Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study.

Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.

Childbearing culture: a prominent context in the process of maternal role attainment in Iranian mothers with preterm neonates.

Transition to the role of mothering is one of the most important events in a woman's life. While childbirth is a biological event, pregnancy and the experiences around it are more influenced by social structure, which is shaped by cultural perceptions and practices. The aim of this study was to explore cultural context during maternal role attainment in neonatal intensive care units (NICUs) in Iran. The study was part of a grounded theory study on how the mothers of preterm neonates go through maternal role attainment. Data collection was carried out by purposeful sampling from 20 participants (15 mothers of preterm neonates and 5 NICU nurses). Data were analysed according to Corbin and Strauss's (2015) approach. Four categories of childbearing culture emerged: 'The necessity of childbearing', 'Childbearing rituals', 'Maternal persistent presence' and 'Attitudes and religious beliefs'. The findings showed that the special beliefs and practices in Iranian culture affected all of the participants' reactions to mothering process. Culture is one of the most important factors affecting the development of motherhood in Iran. In order to provide sensitive and culturally appropriate care, nurses should be aware of the general impact of cultural norms and values on the process of maternal role attainment and strive to meet the cultural needs of all mothers.

The Main Features of Resilience in Healthcare Providers: A Scoping Review.

Background: Resilience refers to the capacity for suitable responding to stress in achieving the objectives at the least physical and psychological costs. The present review aims to illustrate the individual and contextual features of resilience improvement in healthcare professions. Methods: A scoping review was conducted according to the PRISMA-ScR guidelines and searching the online databases as PubMed, Embase, Scopus, Web of Science, and Google Scholar from January 2014 to December 2020 using a combination of MESH and EMTREE entry terms and free keywords. The English articles, book chapters, and grey literature were included in the study. The data were recorded to an extraction form designed in Excel. The quality assessment of studies wasn't performed due to scoping review. Thematic analysis was used to synthesize the data. Results: 5434 articles were identified via searching in the databases. 63 articles were reviewed that most of them from the USA (30 articles, 46%) and conducted as a qualitative study (32 articles, 50%). The main aspects of resilience that were extracted from the included studies were personal resilience, resilience in the emergency department, and resilience in healthcare providers. The main feature of resilience among healthcare providers was coping. Conclusion: Studies with more accurate methodology should investigate the situation of the healthcare providers' resilience in difficult healthcare conditions instead of the mere emphasis on providing a fixed concept for all persons without considering the system impacts.

Emotional disorganization: The prominent experience of Iranian mothers with preterm neonate: A qualitative study.

When a preterm neonate is born and needs to be taken care of in the neonatal intensive care unit (NICU), the mother experiences a different process of mothering. A grounded theory study was conducted to explore the maternal role attainment in mothers of preterm infants. The authors of this paper report the most prominent experience of Iranian mothers with preterm neonates during their stay in the NICU that emerged as part of the process of maternal role attainment. Data were collected through in-depth semi-structured interviews with mothers in the NICU. We found four categories as emerged from experiences that formed the concept of "emotional disorganization". We argue that these findings can help caregivers and nurses to provide sensitive and supportive care to mothers of preterm neonates.

New visiting policy: A step toward nursing ethics.

BACKGROUND:: Patients' rights arise from their expectations of the healthcare system, which are rooted in their needs. Visitation is seen as a necessary need for patients and families in intensive care units. OBJECTIVES:: The authors attempted to design, implement, and evaluate a new visiting policy in the intensive care units. RESEARCH DESIGN:: This study was an action research, including two qualitative and quantitative approaches. PARTICIPANTS AND RESEARCH CONTEXT:: The viewpoints of 51 participants (patients, families, doctors, nurses, and guards) on how to change the limited visiting policy were explained through semi-structured interviews and focus groups. The new visiting policy (contractual visitation) was designed, implemented, and evaluated with the involvement of participants. ETHICAL CONSIDERATIONS:: The hospital ethics committee approval was gained and the informed consent was obtained from all the participants. FINDINGS:: The content of interviews was analyzed and classified into four categories: advantages and disadvantages of visiting policies, and barriers and facilitators of changing the limited visiting policy. After implementation of the new policy (contractual visitation), a significant difference observed in satisfaction status before and after the changes (p value < 0.001). DISCUSSION:: Nowadays, many countries' clinical guidelines recommend flexible visiting policy, which is consistent with the results of this study. CONCLUSION:: Changing the limited visiting policy was a necessary need for patients and families that established with the involvement of them and staff.

Nurse's social responsibility: A hybrid concept analysis in Iran.

