The experiences of psychiatric patients, their caregivers and companions in upholding patient dignity during hospitalization: A qualitative study.

INTRODUCTION: The quality of care and patient satisfaction is closely linked with dignity, which is a crucial component of therapy and care. However, there is very little study on dignity in the context of mental health care. Planning for ongoing patient care might benefit from an understanding of the notion of dignity by exploring the experiences of patients, caregivers and companions of patients who have a history of hospitalization in mental health institutions. To retain patients' dignity while they were being treated in mental wards, this study sought to understand the experiences of patients, caregivers and companions of patients. MATERIALS AND METHODS: This investigation was qualitative. Semistructured interviews and focus groups were utilized to collect the data. The purposeful sampling method was employed for participant recruitment, which continued until data saturation. Two focus group discussions and 27 interviews were conducted. Participants included 8 patients, 2 patients' family members (companions), 3 psychologists, 4 nurses and 11 psychiatrists. Two focus group discussions were held with seven family members or companions of patients. Thematic analysis was used for data analysis. RESULTS: The primary theme that emerged was the infringement of patients' dignity, through negative guardianship, dehumanization and violations of their rights. Subthemes included dehumanization, worthlessness and namelessness, patient rights violations and stripping patients of authority. CONCLUSION: Our results suggest that, regardless of the severity of the illness, the nature of psychiatric illness significantly compromises patients' dignity. Mental health practitioners, due to their sense of guardianship, may unintentionally treat patients with mental health disorders, thus compromising the patient's dignity. PATIENT OR PUBLIC CONTRIBUTION: The research team's experiences as a psychiatrist, doctor and nurse informed the study's objectives. Nurses and psychiatrists who work in the healthcare industry designed and conducted the study. The primary authors, who are healthcare providers, collected and analysed the required data. Furthermore, the entire study team contributed to the writing of the manuscript. Study participants were involved in the data collection and analysis.

The effect of a group cognitive behavioral therapy on the quality of life and emotional disturbance of women with breast cancer.

PURPOSE: While the rate of survival has increased in the past decade, the diagnosis of breast cancer is an extremely stressful experience for patients and it is associated with the manifestation of several psychological problems. To examine the effect of a group cognitive behavioral therapy (CBT) on the quality of life and emotional disturbance of women with breast cancer. METHODS: The study was a randomized controlled clinical trial. Samples were 48 women who had been diagnosed with breast cancer and had undergone mastectomy and chemotherapy. Study variables were measured before and after the intervention and 1 month after the end of the intervention as a follow-up. Controls received nothing and were just followed-up. Repeated measure ANOVAs were used to compare the effectiveness of the intervention on the study variables. RESULTS: The results of 32 women were analyzed. The increase in quality of life scores was significantly higher in the intervention group compared to the control group (P < 0.05). There were also significantly lower changes in the depression, anxiety, and stress scores of the intervention group (P < 0.05). However, the changes in the score of death anxiety were not significantly lower in the intervention group in comparison to controls (P > 0.05). CONCLUSION: Group cognitive behavioral therapy was effective in the improvement of quality of life and decreases some aspects of emotional disturbance. Findings of this study suggest that women with breast cancer can benefit from group CBT. Yet, some aspects of the mental health of these women may need more attention and individualized methods. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: IRCT20100911004728N4.

Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: a randomized clinical trial.

BACKGROUND: With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings. METHODS: This study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16. RESULTS: The pain score's increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η2 = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen's d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen's d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen's d = 0.54) for the emergency department. CONCLUSIONS: Facilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant's admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting. TRIAL REGISTRATION: Current Controlled Trials IRCT201408029568N9, 2014-09-08.

Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment.

