Outcomes of professional misconduct by nurses: a qualitative study.

BACKGROUND: Professional misconduct by nurses is a critical challenge in providing safe quality care, which can lead to devastating and extensive outcomes. Explaining the experiences of clinical nurses and nursing managers in this regard using an in-depth qualitative method can be beneficial. This study was conducted with the aim of explaining the experiences of nurses regarding the outcomes of professional misconduct. METHODS: The present study used a qualitative descriptive with a conventional content analysis approach. A total of 22 clinical nurses and nursing managers were selected through purposive sampling until data saturation was reached. Data were collected using semi-structured in-depth interviews and analyzed using Graneheim and Lundman's approach. RESULTS: Analyzed data were categorized into four main themes and 11 subthemes: (1) Physical outcomes: critical threat and weakening patients' safety; (2) Psychological outcomes: psycho-emotional responses of patients and their families, moral distress, and cautionary tale of nurses; (3) Financial outcomes: imposing costs on the patient and financial loss of the nurse; (4) Organizational outcomes: the normalization of misconduct, chaos in the organization, waste of the organization's resources, and reputational damage to the organization. CONCLUSION: Professional misconduct by nurses can have adverse outcomes for patients in physical, mental, and financial dimensions, their families, nurses, and healthcare organizations. Therefore, it is indispensable to adopt management strategies to reduce the rate of professional misconduct.

Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial.

OBJECTIVE: The responsibility of caring for patients with leukaemia places a heavy burden on family caregivers (FCs) and negatively impacts their quality of life (QoL). This study aimed to investigate the effects of peer support (PS)-based online education programme on the burden of care (BoC) and QoL of FCs of patients with leukaemia. METHODS: This before-after study involved a total of 80 eligible FCs of patients with leukaemia (40 individuals per group). The participants received the necessary information from a researcher and peers through online sessions and WhatsApp group. To collect data, the Zarit Burden Interview and the Caregiver Quality of Life Index-Cancer (CQOLC) had been been completed once before the intervention and once 1 month after the intervention. RESULTS: There was no significant difference between the two groups regarding baseline variables except the mean BoC that was significantly higher in the intervention group (IG) (p<0.001). However, after controlling for the effects of confounding variables, the mean BoC score of participants in IG was significantly lower than that of the control group (p<0.001). Additionally, there was no significant difference between the two groups in terms of CQOLC before (p=0.178) and after (p=0.538) the intervention. CONCLUSION: The PS-based online education programme had a positive impact on reducing the care burden of FCs of patients with leukaemia. This programme can effectively reduce costs, particularly during emergencies and crises such as pandemics, as it eliminates the need for FCs and peers to physically visit hospitals. REGISTRATION: The study was registered at the Iranian Registry of Clinical Trials on 18 July 2021 (IRCT registration number: IRCT20210507051209N1).

Living with Mental Distress, Social Anger, and In-Group Commitment among Working Children: A Qualitative Study.

Background: Working as a child can have various effects on all aspects of children's health. Investigating and identifying issues related to the health of working children can be useful in promoting their health. Therefore, in this qualitative study, we examined issues related to the mental health and behavior of working children. Materials and Methods: This qualitative study was conducted in Tehran, Iran, in 2021 with the contractual content analysis approach. The main participants (N = 32) in this study were working children aged 10 to 18 years. To collect data, in-depth and semi-structured interviews were conducted with working children, their parents, and the center officials. In addition to the interview, some field notes were also taken from interactions between working children. After each interview, they were transcribed and coded. After 27 interviews, the data were saturated, no new code was extracted, and further interviews were conducted to ensure data saturation. Data analysis was performed based on the proposed method of Lundman and Graneheim. Results: The results revealed the three main categories of mental distress (fear and anxiety, depression, loneliness and isolation, decreased self-confidence, and decentralized mind), social anger (negative social role modeling, harassment and harm of others, reprehensible and antisocial behavior, disregard for the property of others, disrupted relationships, and violence), and in-group commitment (self-censorship outside the group, individual independence and group cohesion, and caring for the group). Conclusions: Most working children suffer from various forms of mental and behavioral issues, which, if not taken care of, can have irreparable consequences.

The nurses' perception of the factors influencing professional misconduct: A qualitative study.