Background: Social responsibility in nursing is a complex concept that is completely associated with the context and healthcare system of every society. This study was conducted to analyze the concept of nurse's social responsibility in Iran. Methods: This analysis was done using a hybrid model, which consists of three phases: a literature review in the theoretical phase, semi-structured interviews in the fieldwork phase, and combination of the results of the two previous phases in a final analytical phase. Results: The four main themes extracted in the theoretical phase included: "Multi-dimensional and comprehensive approach", spirituality-based, learner-based and an evolutionary-process. In the fieldwork phase, all the themes obtained in the previous phase were confirmed, and one more theme emerged as "being relative". In the final phase, with the combination of the results of two previous phases, the final definition of the concept was presented. Conclusion: Clarifying the social responsibility of nurses and highlighting it in nursing will definitely lead to satisfaction in patients and clients, professional development and reduction of health care costs. Also, by identifying facilitators, inhibitors and social responsibility concepts, nursing managers and nursing educators will be able to design and implement their management and training activities based on scientific findings based on the findings that are necessary for the correct learning and implementation.

Nurses' Error Management in Critical Care Units: A Qualitative Study.

Nursing errors are common in critical care units, and nurses are in the first line of confrontation. The purpose of this study was to explore the processes of managing nursing errors in critical care units in Iran and to develop a theoretical explanation of the phenomenon. This was a grounded theory study. We recruited a sample of 18 critical care nurses for the study. The sampling method was purposive and then changed to theoretical. The data were collected through in-depth interviews. For data analysis, we employed the constant comparative analysis technique. The core category of the study was "continuous situational analysis." The main categories were situational analysis and error removal. When nurses confronted an error, they opted for analyzing the error situation in terms of the nature of error, probable consequences, monitoring, and life threat. Accordingly, they employed error removal strategies such as self-action, cooperation, notifying, and censoring. These steps happened concurrently, successively, or cyclically. To manage their committed errors, nurses usually go through an informal process. Nurse-managers need to design effective error management strategies and require the practicing nurses to adhere to them. A practical model for effective prevention and management of nursing errors in critical care units is necessary.

Strengthening ethical decision-making: the experience of Iranian nurses.

AIMS: Ethical decision-making is a complex process that nurses perform daily. The aim of this study is to explain how ethical leaders in Iran strengthen ethical decision-making in their nursing teams. METHOD: Data were collected using deep and semi-structured interviews with 20 Iranian nurses in 2015. Analysis was based on constant comparative analysis. RESULTS: Ethical leaders strengthen ethical decision-making by promoting ethical commitment, developing an ethical atmosphere and guiding ethical decision-making. CONCLUSION: The development of ethical decision-making in nursing can improve ethics-based nursing care.

Males' perspectives on health in Iran: A grounded theory study.

Background: Males' health plays a basic role in the community's health, especially in family's health. Health is a multifaceted issue that affects people in all aspects. Health is also one of the 4 metaparadigm concepts in nursing. This study was conducted to explore males' perspectives on health. Methods: In this qualitative study conducted based on a grounded theory approach, 22 males were selected through a purposive sampling. Data were collected through semi-structured interviews and continued until data saturation. Data analysis was done using Strauss and Corbin's three-stage coding process. Results: Based on the perspectives of the participants, 8 categories emerged, which are as follow: psychological health; physical health; family health; spiritual health; welfare and social health; health and relationships; sexual health; and occupational-economic health. Psychological health was emerged as the core variable. Conclusion: As a multifaceted phenomenon, health is an individual's general condition in all these aspects, particularly psychological aspect. Males' health should be taken into account for the role they play in managing the family. Males as the family heads require evidence-based decision making and planning.

Perception of social support among family caregivers of vegetative patients: A qualitative study.

A vegetative state (VS) is the probable result after brain damage. After VS patients are discharged from the hospital, the responsibility of caring of them is transferred to their families, which impacts a caregiver's physical and psychological health. Social support as a valuable resource reduces the negative effects of stressful events. This study aimed to explore the perception of social support among family caregivers of VS patients. This study is a part of a larger qualitative study which used the descriptive and qualitative method. Purposeful and theoretical sampling was done, and data was gathered through face-to-face, in-depth interviews. The four categories of "Family, a supporter in all aspects," "Beautiful emanation of the nurse's role," "Revitalization via empathy and companionship," and "Defects in support," were extracted. The primary concern of participants was receiving social support which can facilitate caregiving and coping with difficulties, but there are many shortcomings in supporting these caregivers.

From margins to centre: an oral history of the wartime experience of Iranian nurses in the Iran-Iraq War, 1980-1988.

