violence against women occurs all over the world; it is a phenomenon that is considered an invasion of human rights. The most common form of this phenomenon is domestic violence (DV). AIM: The purpose of this study was to explore the health-related perceptions of married women in Iran who have experienced DV. METHOD: This qualitative study was carried out using conventional content analysis method. In total, a purposive sample of 27 women who had been subjected to violence by their spouses agreed to participate in this study. Individual, in-depth, and semistructured interviews were conducted. FINDINGS: Three main categories emerged from the data: (a) perceptions related to physical health (including non-sex-organ injuries and sex organ injuries), (b) perceptions related to psychological health (including fear, concern, and the creation of challenges), and (c) perceptions related to sociocultural health (specifically social health and cultural health). CONCLUSION: In Iran, DV threatens women's health and is influenced by personal, familial, social, and cultural factors. Nurses should consider various aspects of physical, psychological, and sociocultural health when caring for women who have experienced DV. Social and cultural-based interventions are needed to address negative attitudes, stigma, and false beliefs that sanction DV in Iran.

Comparison of self-, peer, and teachers' evaluation about the clinical skills of nursing students at the department of psychiatry.

BACKGROUND: Evaluating clinical performance is a challenge in nursing education. On the other hand, a single evaluation method cannot be used to judge different areas of interpersonal skills. Therefore, this study was conducted to compare the evaluation of teachers', peer, and self-evaluation of nursing students in the psychiatric ward of Baharan Hospital affiliated to Zahedan University of Medical Sciences. MATERIALS AND METHODS: In this analytical cross-sectional study, forty trainee students were selected by a census method in a time period and they were evaluated by three methods including self-, peer, and teachers' evaluation. Their clinical skills were assessed using a school-based clinical evaluation questionnaire containing 15 questions in the areas of taking history, examination of psychiatric health, and the ability to communicate with the patient. The analyses were performed by SPSS-22 software. RESULTS: The mean and standard deviation of the evaluation scores of clinical teachers as well as peer and self-evaluation in the areas of taking patient's history were 13.82 ± 2.74, 14.46 ± 2.68, and 15.75 ± 2.56, respectively. In addition, the outcomes in the areas of psychiatric examination were 8.11 ± 1.54, 9.25 ± 2.70, and 10.43 ± 2.65 and in the areas of clinical communication were 8.93 ± 2.03, 9.04 ± 2.25, and 10.21 ± 1.98, respectively. There was a significant correlation between the mean of teachers' evaluation and self-evaluation scores (P = 0.003) as well as comparing peer and self-evaluation (P = 0.048). However, no significant correlation was observed between teachers' and peer evaluation (P = 0.062). CONCLUSION: Due to the difference in scores of different methods of evaluation, self- and peer evaluation can be used as a complementary method with teachers' evaluation in measuring the clinical performance of clinical students.

Nurses' perception of ethical challenges in caring for patients with COVID-19: a qualitative analysis.

Nurses face several challenges in providing care for patients with coronavirus disease in 2019 (COVID-19). The study aimed to explain the nurses' perception of ethical challenges in this regard. The qualitative study was carried out using a content analysis method. Individual and semi-structured interviews were conducted with 24 nurses. Inductive content analysis was used to categorize the data. Nurses' narratives indicated that ethical challenges in caring for patients with COVID-19 included threats to professional values ​​and the absence of a holistic COVID-19 care approach. The first category was subcategorized into the risk of declining quality of patient care and a stigmatized public image about COVID-19 care. The second category was divided into poor spiritual care, poor compassionate care, and lack of family-centered care. Health care managers must develop protocols for nurses that address these issues to alleviate the ethical challenges of COVID-19 care.

The Effect of Cognitive-Behavioral Training Versus Conventional Training on Self-care and Depression Severity in Heart Failure Patients with Depression: A Randomized Clinical Trial.