BACKGROUND: Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors. AIM: This study aimed to explain the factors influencing professional misconduct in nurses. RESEARCH DESIGN: This qualitative study was conducted using the conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach. ETHICAL CONSIDERATIONS: The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality. FINDINGS: Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics). CONCLUSION: This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.

Design and validation of the presenteeism scale in nursing.

BACKGROUND: The instruments used to measure presenteeism are all flawed and only incompletely measure the concept of presenteeism in employees of the general population. As a result, the concept of presenteeism is not measured, and in most of these instruments, the population for which the instrument has been developed differs from the nursing population. The present research was conducted to design and validate the instrument for evaluating presenteeism in nursing. METHODS: The present study was part of an exploratory sequential mixed study. In this study, the instrument for measuring the level of presenteeism among nurses was developed and validated based on the results of the qualitative stage. To this end, the instrument's psychometric properties were investigated using face, content, and construct validity, as well as reliability through internal consistency and stability. RESULTS: In this study, an instrument containing 17 items and three dimensions (imperfect cognitive presence, imperfect emotional presence, and imperfect movement presence) with favorable validation characteristics was developed. Therefore, the instrument was able to explain 56.375% of the total variance. Furthermore, Cronbach's alpha and McDonald's omega coefficients were 0.881 and 0.815, respectively. The intra-cluster correlation coefficient (ICC) was also reported as 0.972 for the entire instrument, with a 95% confidence interval of 0.941 to 0.987. CONCLUSION: Based this study, it was possible to measure the level of nurses' presenteeism through an instrument with favorable psychometric properties. This study helps health managers lay the groundwork for designing a system for measuring presenteeism among Iranian nurses using the developed instrument.

Analysis of the strategies used by iranian nurses for management of provided care for patients with COVID- 19: a qualitative study.

BACKGROUND: Nurses have been at the center of managing the COVID-19 outbreak through direct bedside care in respiratory, emergency and intensive care environments, managing hospital units, providing Covid-19 testing, vaccination and contact tracing. Thus, the present study aimed to analysis the strategies used by Iranian nurses for management of Provided Care for patients with COVID- 19. METHODS: The present study was conducted based on the conventional content analysis method and Graneheim & Lundman approach. The participants included the nurses working in the COVID-19 wards and were recruited by purposeful sampling and based on inclusion criteria. The data were collected by conducting semi-structured, in-depth, one-to-one interviews until reaching data saturation. RESULTS: In-depth interviews with 10 nurses represented four main categories and fifteen subcategories. Four main categories emerged in this study i.e. "justice in human resources management", "The art and science of comprehensive nursing care", "managers as agents of change in crisis" and "challenges and its management". CONCLUSION: The nurses' experiences of management strategies showed that paying attention to the financial, psychological, educational, equipment needs of nurses and maintaining their safety make the suitable environment for providing high quality care for patients with covid-19.

Challenges of and corrective recommendations for healthcare-associated infection's case findings and reporting from local to national level in Iran: a qualitative study.

BACKGROUND: The accuracy of health care-associated infections (HAIs) statistics in many countries is questionable and the main reasons of this inaccuracy are not well-known. The study aim was to explore inhibitors of and corrective recommendations for HAIs case findings and reporting in some of Iran hospitals. METHODS: Sixteen face-to-face interviews and an expert panel were performed with expertise of infection prevention and control (IPC) programs in hospitals, and Deputies of Health and Treatment in medical university and Ministry of Health from Feb 2018 to May 2019. Using conventional content analysis, code, subcategories and categories were developed. RESULT: Three categories emerged including improper structure preparation, conflict of interest, and inadequate motivation. Allocating distinct budget and adequate staff to IPC programs, developing a user-friendly surveillance system and engaging physicians and nurses for HAIs reporting are the main corrective recommendations accepted by the expert panel. CONCLUSION: Despite the improvement in growing case-findings and reporting of HAIs in Iran, there are many challenges which inhibit accurate case finding and reporting of HAIs. So it is necessary to update the structure, system and rules to reach accurate HAIs data in Iran.

Fatalism, distrust, and breast cancer treatment refusal in Ghana.

