Investigating the effect of inquiry-based stress reduction on mortality awareness and interpersonal problems among intensive care unit nurses.

INTRODUCTION: Caring for dying patients is one of the job stressors. Nurses in intensive care units are among the medical staff who have a close interaction with dying patients. Studies have shown that psychological interventions are very helpful in improving thinking about death and its problems. Therefore, this study was conducted to investigate the effect of Inquiry-Based Stress Reduction on mortality awareness and interpersonal problems among intensive care unit nurses in southeastern Iran. MATERIALS AND METHODS: This was a Quasi-experimental study with a pretest-posttest design in southeast of Iran in 2021. Nurses were selected using the convenience sampling method and divided into intervention (n = 32) and control (n = 35) groups using the block randomization method. The intervention group received a two-hour Inquiry-Based Stress Reduction counseling session every week for 6 weeks. Data were gathered using Multidimensional Mortality Awareness Measure and Inventory of Interpersonal Problems before, immediately after, and 6 weeks after the intervention. IBM SPSS Statistics software version 25 was used for data analysis. RESULTS: In the intervention group, the mean scores of Mortality Awareness before, immediately after, and 6 weeks after the intervention were 130.41 ± 5.91, 164.47 ± 8.66, and 163.91 ± 9.29, respectively. Therefore, in the intervention group, the increase of Mortality Awareness mean score was statistically significant (P < 0.001). In the control group, the mean scores of Mortality Awareness before, immediately after, and 6 weeks after intervention were 129.63 ± 5.59, 135.26 ± 11.14, and 132.66 ± 5.62, respectively. Difference between the two groups was significant (P < 0.001). The results also showed that in the intervention group the mean scores of Interpersonal Problems immediately after and 6 weeks after the intervention were lower than before the intervention (P < 0.001). In the control group, Interpersonal Problems increased over time (P < 0.001). Accordingly, the difference between the two groups in terms of Interpersonal Problems during the study was statistically significant (P < 0.001). CONCLUSION: The study results suggest that the Inquiry-Based Stress Reduction is an appropriate intervention method to improve mortality awareness and reduce interpersonal problems in intensive care unit nurses.

Power of Religious Beliefs and Coping with Cancer: Opinions of Iranian Parents.

Childhood cancer as a stressful event has many consequences for both the parents and their children. The aim of the study was to assess the coping strategies used by Iranian parents of children with cancer. The present study was conducted through convenience sampling with the participation of 205 parents with at least one child with cancer referred to the oncology ward, in the southeast of Iran. The Coping Health Inventory for Parents was used to measure parental coping strategies. Results showed that the highest and the lowest mean coping score belonged to the dimensions of social support and medical factors, respectively. Briefly, "Belief in God" and "Gratefulness for his Blessings" were the most helpful coping strategies among parents. Based on results of this study, it seems necessary for nurses to be aware of all aspects of human existence, including religion and spirituality as strong sources of power for parents to adapt with the illness of their child. Also, providing interventions to teach effective coping skills to parents may reduce their distress and improve their quality of life.

Growth: A Journey from Experience to Higher Perception Among Iranian Muslim CPR Survivors.

Several studies have been conducted among cardiopulmonary resuscitation (CPR) survivors. Some studies have shown that positive and negative experiences coexist. Emotional distress and psychopathology in CPR survivors are related to the urgent need to make growth. Understanding the meaning of CPR survivors' lived experiences of growth may facilitate their growth. The aim of the study was to illuminate the meaning of CPR survivor's lived experiences of growth in southeast Iran. A qualitative design using a phenomenological hermeneutic approach influenced by Ricoeur was used in 12 CPR survivors. Three main themes emerged including: (1) opening up a new horizon in the meaning of life, (2) opening up a new horizon in the meaning of interpersonal connections and (3) opening up a new horizon in the meaning of God and spirituality. The interpreted comprehensive understanding conveyed a meaning that CPR survivors' experience of growth seems to be like opening the doors of perception to the higher reality. The finding may assist other CPR survivors to learn from participants in this study. Exposure to suitable narratives under health care provider supervision could develop profound learning. Training sessions with an emphasis on meditation education and how to use connecting to God in the adaptation process may approve the quality of life of CPR survivors.

