Nurses' perceptions of the challenges involved in providing of end-of-life care to people with heart failure: a context-based study.

BACKGROUND: High quality end-of-life care is essential. Yet for those experiencing heart failure, the provision of high-quality end- of -life care can be challenging. The aim of this study was to explore Iranian nurses' perceptions of the challenges involved in providing of end-of-life care to people with heart failure. METHODS: Conventional content analysis was used to analyze qualitative data collected from nurses (n = 33) using semi-structured and individual interviews. Participants were aged between 29 and 51 years. The majority of participants were women (n = 20). Most had a bachelor's degree (n = 24), and work experience of between 7 and 18 years. RESULTS: Nurses challenges in providing end-of-life care to those with heart failure included (1) adverse consequences relating to compassion fatigue and continued futility in care and (2) lack of palliative care services with regards to a lack of specialists, lack of support from health systems, and poor teamwork. CONCLUSIONS: This is the first qualitative study to explore Iranian nurses' challenges in providing end-of-life care to those with heart failure. Investment is required in education and research in this area. Particular attention must be paid to prevention of compassion fatigue. Law changes would enable the delivery of higher-quality palliative care in this context overall.

Development and psychometric evaluation of perceived clinical nurses' professional dignity scale: a sequential-exploratory mixed-method study.

BACKGROUND: In recent years, one of the concepts that has received attention in the nursing profession is professional dignity. On the other hand, there was no proper scale to evaluate this concept. This study aimed to develop and evaluate the psychometric properties of perceived clinical nurses' professional dignity scale (PCNPDS). METHODS: This exploratory sequential mixed method was developed and implemented in Iran. The study was conducted in two phases; (a) item generation by hybrid concept analysis and (b) item reduction by psychometric evaluation including validity and reliability of the developed scale. Also, the interpretability (ceiling and floor effect), stability (intraclass correlation coefficient), and absolute stability (standard error of measurement) were calculated. RESULTS: 68 items in the primary item pool were finally reduced to 22 items after evaluating the validity (face, content, and construct validity) and reliability. Exploratory factor analysis revealed three factors (organizational dignity, dignity-based competency, and dignity-based appreciation) and explained 47.55% of the total extracted variance. Confirmatory factor analysis showed that the model had a good fit. Finally, Cronbach's alpha coefficient, McDonald's omega, ICC, and SEM were calculated as 0.90, 0.89, 0.96, and 1.91, respectively. CONCLUSION: The 22-item developed scale is valid and reliable for professional dignity measurement among Iranian clinical nurses.

Prevalence of and Factors Influencing Suicide Ideation, Attempt, and Completion in Heroin Users: A Systematic Review and Meta-Analysis.

Background: Suicide is considered a fundamental problem in discussions on public and global health. Thus, the current study aimed to review the prevalence of and reasons for successful suicide attempts in heroin users. Methods: This study was conducted by systematically searching the electronic databases of PubMed, Scopus, Web of Science, and PsycINFO from 1960/1/1 to 2021/11/1 based on the PRISMA checklist and using MeSH keywords with no temporal or linguistic limitations. The primary and secondary impacts of suicide were identified, and all studies following an observational design (cohort, case-control, and cross-sectional studies) were included in the research. Data analysis was performed using Stata version 13. Finally, 17 studies were included in the work process for systematic review and meta-analysis. Findings: The results showed the most frequent reasons for suicide among the studied individuals were gender (being female), youngness, heroin overdose, multi-drug abuse, history of repeated suicide attempts, history of psychiatric disorder (especially depression), joblessness, homelessness, distorted family relationships, etc. Moreover, the results of synthesizing the studies revealed the prevalence of suicide attempts equaled the effect size (95% CI=0.3 [0.23-0.37]) among these individuals, and the prevalence of successful suicides approached the effect size (95% CI=0.03 [0.01-0.05]). Conclusion: The results of the present study showed the high prevalence of suicidal thoughts and suicide attempts among the heroin-abusing population. Furthermore, according to the findings, the prevalence of unsuccessful suicide attempts was ten times more than that of successful ones in the target population.