BACKGROUND: The extensive nature of the Iraq-Iran war converted to a human tragedy with large casualties; it has affected nursing discipline dramatically. AIM: To analyse the history of the wartime experience of Iranian nurses in Iran-Iraq War. METHOD: The current study was conducted with oral history. The study sample consisted of 13 Iranian nurses who served in the war zones during the wartime. Purposive and snowball sampling were used to recruit the participants. During the face-to-face interviews, participants were asked to describe their experience in the war zones during the war years. Data collection and analysis took place from April to August 2013, when saturation was reached. All interviews were tape recorded and transcribed and then analysed with thematic content analysis. RESULTS: Finally, five themes and 18 subthemes emerged from data analysis of significant statements from 17 interviews. The five emerged themes included (1) 'From margin to centre', (2) 'Development of referral care', (3) 'Personal and professional growth and development', (4) 'The emerging pillar of culture in war nursing' and (5) 'Threats to nursing at the war'. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Nursing in Iran at wartime has a difficult path to development. There are powerful implications for clinical practice. It is recommended to continue collection, archiving and analysing the wartime experiences of Iranian nurses.

Living with a heart transplant: a phenomenological study.

BACKGROUND: Heart transplantation is a relatively new medical treatment for end-stage heart failure. Many studies have addressed the outcomes and the complications and technical problems associated with heart transplants, but few have explored the whole clinical experience of being a heart transplant recipient. PURPOSE: To understand and gain deeper insight into the lived experience of Iranian heart transplant recipients. METHODS: Interviews of 11 heart transplant recipients were analyzed according to phenomenological guidelines set forth by Diekelmann. RESULTS: Six major themes emerged from 29 subthemes, depicting the meaning of living with a transplanted heart. These themes include having a new life, living with new concerns, living with vigilance, paradoxical emotions, bearing others' behaviors, and the prominent role of God in life. CONCLUSION: Heart transplant recipients in Iran experience a new life in which their faith in God helps them go through hardships and difficulties.

Iranian nurses' perceptions of social responsibility: a qualitative study.

Social responsibility is intertwined with nursing; however, perceptions of Iranian nurses about social responsibility has not been explored yet. This study, as part of a larger qualitative grounded theory approach study, aims to explore Iranian nurses' perception of social responsibility. The study participants included 10 nurses with different job levels. The study data were generated through semi-structured interviews. The participants were selected through purposeful sampling approach, which was then followed by theoretical sampling until reaching the point of data saturation. All the interviews were recorded, transcribed, and analyzed through constant comparative analysis. Positive human characteristics, professional competencies, professional values, solution-focused nursing care, and deployment of professional performance are five categories obtained from the study. The participants believed socially responsible nurses to have positive personality characteristics as well as the necessary skills to do their duties accurately. Such nurses also respect the values, observe the professional principles, and take major steps toward promotion and deployment of the nursing profession in the society.

Critical care nurses' perception of nursing error and its causes: a qualitative study.

Nurses' perceptions of nursing error could affect their professional practice. The aim of the study was to explore critical care nurses' perceptions of nursing error and its causes. This was a qualitative study in which 12 critical care nurses were recruited through purposive sampling. The data were collected via in-depth interviews and analyzed through qualitative content analysis method (Elo & Kyngäs, 2008). Nursing error was deemed as an unavoidable issue which consisted of the lack of congruence with standards, doing extra-nursing tasks and giving care against the agreed-upon routines. Five categories emerged as the causes of error: individual reasons, work pressure, caring blindly, the uniqueness of caring environment and the lack of coordination among health care team members. The perception of nursing error is sort of unique; hence, managers should provide support for critical care nurses and pave the way for the prevention of errors.

Knowledge translation in health care: a concept analysis.

BACKGROUND: Although knowledge translation is one of the most widely used concepts in health and medical literature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify the characteristics of KT. This will assist the theoretical development of it and shape its implementation into the health care system Methods: Walker and Avant's framework was used to analyze the concept and the related literature published between 2000 and 2010 was reviewed. A total of 112 papers were analyzed. RESULTS: Review of the literature showed that "KT is a process" and "implementing refined knowledge into a participatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occur successfully, KT needs some necessary antecedents like an integrated source of knowledge, a receptive context, and preparedness. The main consequence of successful process is a change in four fields of healthcare, i.e. quality of patient care, professional practice, health system, and community. In addition, this study revealed some empirical referents which are helpful to evaluate the process. CONCLUSION: By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, consequences and empirical referents. Identifying the characteristics of this concept may resolve the existing ambiguities in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these findings can be used as a knowledge infrastructure for developing the KT-related models, theories, or tools.

Stigma among Iranian family caregivers of patients with Alzheimer's disease: A hermeneutic study.

Although there is evidence of stigmatization of patients with Alzheimer's disease, few studies have evaluated stigma among family caregivers. This study was aimed at understanding the experiences of family caregivers of persons with Alzheimer's disease within Iran. We conducted a qualitative study using hermeneutic phenomenology. Semistructured in-depth interviews with 10 Iranian family caregivers of persons with Alzheimer's were audiotaped and transcribed. The transcriptions were then analyzed using Van Manen's method. Family stigma emerged as one of the most important themes in this study. It consisted of two subthemes of "feeling of shame due to the unusual behaviors and speech of the patients" and "fear of judgments made by others." An understanding of the experience of family stigma may lead to the development of supportive strategies to manage this problem among the caregivers. Educating families of patients about the disease plays a critical role in facilitating the process of caregiving. In addition, promoting public awareness about Alzheimer's disease can diminish stigma and prejudice toward patients and their caregivers. Educating caregivers on stigma management may also be an important factor in alleviating their stress.