OBJECTIVE: The present study examined the extent to which social support (SS) availability and satisfaction could predict the extent of caregiver burden (CB) among mothers of children with Acute Lymphocytic Leukemia (ALL). METHOD: The study was a cross-sectional, descriptive-correlative study. It was conducted on a sample of 117 mothers whose children were undergoing treatment in a public hospital in Bam, Iran. The Norbeck Social Support Scale and the Caregiver Burden Scale were used to measuring study variables. The data were analyzed using Pearson's correlations, t-tests, ANOVAs, and linear regressions. RESULTS: Significant correlations were observed between CB and SS availability (r = -0.499, p < 0.001), SS satisfaction (r = -0.543, p < 0.001), the age of the child with cancer (r = -0.22, p = 0.01), and duration of treatment (r = 0.336, p < 0.001). Married mothers experienced less CB than those that were widowed or divorced. Within the regression equation, SS satisfaction, SS availability, marital status, and duration of treatment were the predictors of CB. SIGNIFICANCE OF RESULTS: Based on the results of the current study, mothers who have less SS, especially those who are single mothers, with younger children, and who have taken care of their child for an extended duration should be given special attention. Furthermore, it appears that there are distinct cultural variations amongst Iranian mothers which suggest that culture may impact upon SS availability. Results also suggest a need for interventions that enhance nurses' ability to provide support to caregivers and the broader family unit as a whole. Nurses in cancer care need to have psychological competencies to help family members of cancer patients especially mothers and more so those that are single mothers. As integral members of the patient care experience, nurses may be uniquely positioned to provide this needed psychosocial support.

Health care reform in Iran: Implications for nurses' moral distress, patient rights, satisfaction and turnover intention.

AIM: The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention. BACKGROUND: Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population. METHODS: This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran. FINDINGS: Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention. CONCLUSIONS: Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention. IMPLICATIONS FOR NURSING MANAGEMENT: Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel.

Comparing the effectiveness of vapocoolant spray and lidocaine/procaine cream in reducing pain of intravenous cannulation: A randomized clinical trial.

INTRODUCTION: Venous cannulation is the most common procedure in emergency departments. The aim of this study was to compare the effectiveness of vapocoolant spray and EMLA cream in reduction of pain during venous cannulation in 6-12years old children. METHODS: The study was a randomized clinical trial with a crossover design. It took place between June and December 2015 at Ali-Asghar hospital in Tehran, Iran. 40 Thalassemic children who need regular blood transfusions were randomly assigned in two groups. The pain of intravenous cannulation was measured using a visual analogue scale for pain (VAS-P). With the crossover design each patient received vapocoolant spray and EMLA cream in the next two visits. The patients were allocated into two groups (A and B). The patients in Group (A) received Vapocoolant spray in the first visit and EMLA cream in the second visit before intravenous cannulation. The patients in Group (B) group were exposed to the opposite order. RESULTS: The pain after Vapocoolant spray was 3.22±1.18 which was significantly lower than control (7.12±1.36) and higher than EMLA cream (0.77±1.09), p>0.001. The anxiety before cannulation had a significant effects on the reported pain by children. The ANCOVA showed that despite the effects of anxiety the results did not change significantly. CONCLUSION: The results indicated that vapocoolant spray was not as effective as EMLA cream, in the event of an emergency and in patients with allergic reactions to lidocaine and procaine ingredients Vapocoolant is an efficacious alternative.

Becoming a nurse as a moral journey: A constructivist grounded theory.

BACKGROUND: Nursing students, during their study, experience significant changes on their journey to become nurses. A major change that they experience is the development of their moral competency. OBJECTIVE: The purpose of this study is to explore the process of moral development in Iranian nursing students. RESEARCH DESIGN: A constructivist grounded theory method was adopted. Twenty-five in-depth, semi-structured, face-to-face intensive interviews with 22 participants were conducted from September 2013 to October 2014. All interviews were audio-taped, transcribed, and analyzed using writing memos and the constant comparative method. Participants and research context: The setting was three major nursing schools within Tehran, the capital of Iran. Nineteen nursing students and three lecturers participated in the study. Ethical considerations: The study was approved by the Tehran University of Medical Sciences Committee for Medical Research Ethics (92/D/130/1781). It was explained to all participants that their responses would be treated with confidentiality and that they would not be identified in any way in the research and any publication ensuing from the research. All participants agreed to be interviewed and signed written consent forms agreeing to the recording and analyses of the interview data gathered. FINDINGS: Findings indicated three levels of moral development along with the formation of professional identity. The three levels of moral development, getting to know the identity of nursing (moral transition), accepting nursing identity (moral reconstruction), and professional identity internalization (professional morality), were connected to the levels of professional identity formation. DISCUSSION: The proposed model added a new insight to professionalism in nursing. CONCLUSION: From the findings, it was concluded that to enhance higher moral practice, nursing instructors should promote the professional identity of nursing students. Reinforcement of moral characteristics and professional identity within registered nurses occurs over a series of phases and, once fully integrated into the identity of nursing students, the moral characteristics that they acquire become part of their both professional and personal identities.