Following recent advancements in science and technology, cancer treatment options have increased remarkably alongside improved survival rates. Yet, some individuals diagnosed with breast cancer refuse treatment. This study aimed to explore how breast cancer patients' personal beliefs and ideas influence their decision to refuse medical treatment. Thirteen participant interviews were selected from a larger cohort for a secondary analysis using the grounded theory approach. The decision to forgo medical treatment was influenced mainly by personal beliefs, which were framed as: 1. Triangle of religion, superstition, and ignorance, 2. Ghanaian traditional belief system, 3. My destiny, 4. Frail patient-staff relationships, 5. Futile appointments, and 6. Endless journey. Together, these fit into two overall themes-fatalism and poor communication patterns between healthcare providers and patients. Personal beliefs and managerial gaps within the health system mainly influence the growing trend of refusal of medical treatment among breast cancer patients in Ghana. These findings highlight the need for breast cancer education, professional counselling, and psychological support services.

Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis.

INTRODUCTION: To date, no definitive results have been reported on the effect of omega-3 fatty acids on premenstrual syndrome (PMS). Therefore, this systematic review and meta-analysis aimed to determine the effect of omega-3 fatty acids on PMS. METHODS: In this systematic review and meta-analysis, the databases were searched. In this regard, randomized clinical trials investigating the effect of omega-3 fatty acids on PMS were included. The quality of the studies was assessed using the Cochrane Collaboration's Risk of Bias tool. Meta-analysis was done based on random effects model and calculation of standardized mean difference (SMDs). RESULTS: The results of meta-analysis showed that omega-3 fatty acids were efficient in reducing the severity of PMS in women (SMD = -0.968, 95% confidence interval [CI]: -1.471 to -0.464). In addition, the results showed that the studies were heterogeneous (I2  = 89.11%, p <0.001). Based on meta-regression analysis, aging (ß = -0.150, 95% CI -0.202 to -0.098, p <0.001) and increasing the duration of intervention (ß = -0.579, 95% CI -0.781 to -0.378, p <0.001) had a significant effect on the severity of PMS. We also found that omega-3 fatty acids could significantly reduce the somatic (SMD = -0.800, 95% CI: -1.126 to -0.474) and psychological (SMD = -0.373, 95% CI: -0.686 to -0.061) symptoms of PMS. CONCLUSION: Omega-3 fatty acids could reduce the severity of PMS. However, we should caution in the conclusion in affirming the beneficial effects of n-3 PUFAs on PMS, since the heterogeneity is evident in the analysis. The efficacy of the treatment was enhanced by increase of the treatment duration.

Clinician attitude towards safety in medication management: a participatory action research study in an emergency department.

OBJECTIVES: Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians' attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians' attitudes to safety in medication management. SETTING: Emergency department of one university affiliated hospital. PARTICIPANTS: A total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives. DESIGN: Data are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis. RESULTS: Clinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians' attitude towards medication management was improved. CONCLUSIONS: The results support the impact of participatory action research on enhancing clinicians' positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.

The nurse without a nurse: the antecedents of presenteeism in nursing.

BACKGROUND: Presenteeism describes the state in which staff who lack the conditions for being present at work and need rest and leave for various reasons (such as illness, low spirits, fatigue, etc.) are present at the workplace. Due to the lack of knowledge about the antecedents of presenteeism in nurses and the context-based nature of this concept, the present study was conducted to explain the reasons for presenteeism in nurses. METHODS: This qualitative study was performed using the qualitative content analysis method. The study population consisted of 17 nurses working in different wards of hospitals. In this regard, data were collected from February to June 2020 using individual, face-to-face, in-depth, semi-structured interviews and were analyzed using qualitative content analysis. RESULTS: The nurse without a nurse was a category introduced as an antecedent of presenteeism. In this respect, nurses experienced limited power, injustice, compulsory presence, inadequate structural facilities, damaged professional identity, manager-nurse disconnect, insufficient knowledge, physical and mental health complications, job stress, job burnout, multitasking, and impaired communication. CONCLUSION: The nurse, who has been responsible for caring, supporting, advising, advocating, and educating the patient, has now been left without a nurse. In other words, not nursing the nurse has given rise to the emergence of presenteeism. It is recommended that the results of this study be used in making health policies. The results of this study can make nurses' voices heard by health leaders and managers. A voice that has never been heard as it deserves.

