Impact of Watson's human caring-based health promotion program on caregivers of individuals with schizophrenia.

BACKGROUND: Caring for people with schizophrenia is accompanied by challenges that impact caregiver health. We conducted this study to explore the effect of a Caring Science-Based health promotion program on the sense of coherence and well-being among caregivers of persons with schizophrenia. METHODS: This randomized clinical trial with the Solomon four-group design was conducted on 72 caregivers randomly allocated into two intervention and two control groups. A health promotion program based on Watson's theory was performed individually through five face-to-face sessions and a four-week follow-up. Settings were the psychiatric centers of the three educational, specialty, and subspecialty Ibn-e-Sina, Moharary, and Hafez hospitals affiliated with Shiraz University of Medical Sciences (SUMS), south of Iran. The data were collected using a demographic information form, the Sense of Coherence Scale, and the Caregiver Well-Being Scale. One-way ANOVA, chi-square, Kruskal-Wallis, and independent t-test were used to determine the homogeneity at baseline. In the post-test, multiple between-groups and pairwise comparisons were assessed by One-way ANOVA and Tukey's post-hoc. Within-group comparisons were evaluated using paired t-tests. All tests were two-tailed, and the statistical level was considered 0.05. RESULTS: Data analysis showed that the mean scores of caregiver sense of coherence and well-being from pre-intervention to post-intervention were significantly increased in the intervention groups (p < 0.001). At the same time, there were no significant differences in the control groups. CONCLUSION: The health promotion program based on Watson's human caring theory facilitated ongoing intrapersonal, and holistic caring and improved the sense of coherence and well-being in caregivers of persons with schizophrenia. Hence, this intervention is recommended for developing healing care programs. TRIAL REGISTRATION: https://www.irct.ir/trial/55040 : IRCT20111105008011N2 (11/04/2021).

Effect of Hypnotism on the Severity of Gastrointestinal Symptoms and Quality of Life in Individuals With Irritable Bowel Syndrome.

The current study aimed to determine the effects of hypnotism on the severity of gastrointestinal symptoms and quality of life in individuals with irritable bowel syndrome (IBS). This trial study was conducted on 100 people with IBS in Shiraz, Iran. Hypnotism of participants was performed in 1-hour sessions for the intervention group at Weeks 4 and 6. A demographic characteristic questionnaire, Gastrointestinal Symptom Rating Scale, and IBS Quality of Life Index were used for data collection. The severity of gastrointestinal symptoms of participants in the intervention group significantly improved at 6 and 15 weeks after hypnotherapy. These individuals also had a significantly better quality of life after 15 weeks of hypnotherapy. Hypnotherapy may be beneficial in reducing gastrointestinal symptoms and improving quality of life in individuals with IBS. Combining this method with medicinal treatments could be effective for patients and health systems. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 55-62.].

Exploring the necessity of establishing a doctor of nursing practice program from experts' views: a qualitative study.

BACKGROUND: Complex healthcare systems increasingly demand influential nurse leaders adept at managing changes in unstable environments. The doctor of nursing practice (DNP) prepares the nurses for the most advanced level of clinical practice. The aim of this study was to explore the necessity of establishing a DNP program in Iran from experts' views. METHODS: The study used a qualitative descriptive approach. The participants consisted of 13 faculty members and Ph.D. candidates selected using purposive sampling. Data were collected through focus group and semi-structured interviews, and analyzed using qualitative content analysis. RESULTS: The content analysis led to the extraction of two main categories: "providing infrastructures" and "DNP as an opportunity to make positive outcomes." CONCLUSIONS: It is concluded that it is not necessary to establish a DNP program for Iran's nursing education system. Supplying infrastructures is a crucial component to establishing a new program in Iran. Although DNP, as an opportunity to drive positive changes, is recommended, in the current situation, using alternative solutions may yield better outcomes than establishing a DNP program.

Cancer patients' perspectives on dignity in care.

BACKGROUND: Since "dignity" is one of the fundamental rights of every patient, consideration for patients' dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran. RESEARCH OBJECTIVE: This study aimed to evaluate the perception of Iranian cancer patients on human dignity. RESEARCH DESIGN: A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method. PARTICIPANTS AND RESEARCH CONTEXT:  This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018. ETHICAL CONSIDERATIONS: The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study. FINDINGS: Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the "personal space and privacy," "respect for human values," and "moral support." DISCUSSION: The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity. CONCLUSION: Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.

Spirituality Experiences in Hemophilia Patients: A Phenomenological Study.

