Experiences and attitudes of clinical and academic nurses about infection prevention and control nursing curriculum and duties - a qualitative study.

BACKGROUND: Infectious diseases are becoming more widespread and re-emerging, causing psychological, social, economic, and health effects at both national and international levels. Specialist nurses can help prevent and control these infections. However, in Iran, there are currently no specialist infection prevention and control (IPC) nurses to manage and control infections. This study aims to explore clinical and academic nurses' attitudes toward IPC nursing curriculum and duties. METHODS: The study used a qualitative content analysis approach. Thirty-six participants, including clinical and academic nurses, were selected using a purposeful sampling method. Data was collected through seven focused group discussions. The accuracy and validity of the research tools were measured using the Four-Dimension Criteria developed by Lincoln and Guba. Data analysis was conducted using directed content analysis. RESULTS: The data analysis of the discussions held in the seven focus groups extracted 628 codes. Three themes were developed from the qualitative analysis: "Core characteristics of the curriculum", "Expected competencies and skills", and "Evaluation." These themes were derived from nine main categories and 25 subcategories. CONCLUSIONS: Specialist IPC nurses can play important roles in various positions and environments. Therefore, educational policymakers in Iran should consider establishing IPC nursing courses. It is also recommended that policymakers and decision-makers in the nursing field of other less developed countries should prioritize this issue.

Clinical practice guideline for end-of-life care in patients with cancer: a modified ADAPTE process.

PURPOSE: This study seeks to adapt a guideline for end-of-life care in patients with cancer to be used by healthcare teams. METHODS: This methodological study was conducted by modifying the ADAPTE process and adding to it a qualitative study and consensus ratings by a multidisciplinary panel of experts. A qualitative study was thus performed to identify the end-of-life needs of patients with cancer. Then, the source guidelines and the results of the qualitative study were used to draft the initial version of the guideline, with 85 adaptation recommendations. A multidisciplinary panel of healthcare experts performed the external review of the recommendations based on the four criteria of relatedness, comprehensibility, usefulness, and feasibility and scored them on a scale of 1-9. The mean score of each recommendation was calculated, and the recommendations were classified into three categories: appropriate (mean score of 7-9), uncertain (mean score of 4-6.99), and inappropriate (mean score of 1-3.99). RESULTS: All the recommendations were approved, as they all had a mean score of 7 or higher, and were then categorized into 11 dimensions: communication management; participatory and evidence-based decision-making management; pain management; dyspnea management; nausea and vomiting management; anorexia and cachexia management; constipation management; death rattle management; management of delirium, anxiety, and restlessness; hydration management; and pharmacological considerations. CONCLUSION: The adaptation of the guideline for end-of-life care in patients with cancer in Iran was performed by modifying the ADAPTE process with the participation of multidisciplinary stakeholders and based on the local needs.

The quality of guidelines on the end-of-life care: a systematic quality appraisal using AGREE II instrument.

BACKGROUND: Guidelines are intended to facilitate knowledge translation and evidence-based clinical decision-making, but they vary in methodological rigor and quality. The present study was conducted to assess the quality of guidelines available on end-of-life care in patients with cancer using AGREE II. METHODS: A comprehensive search was carried out in EMBASE (Excerpta Medica Database), MEDLINE/PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and gray literature sources until December 2016. The quality of the guidelines was assessed independently by five appraisers using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). To promote consistency with available studies using AGREE II and identify high-quality guidelines, the AGREE II scores were also categorized as "Strongly recommended," "Recommended with modifications," or "Not recommended." RESULTS: A total of 8 guidelines were included in this study. Five of the guidelines were developed based on evidence and two by consensus and one provided no information about its method of development. The highest mean score (82.77%) pertained to "Clarity of presentation" and the lowest to "Editorial independence" (44.80%). Based on the AGREE II results, three guidelines were "Strongly recommended," four were "Recommended with modifications," and one was "Not recommended." CONCLUSION: Despite the variations in the quality and strength of the recommendations, a number of guidelines are currently available on end-of-life care. Health team members should be aware of this variability.

The framework for developing nursing specialist roles in the health care system of Iran.

