The elderly, COVID-19, and violence: A qualitative content analysis.

Introduction: Violence against the elderly is one of the types of domestic violence that is one of the major social health problems in modern societies and whose incidence has increased sharply in the last two decades, especially during the COVID-19 pandemic. The present study aims at explaining the concept of violence against the elderly during lockdown and the epidemic of COVID-19. Methods: This qualitative study was conducted with a conventional content analysis approach in Izeh (a city in Khuzestan Province) in 2021. The data were collected through conducting unstructured interviews as well as taking field notes with as many as 13 elderly family members. After obtaining informed consent, the collected data were written word for word, and the content analysis method was applied to name the data, create analytical codes, and determine subgroups and categories. The data were analyzed using MAXQDA-10. Results: The results of this study indicated that the elderly who have been subjected to violence have many ambiguities in the process of identifying and dealing with the violence inflicted on them; the fear of being rejected by family members and their escalated violence make the violence remain hidden. Conclusion: Given their failure to seek help and the lack of support provided by the related organizations, the elderly did not report violence inflicted on them, which in turn led to the spread of violence against them. Thus, it is recommended that nurses and health policymakers provide the required planning to address the problems of violence against the elderly during the COVID-19 pandemic and post-pandemic era.

The clarification of the concept of colostomy nursing care in ostomy care centers: A concept analysis through Walker and Avant's method.

BACKGROUND: Specialist nurses need to have an accurate understanding of colostomy care-related concepts to provide care. Although patients with different types of ostomy have different types of needs, terms such as ostomy care, colostomy care, and ileostomy nursing are interchangeably used. Moreover, there are limited concept analysis studies into the concept of colostomy nursing care (CNC) in ostomy care centers (OCCs). The aim of this study was to analyze and clarify the concept of CNC in outpatient OCCs. METHODS AND MATERIAL: This was a concept analysis study. This concept analysis was conducted using Walker and Avant's eight-step method. The online databases were searched until 2022 to retrieve documents on CNC. Finally, 35 articles and four books were included in the analysis, the defining attributes, antecedents, and consequences of the concepts were determined, and model and additional cases as well as empirical referents were presented. RESULTS: The defining attributes of CNC in OCCs are the development of professional role, participatory practice and interdisciplinary care, selection of the best clinical procedures, care based on patient education, and patient rehabilitation. The antecedents of the concept are nurse-related antecedents, patient- and family-related antecedents, environmental antecedents, and professional rules and regulations. Its consequences are patients' and families' greater care-related knowledge, improvement of nurses' care quality, patient autonomy, and self-efficacy. CONCLUSION: The concept of CNC in OCCs can be defined as "a continuous and coherent care based on knowledge, skill, expertise, experience, and colostomy type which uses interdisciplinary collaboration and the best available evidence in order to select and provide the best services according to patients' and families' culture and background, fulfill patients' physical, mental, sexual, social, and spiritual needs, and timely refer patients to specialists, with the ultimate goal of improving patient autonomy and facilitating their return to normal life."

The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers: A qualitative study.

BACKGROUND: Ostomy care nurses are responsible for the management of patients with colostomy from the time of diagnosis. Currently, most ostomy care services are provided in outpatient ostomy care centers in order to reduce patients' hospital stay and reduce hospitalization-related costs. Many different factors can affect colostomy nursing care provision in these centers. Identification of these factors can facilitate quality care provision. MATERIALS AND METHODS: This descriptive qualitative study was conducted in 2020-2021 to explore the barriers and facilitators to nursing care for patients with permanent colostomy in Tehran and Qom ostomy centers. Participants were twelve nurses with ostomy care licenses, two adult patients with permanent colostomy for at least two years, and one family caregiver of a patient with permanent colostomy purposefully selected from outpatient ostomy care centers in Iran. RESULT: Data were collected via fifteen in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's conventional content analysis. The barriers and facilitators to nursing care for patients with permanent colostomy in outpatient centers came into three main categories, namely specialized capabilities of colostomy care, care continuity, and caring status in the family. CONCLUSION: These findings imply that not only nurses, but also patients, family caregivers, and referral systems can influence nursing care provision to permanent colostomy. Effective management of these factors can improve the quality of ostomy nursing care.