Spirituality plays an important role in coping with chronic diseases. However, the meaning of spirituality is not known in hemophilia, as a chronic disease. This study aimed to explore the essence of spirituality in hemophilia patients. This qualitative study with a hermeneutic phenomenological approach was conducted on twelve Muslim adult hemophilia patients. The participants were selected using purposeful sampling. The data were gathered through interview. Then, the data were analyzed using thematic analysis and van Manen's methodological framework. MAX.QDA qualitative software package 2010 was used to import the transcripts and analyze the data. Four themes were identified: "relationship with God," "God as the fulcrum," "strong religious beliefs," and "spiritual satisfaction." "Relationship with God" meant "to ask God for help" and "praying for oneself and others." "God as the fulcrum" consisted of two subthemes, i.e., "hope in God" and "Trust in God." "Strong religious beliefs" also included "belief in openness of God's mercy," "belief in God and the omnipotence of God," and "belief in creation by God." Finally, "spiritual satisfaction" consisted of two subthemes, namely "accepting the providence" and "thanking the divine blessings." Spirituality in hemophilia patients meant having relationship with God who was considered as the fulcrum, strong religious beliefs, and spiritual satisfaction. By understanding the hemophilia patients' spirituality experiences, the nurses and healthcare workers could provide holistic care focused on spirituality. Yet, more studies are recommended to be conducted on hemophilia patients to explore spirituality in other religions.

Facilitators and inhibitors in developing professional values in nursing students.

BACKGROUND: Values are the basis of nursing practice, especially in making decisions about complicated ethical issues. Despite their key role in nursing, little information exists on the factors affecting their development and manifestation in nursing students. OBJECTIVE: This study identifies and describes the facilitators and inhibitors of the development and manifestation of professional values based on the experiences of nursing students and instructors and nurses. RESEARCH DESIGN: Data were collected through 29 semi-structured interviews and two focus group interviews in 2013-2015 and were analyzed using the conventional content analysis method of Elo and Kyngäs. Participants and research context: In total, 18 nursing undergraduates, five nursing instructors, and five nurses from Shiraz University of Medical Sciences and one of the teaching hospitals in Shiraz were selected through purposive sampling. Ethical considerations: The research was approved by the Ethics Committee of Shiraz University of Medical Sciences and the teaching hospital examined. FINDINGS: The findings consisted of two categories: personal and environmental factors. Personal factors consisted of the two subcategories of personal stimuli (work experience and past relationships, inner beliefs and acting on values, belief in God and a divine worldview) and personal inhibitors (the lack of professional motivation and enthusiasm, negative emotions). Environmental factors consisted of the two subcategories of environmental stimuli (cooperation, order and discipline) and environmental inhibitors (unfavorable work environment, society's negative attitude toward nursing, the violation of rights). DISCUSSION AND CONCLUSION: Given the impact of personal and environmental factors on the development and manifestation of professional values in nursing students, it is upon the education authorities to take account of them in their planning, and nursing managers are also recommended to further address these factors in their development of a proper work environment, provision of standard facilities and removal of barriers.

Anger management in substance abuse based on cognitive behavioral therapy: an interventional study.

BACKGROUND: Anger and aggression have been developing notably in societies, especially among patients depending on substance abuse. Therefore, this study aimed to investigate the effect of anger management based on group education among patients depending on substances according to Patrick Reilly's cognitive behavioral approach. METHODS: In a quasi- experimental study, all patients who met the inclusion criteria were evaluated regarding their aggression level. The participants were assigned to 12 educational sessions based on group therapy and Patrick-Reilly's anger management by focusing on using a combination of cognitive intervention, relaxation, and communication skills. The data were analyzed using the SPSS statistical software, version 16. RESULTS: The findings showed a significant difference between the two groups regarding aggression level after the intervention (p = 0.001). No significant relationship was observed between aggression level and demographic variables (p > 0.05). CONCLUSION: The intervention of this study can be used for establishing self-management and decreasing anger among patients depending on substances. They can also be used as a therapeutic program in addition to pharmacotherapy. TRIAL REGISTRATION: IRCT2016102030398N1 .

A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers.