Introduction: Psychological factors including depression and anxiety are the most critical risk factors in the treatment and prognosis of heart failure which should be addressed in treatment and care programs. The purpose of this study was to examine the effect of cognitive-behavioral training (CBT) on depression severity and self-care ability of patients with heart failure. Methods: This study was a randomized clinical trial that carried out on 80 patients with heart failure who had been hospitalized in 2018. The participants were divided into the CBT group (n= 40) and the conventional training (CT) group (n= 40), randomly. Data were collected using Beck Depression Inventory (BDI) and the Self-Care of Heart Failure Index (SCHFI) version 6.2 before and 8 weeks after the educational interventions. Data were analyzed in SPSS 21 using paired t-test, independent t-test, chi-square test, and covariance analysis. Results: The mean score of self-care in the CBT group turned out to be significantly higher than the CT group after receiving the intervention. Also, the mean depression score of the CBT group 26.95 (5.53) after intervention was significantly lower than the CT group 36.04 (8.45). Conclusion: Cognitive-behavioral intervention, compared with conventional training, had a greater positive impact on improving self-care and alleviating the severity of depression symptoms. Therefore, it is recommended that the principles of cognitive-behavioral therapy be integrated into routine educational programs.

The Effect of Regular Family Appointments on Hope of Hospitalized Depressed Patients: a Randomized Clinical Trial.

Introduction: Depression is one of the most common psychological disorders in the world. Many depressed patients are being hospitalized in psychiatric centers every year, which can lead to hopelessness and indifference. Considering the role of family as a support system in caring for depressed patients, the goal of the present study is to assess the effects of regular family appointments on the hope of hospitalized depressed patients. Methods: This was a randomized clinical trial on 70 hospitalized depressed patients in the Baharan psychiatric hospital of Zahedan. Block Randomization was used to categorize the participants continuously into two groups intervention (n=35) and control groups (n=35). The data collection tools were demographic characteristics questionnaire and Schneider hope scale. The patients in the interventions group received 6 sessions of regular family appointments with first- degree relatives. The control group received freely and without any planning appointments. Hope level was measured and compared before and after the intervention for two groups. The data were analyzed by SPSS using the chi-square test, the independent t-test and the paired t-test. Results: The results showed that both groups were homogeneous in terms of socio- demographic differences. The hope scores of patients in the intervention group significantly increased compared to those of the control group. Conclusion: Encouraging family cooperation and using patient's choice in selecting visitors is recommended.

Epidemiology, Associated Factors and Treatment Methods of Cutaneous Leishmaniasis Based on Previous Data from 2013 to 2018 in Ilam, Western Iran.

OBJECTIVE: The aim of this study was to evaluate the epidemiology, clinical presentation and types of treatment of cutaneous leishmaniasis (CL) in the province of Ilam (Western Iran) in 5 years (from May 2013 to January 2018). This cross-sectional study involved patients diagnosed with CL who were referred to Mehran City Health center. METHODS: All patients were diagnosed by clinical and parasitological (Giemsa staining of lesion to observe the parasite) methods. Moreover, a structured questionnaire on demographic data including age, sex, occupation, number and site of the lesions, treatment regimen was administered to each case. RESULTS: In total, 2001 positive CL cases were observed in this study. The highest prevalence of CL was reported in the autumn season and mainly among male subjects residing in urban communities. The prevalence of CL varied with the age group: higher in the age group of 1-10 years than other groups. Besides, hands and faces were the most affected regions of the body. Most of the cases (47.35%) were managed by topical treatment (glucantime) and cryotherapy followed by systemic treatment (pentavalent antimony) 26.85%. CONCLUSIONS: The prevalence of disease varied with age, increasing the prevalence rate in children due to their habitats, the highest prevalence in autumn due to climatic conditions. These findings help to better discuss the prevention and treatment of infections.

Ethical Challenges in Cancer Care: A Qualitative Analysis of Nurses' Perceptions.

