Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis.

BACKGROUND: Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. AIM: This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. METHODS: A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. RESULTS: Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. CONCLUSION: Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

The intention to leave among academics in Iran: an examination of their work-life quality and satisfaction.

BACKGROUND: Despite the importance of faculty retention, there is little understanding of how demographic variables, professional and institutional work-life issues, and satisfaction interact to explain faculty intentions to leave. This study aimed to investigate the intention to leave among academics and their Work-Life Quality and Satisfaction. METHODS: This is a descriptive cross-sectional study conducted by 8 faculties affiliated to Urmia University of Medical Sciences located in Urmia, West Azarbaijan province, Iran. The participants in the study were 120 faculty members from Nursing and Midwifery, Medicine, Allied health professions, and Health management and medical information faculties. The Work-Life Quality and Satisfaction scale, and the intension to leave scale were used for data collection. Uni- and multivariable linear regression analyses were employed to determine predictors of the intention to leave (P-values < 0.05). RESULTS: The mean scores of all dimensions of Work-Life Quality and Satisfaction scale, and intention to leave were in an average level. There is a negative correlation between Work-Life Quality and Satisfaction subscales, along with demographic factors, and the intention to leave (P < 0.05), while multivariate analysis showed that work experience and Discipline were significant independent predictors of intention to leave (P < 0.05). CONCLUSIONS: In order to improve education in universities, it is necessary to pay attention to the conditions of creating job satisfaction in academics. Considering the high intention to leave among Nursing lecturers, without sufficient support of nursing schools in terms of human resources, it may suffer by the lack of academic staff; eventually the quality of education will reduce in undergraduate nursing in the long term.

Pain Self-management Strategies in Patients With Cancer: A Qualitative Study.

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet.

Nurses' experiences of ethical and legal issues in post-resuscitation care: A qualitative content analysis.

BACKGROUND: Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. OBJECTIVE: To explore nurses' experiences of ethical and legal issues in post-resuscitation care. RESEARCH DESIGN: This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. PARTICIPANTS AND RESEARCH CONTEXT: In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed by conventional content analysis. ETHICAL CONSIDERATIONS: The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. FINDINGS: Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. CONCLUSION: There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges.

Nurses' Perceptions Towards Resuscitated Patients: A Qualitative Study.

Nurses' perceptions of resuscitated patients may affect their care, and this has not been investigated in previous literature. The aim of this study was to explore nurses' perceptions towards resuscitated patients. In this descriptive-qualitative study seventeen clinical nurses participated using purposive sampling. In-depth, semi-structured interviews were conducted and data were analyzed by conventional content analysis. Four main categories emerged: Injured, undervalued, problematic, and destroyer of resources. Participants considered resuscitated patients to have multiple physical injuries, which are an important source of legal problems and workplace violence, and they believed that these patients will eventually die. Resuscitated patients are considered forgotten and educational cases. Iranian nurses have a strong negative perception towards resuscitated patients. Improving the quality of cardiopulmonary resuscitation, improving the knowledge and skills of personnel in performing resuscitation, and supporting managers and doctors to nurses in the post-resuscitation period can change the attitude of nurses and improve post-resuscitation care.

Determinant factors in adopting mobile health application in healthcare by nurses.

BACKGROUND: Mobile applications are among effective learning tools and have a significant role in transferring information and knowledge to nurses. The current study was carried to identify the factors affecting nurses' use of practical health related mobile applications in education and patient interaction based on the combined Technology Acceptance Model (TAM) and Diffusion of Innovation (DOI). METHOD: The study is a descriptive-analytical study with a cross-sectional method. The research population includes nurses working at Tabriz University of Medical Sciences hospitals, 150 of which were selected as the research sample using simple and available sampling. The data collection instrument was a questionnaire, the validity and reliability of which were confirmed (α = 0.9). Data analysis was carried out using a correlation test and regression analysis by applying SPSS v16 software. RESULTS: The findings show that perceived usefulness and perceived ease of use have a direct and significant effect on the rate of using mobile applications by nurses (P value ≤ 0.01), [(ß = 0.52), (ß = 0.40)]. Other findings indicate that relative advantage, compatibility, trialability and observability, have a direct and significant effect on nurses' use of mobile applications, while complicatedness does not have a significant effect. CONCLUSION: The current study identifies the effective factors in nurses' use of health-related mobile applications based on an integrated model of TAM and DOI. Designers of mobile applications should consider these factors in designing and developing programs so that mobile applications can successfully fulfill their purpose in healthcare.