BACKGROUND: Mood disorders in pregnancy and post-partum period are common and considered as a public health issue. Researchers have studied the relationship between low serum vitamin D concentration and perinatal depression, although no clinical trial has been conducted on vitamin D's effects on depression related to childbirth. This study evaluated the effect of vitamin D3 supplementation on perinatal depression scores. METHODS: This randomized clinical trial was done in pregnant women who were under prenatal care in a teaching hospital in Shiraz, Iran. The inclusion criteria were: being 18 years or older, no history of mental illness and internal diseases, a singleton live fetus, without any pregnancy complications, gestational age of 26-28 weeks upon enrollment, and depression score of 0 to 13. The Edinburgh Postnatal Depression scale was used to evaluate depression scores. A total of 169 participants were assigned to the two groups of placebo and vitamin D through block randomization design. Vitamin D group received 2000 IU vitamin D3 daily from 26 to 28 weeks of gestation until childbirth. Maternal serum 25-hydroxyvitamin D concentrations were measured at baseline and childbirth. Besides, depression scores were evaluated four times: at 26-28 and 38-40 weeks of gestation, and finally at 4 and 8 weeks after birth. RESULTS: The two groups were similar in relation to baseline 25-hydroxyvitamin D concentrations. However, at childbirth, the vitamin D group had significantly higher 25-hydroxyvitamin D concentration in comparison to the control group (p < 0.001). At baseline, no correlation was observed between 25-hydroxyvitamin D concentration and depression score (r = 0.13, p = 0.09). There was no significant difference between the two study groups in relation to the baseline depression score. While, the vitamin D group had greater reduction in depression scores than the control group at 38-40 weeks of gestation (p = 0.01) also, at 4 and 8 weeks after birth (p < 0.001). CONCLUSIONS: The present trial showed that consuming 2000 IU vitamin D3 daily during late pregnancy was effective in decreasing perinatal depression levels. We suggest further clinical trial in pregnant mothers who are at risk for postnatal depression. TRIAL REGISTRATION: Iranian Registry of Clinical Trials  IRCT2015020310327N11 . Date of registration: March 9th 2015.

The Challenges of Nursing Students in the Clinical Learning Environment: A Qualitative Study.

Background/Aim. Clinical learning is a main part of nursing education. Students' exposure to clinical learning environment is one of the most important factors affecting the teaching-learning process in clinical settings. Identifying challenges of nursing students in the clinical learning environment could improve training and enhance the quality of its planning and promotion of the students. We aimed to explore Iranian nursing students' challenges in the clinical learning environment. Materials and Methods. This is a qualitative study using the content analysis approach. The participants consisted of seventeen nursing students and three nursing instructors. The participants were selected through purposive sampling method and attended semistructured interviews and focus groups. Results. Three themes emerged after data analysis, including ineffective communications, inadequate readiness, and emotional reactions. Conclusion. Nursing students in Iran are faced with many challenges in the clinical learning environment. All challenges identified in this study affected the students' learning in clinical setting. Therefore, we recommend that the instructors prepare students with a specific focus on their communication and psychological needs.

How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research.

BACKGROUND: It seems we are now experiencing "responsibility problems" among medical trainees (MTs) and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on "responsibility" especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. METHOD: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS) using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. RESULTS: "Try to find acceptance toward expectations", "try to be committed to meet the expectations" and "try to cope with unacceptable expectations" were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was "to preserve the integrity of student identity" which was the core category of this research too. Moreover, it was also found that practically, "responsibility" is considerably influenced by lots of positive and negative contextual and intervening conditions. CONCLUSION: "Acceptance" was the most decisive variable highly effective in MTs' responsibility. Therefore, investigating the "process of acceptance" regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

Patients' perception of epilepsy and threat to self-identity: a qualitative approach.

INTRODUCTION: A clinical diagnosis of epilepsy often carries a silent social stigma and is associated with metaphysical forces. This qualitative study aimed to explore the Iranian patients' perception of epilepsy where clinical aspects are more benign than the social implications with long-term psychological consequences. Historically, epilepsy has been known as a form of insanity, madness, sorcery, and possession by evil spirits. METHOD: Thirty participants consisting of 21 patients with epilepsy, 5 family members, and 4 medical staff were selected from urban and rural medical and health care centers, hospitals, physician offices, outpatient clinics, and the Iranian Epilepsy Association. Unstructured and semistructured interviews were applied to obtain data. Transcribed interviews and field notes were analyzed using qualitative content analysis method. FINDINGS: Categories and subcategories emerged from the participants' perceptions of epilepsy and its disruptive effects on their self-identity. The main categories derived from data were 1) a different perspective about epilepsy, 2) self-debasement, and 3) being a burden. The major theme found in this study was "identity loss". CONCLUSION: Our study results highlight the importance of public awareness among community members and healthcare professionals on how patients with epilepsy experience their disease with psychosocial implications. Understanding patients' perspectives can be essential to developing a comprehensive and holistic care plan for patients with epilepsy and addressing their multidimensional needs.