The Effect of Family-Centered Supportive Program on Chemotherapy-Induced Symptoms in Patients with Acute Lymphoblastic Leukemia (ALL).

Background: Acute lymphoblastic leukemia is a disease of the hematopoietic system and chemotherapy is recommended as the primary treatment. As many chemotherapeutic agents have severe adverse effects, patients require to be supported by their family to deal with chemotherapy-related symptoms. This study attempted to investigate the effect of family-centered supportive programs on chemotherapy symptom control in patients with acute lymphoblastic leukemia. Materials and Methods: Sixty-six patients with acute lymphoblastic leukemia undergoing chemotherapy along with their caregivers participated in this nonrandomized clinical trial. Patients in Shariati and Taleghani Hospital were assigned to intervention (n=33) and control group (n=33), respectively. A survey of family-centered supportive program was conducted via in-person and telephone up to 6 cycles of chemotherapy. The chemotherapy symptom assessment scale was administered to record the data during 6 cycles of chemotherapy treatment. The control group only received routine interventions. Data were analyzed using Chi-square and Mann-Whitney U tests. Results: The results of the study indicated that there was a statistically significant difference in terms of the frequency of 9 chemotherapy-induced symptoms including nausea, shortness of breath, problems related to skin and nails, a sore/sensitive mouth or throat, anorexia, weight gain or loss, headache and sore/scratchy/dry eyes between the control and intervention group. There was also a statistically significant difference in the severity and level of discomfort of 19 chemotherapy-induced symptoms between the control and intervention group. Conclusion: Family-centered supportive program can be considered as an approach to decrease the frequency, severity and discomfort level of chemotherapy-induced symptoms.

Behavioural changes in medication safety: Consequent to an action research intervention.

AIM: To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff. BACKGROUND: Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes. METHOD: Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles. RESULTS: The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate. CONCLUSIONS: Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours. IMPLICATION FOR NURSING MANAGEMENT: This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety.

Limited access to care for persons with breast cancer in Africa: A systematic review.

PURPOSE: To systematically review the available evidence and examine the factors that may limit patients' access to breast cancer care in Africa. METHODS: We searched six databases (Google Scholar, Web of Science, PubMed, EMBASE, CINAHL, and Scopus) for studies conducted among breast cancer patients in Africa, highlighting patient challenges and barriers to care or treatment. The search was limited to studies published in the English language and from January 2000 until August 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. There were no limitations to the methodological design of the included studies. RESULTS: In total, 18,154 articles were retrieved through electronic search; twenty-five were eligible for inclusion after quality appraisal. We analyzed the data using the deductive content analysis approach. Three categories emerged as barriers to breast cancer care: Socio-economic challenges, Institutional shortfalls, and Distinctiveness. CONCLUSIONS: The findings support that economic hardships, fear, and scarcity of cancer treatments/equipment are critical in limiting access to breast cancer care. Sustainable strategies aimed at scaling-up breast cancer care in the region are necessary. The results also highlight the need for reduced treatment cost and aggressive educational campaigns across healthcare facilities and the local communities.

Exploring the concept of presenteeism in nursing: A hybrid concept analysis.

PURPOSE: To explore the concept of presenteeism in nursing. METHOD: A three-phase concept analysis using a hybrid model was used. In the theoretical phase (first phase), a literature review was conducted using PubMed, Web of Science, Proquest, EBSCO, Scopus, OVID, Cochrane Library, PsycINFO, Google Scholar, SID, and Iranmedex. In the fieldwork phase (second phase), semistructured interviews with 17 nurses were used. In the final analytical phase (third phase), the results of the previous phases were combined. FINDINGS: In the final definition, presenteeism can be considered as a kind of fall from balance, in whose nature lies the non-actualization of capacities. If the imbalance of presence is due to the body, we are faced with the non-actualization of movement capacity, and regarding the imbalance caused by the soul, cognitive and emotional actualization is challenged. CONCLUSION: Exploration of the concept of presenteeism in the nursing is the basis for identifying this concept in a profession that deals with health as the most valuable human property. IMPLICATIONS FOR NURSING PRACTICE: The identified attributes of presenteeism provide a deep insight for nurse managers into the nature of presenteeism. Nurse managers cannot deal with a destructive phenomenon without exploring and identifying its exact meaning.