Correction to: Burst Out of the Dead Land by the Help of Spirituality: A Case Study of Living with Blindness and Cancer.

In the original version of this article, there is a typo in the family name of the author. The co-author family name should be Seyed Bagheri; instead, it has been published as Seyed bagheri.

Getting Out or Remaining in the Cage of Inauthentic Self: The Meaning of Existential Challenges in Patients' with Cancer.

CONTEXT: Cancer as a life-threatening disease develops a range of existential challenges in persons. These challenges cause the patients to encounter some existential questions and tensions. This study method focuses on a person's experience about them. AIMS: The aim of this study is to illuminate the meaning of existential challenges in patients with cancer in Iran. SUBJECTS AND METHODS: A hermeneutic phenomenological approach, influenced by the philosophy of Ricoeur, was used to analyze the experiences of 10 Iranian patients with cancer. Data analysis was based on three stages of simple and fast understanding, structural analysis, and comprehensive understanding. RESULTS: The present study showed that existential challenges in patients with cancer can be considered as getting out or remaining in the cage of inauthentic self. This theme consists of two subthemes "Being exposed to the light of awareness that revealed the cage of inauthentic self" and "The tension between getting out of the cage or remaining." First, being exposed to the light of awareness revealed the cage of inauthentic self which subjectively refers to the emergence of existential questions, the past, the fear of future, and the collapse of physical body identity. Second, the tension between getting out of the cage or still staying which is characterized by anger, denial, sense of loneliness, and depression. CONCLUSIONS: According to the results of this qualitative study, it is possible to form discussion groups with peers or have self-reflective practice teaching groups to reflect patients' questions and existential challenges. In this way, participants can express themselves, share their experiences, challenges, learn, and find the answers.

Burst Out of the Dead Land by the Help of Spirituality: A Case Study of Living with Blindness and Cancer.

Blindness is one of the most complex problems related to health throughout the world. The condition is worse when such stress is accompanied with cancer. The aim of this case study was to introduce a patient with both these conditions who could come over her problems well. A phenomenological hermeneutic approach influenced by Ricoeur was used to explore the experience of the patient. Data were collected through unstructured and deep interview and by checking patient medical records. The patient is an Iranian 58-year-old teacher residing in Kerman who became blind at age 32 due to bloodshed inside the eye and was affected by breast cancer at age 52. The patient could come over these divine tests through the help of spirituality so that she believed blindness and cancer was the best events in her life. Spirituality is one of the human aspects that give meaning and purposes to life. Health care providers are suggested to implement spiritual strategies such as instructional workshops for increasing spirituality in settings, such as oncologic wards for patients to pass stages of adaptation to such great stresses easily and rapidly.

Compassion and care at the end of life: oncology nurses' experiences in South-East Iran.

BACKGROUND: End of life (EOL) care is newly established in the Iranian context. Context, in this case, refers to the internal and external manifestation of the nurse values, norms and experiences that are learnt throughout life. AIM: The aim of this study was to explore nurses' experiences of caring for dying patients in Iran. METHODS: A phenomenological hermeneutic approach, influenced by the philosophy of Ricoeur, was used to analyse 10 oncology nurses' experiences of caring for dying persons. FINDINGS: Three themes emerged from the analysis: 1) seeing the patient as unique person, 2) being present and open to seeing patients as unique persons and 3) personal and professional development as a result of closeness between nurse and patient. Caring for dying persons means assisting them at the end of their lives. CONCLUSION: Caring relationships underlie professional palliative care and are essential in EOL care. Proper palliative education and professionally led supervision should be included in the Iranian nursing curriculum.

Post-traumatic Stress Symptoms among Iranian Parents of Children during Cancer Treatment.