Psychological Distress in South African Healthcare Workers Early in the COVID-19 Pandemic: An Analysis of Associations and Mitigating Factors.

While the global COVID-19 pandemic has been widely acknowledged to affect the mental health of health care workers (HCWs), attention to measures that protect those on the front lines of health outbreak response has been limited. In this cross-sectional study, we examine workplace contextual factors associated with how psychological distress was experienced in a South African setting where a severe first wave was being experienced with the objective of identifying factors that can protect against HCWs experiencing negative impacts. Consistent with mounting literature on mental health effects, we found a high degree of psychological distress (57.4% above the General Health Questionnaire cut-off value) and a strong association between perceived risks associated with the presence of COVID-19 in the healthcare workplace and psychological distress (adjusted OR = 2.35, p < 0.01). Our research indicates that both training (adjusted OR 0.41, 95% CI 0.21−0.81) and the reported presence of supportive workplace relationships (adjusted OR 0.52, 95% CI 0.27−0.97) were associated with positive outcomes. This evidence that workplace resilience can be reinforced to better prepare for the onset of similar outbreaks in the future suggests that pursuit of further research into specific interventions to improve resilience is well merited.

Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The COVID-19 pandemic has had a far-reaching negative impact on healthcare systems worldwide and has placed healthcare providers under immense physiological and psychological pressures. OBJECTIVE: The aim of current study was to undertake an in-depth exploration of the experiences of health-care staff working during the COVID-19 crisis. METHODS: Using a thematic analysis approach, a qualitative study was conducted using semi-structured interviews with 97 health care professionals. Participants were health care professionals including pre-hospital emergency services (EMS), physicians, nurses, pharmacists, laboratory personnel, radiology technicians, hospital managers and managers in the ministry of health who work directly or indirectly with COVID-19 cases. RESULTS: Data analysis highlighted four main themes, namely: 'Working in the pandemic era', 'Changes in personal life and enhanced negative affect', 'Gaining experience, normalization and adaptation to the pandemic' and 'Mental Health Considerations' which indicated that mental ill deteriorations unfolded through a stage-wise process as the pandemic unfolded. CONCLUSIONS: Participants experienced a wide range of emotions and development during the unfolding of the pandemic. Providing mental health aid should thus be an essential part of services for healthcare providers during the pandemic. Based on our results the aid should be focused on the various stages and should be individual-centred. Such interventions are crucial to sustain workers in their ability to cope throughout the duration of the pandemic.

An Evolutionary Route for the Moral Development of Nursing Students: A Constructivist Grounded Theory.

BACKGROUND: Developing moral competency is a main aim of educational systems, especially in healthcare-related disciplines. PURPOSE: The aim of this study was to explore the moral development process in nursing students. METHODS: This study used a constructivist grounded theory. Twenty-five semistructured, face-to-face interview with 22 participants were conducted to gather the data. The participants were nursing students and educators attending three nursing schools in Tehran. RESULTS: Moral development evolves within nursing students following a stepwise progression. Within each step or phase, students experience specific changes with regard to both their practical skills and their moral capabilities and competencies. Three main steps were identified: moral transition, moral reconstruction, and moral internalization. Techno-scientific competence, biomedical competence, and nursing competence are developed in each step, respectively. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Moral competency in nursing students develops along with their competency as nursing practitioners. To facilitate progress through each phase, it needs to be ensured that the learning experiences that students are exposed to during each consecutive year of study facilitate as much as possible the development of moral competence.