Life story of Iranian parents of a child with phenylketonuria: a qualitative study.

Parents of a child with phenylketonuria (PKU) face many challenges in childcare. It is crucial for health care workers to understand the situation of parents of a child with PKU and their needs. The purpose of this study was to explore the life story of parents with a child with PKU. This qualitative study has been done with a conventional content analysis approach. Twenty-four parents were selected purposefully. A semi-structured interview was conducted. Data analysis identified three main themes, which included parental reactions, consequences of a child with PKU in parents, and parents' needs. Parents of children with PKU can be considered people at risk for mental health because of their feelings of isolation and their lonely struggle to manage the disease and its effects on their child. This study shows that mothers need more support due to the misconceptions in and attitudes of their social environment. Therefore, it is necessary to understand this group, their needs and lives, and provide further support and promote empathy in the health system for the parents.

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

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

Nursing in oncology ward with intertwined roles: a focused ethnography.

BACKGROUND: Characteristics of nursing care in the oncology ward depend on this ward's specific context. This study aimed to investigate the nursing care in the oncology ward regarding the culture of this ward. METHODS: This qualitative study was conducted in an oncology ward using a focused ethnographic approach. The whole nursing team of the selected ward (N = 16) participated in the study through purposeful sampling. Three methods of observation, interview, and field documents were used for data collection. Data were analyzed by Spradley's (1980) ethnographic method. RESULTS: 'Nursing in the oncology ward with intertwined roles' emerged as the main theme. This theme included the following subthemes: 'Robin Hood nurse,' 'a secretive nurse,' 'a negligent nurse,' 'a snitching nurse,' 'a complaining nurse,' 'an apathetic senior nurse,' 'a stigmatized training nurse,' 'a brazen-bodied nurse,' 'a compassionate nurse,' 'a moonlighting nurse,' and 'a drug bartender.' CONCLUSION: This study provided a deep cultural insight into nursing care in the oncology ward, considering the particular culture of this ward and emphasizing the nurses' intertwined roles. These roles are on a spectrum, with positive roles, such as compassion, on one side and negative roles, such as negligence, on the other. The results of this study can be provided to nursing managers; therefore, by being aware of nurses' roles considering the specific subculture of the oncology ward, they can provide psychological interventions to improve the mental health of reluctant and complaining nurses and ethics-based training for secretive, negligent, and snitching nurses to provide quality care to the patient.

Design of a Palliative Care Program for Nursing Students in the Neonatal Intensive Care Unit: A Mixed-Method Study.

This study introduces an innovative design for a palliative care program by nursing students in an internship in a neonatal intensive care unit. An embedded mixed-method approach simultaneously collected quantitative and qualitative data. Themes identified were supporting and encouraging palliative care, changing the nursing culture, and promoting quality of care. Teaching palliative care during this internship rotation helped promote quality care by the students, with positive results for infants and their families, and empowerment of the students through increased knowledge and awareness of human needs for high-quality nursing care.

Nurses' attitudes toward caring for terminally ill neonates and their families in Iran: a cross-sectional study.

Providing care for terminally ill neonates is an important issue in NICUs. This research aimed to determine nurses' attitudes toward providing care for terminally ill neonates and their families. A total of 138 nurses working in neonatal intensive care units (NICUs) affiliated to Tehran University of Medical Sciences participated in this cross-sectional study via convenience sampling in 2019. The Data collection tool was the Frommelt attitudes toward caring for terminally ill persons and their families scale. The nurses in this study had the most positive attitudes toward the items "nursing care should include the family of the terminally ill patient, too" (4.2 ± 0.6) and "the care provider can prepare the patient or his/her family for death" (4.1 ± 0.7). The nurses had the least positive attitude toward the item "the time spent on caring for terminally ill patients creates a sense of frustration in me" (1.06 ± 1). The mean score of the attitudes of NICU nurses toward caring for terminally ill neonates and their families indicates the necessity of improving this attitude.