Compassionate Nursing Care Model: Results from a grounded theory study.

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research.

Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises - study protocol for a randomized controlled-trial.

BACKGROUND: Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine und mittlere Unternehmen - Gesundheitsoffensive; en: small and medium-sized enterprises - health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees. METHODS: The study is planned as a 2 × 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees' mental health. Further dependent variables are leaders´ depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers' point of view. DISCUSSION: Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders´ and also employees` mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives. TRIAL REGISTRATION: The KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (05.11.2020).

Palliative Care Models for Cancer Patients: Learning for Planning in Nursing (Review).

Cancer is the second cause of mortality in the world. Increased incidence of cancer and its growing trend have drawn attention to care for these patients. Palliative care is a solution for improving the quality of cancer care. However, only 14% of cancer patients in the world are receiving palliative care and most nurses lack the adequate knowledge and education to implement different palliative care models for cancer patients. This review of the literature intended to identify the palliative care models used by nurses for cancer patients as well as the similarities and differences between these models. Databases such as PubMed, ProQuest, google scholar, and CINAHL were searched, and experimental studies that presented palliative care models for cancer patients that nurses were involved were selected. From a total of articles selected by searching the databases, 16 experimental articles were selected. These articles presented 12 palliative care models that involved nurses and participants were cancer patients. The palliative care models presented in the experimental articles were based on hospice, hospital, home care, ambulatory, community, pediatric, spirituality, early, family, telehealth, dignity, and integrated. It was found out that several palliative care nursing models for cancer patients can be employed by nurses as they are the key agents in the provision of palliative care. The collaborative nature of the models, their positive consequences for patients being common components of models, and the implementation of the models considering the disease trajectory were among their distinctions.

The Relation of Readiness for Return to Work and Return to Work Among Iranian Cancer Survivors.

Return to work after completion of cancer treatments has many benefits for patients, families, and society. Readiness for return to work (RRTW) seems to be an effective factor for return to work in cancer survivors. Therefore, the present study was to investigate return to work and its relation to RRTW among Iranian survivors of cancer. This descriptive-correlational study examined a total of 227 survived cancer patients with completed primary treatments and without active cancer symptoms. Data were collected by the return to work and RRTW questionnaires and analyzed with descriptive statistics and inferential statistics using SPSS software. Upon completion of initial treatment, 166 (73.2%) of survivor participants returned to work, of which 78 (34.4%) and 88 (38.4%) participants returned to full-time and part-time works, respectively. ANOVA test showed a significant difference between RRTW and the type of return to work. In addition, results of regression analysis revealed that there was a positive significant relationship between RRTW and the rate of return to work before and after the adjustment of variables (p ≤ 0.05). Considering the findings of the study, there is a necessary need planning for rehabilitation programs by nursing managers concerning these patients to facilitate their return to work.

The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial.

OBJECTIVES: The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy. MATERIALS AND METHODS: In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up. RESULTS: The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week. CONCLUSIONS: Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy. CLINICAL RELEVANCE: The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle. TRIAL REGISTRATION: IRCT2015121419919N7.

A Qualitative Study on Cancer Care Burden: Experiences of Iranian Family Caregivers.

The aim of this study was to explore the experiences of Iranian family caregivers with regard to the burden of caregiving. This is in the context of illuminating and identifying the experiences of family members from different contextual perspectives. In this qualitative study, purposive sampling was conducted in 2016. Data were collected using semistructured interviews and were analyzed using content analysis. Data analysis identified 4 categories and 8 subcategories: (1) burnout (physical problems and psychoemotional stress), (2) role conflict (balancing caring roles and family responsibilities; failure in professional or educational roles), (3) health system tensions (inadequate support from health professionals; ignorance of family members in health structure), and (4) social challenges of cancer (economic burden; taboo of cancer). In conclusion, nurses need to provide individualized support and counseling that address the sources of burden. This highlights the benefit of training health care professionals to provide culturally sensitive support based on family caregivers' needs and circumstances.