Quality of life of childbearing age women and its associated factors: an application of seemingly unrelated regression (SUR) models.

PURPOSE: This article is a report of using seemingly unrelated regression (SUR) models to examine the determinants of different dimensions of quality of life (QoL) among childbearing age women. There are a limited number of studies on QoL and its associated factors among women in developing countries such as Iran. Therefore, more attention should be focused on identifying these issues. METHODS: We administered the Persian's abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to 1,067 married women aged between 15 and 49 years. The women were chosen via a multistage research design from the rural region of Shiraz, the center of Fars Province in Iran in 2008. Clinical and socio-demographic characteristics as well as their reproductive health-related characteristics were investigated. To identify associated factors of QoL dimensions, ordinary least squares (OLS) regression and SUR were used and their findings were compared. RESULTS: The WHOQOL-BREF showed acceptable consistency (Cronbach's alpha range: 0.62-0.75 across domains). Lower age, absence of long-term illness, economic status satisfaction, higher level of education, lower number of pregnancies, and higher body mass index were important associated factors of different dimensions of the QoL among these women. The estimated parameters for these factors were in close agreement in both OLS and SUR estimation methods. However, the SUR estimator provided the higher precision of the estimates than the OLS estimator, as the parameters obtained by SUR are characterized by lower standard errors. Women's age, income satisfaction, and level of education were common for all domains. CONCLUSIONS: This study presents a novel approach to simultaneously predict QoL domains using the SUR estimators and the results are relevant for implementing objective QoL. SUR estimators performed consistently better than the OLS estimators, since SUR takes the correlation between error terms into account. Thus, the SUR method could be a useful methodology for predicting QoL domains.

Effectiveness of video information on coronary angiography patients' outcomes.

BACKGROUND: Coronary angiography is a widely used invasive procedure for diagnosis of coronary artery diseases. The patients benefit from information about an invasive diagnostic procedure. OBJECTIVES: The aim of this study was to evaluate the effects of two educational methods (video information vs. verbal information) on the level of satisfaction, comfort, tolerability and on the heart rate and blood pressure of patients undergoing coronary angiography. METHODS: A randomized controlled trial design was employed in this study. 128 patients candidate for coronary angiography were randomly assigned to experimental (n = 64) and control (n = 64) groups. The data were collected from January to April 2009. The experimental group watched an informative video about the procedure of coronary angiography as well as pre- and post-angiography care, while the control group received only routine verbal education by nurses. Heart rate and blood pressure were obtained at baseline and after educational intervention. The levels of comfort, satisfaction, and tolerability were measured after the procedure. Statistical analysis was done using SPSS soft ware (Version, 11.5). RESULTS: The experimental group showed a statistically significant decrease in the heart rate and blood pressure after the educational intervention compared to the control group (P < .001). The patients in the experimental group had significantly higher levels of comfort, satisfaction, and tolerability than the control group (P < .001). CONCLUSIONS: Patients' education using an informative video before coronary angiography can effectively maximize the patients' outcome. The results of this study confirm the usefulness of video information prior to an invasive coronary angiography procedure.

The effect of cardiac rehabilitation on anxiety and depression in patients undergoing cardiac bypass graft surgery in Iran.

BACKGROUND: Many patients experience anxiety and depression after cardiac bypass surgery.The aim of this study was to examine the effect of cardiac rehabilitation on anxiety and depression in patients undergoing coronary artery bypass grafting in hospitals affiliated to Shiraz University of Medical Sciences in southern Iran. METHODS: For this randomized controlled trial, 80 patients who met the inclusion criteria were recruited and randomly assigned to case and control groups. Anxiety was measured with the Spielberger Anxiety Scale and depression was measured using Beck's Depression Inventory at three points in time: on discharge from the hospital, immediately after the intervention, and 2 months after cardiac rehabilitation. After measuring anxiety and depression in both groups upon discharge, the experimental group participated in 8 cardiac rehabilitation sessions over a 4-week period. The control group received only the routine follow-up care. RESULTS: There was a statistically significant difference in depression scores between groups at all three time-points (Mean score from 19.6 to 10 in the intervention group and from 19.5 to 14 in the control group, P = 0.0014). However, no significant difference was seen in anxiety scores between the groups (Mean score from 37 to 28 in the intervention group and from 38 to 32 in the control group, P = 0.079). CONCLUSIONS: Cardiac rehabilitation was effective in reducing depression 2 months after surgery in patients undergoing coronary artery bypass grafting. TRIAL REGISTRATION: IRCTN201203262812N8.