BACKGROUND: A key step to the development of a roadmap for developing nursing specialist roles is to create its framework based on the immediate context. PURPOSE: This study aimed to create the framework for developing nursing specialist roles in the health care system of Iran. METHODS: This was a descriptive qualitative study. A purposeful sample of 81 nursing and nonnursing experts was recruited. The directed content analysis approach was used for data analysis. FINDINGS: The framework for developing nursing specialist roles in the health care system include eight main categories. These categories are role titles, prioritization of the necessary specialties, the necessary competencies of nurses at specialist level, the scope of nursing specialist practice, expected authorizations, requirements for role development, and its barriers and facilitators. DISCUSSION: Creating a context-based framework for nursing specialist role development based on the characteristics of each country is recommended.

The requirements of hospital-based spiritual care for cancer patients.

PURPOSE: This paper aimed to discover the requirements of hospital-based spiritual care for cancer patients. METHODS: This study was a descriptive qualitative-exploratory research, in which 25 participants were selected through purposive sampling and had semi-structured interviews. RESULT: The data analysis revealed 3 themes and 8 sub-themes including fundamental requirements (changes in the attitudes and behaviors of the healthcare team), structural requirements (inter-professional collaborations, a reference system), and functional requirements (religious-spiritual, pastoral, psycho-spiritual, and supportive-spiritual care). In this study, the received topics have been related to the spiritual care which can help improve patient care. CONCLUSION: The results were added to the repertoire of knowledge about the spiritual needs of cancer patients. The results indicated that it is essential to get acquainted with the spiritual care requirements in the hospital and enforce them through inter-professional collaboration. Accordingly, the spiritual care program should be designed, implemented, and evaluated.

Mastering the Art of Collaboration: Supporting Family Caregivers of Mental Health Patients by Service Providers in Iran.

Responsive support systems, designed and promoted by policy makers, are critical in supporting family caregivers. The purpose of this study was to explore viewpoints of service providers in supporting family caregivers of mental health patients in Iran. In this qualitative study, a purposive sample of 29 service providers and policy makers consented to participate in semi-structured interviews. Data were analyzed through qualitative content analysis and three main categories and seven sub-categories were identified. The main categories were: interpersonal collaboration, intra-organization collaboration and inter-sectorial collaboration. A common theme in this study was that service providers play a key role in coordinating responsive support services for Iranian family caregivers of mental health patients across all levels. The increasing complexity of the health care system and resource limitations have created complex problems, which require the use of participatory approaches by the various specialties, disciplines and departments to provide complementary services and mutual support. This approach is the best way of ensuring that service users receive the most relevant services from the right service providers in the right place as and when needed.

Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients.

PURPOSE: Family caregivers play a significant role in the care of cancer patients, especially in their end of life. Identifying and meeting the needs of these caregivers is essential to improving their quality of patient care. This study was conducted to identify the unmet needs of the caregivers of end-of-life cancer patients. METHODS: A total of 18 semi-structured interviews were held with the family caregivers of end-of-life cancer patients using purposive sampling. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. RESULTS: The analysis of the data led to the formation of three main categories, including social needs, cognitive needs, and psychological needs. The social needs category comprised of the subcategories of support for care, effective communication and financial support. The cognitive needs category comprised of educational support and support in decision-making. The psychological needs category comprised of support for psychological trauma, preparation to confront the reality of the death of a loved one, and support for mourning. CONCLUSIONS: The family caregivers of end-of-life cancer patients take on the responsibility of many aspects of care for their patient, but many of their own needs remain unmet. The findings of this study can be used for healthcare policy planning and the development of palliative interventions, particularly for the family caregivers of end-of-life cancer patients.

Support Needs for Family Caregivers of Clients with Mental Illness in Iran: A Qualitative Study.

This paper explored the support needs of family caregivers of people living with a mental illness in Iran. This descriptive study focused on the experiences of 20 family caregivers as well as the views of 29 professional support workers through individual face-to-face interviews. From these interviews three key themes emerged in regards to the care needs of family caregivers: (i) social support; (ii) emotional support; and (iii) safety and security. These themes highlighted the complex role of caring for a family member with a mental illness and the emotional, social and economic challenges that these caregivers experienced as a result. Iranian caregivers garnered support not only from other family members but also from neighbors and religious leaders but lacked the much needed respite care found in western countries. This research study highlighted the importance of ensuring that the caregivers themselves receive appropriate and adequate support to fulfill their caregiving role.

The most frequent and important events that threaten patient safety in intensive care units from the perspective of health-care professionals'.

