Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis.

BACKGROUND: Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. AIM: This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. METHODS: A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. RESULTS: Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. CONCLUSION: Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

Parental supporter in pediatric resuscitation: A mixed-method study with Delphi and analytic hierarchy process.

INTRODUCTION: Providing support to parents is an evidence-based practice and a crucial part of family-centered nursing care. However, it is not clear who and how to provide the best support to parents during and after their child's resuscitation attempts. PURPOSE: This study was conducted to explore the characteristics and roles of parental supporters responsible for caring for parents during and after their child's resuscitation. METHODS: This is a mixed-method study combining the Delphi technique and the Analytic Hierarchy Process. A list of potentially important items describing the characteristics and roles of parental supporters caring for parents during and after pediatric resuscitation was developed through qualitative interviews with parents and members of the resuscitation team, and a thorough literature search. Then, the Delphi round was conducted with key experts. In the final step, the Analytic Hierarchy Process was used for ranking items in the order of their importance. RESULTS: A list with 69 items describing the characteristics and roles of parental supporters was developed. 15 items (21.74%) were related to the "Characteristics of parental supporter" category; 8 items (11.59%) were related to the "Roles of a parental supporter during resuscitation" category; 13 items (18.84%) were related to the "Roles of a parental supporter after successful resuscitation" category; 23 items (33.34%) were related to the "Roles of a parental supporter after unsuccessful resuscitation" category; and 10 items (14.49%) were related to the "Roles of a parental supporter after unsuccessful resuscitation with help of other staff of the hospital" category. CONCLUSION: The findings of this study can be used to develop guidelines that include parental supporter characteristics and roles to support parents during and after their child's resuscitation according to family-centered care practices in pediatric settings. CLINICAL RELEVANCE: Study findings indicate the need for the presence of a parental supporter during and after pediatric resuscitation, whether witnessed by the parents or not. Knowledge regarding the characteristics and roles of parental supporters can be used in practice to uphold family-centered nursing care during critical situations.

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review.

AIM: The current study aimed to systematically review the data obtained from studies on women with breast and gynaecologic cancers subjected to Intimate Partner Violence (IPV). DESIGN: Systematic review without meta-analysis. DATA SOURCES: PubMed, ProQuest, Google Scholar, Scopus, Web of Science; databases were searched without time limit. REVIEW METHOD: The PRISMA model was guided the systematic literature search using Boolean keywords and operators. PICO statement was used to develop a question of this review. Studies examining women with breast and gynaecologic cancers subjected to IPV were included in the study after the quality of the articles was reviewed. RESULTS: Eight studies that met the inclusion criteria and were conducted between 2000 and 2021 were included in the study. CONCLUSIONS: Studies confirm the effect of IPV on the severity and consequences of breast and gynaecologic cancers. Having a history of IPV can indirectly lead to breast and gynaecologic cancers. On the other hand, women suffering from IPV are more likely than other women to delay screening or not perform screening for cancer. IMPACT: The dimensions and nature of violence and the disclosure or non-disclosure of violence in vulnerable women are strongly affected by society's culture. Therefore, researchers need to have sufficient knowledge of the culture and social factors governing the community to achieve reliable findings related to IPV in qualitative, quantitative, and psychometric studies and the design of IPV assessment tools. It is recommended that IPV screening teams, that is, multidisciplinary teams of trained physicians, nurses and social workers, participate in two-way screening programmes: IPV screening for women with gynaecological cancer and screening for gynaecological cancer in women with IPV.

Clarification of ethical principle of the beneficence in nursing care: an integrative review.

BACKGROUND: Ethics-based nursing practice can transform health care practices. As the biggest human capital in the health care system, nurses are obliged to follow ethical principles in this field. One of these ethical principles; is beneficence, which is considered the core of nursing care. This study aimed to investigate clarification of the principle of beneficence in nursing care and its related challenges. METHODS: This integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, and Scopus were searched using the keywords; "beneficence", "ethic", "nursing" and "care" in English and Persian in the time range of 2010 to 10 February, 2023. After applying inclusion criteria and assessing the articles using Bowling's Quality Assessment Tool, finally, 16 papers were included from 984. RESULTS: After reviewing and evaluating the qualified articles, the findings were classified into four main categories: (1) nature, (2) applicability, (3) Relevant and influential factors, and (4) challenges related to the ethical principle of beneficence in nursing care. CONCLUSION: Based on the results of this review it seems that paying attention to clarification the principle of beneficence in nursing care can provide positive outcomes for patients to benefit from this principle and finally, it leads to increasing the well-being and health of patients, reducing their mortality rate, increasing satisfaction and maintaining the respect and human dignity of patients.