Support of parents of children with cancer requires healthcare personnel to be knowledgeable about the prevalence of post-traumatic stress symptoms among Iranian parents of children with cancer. This study was conducted to fulfill this aim in the South-East of Iran. Using the Impact of Event Scale -Revised, for parents of children with cancer, 200 parents in two hospitals supervised by Kerman University of Medical Sciences, were assessed. The total mean score of post-traumatic stress symptoms was 41.70. Among all categories of the Impact of Event Scale -Revised, the highest mean belonged to the category of 'intrusion' 16.03 (SD  =  6.24) and the lowest one belonged to the category of 'hyperarousal' 10.68 (SD  =  4.58). Based on the results, mothers had higher post-traumatic stress symptoms compared with fathers (p < 0.05). Adjusted odds ratio showed that the prevalence of post-traumatic stress symptoms among mothers was 2.49 times more than that among fathers (p  =  0.01). There was no association between sociodemographic data and post-traumatic stress symptoms. More research is needed to elucidate the Iranian parents' experience of having children with cancer.

Spiritual wellbeing and perceived uncertainty in patients with multiple sclerosis in south-east Iran.

BACKGROUND: The increasing incidence of multiple sclerosis (MS) over the previous decade in Iran has been examined in the literature. This chronic and unpredictable disease creates psychological impairment, including uncertainty, among patients. It is important to examine the extent of uncertainty experienced by patients with MS and their spiritual wellbeing. It could also be useful to assess the relationship between these two variables. PURPOSE: This study was conducted to examine the relationship between spiritual wellbeing and uncertainty among MS patients in south-east Iran. METHOD: The sample in this cross-sectional, descriptive study comprised 200 non-hospitalised patients with MS referred to a disease centre in Kerman (south-east Iran). Using the Mishel Uncertainty in Illness Scale (MUIS-C) and spiritual wellbeing scale (SWB), data were collected and analysed. RESULTS: The study results showed that the total mean score of SWB was 93.81 (SD=15.25). The mean score of the sub-scale of religious wellbeing was greater than the sub-scale of existential wellbeing (50.80 vs 43.01). The mean score of uncertainty scale was 67.20 (12/35). The highest mean score belonged to the sub-category of ambiguity (32.24±7.90). Pearson correlation test showed that perceived uncertainty score negatively correlated with spiritual wellbeing (r=-0.345; p=0.000), existential wellbeing (r=-0.421; p=0/00) and religious wellbeing (r=-0.172; p=0.015). CONCLUSION: MS patients should be offered opportunities to reflect on their experiences, feelings, actions and reactions to spirituality to enhance the possibility of using their personal experiences as part of positive and constructive learning. The study results suggest that information about spirituality and spiritual care should be included in the continuous and in-service education of MS patients and nurses working with them.

Nurses' professional autonomy and attitudes toward caring for dying patients in South-East Iran.

BACKGROUND: Nurses in Iran have been found to have less professional autonomy than nurses in Western countries. Professional autonomy is important, affecting nurses' caring behaviour and attitudes. AIM: This study aimed to examine the correlation between the professional autonomy of oncology and intensive care unit (ICU) nurses in the south-east of Iran and their attitudes toward the care of dying patients. METHODS: 155 oncology and ICU nurses in three hospitals supervised by Kerman University of Medical Sciences completed the Frommelt Attitude Toward Care of the Dying (FATCOD) and Pankratz Nursing Questionnaire (PNQ) tools during April-June 2013. RESULTS: The participants had a neutral to moderately positive mean attitude toward caring for dying patients (mean=3.18±0.37 out of 5) and moderate professional autonomy (mean=3.08±0.33 out of 5). There was a significant positive correlation between total scores on professional autonomy and total scores on attitudes toward caring for dying patients. There was also a significant positive correlation between the PNQ subscale of 'patients' rights' and attitudes toward caring for dying patients. CONCLUSIONS: Autonomy could be an important component of nurses' attitudes toward caring for dying patients. To improve nurses' autonomy, nursing education in end-of-life care in Iran must be improved. Other factors relating to autonomy and attitudes specific to the Iranian context should also be considered.

Nurses' knowledge about palliative care in Southeast Iran.

OBJECTIVE: Palliative care requires nurses to be knowledgeable about different aspects of the care that they provide for dying patients. This study, therefore, was conducted to examine oncology and intensive care nurses' knowledge about palliative care in Southeast Iran. METHOD: Using the Palliative Care Quiz for Nursing (PCQN), 140 oncology and intensive care unit (ICU) nurses' knowledge about palliative care in three hospitals supervised by Kerman University of Medical Sciences was assessed. RESULTS: In PCQN, the mean score was 7.59 (SD: 2.28). The most correct answers were in the category of management of pain and other symptoms (46.07%). The lowest correct answers were in the category of psychosocial and spiritual care (19.3%). SIGNIFICANCE OF RESULTS: These findings suggest that nurses' knowledge about palliative care can be improved by establishing specific palliative care units to focus on end-of-life care. This establishment requires incorporation of an end-of-life nursing education curriculum into undergraduate nursing studies.