Effect of a psycho-educational intervention for family members on caregiver burdens and psychiatric symptoms in patients with schizophrenia in Shiraz, Iran.

BACKGROUND: This study explored the effectiveness of family psycho-education in reducing patients' symptoms and on family caregiver burden. METHODS: Seventy Iranian outpatients with a diagnosis of schizophrenia disorder and their caregivers were randomly allocated to the experimental (n = 35) or control groups (n = 35). Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers. The psycho-educational program consisted of ten 90-min sessions held during five weeks (two session in each week). Each caregiver attended 10 sessions (in five weeks) At baseline, immediately after intervention, and one month later. Validated tools were used to assess patients' clinical status and caregiver burden. RESULTS: Compared with the control group, the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later. CONCLUSIONS: These results suggest that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families. TRIAL REGISTRATION: IRCT Number:138809122812 N1`.

The characteristics that propel Iranian MS students of nursing into self-directed learning: A qualitative research.

BACKGROUND: Rapid scientific progression in today's world has caused a significant decrease in the half-life of knowledge in different scientific fields. An effective way to be up-to-date in this ever changing world is to be a self-directed learner. PURPOSE: This study aimed to explore the characteristics that propel Iranian MSc students of nursing into self-directed learning. METHODS: A qualitative design using conventional content analysis approach was used in this study. Totally, 20 semi-structured interviews were conducted with fourteen MSc nursing students and three instructors from Shiraz University of Medical Sciences selected using purposive sampling. Data collection and analysis were run concurrently and continued until data saturation. RESULTS: Data analysis indicated that self-directed students had various characteristics that motivated them towards learning. These characteristics were categorized into three main themes, including "openness to experience", "motivation to improve", and "socio-professional commitment", and sixteen subthemes. CONCLUSION: The findings showed that some characteristics facilitated and directed the process of self-directed learning and helped the students to attain their learning goals. Since some of these characteristics can be acquired and improved during education, their recognition can provide a foundation for their development in different levels of academic learning, especially in higher education.

Striving for balance: coping with epilepsy in Iranian patients.

Patients with epilepsy are subject to a wide range of distinctive psychosocial consequences, which can be more harmful than the seizures themselves and other medical difficulties accompanying them. This qualitative study was aimed at identifying coping strategies employed by 21 Iranian adults with epilepsy. The study participants were chosen by purposeful sampling from hospitals, neurologists' clinics, rural health care facilities, and epilepsy associations. Data were collected through semistructured interviews. A qualitative content analysis method was used to analyze the gathered data. The analysis resulted in the emergence of six themes and seven subthemes: confronting the disease using religious sentiment, seeking support, fighting the disease, defending oneself against the disease, concealing the disease, and expressing emotions. The findings showed that the participants used an emotion-focused approach more often than a problem-focused approach as a coping strategy. The results will improve health care professionals' knowledge of how Iranian patients cope with epilepsy and help them to design nursing care models to promote successful coping strategies for patients.

The effect of peer-led education on the life quality of mastectomy patients referred to breast cancer-clinics in Shiraz, Iran 2009.

BACKGROUND: Breast cancer among women is a relatively common with a more favorable expected survival rates than other forms of cancers. This study aimed to determine the improved quality of life for post-mastectomy women through peer education. METHODS: Using pre and post test follow up and control design approach, 99 women with stage I and II of breast cancer diagnosis were followed one year after modified radical mastectomy. To measure the quality of life an instrument designed by the European organization for research and treatment of cancer, known as the Quality of Life Question (QLQ-30) and its breast cancer supplementary measure (QLQ-BR23) at three points in time (before, immediately and two months after intervention) for both groups were used. The participant selection was a convenient sampling method and women were randomly assigned into two experimental and control groups. The experimental group was randomly assigned to five groups and peer educators conducted weekly educational programs for one month. Tabulated data were analyzed using chi square, t test, and repeated measurement multivariate to compare the quality of life differences over time. RESULTS: For the experimental group, the results showed statistically significant improvement in all performance aspects of life quality and symptom reduction (P < 0.001), while the control group had no significant differences in all aspects of life quality. CONCLUSION: The findings of this study suggest that peer led education is a useful intervention for post-mastectomy women to improve their quality of life.