Rehabilitation nursing care in the acute phase of diseases with physical disabilities: A concept analysis study.

BACKGROUND: Despite the importance of rehabilitation nursing care in improving patient outcomes, the provision of this care in the early stages of diseases and injuries is limited. In this situation, analyzing the concept of rehabilitation nursing care can increase nurses' understanding of this concept and improve the provision of rehabilitation nursing care in the acute phase. This study aimed to analyze the concept of rehabilitation nursing care in acute phase of diseases with physical disability. METHOD: Walker and Avant's approach to concept analysis was performed in eight stages, including choosing a concept, determining the purpose of analysis, identifying all uses of the concept, defining attributes, identifying a model case, identifying borderline and contrary cases, identifying antecedents and consequences, and defining empirical referents. RESULTS: The important characteristics of rehabilitation nursing are comprehensive, education-based, specialized, client and family centered, interprofessional, and need-based. The antecedents of rehabilitation nursing care are related to nurses, the care settings and the nursing profession. The most important consequence of rehabilitation nursing care is improving the quality of life of patients. Rehabilitation nursing care also has positive outcomes for nurses and the healthcare systems. CONCLUSION: The findings indicate that rehabilitation nursing care has several attributes that require antecedents such as knowledge and specialized skills such as teamwork skills, effective communication skills, cultural sensitivity, holistic perspective, intuitive thinking, and reasoning. The most important consequence of rehabilitation nursing care is improving the quality of life of patients.

Factors influencing support provision to the family caregivers of elderly patients with cancer: A qualitative study.

PURPOSE: Family caregivers (FCs) play a significant role in providing care to elderly patients with cancer (PWC). Meanwhile, they face a wide range of challenges and are considered hidden patients who require special attention and support. Nonetheless, they do not receive adequate support. This study aimed at exploring the factors influencing support provision to the FCs of elderly PWC. METHOD: This descriptive qualitative study was conducted in 2020-2022. Thirty-one FCs and family members of elderly PWC and healthcare providers were purposefully recruited from various healthcare centers in Tehran, Iran. Data were collected through semi-structured interviews and analyzed using Graneheim and Lundman's conventional content analysis approach. Trustworthiness was ensured through Lincoln and Guba's criteria. RESULTS: Factors influencing support provision to the FCs of elderly PWC came into three main categories, namely the potential for supporting elderly PWC and FCs, complexity of family and social support, and support-related challenges of the healthcare system. CONCLUSIONS: Identifying the factors influencing support provision to the FCs of elderly PWC can assist healthcare policymakers and authorities in developing more effective strategies to support these groups.

The barriers to family-centered care in the pediatric rehabilitation ward: A qualitative study.

BACKGROUND: Family-centered care (FCC) is one of the fundamental principles of care provision to children with disability (CWD). It is based on the collaboration of healthcare providers, patients, and families. However, there is limited information about the barriers to FCC in pediatric rehabilitation settings in Iran. This study aimed at exploring the barriers to FCC in the pediatric rehabilitation ward. METHODS: This descriptive qualitative study was conducted in 2022. Participants were nine rehabilitation staff and twelve mothers of hospitalized CWD purposively selected from the pediatric rehabilitation ward of hospital Rofeideh, Tehran, Iran. Rehabilitation staff were three nurses, a head nurse, a nursing manager, a medical specialist, a social worker, a physical therapist, and an occupational therapist. Eleven semi-structured interviews and three focus group discussions were conducted for data collection, and conventional content analysis proposed by Graneheim and Lundman (2004) was used for data analysis. RESULTS: The three main categories of the barriers to FCC in the pediatric rehabilitation ward were family-related barriers (subcategories: knowledge about child rehabilitation, sociocultural background, and participation), staff-related barriers (subcategories: knowledge, ethical concerns, and collaboration), and organizational barriers (subcategories: factors related to FCC policies, managerial factors, environmental factors, and factors related to the coronavirus disease 2019 pandemic). CONCLUSION: The barriers to FCC in the pediatric rehabilitation ward are very diverse due to the long-term course of child disability and long-term interaction of families with rehabilitation centers. Data collection from both families and rehabilitation staff helped acquire an in-depth understanding about these barriers. More in-depth explorations of family-related barriers such as sociocultural factors are essential to determine the reasons for family resistance to healthcare providers' recommendations to develop more effective care plans.