Nurses' attitudes toward palliative care in south-east Iran.

BACKGROUND: Nurses are the element of the palliative care team who spend the most time with patients. Nurses' attitudes toward palliative care affect their behaviour toward their patients. AIM: This study sought to examine oncology and intensive care unit (ICU) nurses' attitudes toward palliative care in south-east Iran. METHODS: A self-administered questionnaire was used to assess the palliative care attitudes of 140 oncology and ICU nurses from three hospitals supervised by Kerman University of Medical Science. RESULTS: Participants had moderately negative to neutral attitudes toward palliative care (2.99 ± 0.29 out of 5). Among all categories, the highest mean score came from the category of 'patient's preferences' (mean=3.66) and the lowest from the category of 'withholding and withdrawing treatment' (mean=2.42). A significant correlation was found between nurses' attitudes toward palliative care and some demographic characteristics, including marital status, type of ward, palliative care education, personal study about palliative care, level of education, and experience of caring for a dying family member. CONCLUSIONS: This study suggests that educational designers should include specific courses about death and palliative care in undergraduate and postgraduate nursing curricula. Educational programmes need to build on the specific experiences of death and dying among nurses and auxiliary nurses.

Meaning of spiritual care: Iranian nurses' experiences.

Spiritual care is an essential component in nursing practice and strongly influenced by the sociocultural context. This article aimed to elucidate the meaning of nurses' experiences of giving spiritual care in southeast of Iran. A phenomenological hermeneutic approach influenced by Ricoeur was used. Eleven staff nurses who were currently working in the 3 major hospitals under the umbrella of the Kerman University of Medical Sciences were interviewed. The meaning of spiritual care was comprehensively understood as meeting patient as a unique being. This can be divided into 3 themes: meeting patient as a being in relationship, meeting patient as a cultural being, and meeting patient as a religious being. The results in this study suggest that education about spirituality and spiritual care should be included in the continuous and in-service education of registered nurses. Spiritual and cultural assessment criteria should be included in this education to improve the provision of holistic care.

The design and psychometric evaluation of the Supportive-Care Needs Scale (ZOKH-SCNS29) in patients living with cancer.

BACKGROUND: Understanding the needs of cancer patients and planning to meet these needs is a major concern of the health system. AIM: The present study aimed to design and conduct a psychometric evaluation of supportive-care needs scale in patients with cancer. METHODS: This study was conducted in both qualitative and quantitative stages. In the qualitative phase, the questionnaire items were generated by analysing the data from 16 interviews, after which, face, content and construct validity were tested. To construct the validity, the questionnaire was completed by 229 cancer patients. The reliability of the questionnaire was assessed by internal consistency. Data were analysed using SPSS (version 18). FINDINGS: In this study, 4 factors were extracted from 29 items through exploratory factor analysis: 'Need to be understood by the spouse and family' (10 items), 'Need to manage existential and psychological challenges' (7 items), 'Need to manage lack of knowledge about the disease' (7 items), 'Need organisational-therapeutic support '(5 items). These factors accounted for 50.1%. of the total variance. Internal consistency was 0.88, and also the Cronbach's alpha coefficient was also 0.89 after construct validity for the scale items'. The Cronbach's alpha was 0.91 after the construct validity. CONCLUSION: The findings of the present study showed that this supportive care needs scale is a valid and reliable scale for identifying the supportive care needs of patients with cancer.

Relationship between Braden scale score and pressure ulcer development in patients admitted in trauma intensive care unit.

The purpose of this study was to determine the relationship between the scores of Braden scale and pressure ulcer development among critically ill patients. All patients who admitted to intensive care unit (ICU) in 3 months (during July-October 2010) were surveyed with Braden scale. Patients who gained higher score of Braden scale were at lower risk for pressure ulcer development compared with the other patients. Braden scale is a useful tool for predicting pressure ulcer development in trauma ICU patients. Also, factors such as age and level of consciousness may influence pressure ulcer development.