BACKGROUND: Patient safety is a priority in all health-care centers across the world. This study aimed to determine the frequency of events that threaten patient safety and the grade threating of events from the perspective of the health-care professionals in the intensive care units (ICUs). MATERIALS AND METHODS: This cross-sectional study was conducted in 2016. The participants were 306 members of health-care professionals (physicians and nurses) with at least 1 year of work experience in ICUs of educational hospitals affiliated to Isfahan University of Medical Sciences. Data were collected using a three-section self-made questionnaire. Data analysis was done using descriptive statistics (frequency distribution and percentage) and version 16 of SPSS software. RESULTS: A total of 306 questionnaires were completed out of 320 questionnaires handed out among participants. During the last month, 91.2% of the participants had reported at least a case of medication error, 75.6% had reported at least a case of ventilator-associated pneumonia, and 74.2% had reported at least a case of catheter-induced urinary infection in ICUs. CONCLUSION: The occurrence of events threatening the patient safety in ICUs warrants proper planning by administrators of health-care centers. Medication error was the most frequent and important event of threat to patient safety and falling was the least frequent event of threat to patient safety in ICUs. Considering the frequency and magnitude of medication error in ICUs, a well-adjusted preventive plan should be designed and implemented to improve the patient safety.

Iranian mothers' perceptions of the impact of the environment on psychological birth trauma: A qualitative study.

Childbirth is a unique experience in women's life. Various factors including human and non-human environment are involved in shaping the experience of childbirth.This study investigated the role of the environment on the psychological birth trauma from the perceptions of Iranian mothers. A qualitative descriptive study was conducted from September 2011 to February 2012, using audiotaped interviews with 23 Iranian women recruited from Tehran and Isfahan. The interviews were transcribed verbatim and analysed using the content analysis. Two themes were extracted from the data: human and non-human environment; and several categories also emerged from the data, which are communication with mother, awareness of mother's needs, support for mother, medical clinical competence, professional responsibility, hospital's physical structure, hospital's equipment, routine care in hospital and rules governing the hospital's environment, respectively. Considering the significant role of environment in psychological birth trauma of the mother, an appropriate intervention must be developed to enhance both human and non-human environment in order to reduce the psychological birth trauma.

Concept of Collaboration from the Islamic Perspective: The View Points for Health Providers.

Collaboration involves direct and open communication and respect for different perspectives. In particular, religious literature has many references to collaboration. This study is a report of knowledge synthesis based on qualitative systematic review by content analysis. The study surveys the concept of collaboration from the Islamic point of view and intends to answer the question, 'Does the Quran deal with the use of collaboration in human activities?' This study was conducted using electronic documents from websites related to Islamic and Quran sciences, such as Howzah.net, Nashriat.ir, Tebyan.net and Google Scholar from 1950 until 2013 by focusing on the keywords, collaboration and Islam, and then retrieving the Islamic document (Quran and Hadith). The language in which the search was conducted was English and Persian. Nearly, 28 articles and 72 books related to this topic were found and after applying the search criteria, only 13% of the references were found to be applicable. In the Quran, collaboration is equivalent to Taavon, and Muslims are requested to collaborate in their affairs and never collaborate with each other for illegal affairs. Islam asserts that everyone requires social relationship in their life. God has enacted mutual rights for people and meeting these requirements is only possible through collaboration and respecting mutual rights.

Development of a Heart Failure Palliative Care Educational Program for Nurses: A Multi-Method Approach.

Background: Comprehensive palliative care for patients with heart failure can be developed by educating cardiac nurses. The current study aimed to design a heart failure palliative care educational program for nurses. Materials and Methods: This study was carried out using the multi-method approach based on two out of four steps of Uys educational program development at Dr. Chamran Hospital, Isfahan, in 2020-2021. In step 1, educational needs were collected through literature review, interviews with 15 patients and 10 nurses, examination of patients' documents and medical records, and observation. Then, in step 2, the importance and necessity of teaching the proposed topics and the teaching and evaluation method of the items were assessed through two rounds of delphi technique (15 expert panel members). Eventually, the educational program was finalized. Results: In step 1, the educational needs of nurses were identified in 6 general fields and 26 general learning topics. In step 2, educational needs [specialized knowledge (55% necessity and 55% importance) and social support (33% necessity and 33% importance)], teaching methods (role-playing, experiential learning, and journal club), and evaluation method (the information analysis method) were removed due to a lack of consensus (11%). Finally, the main parts of the program, including the program mission and vision, general learning topics, general goals, objectives, teaching strategies, and evaluation strategies, were compiled. Conclusions: This program provides nurses with up-to-date information on various aspects of the physical, psychological, social, spiritual, and educational needs of heart failure patients and ensures the provision of better services to them.