Pain Self-management Strategies in Patients With Cancer: A Qualitative Study.

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet.

Nurses' experiences of ethical and legal issues in post-resuscitation care: A qualitative content analysis.

BACKGROUND: Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. OBJECTIVE: To explore nurses' experiences of ethical and legal issues in post-resuscitation care. RESEARCH DESIGN: This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. PARTICIPANTS AND RESEARCH CONTEXT: In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed by conventional content analysis. ETHICAL CONSIDERATIONS: The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. FINDINGS: Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. CONCLUSION: There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges.

Care providers' experiences regarding barriers to maternal participation in neonatal pain management.

BACKGROUND: Mothers' involvement in the pain management of infants admitted to the intensive care unit can alleviate the infants' pain. Despite International guidelines, maternal involvement in neonatal pain management is low. Hence, investigating the perspectives of care providers (CPs) on barriers to maternal participation can be helpful in developing practice guidelines. AIMS: The purpose of this study was to investigate the experiences of CPs on barriers to maternal involvement in neonatal pain management in the intensive care unit. DESIGN: In this study, a qualitative design based on the content analysis approach was used. METHOD: We included 24 nurses and physicians in the neonatal intensive care unit from February to September 2020. Data were collected through conducting 11 individual interviews and two focus group discussions with eight and five participants, respectively. RESULTS: Three main categories and seven sub-categories were found, including maternal barriers (inadequate emotional readiness and unfamiliarity with role), CPs' barriers (time pressure, fear of family-care provider tension, and insufficient knowledge), and organizational barriers (neglected joint decision-making and restricted organizational participative policies). CONCLUSIONS: The identified barriers could be classified into those related to mothers, care providers, and organizations. The lack of appropriate interaction and cooperation between parents and care-providers can affect the emergence of barriers related to the mothers and staff. RELEVANCE TO CLINICAL PRACTICE: There is a lack of knowledge regarding neonatal pain management in the health care team and mothers. Educating mothers and CPs about the benefits and ways of mothers' participation can increase readiness and capabilities. Providing clear guidelines about family-centred care and promoting parent-CPs' interactions can increase the mothers' participation.

Nurses' Perceptions Towards Resuscitated Patients: A Qualitative Study.

Nurses' perceptions of resuscitated patients may affect their care, and this has not been investigated in previous literature. The aim of this study was to explore nurses' perceptions towards resuscitated patients. In this descriptive-qualitative study seventeen clinical nurses participated using purposive sampling. In-depth, semi-structured interviews were conducted and data were analyzed by conventional content analysis. Four main categories emerged: Injured, undervalued, problematic, and destroyer of resources. Participants considered resuscitated patients to have multiple physical injuries, which are an important source of legal problems and workplace violence, and they believed that these patients will eventually die. Resuscitated patients are considered forgotten and educational cases. Iranian nurses have a strong negative perception towards resuscitated patients. Improving the quality of cardiopulmonary resuscitation, improving the knowledge and skills of personnel in performing resuscitation, and supporting managers and doctors to nurses in the post-resuscitation period can change the attitude of nurses and improve post-resuscitation care.

Nurses, physicians and patients' knowledge and attitudes about nurse prescribing.

BACKGROUND: One of the roles that nurses have acquired in recent years is the role of prescribing. This study aimed to investigate the knowledge and attitudes of critical care nurses, physicians and patients about nurse prescribing. METHODS: A descriptive cross-sectional study with the participation of 152 nurses, 53 physicians and 75 patients was carried out. Participants were selected by stratified random sampling from the critical care units of six hospitals in Tabriz, Iran. Demographics and participants' knowledge and attitudes about nurse prescribing questionnaires were used to collect data. The collected data were analyzed using SPSS-22 software. RESULTS: The mean scores of total knowledge about nurse prescribing in nurses, patients and physicians' were 15.41 ± 1.85,16.45 ± 2.31, 14.74 ± 1.7 respectively (from a range of 10 -20), and the mean score of knowledge by physicians was significantly higher than others (P = 0.000) and they had more knowledge about nurse prescribing. The mean scores of the attitudes towards nurse prescribing in nurses, physicians and patients were 40.62 ± 3.68, 37.98 ± 5.92 and 39.38 ± 4.39 respectively (from a range of 10 -50). However, the total mean score of attitudes among nurses was significantly higher than others (P = 0.000) and nurses had more positive attitudes toward prescribing. CONCLUSION: The results showed that the participants have a good understanding and attitudes toward nurse prescribing. Nurse prescribing as a new duty and authority can be considered in providing more effective care by specialist nurses. The results of this study can also be used in the future planning of health policy for nurses to have the right to prescribe and ultimately improve the quality of patient care.