Factors Affecting Patient Safety in Inpatient Rehabilitation Hospital: A Multidisciplinary Perspective.

Patient safety (PS) is of special importance in Inpatient Rehabilitation Hospital (IRH). Few studies have assessed the factors affecting PS in IRH. Therefore, this study aimed to explore the factors affecting PS based on the experiences of the rehabilitation team in an IRH. This qualitative study was conducted using the conventional content analysis approach in 2020-2021. The participants were 16 members of the rehabilitation team. They were purposively selected from Rofaydeh rehabilitation hospital, Tehran, Iran. Data collection was performed through semi-structured interviews and was continued up to data saturation. The mean age of the participants was 37.31 ± 8.68 years and their mean work experience was 8.75 years. The factors affecting PS in IRH were classified into five main categories, namely shortage of organizational resources, inappropriate physical environment of the IRH, inappropriate PS culture, patients' and their caregivers' limited participation in safety programs, and poor fall prevention programs. The results of this study revealed the factors affecting PS in IRH. Accurate identification of the influential factors on PS can help healthcare providers, managers, and policymakers use multi-component interventions to improve PS culture and increase PS in IRHs. Action research studies are also recommended to determine the main components of such interventions.

Nurses' experiences of discrimination in health care: A qualitative study in Iran.

BACKGROUND: Justice in health is one of the main concerns of health organizations, and discrimination in health care is one of the negative outcomes to achieving this goal. Hence, a full understanding of the phenomenon of discrimination in health care and adopting strategies to eliminate it is necessary. The present study was conducted to explore and describe the experiences of nurses of discrimination in health care. MATERIALS AND METHODS: The present qualitative content analysis study was conducted between 2019 and 2020. Data were collected through semi-structured interviews with 18 participants (two physicians, three nursing supervisors, two head nurses, four clinical nurses, two nursing assistants, and three hospitalized patients) in one public and one private hospital in the city of Tehran. The participants were selected by purposive sampling, which continued until saturation of data. Data obtained were analyzed using the Graneheim and Lundman method. RESULTS: Four main categories and 14 subcategories were extracted from data analysis: 1) habitual discrimination (everyday discrimination in health centers, ignoring patient rights, low levels of trust in medical staff); 2) interpersonal relationships (expectations of associates, respect for colleagues and friends, the possibility of the occurrence of similar situations, reciprocating people's favors); 3) shortage of health-care resources (shortage of medical equipment, heavy workload, infrastructure of medical centers, lack of access to physicians); and 4) favoritism (ethnicity, favoritism as a common method, and favoritism as the ultimate solution to treatment problems). CONCLUSION: The present study revealed certain dimensions of discrimination in health care that remain hidden in many quantitative studies. It appears that health system managers will be able to move toward eliminating discrimination in health care. Thus, designing effective models to reduce discrimination in health care based on the underlying concepts of this study is recommended.

Culture of discrimination in healthcare: A grounded theory.

BACKGROUND: Discrimination in health care is an international challenge and a serious obstacle to justice and equality in health. RESEARCH OBJECTIVE: The purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients. RESEARCH DESIGN: This qualitative study was conducted using by the grounded theory method. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse's assistants, and three patients in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach. ETHICAL CONSIDERATIONS: The study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form. FINDINGS: The "culture of discrimination" was the study's core category, reflecting the nature of discrimination in health care. The theory of "culture of discrimination in health care" is the result of five main categories: "individual social stimuli," "culture of discrimination," "unintentional discrimination," "conflict with discrimination," and "dissatisfaction with discriminatory behavior." These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care. DISCUSSION: The results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers. CONCLUSION: The theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended.

Barriers and facilitators of rehabilitation nursing care for patients with disability in the rehabilitation hospital: A qualitative study.