Living under psychosocial pressure: Perception of mothers of children with autism spectrum disorders.

PROBLEM: Mothers of children with autism spectrum disorders (ASD) experience higher levels of stress compared to mothers of typically developing children. This study identified mothers' perceptions of the stress caused by lifelong caregiving to a child with ASD. METHODS: The current study was conducted in Iran using qualitative methods. In-depth, semi-structured interviews were conducted with twenty-seven mothers. Content analysis was used to analyze and categorize the data. FINDINGS: The main categories included (1) psychological concerns and suffering and (2) sociocultural challenges. The first category consisted of two subcategories, including disruption in mother-child relationships and fears and worries. Also, the second category included subcategories of cultural constraints and lack of social support. CONCLUSIONS: In this study, the mothers of autistic children experienced psychosocial pain. Identifying the stressors for these mothers could lead to appropriate planning to provide psychological, social, and cultural support for them in Iranian society.

Compassion-based care for COVID-19 patients: a qualitative analysis of nurses' perceptions.

Compassion is a basic approach to medical practice and is the core component of health care. The purpose of the present study was to explore nurses' perceptions of compassion-based care (CBC) for COVID-19 patients. In this qualitative study, the participants were selected using purposeful sampling. Individual and semi-structured interviews were conducted with 25 nurses, and conventional content analysis was used to categorize the data. In the care of COVID-19 patients, CBC consisted of three categories including pro-social behaviors, paying attention to the beliefs and values of patients, and concern for family members. The first category had three subcategories including empathy, altruism, and helping in critical situations. The second category included the subcategories of the spiritual approach to care and respect for cultural aspects. The third category, concern for family members, had one subcategory: the need to consider the patient's family. Our findings may help to develop a comprehensive model in COVID-19 care according to which, in addition to routine patient care, nurses will consider concepts such as empathy, altruism, helping in critical situations, spirituality, cultural values, and the family's needs at the end of the patient's life.

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

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

The Effect of Psychoeducation on Internalized Stigma of the Hospitalized Patients with Bipolar Disorder: A Quasi-Experimental Study.

Stigma is one of the common problems of patients with bipolar disorders, which impedes their recovery. This is a quasi-experimental study on 76 hospitalized patients with bipolar disorder (38 in each group) in Iran. The intervention group received six sessions of psychoeducation in a period of 2 weeks. Internalized stigma was measured by the Internalized Stigma of Mental Illness scale. The education significantly reduced the scores of alienation, discrimination experience, stigma resistance and total score of stigma in the intervention group. Hence, this education can be used as an accessible technique in hospitals to reduce the internalized stigma.

Exploring patients and family members' experiences of care in the emergency department.

BACKGROUND: Patient experience and satisfaction are often used to evaluate the quality of care provided in emergency departments (EDs). Several studies have evaluated the experiences of patients and their family members in EDs internationally, but few studies have investigated the experiences of those attending EDs in Iran. AIM: To investigate patients and family members' experiences of care in one ED in Iran. METHODS: Semi-structured interviews were conducted with 17 patients and ten family members in one ED in Tehran, Iran. A qualitative content analysis approach was used to analyse the data. FINDINGS: Three themes emerged from the data: quality of nursing care; satisfaction with medical care and waiting times; and adequate diagnostic testing and equipment. Participants reported several issues in relation to the care provided in the ED, including a lack of attention from nursing staff, long waiting times, delays in symptom management, and family members' involvement in care to compensate for high staff workload and overcrowding. CONCLUSION: The findings of this study demonstrate that the most important determinants of patients and family members' experiences in EDs are the quality of nursing and medical care, the length of waiting times, and adequate diagnostic testing and equipment. While it may be beneficial to involve family members in patient care, regular communication with them is essential to explain challenging situations that may affect the quality of ED care, such as low staff levels.

Perceived factors to providing palliative care for patients with cancer - a qualitative systematic review.