Health care staff support for mothers in NICU: a focused ethnography study.

BACKGROUND: Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU. METHODS: A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework. RESULT: Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained. CONCLUSION: The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

Iranian superwomen's career experiences: a qualitative study.

BACKGROUND: Superwoman refers to the identity of a woman who performs several important roles simultaneously and full-time, such as being a wife, mother, and homemaker while holding a job. This study aims to examine the career experiences of Iranian superwomen who maintained their mental health while holding multiple roles. METHODS: Data for this qualitative study were collected via semi-structured interview and analyzed using conventional content analysis. The study participants were 12 multi-role women from different occupations in Tabriz, North West of Iran selected through purposive and theoretical sampling. The women's mental health status was assessed using Mental Health Continuum-Short Form questionnaire before participating in the research. RESULTS: The results were classified into three main categories. The first category included Underlying Factors of Job Experience with six subcategories, including Limited job opportunities for women, Educational context (mindset shaped in the parental home), Commitment or freedom in obtaining a job and its continuation, Personality traits, and Non-cognitive skills (emotional intelligence and spiritual intelligence); the second category included the adopted strategies to solve career problems with two subcategories: effective strategies, including the benefits of having a mindset of abundance and having a vision and strategic planning, and ineffective strategies, including the benefits of having a mindset of scarcity; and the third category included Perceived Consequences of employment with two subcategories: psychological consequences and social consequences, with both subcategories including some positive and negative further subcategories. Moreover, a conceptual relationship between the main categories and the subcategories was evident. CONCLUSIONS: The content obtained not only supports the findings about the experiences of multi-role women in cultures outside Iran, but also points to the unique aspects of Iranian superwomen's life experiences and narratives. The findings of this study can help us perceive the real career experiences from the perspective of Iranian professional women with multiple roles.

Hemodialysis patients perceived exercise benefits and barriers: the association with health-related quality of life.

BACKGROUND: Patients on hemodialysis have less exercise capacity and lower health-related quality of life than healthy individuals without chronic kidney disease (CKD). One of the factors that may influence exercise behavior among these patients is their perception of exercise benefits and barriers. The present study aimed to assess the perception of hemodialysis patients about exercise benefits and barriers and its association with patients' health-related quality of life. METHODS: In this cross-sectional study, 227 patients undergoing hemodialysis were randomly selected from two dialysis centers. Data collection was carried out using dialysis patient-perceived exercise benefits and barriers scale (DPEBBS) and kidney disease quality of life short form (KDQOL-SF). Data were analyzed using SPSS software ver. 21. RESULTS: The mean score of DPEBBS was 68.2 ± 7.4 (range: 24 to 96) and the mean KDQOL score was 48.9 ± 23.3 (range: 0 to 100). Data analysis by Pearson correlation coefficient showed a positive and significant relationship between the mean scores of DPEBBS and the total score of KDQOL (r = 0.55, p < 0.001). Moreover, there was a positive relationship between the mean scores of DPEBBS and the mean score of all domains of KDQOL. CONCLUSION: Although most of the patients undergoing hemodialysis had a positive perception of the exercise, the majority of them do not engage in exercise; it could be contributed to the barriers of exercise such as tiredness, muscle fatigue, and fear of arteriovenous fistula injury. Providing exercise facilities, encouraging the patients by the health care provider to engage in exercise programs, and incorporation of exercise professionals into hemodialysis centers could help the patients to engage in regular exercise.

Pre- and during-labour predictors of low birth satisfaction among Iranian women: a prospective analytical study.

BACKGROUND: Maternal childbirth dissatisfaction has short- and long-term negative effects on the mothers' health and life, as well as on relation with her child and family. Due to lack of studies in Iran and other counties, we aimed to determine pre- and during- labour predictors of low birth satisfaction. METHODS: Seven hundred women with low risk singleton pregnancy participated in this prospective analytical study. The participants were hospitalized for vaginal delivery with fetus in cephalic presentation and gestational age of 370-416 at two teaching centers in Tabriz (Iran). Woman characteristics, anxiety state (using Spielberger inventory) and dehydration were assessed at cervical dilatation of 4-6 cm. Iranian (Persian) birth satisfaction scale-revised was applied 12-24 h after birth. Multiple linear regression was used to determine the predictors. RESULTS: Excluding 26 women who were outliers, 674 women were analyzed. The mean birth satisfaction score was 23.8 (SD 6.5) from an attainable score of 0-40. The during-labour predictors of low birth satisfaction score were severe and moderate anxiety, labour dystocia, insufficient support by staff, vaginal birth with episiotomy and tear, emergency cesarean section, labour induction and labour augmentation with oxytocin, and woman dehydration. The pre-labour predictors included being primiparous, sexual and emotional violence during pregnancy, gestational age of 400-416, preference for cesarean section, no attendance at pregnancy classes, and insufficient household income. The proportion of the variance explained by the during-labour variables was 75%, by pre-labour variables was 14% and by overall was 76%. CONCLUSIONS: The controllable during-labour predictors explains most of the variance of the satisfaction score. It seems that responding to women's physical and psychological needs during labour and applying less interventions could improve women's childbirth satisfaction.