Nurses play a key role in providing rehabilitation care. In this regard, identifying the factors that affect their practice can be useful in planning to improve the quality of rehabilitation nursing care. This study aims to explore the experience of nurses and members of the rehabilitation team about barriers and facilitators of rehabilitation nursing care of patients with disability in the rehabilitation hospital. This qualitative study was conducted in the main public rehabilitation hospital in Tehran, Iran. Eighteen persons including 12 nurses in clinical and managerial positions, an occupational therapist, a physical medicine specialist, a patient, and an informal caregiver participated in this study. Participants were selected based on purposeful sampling. Data were collected through 18 in-depth semi-structured interviews and analyzed based on qualitative content analysis principles. Three themes were derived from the data analysis, which represented Barriers and facilitators related to nurses (specialized knowledge and skills, psychological status, mentoring, professional communication), barriers and facilitators related to the work environment (nurses' performance evaluation, nursing workforce, comprehensive care facilities, workplace design, specialized unit), barriers and facilitators related to patients and caregivers (patient's participation in nursing care, patient adaptation, efficiency of formal caregivers). The experiences of the rehabilitation team shows that not only nurses, but also the environment, patients, and caregivers can affect the provision of care and change the quality of care. Identifying these factors can help managers, researchers, and clinical nurses to facilitate and improve rehabilitation nursing care by modifying the influencing factors.

Justice and unintentional discrimination in health care: A qualitative content analysis.

BACKGROUND: Discrimination in health care is a common phenomenon whose complete understanding has always been a major concern of health-care systems to control and reduce it. This study aimed to explore the experiences of unintentional discrimination and related factors in health-care providers. MATERIALS AND METHODS: This qualitative study was conducted with a content analysis approach in 2019. Data were collected through semi-structured interviews with 13 health-care providers including two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling. The obtained data were analyzed by Graneheim and Lundman method. RESULTS: Three main categories and eight subcategories were obtained from the data analysis: (1) forced discrimination (superiors' pressures and executive orders, occupational concerns, and fear of the superiors); (2) guided discrimination (professional challenges, managers' policymaking, and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of medical equipment). CONCLUSION: The results of this study suggest that health-care providers such as doctors and nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing the factors that lead to superiors' pressures and occupational forces and improving the medical ethics knowledge should be considered by health-care managers.

The principles of physical restraint use for hospitalized elderly people: an integrated literature review.

BACKGROUND: Physical restraint (PR) is a routine care measure in many hospital wards to ensure patient safety. However, it is associated with many different professional, legal, and ethical challenges. Some guidelines and principles have been developed in some countries for appropriate PR use. The present study aimed to explore the principles of PR use for hospitalized elderly people. METHODS: This was an integrative review. For data collection, a literature search was conducted in Persian and English databases, namely Magiran, Scientific Information Database (SID), Scopus, Google Scholar, Web of Science, and PubMed as well as the websites of healthcare organizations and associations. Eligibility criteria were publication in English or Persian between January 1, 2010, and January 1, 2021, and description of the principles of PR use for hospitalized elderly people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection, while the critical appraisal tools of the Joanna Briggs Institute (JBI) and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument were used for quality appraisal. The data were analyzed through constant comparison. RESULTS: Primarily, 772 records were retrieved, while only twenty were eligible for the study. The principles of PR use for hospitalized elderly people were categorized into six main categories, namely principles of education for PR use, principles of decision making for PR use, principles of implementing the PR procedure, principles of monitoring patients with PR, principles of PR use documentation, and principles of PR management. CONCLUSION: PR should be used only by trained healthcare providers, with the consent of patient or his/her family members, with standard devices and safe techniques, based on clear guidelines, and under close managerial supervision. Moreover, elderly people with PR should continuously be monitored for any PR-related complications. The findings of the present study can be used for developing clear PR-related guidelines.

Iranian nurses' perceptions about using physical restraint for hospitalized elderly people: a cross-sectional descriptive-correlational study.