Iranian pre-hospital emergency care nurses' strategies to manage workplace violence: A descriptive qualitative study.

AIM: To explore the experiences of Iranian nurses working in pre-hospital emergency care services and the strategies used to manage of workplace violence. BACKGROUND: Pre-hospital emergency nurses are subject to workplace violence; however, little research addresses their experiences, particularly related to their strategies in dealing with workplace violence. METHODS: A descriptive qualitative study that involved nineteen male nurses who were working in pre-hospital services collected data using semi-structured interviews and analysed it using qualitative content analysis. RESULTS: Data analysis yielded four descriptive categories including no reaction to violence (tolerance and acceptance as common workplace conflicts), situational management (patient and scene management), confrontation (direct and indirect) and escaping the scene. Patient management was the dominant strategy used and had the best outcomes related to both patient and personnel safety. CONCLUSION: This study showed that pre-hospital nurses use different strategies to manage violence and patient management was a common and useful strategy for managing workplace violence. However, the pre-hospital nurses have little training, insufficient support and are poorly prepared to manage workplace violence. IMPLICATIONS FOR NURSING MANAGEMENT: The development of context-based guidelines, continuing education, better-equipped ambulances that include medical and defence equipment, as well as better coordination of the police force in ambulance operations, can help to reduce workplace violence.

The Correlation between Respecting the Dignity of Cancer Patients and the Quality of Nurse-Patient Communication.

CONTEXT: Nurse-patient communication is one of the important factors affects the promotion and maintenance of the dignity of cancer patients in the hospital settings. AIMS: This study aimed to determine the perceptions of cancer patients regarding respecting their dignity and its correlation with nurse-patient communication in the hospital settings. SUBJECTS AND METHODS: This correlational study was conducted on 250 cancer patients admitted to the Oncology Departments of Tabriz Shahid Ghazi University Hospital, Iran. These patients were selected using a convenience sampling method. The Patient Dignity Inventory and Nurse Quality of Communication with Patient Questionnaire were used for collecting the data. STATISTICAL ANALYSIS USED: Descriptive and inferential statistics were applied to the data. RESULTS: The score of nurse-patient relationship is significantly correlated with patient's dignity score (R = -0.21, P = 0.001). CONCLUSIONS: Due to the importance of nurse-patient communication on maintenance of the dignity of cancer patients, it is a necessary requirement to take proper actions in this area, particularly by promoting "nurse's communication skills."

Cancer survivors' experiences of return to work: A qualitative study.

OBJECTIVE: The study aimed to explore Iranian cancer survivors' experiences of returning to work. METHODS: Semistructured interviews were conducted with 20 cancer survivors at their workplace and in a referral cancer center. Data were analyzed using a conventional content analysis technique. RESULTS: Three main categories were identified as important in cancer survivors' experiences of returning to work: (1) individual perspectives, (2) nature of disease, and (3) access to support system. Results showed that returning to work contained different meaning for men and women. Also, it was found that cancer survivors had limited information about the disease and return to work that made them doubtful about returning to work. CONCLUSION: Cancer survivors have different individual perspectives that affect their decision about returning to work. Their perspectives should be assessed before returning to work, and necessary support should be provided for them in returning to work process. In this regard, health care systems and rehabilitation specialists should inform cancer survivors about the disease and return to work. Also, employers should prepare work places for cancer survivors' entrance.

Factors facilitating nurses to deliver compassionate care: a qualitative study.