Mutual trust in infant care: the nurses and mothers experiences.

The relationship between healthcare providers and parents of infants in neonatal intensive care unit is based on trust and constitutes a core measure of family-centred care and health. The aim of the present qualitative study was to explore mothers and nurses experiences of trust in one another around the caregiving of the hospitalised infant in intensive neonatal care unit. Focused ethnographic research study conducted through observations and in-depth interviews with 20 mothers and 16 nurses in NICU of Tabriz (Iran) in 2017. Two main themes of 'gradual and fragile trust of mother-to-nurse' (subthemes: Primary trust-mistrust, mother's trust to responsible nurse, mother trust Increase with skilful nurse performance, and vulnerability to trust) and 'gradual and fragile trust of nurse-to-mother' (subthemes: Nurse's initial assessment of trust to mother's readiness to participate, Development of trust to mother, and vulnerability of nurse's trust to mother) were obtained. The present study revealed that mutual trust between the nurse and the mother in the care of the infant was a gradual and progressive process that was achieved over time. Complexities around the care of a hospitalised infant influenced how fragile or vulnerable the trust became between nurse and mother. Findings from this research can be used in supporting increased maternal participation in infant care and improvement of family-centred care in the neonatal intensive care unit.

Palliative Care Models for Cancer Patients: Learning for Planning in Nursing (Review).

Cancer is the second cause of mortality in the world. Increased incidence of cancer and its growing trend have drawn attention to care for these patients. Palliative care is a solution for improving the quality of cancer care. However, only 14% of cancer patients in the world are receiving palliative care and most nurses lack the adequate knowledge and education to implement different palliative care models for cancer patients. This review of the literature intended to identify the palliative care models used by nurses for cancer patients as well as the similarities and differences between these models. Databases such as PubMed, ProQuest, google scholar, and CINAHL were searched, and experimental studies that presented palliative care models for cancer patients that nurses were involved were selected. From a total of articles selected by searching the databases, 16 experimental articles were selected. These articles presented 12 palliative care models that involved nurses and participants were cancer patients. The palliative care models presented in the experimental articles were based on hospice, hospital, home care, ambulatory, community, pediatric, spirituality, early, family, telehealth, dignity, and integrated. It was found out that several palliative care nursing models for cancer patients can be employed by nurses as they are the key agents in the provision of palliative care. The collaborative nature of the models, their positive consequences for patients being common components of models, and the implementation of the models considering the disease trajectory were among their distinctions.

Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review.

STUDY OBJECTIVE: We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED). METHODS: A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification. Primary outcomes were identified treatment delays and causes of loss of eligibility for intravenous recombinant tissue plasminogen activator (r-tPA). RESULTS: Of patients with acute ischemic stroke, 80.2% did not meet intravenous r-tPA eligibility; the most common cause was delayed (>4.5 hours) ED arrival after symptom onset (71.82%; n=283). Of 19.8% of subjects for whom the stroke code was activated, intravenous r-tPA was administered in only 5.3%. The average time from patients' arrival to first emergency medicine resident visit, notification of acute stroke team, presence of neurology resident, and computed tomography scan interpretation was lower for patients who met criteria of intravenous r-tPA than for those who lost eligibility for fibrinolytic therapy. The average door-to-needle time was 69 minutes (interquartile range 46 to 91 minutes). CONCLUSION: Our ED and acute stroke team had a favorable clinical performance meeting established critical time goals of inhospital care for potentially eligible patients, but a poor clinical performance for the majority of patients who were not candidates for fibrinolytic therapy.

A Qualitative Study on Cancer Care Burden: Experiences of Iranian Family Caregivers.