BACKGROUND: Using physical restraint (PR) for hospitalized elderly people is a major nursing challenge. It is associated with different physical and mental complications and ethical dilemmas, though many nurses still use it to ensure patient safety. Nurses' perceptions are one of the most important factors affecting PR use. This study aimed to evaluate Iranian nurses' perceptions about PR use for hospitalized elderly people. METHODS: This cross-sectional descriptive-correlational study was conducted from July to December 2019. Participants were 270 hospital nurses who were purposively recruited from intensive care units and medical and surgical wards of three teaching hospitals in Kermanshah, Iran. Data were collected using a demographic questionnaire and the Perceptions of Restraint Use Questionnaire (PRUQ). The SPSS software (v. 23.0) was used for data analysis through the independent-sample t test, the one-way analysis of variance, and the multiple regression analysis. RESULTS: The total mean score of PRUQ was 4.08 ± 0.12 in the possible range of 1-5. The most important reasons for PR use were to prevent patients from falling out of bed and to prevent them from pulling out catheters. The total mean score of PRUQ had significant relationship with participants' age, work experience, and history of receiving PR-related educations (P < 0.05), but had no significant relationship with their gender, educational degree, and affiliated hospital ward (P > 0.05). CONCLUSION: This study suggests that nurses attach high importance to PR use for hospitalized elderly people. Healthcare policy-makers at national and hospital levels are recommended to provide nurses with PR-related educations in order to reduce the rate of PR-related complications.

Musculoskeletal disorders and working conditions among Iranian nursing personnel.

This study investigated the prevalence of musculoskeletal disorders (MSDs) and associations with organizational, physical and psychosocial working conditions among 520 nursing personnel in Tehran, Iran. The results of the cross-sectional study on aids and different educational levels of nurses showed that the participants experienced 88% of MSDs in at least one body region during the past 12 months. The 3 most prevalent body regions were the low back (65.3%), knee (56.2%) and neck (49.8%). The participants reported inflexible work schedule, poor quality of devices for transferring patients, overexertion and job dissatisfaction. Physical and psychosocial exposure revealed an elevated odds ratio (95% confidence interval) of MSDs. The results showed a combination of high physical and psychosocial work demands along with low control over the work which increased work-related stress and enhanced the risk of MSDs. This study findings could help to understand work-related MSDs among nursing personnel in a developing country where the work situation and sociocultural context differ from other countries.

Adaptation of questionnaire measuring working conditions and health problems among Iranian nursing personnel.

PURPOSE: To adapt a questionnaire in the Persian language measuring working conditions and health problems among nursing personnel. A further aim was to test the validity and reliability of the questionnaire. METHODS: The adapted questionnaire was based on three well-established questionnaires. Physical working conditions items were from Nurse Early Exit Study. Psychosocial working conditions scales were included from Copenhagen Psychosocial Questionnaire which contains two scales on general and mental health as well. The Nordic Musculoskeletal Questionnaire was the origin of the musculoskeletal disorders questions. During the culture adaptation process, an expert panel method was used. To achieve equivalence between the sources and target version, some changes were made by the expert panel. Then the questionnaire was examined in the field for face validity and construct validity (n = 92) among Iranian nursing personnel from two hospitals. Construct validity was assessed using a priori hypothesized correlations of the outcomes with exposures. Finally the adaptation process was completed by reliability assessment using Cronbach's alpha and Intra-class Correlation Coefficient (ICC). RESULTS: The construct validity result was the correlation of the health outcome with the work-related exposure (physical rs = .71 and psychosocial rs = .66). In the reliability assessment, Cronbach's alpha and ICC were .60 and .70 respectively. CONCLUSION: The findings show that the adapted questionnaire has an acceptable conceptual structure and provides reliable information from the nursing profession. Consequently, the questionnaire is applicable to work situation studies among nurses and other health care workers.

Striving for balance between family and work demands among Iranian nurses.

The study reported here explored Iranian nurses' experience of managing work and family roles. Grounded theory method guided the data collection and data analysis from both individual and focus group interviews. Five categories emerged: family role, working conditions, seeking support, perceiving dissatisfaction, and perceiving threats to health. The core concept that emerged was striving for balance between family and work demands. In the work-family role the Iranian nurses faced significant pressures, and they mostly relied on their own capabilities to create balance, often neglecting their own needs. This resulted in perceived dissatisfaction and health threats.