The Effects of Peer Education on Treatment Adherence among Patients Receiving Hemodialysis: A Randomized Controlled Trial.

Background: Non-adherence to treatments increases the rates of hemodialysis complications, hospitalization, and mortality. One strategy for adherence improvement is peer education. This study aimed to investigate the effects of peer education on treatment adherence among patients receiving hemodialysis. Materials and Methods: This was a randomized controlled trial. Patients in the control group were provided just with routine care, and the intervention group received peer education. Treatment adherence was assessed both before and after the intervention via the End-Stage Renal Disease (ESRD) Adherence Questionnaire. Data analysis was conducted by the Chi-square, the Mann-Whitney U, the paired-sample t, and the independent-sample t tests. Results: There were no significant between-group differences in terms of the pre-test mean scores of Adherence to regular attendance at hemodialysis sessions (t = 0.19, p = 0.85), Adherence to the prescribed medications (t = 0.46, p = 0.64), and Adherence to fluid restrictions (t = 0.24, p = 0.81). The same finding was observed after the intervention, except for the mean score of the adherence to fluid restrictions dimension which was significantly greater in the intervention group (t = 2.86, p = 0.006). Moreover, no significant changes were observed in the mean scores of treatment adherence dimensions in the control group. However, in the intervention group, the mean scores of the adherence to regular attendance at hemodialysis sessions (t = 3.79, p < 0.001) and the adherence to fluid restrictions dimensions were significantly greater than their pre-test values (t = 4.47, p < 0.001). Conclusions: Education by peer groups improves the compliance of patients with regard to the consumption of fluids in the interval between two dialysis sessions.

Barriers to education in cardiac rehabilitation within an Iranian society: a qualitative descriptive study.

INTRODUCTION: Cardiac rehabilitation programmes that include patient education aim to maximise physical, psychological and social functioning, and enable people with acute coronary syndrome to lead fulfilling and productive lives. Despite strong evidence for the benefits of patient education, various barriers exist that need to be addressed to ensure the effective delivery of care. This study explores patients/family members and health professionals' perceptions and experiences of the barriers to cardiac rehabilitation education in an Iranian context. METHODS: A thematic analysis of in-depth interviews was undertaken using a constant comparative approach. Participants (10 health professionals, 15 patients/family members) were recruited from educational-medical centers and hospitals in Iran. Credibility and trustworthiness were grounded on four aspects: factual value, applicability, consistency and neutrality. RESULTS: Five major barriers to cardiac rehabilitation were identified relating to human resources, service provision, available educational services, unfavourable attitudes and collaboration gaps. Two main challenges exist to the provision of effective patient education; inadequate human resources in the hospital wards, specifically in terms of trained health care professionals and service users specific health related views and behaviours. CONCLUSION: Barriers to comprehensive patient education and cardiac rehabilitation in Iran must be addressed and urgent consideration should be given to the introduction and evaluation of education programmes to prepare health/support system professionals as well as service users, and cardiac rehabilitation services that employ a collaborative and individualised approach. This in turn may reduce the burden of CVD and improve the overall health and quality of life for people in Isfahan Iran.

Home health care of Iranian elderly with dementia: Study protocol for guideline adaptation.

BACKGROUND: Advanced stages of dementia interfere with elderly self-care. Consequently, they need caregivers who take responsibility for their care in the long-term. Restrictions to the caregiver's access to information, resources, and organizational support have created problems in their caregiver role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing evidence-based information and training programs. As there is no clinical practice guideline for home care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the elderly with dementia. MATERIALS AND METHODS: The ADAPTE process provided by the Guidelines International Network was considered as the basis. In order to identify the care needs of Iranian patients with dementia, semi-structured interviews were added to this guideline. DISCUSSION: The identification and implementation of the perspectives of patients and caregivers during the process of guidelines adaptation increase the applicability of the guidelines. Improved quality of life for the patients in their place of residence is one of the expected consequences of this guideline's implementation. The developed guidelines will be used at home health care centers, and dementia and Alzheimer's associations in Iran.