The aim of this study was to explore the experiences of Iranian family caregivers with regard to the burden of caregiving. This is in the context of illuminating and identifying the experiences of family members from different contextual perspectives. In this qualitative study, purposive sampling was conducted in 2016. Data were collected using semistructured interviews and were analyzed using content analysis. Data analysis identified 4 categories and 8 subcategories: (1) burnout (physical problems and psychoemotional stress), (2) role conflict (balancing caring roles and family responsibilities; failure in professional or educational roles), (3) health system tensions (inadequate support from health professionals; ignorance of family members in health structure), and (4) social challenges of cancer (economic burden; taboo of cancer). In conclusion, nurses need to provide individualized support and counseling that address the sources of burden. This highlights the benefit of training health care professionals to provide culturally sensitive support based on family caregivers' needs and circumstances.

Iranian pre-hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study.

AIM: To explore the experiences of Iranian nurses working in pre-hospital emergency care services and the strategies used to manage of workplace violence. BACKGROUND: Pre-hospital emergency nurses are subject to workplace violence; however, little research addresses their experiences, particularly related to their strategies in dealing with workplace violence. METHODS: A descriptive qualitative study that involved nineteen male nurses who were working in pre-hospital services collected data using semi-structured interviews and analysed it using qualitative content analysis. RESULTS: Data analysis yielded four descriptive categories including no reaction to violence (tolerance and acceptance as common workplace conflicts), situational management (patient and scene management), confrontation (direct and indirect) and escaping the scene. Patient management was the dominant strategy used and had the best outcomes related to both patient and personnel safety. CONCLUSION: This study showed that pre-hospital nurses use different strategies to manage violence and patient management was a common and useful strategy for managing workplace violence. However, the pre-hospital nurses have little training, insufficient support and are poorly prepared to manage workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT: The development of context-based guidelines, continuing education, better-equipped ambulances that include medical and defence equipment, as well as better coordination of the police force in ambulance operations, can help to reduce workplace violence.

Mothers' Emotional Experiences Providing Care for Their Infants Within the Culture of an Iranian Neonatal Unit.

BACKGROUND: Each year, 5% to 8% of Iranian newborns require care in a neonatal unit (NU). Reasons for admission include prematurity, infection, and congenital anomalies. Little research has been conducted on the culture of Iranian NUs and the impact this has on mothers' emotional caregiving experiences. PURPOSE: To explore the emotional caregiving experiences of mothers in an Iranian NU. METHODS: Focused ethnography was used for this study. Mothers (n = 19) of term and preterm infants participated. Data were collected using observations and interviews. Roper and Shapira's 5-step framework was used to analyze the data. FINDINGS: Four major themes emerged: (a) fear, (b) loneliness, (c) competence, and (d) pleasure. Fear occurred when mothers felt unprepared to care for their infants. They were afraid of harming their infant or repeating previous mistakes. Loneliness consisted of bearing the burden of care while feeling alone. Competence occurred when the mothers experienced an increasing ability to provide care for their infants and a growing self-confidence. Finally, the mothers described pleasure as they began to feel worthiness as mothers and intense love for their infants. IMPLICATIONS FOR PRACTICE: The sense of fear and loneliness shared by these mothers has significant implications for practice. While it may be a challenge for nurses to provide adequate support for mothers due to the heavy workload of Iranian NUs, close relatives and other support persons may play a key role. IMPLICATIONS FOR RESEARCH: Future research should be conducted on the impact of maternal support on mothers' NU experiences in Iran.

Cultural aspects of death notification following cardiopulmonary resuscitation.

AIMS: To explore the lived experience of resuscitation team members involved in notifying family members when a patient dies following a resuscitation event in an Iranian cultural context. BACKGROUND: Death notification to the family is indeed a difficult and an important issue for resuscitation team members. The way health professionals deliver news to family members should incorporate elements of sensitivity, timing and adequate clinical explanations with emphasis on the efforts made by the professionals during the resuscitation. DESIGN: A phenomenological study. METHOD: Over a period of 5 months (June 2016-November 2016) eleven nurses and six physicians were interviewed using an in-depth interview process applying Van Manen's hermeneutic phenomenological approach for data collection and analysis. The participants were recruited from six tertiary hospitals in Tabriz, Iran. FINDINGS: There were two main themes that emerged from the data analysis including: "contributing factors on the impact of notification" and "notification strategies". A further 13 subthemes emerged under the main themes. Several culturally related issues emerged with the participants feeling more comfortable informing male rather than female relatives about the death of the patient following a resuscitation. CONCLUSIONS: Notifying family members of a patient's death is a stressful and culturally sensitive task for the resuscitation team members. The nature of the patient's presenting condition, together with the various resuscitation interventions can result in relatives responding unpredictably. Providing health professionals with the appropriate training and skills to effectively communicate with family members will ensure that the families' level of preparedness, understanding and cultural beliefs are taken into consideration.