Nurses' Knowledge and Attitude towards Postoperative Pain Management in Ghana.

Background: Pain management is a very important aspect of nursing care among postoperative patients. Deficit in the knowledge and bad attitude towards pain management among nurses remain a problem in Ghana. In order to manage pain better in the surgical wards, nurses should be well equipped with knowledge of pain assessment and management. Purpose: The purpose of the study was to determine nurse's knowledge and attitude towards pain management among postoperative patients in surgical units in Ghana. Methodology. This study used the quantitative study approach with a descriptive cross-sectional study design. A sample of 211 nurses was recruited using the convenience sampling method. Data were collected using a questionnaire regarding postoperative pain management. Descriptive statistics, Pearson's correlation coefficient, and the chi-squared test were used to analyze the data using SPSS version 16.0. Results: The mean age of the nurses was 29.77, with the youngest nurse being 23 years and oldest being 39 years. Majority (72.5%) of nurses had moderate knowledge, and 89.6% of the nurses had negative attitude towards pain management. There was no significant relationship between nurse's knowledge and years of experience as a nurse (r = -0.03, p=0.64), as well as no significant relationship between knowledge and number of years working in the surgical ward (r = 0.06, p=0.36). Also, there was no significant relationship between nurses' knowledge and nurses' attitude (r = 0.06, p=0.36). Conclusion and recommendation. The level of knowledge and attitude towards postoperative management were generally inadequate among nurses. Therefore, there is the need to implement in-service training on pain management for nurses working in the surgical units frequently.

Comparison the effects of inhalation and massage aromatherapy with lavender and sweet orange on fatigue in hemodialysis patients: a randomized clinical trial.

OBJECTIVES: Fatigue, regardless of the causes, could leave a negative impact on individual performance. The aim of this study was to compare the effects of inhalation and massage aromatherapy with lavender and sweet orange on fatigue among hemodialysis patients. METHODS: This study was a randomized controlled trial. The patients (96 patients) were allocated to three groups (control, an inhalation aromatherapy, and an aromatherapy massage group). A demographic questionnaire as well as the rhoten fatigue scale (RFS) was used to collect the data. The data were analyzed by descriptive and analytical statistics using SPSS version 18. RESULTS: Before the intervention, there was no significant difference among the groups regarding fatigue level (p=0.54). However, eight and 16 weeks after the study, the levels of fatigue in both experimental groups were significantly lower than the control group (p < 0.05). CONCLUSIONS: Interventions with essential oils are effective in reducing fatigue in hemodialysis patients, although the effects of aromatherapy massage on fatigue are stronger than the effects of inhalation aromatherapy.

The Effect of Pelvic Floor Muscle Strengthening Exercise on Urinary Incontinence and Quality of Life in Patients after Prostatectomy: a Randomized Clinical Trial.

Introduction: Urinary incontinence is a common problem after Prostatectomy that affects patients' life. Nurses can assist patients in improving urinary problems. This study aimed to assess the effects of pelvic floor muscle exercises on urinary incontinence and the quality of life in patients after Prostatectomy. Methods: This randomized clinical trial was performed on 60 patients with suprapubic prostatectomy and urinary incontinence who had referred to urology department of Vali-e-Asr Hospital in Tehran. The subjects were selected and randomly divided into control and intervention groups. The control and intervention groups received standard care and pelvic floor muscles exercises after surgery, respectively. The data were gathered in the course of seven days; one, two and three months after surgery, using three questionnaires and a check list for the evaluation of urinary incontinence and assessing Quality of Life. The data were then analyzed, using SPSS ver.13, and statistical tests such as t-test, ANOVA and Chi- square. Results: The quality of life and urinary incontinence score before intervention were not significant between two groups. The findings showed that there was a statistically significant difference between two groups in the average scores of urinary incontinence and the quality of life after intervention. Conclusion: Pelvic muscles exercises reduced urinary incontinence and enhanced quality of life. It's recommended as a non-pharmacologic, non-invasive way to control urinary incontinence. Patients with adequate cognitive and mental abilities can easily be trained on pelvic floor muscle exercises.