Clients as mediators of interprofessional collaboration in mental health services in Iran.

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: "Clients as axis of IPC", "Seamless services as a common incentive for IPC", "Clients as a common interprofessional linkage" and "Clients as a driving force to achieve IPC". From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.

Identifying the dimensions of patient privacy in intensive care units: a qualitative content analysis study.

In intensive care units (ICUs), patient privacy is of particular importance due to the structure of the ward environment and the critical situation of the patients. The aim of this study was to identify the dimensions of patient privacy in ICUs. For this purpose, a descriptive-qualitative-exploratory study was performed. The data collection methods included observations and interviews, which were handwritten and analyzed using qualitative content analysis with a conventional approach. A total of 27 participants were selected based on purposeful sampling and with maximum diversity of health-care providers and recipients. The study environment was the ICUs of two selected hospitals affiliated to the medical sciences universities of Isfahan and Tehran, Iran. The data were analyzed into 4 classes and 12 subclasses. The classes included physical, informational, psychosocial, and spiritual-religious privacy. Findings of the present study identified hidden layers of patient privacy as a multidimensional concept that is influenced by various factors. In order to provide holistic care, preparing the grounds for patient privacy and familiarizing the staff with its various dimensions seem necessary.

Developing patient safety standards for health-care quality promotion in neonatal intensive care units: A mixed-methods Protocol.

BACKGROUND: Neonatal intensive care unit (NICU) is one of the accident-prone settings in the health-care system. There is a series of structural and process threats to the safety of infants hospitalized in this unit, which can be prevented by taking the right actions. For this purpose, developing standards based on current knowledge, available resources, and the context that provides care can determine patient injury prevention requirements. Likewise, it can be a source for national development and application of related guidelines and protocols. This study aims to develop patient safety standards in the NICUs of Iran. MATERIALS AND METHODS: This mixed-methods study will apply the exploration, preparation, implementation, and sustainment framework to develop patient safety standards. In each phase of this framework, a set of activities take place. Exploration is based on the world health organization model to develop standards. Determining the validity and applicability of standards will be done in Phase 2 (Preparation) and Phase 3 (Implementation), respectively. Since the long-term effects are not desired, the fourth phase (Sustainment) will not be considered. DISCUSSION: Patient safety standards from this study will contribute to efficient and effective, equitable, and high-quality health-care delivery. The application of them will further promote patient safety and the quality of medical care in Iranian NICUs.

Iranian nursing students' experiences of workplace violence: a qualitative study.

BACKGROUND: Workplace violence against nursing students is a common phenomenon. This study aimed to investigate Iranian nursing students' experiences of workplace violence, including their reaction to violence and the consequences and the effects of such violence on the students. METHODS: The study participants were undergraduate nursing students. The data were collected using semi-structured, in-depth face-to-face interviews. Data analysis was carried out with qualitative approach using conventional content analysis. RESULTS: Four categories were extracted from the analysis of the interview transcriptions: vertical violence, horizontal violence, reaction to violence and consequences of violence. Nurses were the major imposers of violence against students and psychological and verbal violations were the most of used forms of violence. The students reacted to violence in the forms of counteracting, reporting, disregarding and considering as commonplace. CONCLUSIONS: Workplace violence is a common phenomenon experienced by nursing students in this study, which causes devastating individual, educational, and professional impacts. Action plans including providing safe environment and appropriate support from nurses and educators should be developed in clinical settings to intervene and to prevent workplace violence.

Shared learning in medical science education in the Islamic Republic of Iran: an investigation.

Almost all information about interprofessional education (IPE) comes from a few western countries; little from the rest of the world. This paper helps to rectify that omission. It reports the first phase of a study of "shared learning" between health professions in "medical sciences education" in the Islamic Republic of Iran based on a documentary search and national survey of all government affiliated medical sciences universities (MSUs) with examples which meet some of the criteria for IPE. The second phase, to be reported later, will present findings from an analysis of interviews with administrators at governmental level and teachers and organizers at institutional level regarding their perceptions, experience and expectations of such learning. The study is set in the context of reforms in the organization and delivery of higher education and health care services in Iran.