Palliative care (PC) is one of the necessary cares given throughout a patient's experience with cancer. The aim of this study was to identify the perceived factors to providing PC for patients with cancer. Our study was a systematic review of qualitative literature. To this end, electronic databases, including CINAHL, PubMed, PsycINFO, Ovid, and Web of Science as well as Persian databases were searched and qualitative studies on the role of PC in patients with cancer published between Jan 2008 and Dec 2017 were selected. Generally, 12 studies were reviewed. A thematic synthesis approach was used to analyze the data. Exploring the selected articles, the findings on the perceived factors to providing PC for patients with cancer were categorized into three themes, including organizational factors, ethical factors, and psychological factors. This qualitative systematic review expands our knowledge about factors influencing the provision of PC for patients with cancer. It is necessary for health system managers and caregivers to pay attention to all aforesaid factors in order to improve PC for cancer patients.

Nurses' Perception of Family-Centered Care in Neonatal Intensive Care Units.

Family-centered care (FCC) is one of the important elements of care in neonatal intensive care units (NICUs). The aim of this study was to understand the nurses' perception of FCC in NICUs. This qualitative study was performed using conventional content analysis. Participants in this study included 18 nurses who were selected by a purposeful method. Semistructured, in-depth and face-to-face interviews were conducted with the participants. All interviews were written down, reviewed, and analyzed. Two categories were identified after the data analysis: (1) prerequisite for providing FCC and (2) parents' participation. Prerequisite for providing FCC consisted of two subcategories namely suitable facilities and adequate personnel. Parents' participation included subcategories of parents: neonate's attachment and parents' training. Nurses' perception of FCC in NICUs can facilitate an appropriate condition for the participation of family members in the care of neonates.

Erratum: Nurses' Perception of Family-Centered Care in Neonatal Intensive Care Units.

[This corrects the article DOI: 10.1055/s-0039-1695060.].

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

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

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

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

The Impact of a Stress Management Program on the Stress Response of Nurses in Neonatal Intensive Care Units: A Quasi-Experimental Study.

This study was conducted with the aim to determine the effect of a stress management program on the response to stress by nurses working in neonatal intensive care units. This quasi-experimental study was conducted on 70 nurses in Iran. The nurses were assigned to the 2 groups: experimental and control groups, with each group comprising 35 participants. The McNamara education program was used for nurses in the experimental group. The response to stress in both groups was reviewed pre- and postintervention and 8 weeks after the intervention using the Stress Response Inventory. The 2 groups had no significant differences in terms of stress response preintervention (t = 0.668, P = .506). The mean scores in the experimental group were higher preintervention than those obtained postintervention, and the difference between them was significant. These findings indicate that the program has led to stress reduction in the experimental group.

Exploration of faculty members' perceptions about virtual education challenges in medical sciences: a qualitative study.

INTRODUCTION: Virtual education is among the important factors improving the learning of medical students. This study aimed to explain the perceptions of faculty members towards the challenges of virtual education. METHODS: The present study was carried out with a qualitative approach and using a conventional content analysis method. The participants included 28 faculty members working in Medical universities in Iran who were purposefully recruited and interviewed face to face practicing semi-structured interviews. All interviews were conducted and reviewed; then, the results were extracted. For this purpose, semantic similarities were first measured and subcategories identified. Subsequently, going through the re-review, we grouped the associated subcategories into wider categories. RESULTS: From the analysis of the participants' narratives, two wide categories including organizational barriers and legal-ethical challenges were obtained. The organizational barriers included two subcategories of defective organizational culture and disproportionate infrastructure. The legal-ethical challenges also included subcategories of neglecting intellectual property rights and ignoring ethical actual instances in the field of virtual education. CONCLUSION: Understanding the challenges to which virtual education implementation is faced leads to their elimination which, in turn, develops the application of e-learning in the field of medical sciences. These challenges can be addressed through putting the emphasis on promoting the organizational culture of medical universities, improving the infrastructures of virtual education, and considering the legal and ethical concepts specific to virtual education.