Cancer is a growing problem in the world, meanwhile, the issue of providing care for cancer patients has been associated with multiple ethical challenges (ECs). This study aimed to investigate and explain the nurses' perceptions of ECs in caring for cancer patients in Iran. In this qualitative study, the participants consisted of 25 nurses working in cancer wards. The typical EC that the nurses are faced with while caring for cancer patients included categories such as "creating moral distresses" and "threat to patient's autonomy." The category of creating moral distress consisted of two subcategories, including "faulty communication process" and "provision of futile care." Also, the category of "threat to patient's autonomy" included subcategories of "individual factors" and "organizational factors." Since disregarding ethical principles in caring for patients with cancer will result in greater ECs in this respect, the healthcare administrators should make more effort to help establish transparent rules, and develop protocols needed to identify and eliminate these ECs.

Detection of species and molecular typing of Leishmania in suspected patients by targeting cytochrome b gene in Zahedan, southeast of Iran.

AIM: Cutaneous leishmaniasis (CL) is one of the most important health problems that are capable of involving both tropical and subtropical areas, especially in Iran. This cross-sectional study aimed to differentiate the species that are able to cause CL in Zahedan city by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. MATERIALS AND METHODS: It was conducted on 145 suspected CL patients in Zahedan city between 2014 and 2016. The smears were initially prepared, air-dried, fixed with absolute methanol, and stained with 10% Giemsa. Then, we examined the stained samples by a light microscope under 1000× magnifications. PCR assay targeted cytochrome b(cyt b) gene using LCBF1 and LCBR2 primers and the products digested by Ssp1 enzymes. RESULTS: From 145 suspected CL patients, 76 (52.4%) were positive in microscopic examination. In addition, we detected gene of interest (cyt b) in 98 (67.5%). The results of PCR-RFLP indicated that 53/98 (54%) cases were Leishmania major and 45/98 (46%) were Leishmania tropica, and the main species in these areas was L. major. CONCLUSION: We concluded that the microscopic examination is not sensitive enough and is not able to distinguish between different Leishmania species. Instead, molecular methods like PCR-RFLP can be appropriately used with promising results.

Identifying self-care behaviors in middle-aged women: A qualitative study.

BACKGROUND: Women in their middle-age enjoy abilities that affect their health promotion and improvement. Throughout their entire lifetime, women strive to maintain and improve their health through benefiting from behaviors that come from experience. OBJECTIVE: This study was carried out with the aim of identifying self-care behaviors that middle-aged women consider as far as maintaining and promoting their health are concerned. METHODS: The study was conducted using a qualitative approach in conventional content analysis. Participants comprised of 20 middle-aged women from Zahedan, Iran in 2016 that were invited to enter the study using purposive sampling, and were given semi-structured interviews. After data collection, all interviews were transcribed, reviewed and then the subcategories were extracted. RESULTS: The findings of this study include a main category "preventive self-care behaviors" and three subcategories of "understanding health and disease", "health knowledge" and "awareness of the health threats". CONCLUSION: The findings suggest that preventive self-care behaviors of women are associated with features such as understanding health and disease, health knowledge and awareness of the associated health risks. As a matter of fact, preventive behaviors encompass strategies that women apply to improve their physical and mental health.

Understanding the Contextual Factors Affecting Women's Health in Sistan and Baluchestan Province in Iran: A Qualitative Study.

BACKGROUND: Contextual factors impact health the same way social and cultural conditions do. Women's health, with its varying dimensions, is also under the influence of biological, societal, and cultural contexts. This typical condition has been developed along the continuum of their life cycle, bearing close correlation with their lif style. Therefore, identifying those marices within which women's health behaviors are formed is important.This study aims at exploring the contextual factors affecting women's health in Sistan and Baluchestan in Iran. METHODS: This study was carried out using a qualitative method, on a content analysis approach. Participants were 20 middle-aged women from Zahedan who entered the study with purposive sampling method. The method of collecting data was face-to- face and through conducting semi-structured interviews. After data collection, all interviews were transcribed, andreviewed, from which categories were extracted. The semantic similarities were revised and subcategories were identified, and then the related subcategories were arranged under one category. RESULTS: Two main categories of "features of context-based structure" and "changes in the cultural context" prove to be the basis for health behaviors in women. As for the category of "characteristics of context-based structure", individual, familial and environmental characteristics were identified, and regarding the category of "changes in the cultural context", the context-based cultural features were identified. CONCLUSION: The findings of the study suggest that effective contextual factors influencing women's living conditions had a decisive role in their health behaviors. In fact, the context- based structure in association with the cultural changes that have occurred in the beliefs of men and women, have had a decisive role in the women's health behaviors.