Persistent suffering: Living experiences of patients with rare disease: An interpretative phenomenological study.

BACKGROUND: The low prevalence of rare diseases has caused the need for studies in this field to be neglected. Regardless of the prevalence of rare diseases, many people around the world have to live with the medical, psychological, and social consequences of their condition. Individuals with rare diseases may face challenges that are different from those experienced in more common medical conditions. The life experiences of patients with rare diseases have not been sufficiently investigated. The purpose of this study was to discover the meaning of living as a person with a rare disease. MATERIALS AND METHODS: This interpretative phenomenological study was conducted in 2021-2022 on 10 patients with one of the rare diseases (registered in the Atlas of Rare Diseases of Iran). Based on purposeful sampling, people with rare diseases living in Mazandaran, Golestan, and Tehran provinces were invited to participate in the study. Data collection was done using open and semi-structured interviews. The research question was exploring understanding the experience and meaning of life as a person with a rare disease. Van Manen's interpretive phenomenological approach was used to analyze the data, and the criteria of validity, transferability, and verifiability were used to ensure the trustworthiness of the research. RESULTS: The five main themes "permanent suffering, such as a bird in a cage, rejection, immersion in the whirlpool of thoughts, losing the feeling of life", and 10 sub-themes "nightmare, giving up, deprivation, limitation, worthlessness, being stigmatized, dark vision, confusion, continuous regret, and inferiority feeling" were extracted. CONCLUSION: The results of this study show that the suffering of the disease casts a shadow on all aspects of a patient's life with a rare disease. The effects of illness, disability, limitations, and exclusions had created a human being in a cage, whose right to live like others has been denied.

Barriers to the development of community-based nursing in Iran.

Purpose: Today, the care of chronic patients and older adult people in hospitals has moved towards community-based care, and health systems focus on disease prevention, health promotion, and rehabilitation. Community-based nurses play an essential role in early identification and intervention for these conditions. On the other hand, there is an increasing trend in ageing and chronic diseases in the world especially in Iran, which increases the importance of disease prevention and public health promotion. Therefore, the current research aims to identify barriers to the development of community-based nursing in Iran. Methods: In this qualitative study, 12 semi-structured interviews were conducted with nursing experts recruited in the study by purposive sampling in 2021-2022. Interviews were recorded and transcribed and a framework analysis method was used to analyse the data. Results: The results obtained from the analysis of documents and qualitative interviews led to the identification of 4 barriers: not having a specific position, inappropriate image of nursing in society, inadequacy of education with the needs of society, and high cost of home nursing services. Conclusion: Improving the image of nursing in society, locating a special place in the health system, improving education, and adjusting the costs of home care could be the strategies that help the further development of community-based nursing (CBN).

Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure.

Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.

Lived experiences of Iranian family member caregivers of persons with Alzheimer's disease: caring as 'captured in the whirlpool of time'.

AIMS AND OBJECTIVES: This study aimed to understand the experiences of Iranian family caregivers of persons with Alzheimer's disease. BACKGROUND: Increasing rate of Alzheimer's disease along with the ageing population has made this disease an urgent public health challenge worldwide. As non-professional caregivers, family members play a significant role in delivering care to elders, most of whom have one or more chronic diseases. Family-based caregiving has expanded with the encouragement of non-institutionalisation but at the same time creates challenges for caregivers. DESIGN: A qualitative study was conducted using Heideggerian hermeneutic phenomenology. METHODS: Eight Iranian family caregivers of persons with Alzheimer's disease were interviewed. Interviews were audio-taped and transcribed; data were analysed by Van Manen's methodology. RESULTS: One of the most important themes that emerged was 'captured in the whirlpool of time', which also contained the subthemes of 'reminiscence of past' and 'being afraid of the future'. Family caregivers frequently remembered their common past experiences when interacting with their loved ones with Alzheimer's disease, as though travelling with him/her to the past. Furthermore, caregivers continually compared the past abilities of their relative with their present condition, which resulted in feelings of loss and regret. Further, the unpredictable nature of Alzheimer's disease created fear about the future deterioration of the condition and caregivers' future suffering. CONCLUSIONS: The findings demonstrated the necessity of providing continuous education and support for family caregivers of persons with Alzheimer's disease. RELEVANCE TO CLINICAL PRACTICE: Nurses are among front-line professionals who are in a position to support and provide information for family caregivers of persons with Alzheimer's disease.