Developing and testing a spiritual care questionnaire in the Iranian context.

As most research exploring nurses' perceptions on the topic of spiritual care was conducted in Western countries, these findings may not be applicable in Iran because of cultural and health system differences. Therefore, a new survey instrument was developed for the Iranian context. The study was conducted in two steps: (1) development and validation of items for perception scale and (2) distribution of the questionnaire among nursing students to determine scale reliability and construct validity. The preliminary scale consisted of 50 items designed to measure the participants' perception of spiritual care. Construct validity of the scale was examined on the remaining 33 items. On interpretation of the items, the following four components were identified: (1) meeting patient as a being in meaning and hope, (2) meeting patient as a being in relationship, (3) meeting patient as a religious being, and (4) meeting patients as a being with autonomy. The results in this paper showed that preserving dignity in the nurses' practice meant getting involved in interpersonal caring relationships, with respect for the involved peoples' religious beliefs and their autonomy. Proper education and professionally led supervision with reflection on past and recent experiences may develop student nurses' and nurses' perceptions as well as their attitudes toward spiritual care and to achieve a realistic view of the profession.

Examining the mother's supportive role caring for a child with cancer.

Background: Childhood cancer is a stressful experience for patients and their families; it has a profound effect on families emotionally, psychologically and financially. The mother's supportive role affects the child's treatment outcomes and the health of all family members. Aims: This study was conducted to describe the experiences of mothers of children with cancer. Methods: A total of 14 mothers of children with cancer were recruited using purposive sampling. In-depth semi-structured interviews were conducted using a qualitative inductive content analysis. Data were analysed using Graneheim et al's (2004) approach. Findings: According to data analysis, the mother's supportive role can be depicted across four subthemes: 'being genuinely present with a sick child'; 'keeping the family together and strengthening its cohesion'; 'providing compassionate collaborative care for peers'; and 'empowering the self and taking charge of one's own life'. The main overarching theme extracted from this study was 'sacrifice'. Conclusion: This study results suggest that the mothers' supportive role is relying on their own personal power, in which they not only give the care to the child, family and counterparts, but also drive personal growth and empowerment of mothers. A deeper understanding of mothers' experiences of their supportive role may enhance the quality of care and promote further paediatric approaches to palliative care.

Sense of Coherence in Parents of Children With Cancer and Its Relationship With Self-Construal in Southeastern Iran.

This study aimed to determine sense of coherence and its relationship with self-construal in parents of children with cancer in southeastern Iran. In this descriptive correlational study, 127 parents of children with cancer were studied using sense of coherence scale (SOC) and self-construal scale (SCS) in Iran. The results of the study showed that total mean score of SOC was 51.4 ± 14.2 and the interdependent self-construal (INT) in parents was higher than independent self-construal (IND). Also, the relationship between SOC and SCS showed that IND had a positive and statistically significant relationship with SOC manageability subscale. The weak SOC in the studied parents can cause more stress and suffering in dealing with their child's disease. It is essential that health care providers provide a comprehensive program to enhance parents' SOC and it should be noted that people who have a more INT felt less able to manage challenging situations.

EvaIuating the "good death" concept from Iranian bereaved family members' perspective.

Improving end-of-life care demands that first you define what constitutes a good death for different cultures. This study was conducted to evaluate a good death concept from the Iranian bereaved family members' perspective. A descriptive, cross-sectional study was designed using a Good Death Inventory (GDI) questionnaire to evaluate 150 bereaved family members. Data were analyzed by SPSS. Based on the results, the highest scores belonged to the domains "being respected as an individual," "natural death," "religious and spiritual comfort," and "control over the future." The domain perceived by family members as less important was "unawareness of death." Providing a good death requires professional caregivers to be sensitive and pay attention to the preferences of each unique person's perceptions. In order to implement holistic care, caregivers must be aware of patients' spiritual needs. Establishing a specific unit in a hospital and individually treating each patient as a valued family member could be the best way to improve the quality of end-of-life care that is missing in Iran.