Hope of patient recovery in the ICU from the viewpoint of Iranian nurses: concept analysis.

Nurses' care quality for patients in the ICU depends on their degree/ level of hope to improving patient, but there is no consensus on the concept "hoping to improve patient." The purpose of the present study is to analyze the concept nurses hoping to improving patient in the ICU. To analyze this concept, hybrid model is used which consists of theoretical phase, field work phase, and final analytical phase. In field phase work, semi-structured, face to face and individual interviews were done for nurses working in the ICU, and the data gathered from the interviews were analyzed using inductive content analysis. In theoretical phase, the concept hoping to improve patient was characterized by being available, being professional, expecting positively, and being future- oriented. The scientific definition of this concept was explained through properties which are necessary for qualified nursing care. In field work phase, the categories include nursing care, inner feeling, belief and consequences. In final analytical phase, final definition of the concept was explained through properties such as dynamic expectation, being realistic, and being goal- oriented which is a better function and attitude in effective nursing care accompanying peace of mind for nurses. Concept analysis showed that nurse's awareness of hoping to improve patient helps the nurse do his job in the best way and with peace of mind.

Perception of Iranian middle-aged women regarding moral health concept: a content analysis.

INTRODUCTION: The present study aimed at exploring and describing the perception of moral health from middle-aged women standpoints. Women's decisive role in family is undeniable. In the family which is built upon tradition, faith and ethics, this is women's principle which is represented in the moral health of the individual and the society, deals with the nature of the vice and virtue. This study attempted to identify the perception of Iranian middle-aged women about the concept of moral health. METHOD: The present study completed through a content analysis method. Twenty two middle-aged women were recruited through purposive sampling. Data were granted by face to face, semi-structured interview. RESULT: Our major categories are devotion, preserving moral values and moral challenges. Devotion category includes subcategories such as prioritizing the health of family members and trying to save marriage. Preserving moral values category includes subcategories such as respecting values and consolidating beliefs over time. Moral challenges category consists of individual and familial challenges subcategories. CONCLUSION: Moral health is of high importance which affects various dimensions of individual, social and familial life. The findings of the present study presented new dimensions of middle-aged women's health regarding moral health which can finally have different consequences on familial and social moral health.

Women's Health Concept: A Meta-Synthesis Study.

BACKGROUND: It is necessary to identify unidentified or less- concentrated issues in women's health dimension through an extended study. This study is done to identify different dimensions of women's health among qualitative research. METHOD: The present meta-synthesis study is done through a systematic review. The main criteria were to use qualitative studies issued in the same language and researches in which their participants were women. All the published and indexed articles related to women's health in Iran at SID, Magiran and Iranmedex databases from 2001 to 2013 were scrutinized. Search in these databases was done using key words "health" and "women". Finally, 29 qualitative articles were chosen. Data analysis was performed using qualitative content analysis. RESULTS: Generally, concepts extracted from women's health dimension are classified in three main categories including personal, familial and social dimensions. Each category includes some subcategories, too. Personal factors consist of physical, psychological -emotional and spiritual; familial factors consist of fertility, husband's support and women's fundamental roles, and social factors consist of cultural, socioeconomically support, and women's management issues. CONCLUSION: In this meta-synthesis study, there was an effort to present a new interpretation of the previous studies. This study helped attain a more comprehensive and deeper knowledge about women's health concept and reveal its different aspects, which are not assessed in the country.