BACKGROUND: Compassion is an important ethical foundation of all healthcare professionals especially for nursing. However, there is little understanding of factors which could help and motivate nurses to deliver compassionate care in modern healthcare practices today. Moreover, a cultural context may affect the way compassionate care is delivered by healthcare professionals. AIMS AND OBJECTIVES: This study aimed to explore what facilitates compassionate care in daily practice from the unique perspective of Iranian nurses. RESEARCH METHODS: This qualitative exploratory study was conducted in four hospitals. In this study, 16 nurses were selected from various wards. Data were collected by in-depth, face-to-face interviews. For data analysis, a conventional content analysis approach was used. RESULTS: As the most important theme, the theme 'deepening individual's capacity for compassionate care' emerged, which consisted of three categories: the personal system of values and beliefs, patient experience and positive role models of compassion. CONCLUSIONS: Addressing and developing nurses' capacity for compassion is possible by providing organisational support and professional education, next to recruiting nurses with a high motivation to relieve patient suffering. These recommendations would help to provide high-quality compassionate care in healthcare practices. Moreover, nurses could improve their individual capacity for compassion by following their value and belief system and by considering their colleagues as a role model of compassionate practice.

Going Forward Lightening the Shadow of Cancer: Experiences of Family Caregivers Toward Empowerment.

This qualitative study was conducted to explore the empowerment experiences of family caregivers of patients with cancer. Empowerment consisted of 3 main categories: (1) seeking tranquility with the help of religious beliefs, (2) developing a positive attitude, and (3) restoring control over the situation. Results may help nurses for planning spiritual and supportive care.

Nurses' experiences of unprofessional behaviors in the emergency department: A qualitative study.

The nursing profession is focused on serving others and has high expectations that each member behaves professionally and ethically, as articulated in nursing codes of practice and conduct. Where these are not upheld, inappropriate and unprofessional workplace behaviors follow. Regrettably, unprofessional behavior is neither new nor constrained to the nursing profession, but is known to negatively impact staff and workplace relationships, and importantly, patient safety and care. The aim of this qualitative study was to explore Iranian nurses' experiences of professional communication between colleagues in the emergency department. Fifteen individual interviews were conducted. The overarching theme to emerge from the data was workplace communication, supported by two subthemes: unprofessional behavior and stressors in the workplace. Individually and collectively, these subthemes demonstrated staff attitudes and behaviors that are inconsistent with expectations of professional behavior and practice. Management proactively addressing unprofessional workplace behaviors is fundamental to establishing and maintaining positive workplace environments and supporting safe, quality patient care.

Nurse's perceptions of organisational barriers to delivering compassionate care: A qualitative study.

BACKGROUND: Compassionate care is an international priority of healthcare professionals. There is little understanding about how workplace issues impact provision of compassionate care in nursing practice. Therefore, it is important to address the workplace issues and organizational factors which may hinder compassionate care delivery within nursing practice. OBJECTIVE: The aim of this study was to explore workplace and organizational barriers to compassionate care from the nurses' perspective. RESEARCH DESIGN: The study used a qualitative exploratory design, and data were analyzed by conventional content analysis. Participants and research context: A total of 15 nurses working in different fields of nursing were recruited from four hospitals at northwest of Iran. Participants were selected by purposive sampling. Semistructured interviews were conducted for data collection. Ethical consideration: Ethical approval of this study was gained from the Ethical Review Board of Tabriz University of Medical Sciences. FINDINGS: The main theme which emerged from data analysis was "unsupportive organizational culture." This theme had two main categories including "excessive workload alongside inadequate staffing" and "the lack of value on compassionate care." DISCUSSION: Organizational barriers to development of compassionate in clinical practice were identified in this study. A closer examination of these barriers is required to move compassionate practice from an individual responsibility to a collective responsibility that is owned and shared by organizations. CONCLUSION: For compassionate care to flourish, policy makers, managers, and healthcare providers must foster an organizational atmosphere conducive to compassionate care.

Determine and compare the viewpoints of nurses, patients and their relatives to workplace violence against nurses.

AIM: The present study aims to assess the perception of nurses, patients and their relatives regarding the nature of workplace violence against nurses. BACKGROUND: Workplace violence adversely affects the health, well-being and safety of nurses and the quality of nursing care. METHODS: In the present descriptive comparative study, the nature of violence was assessed using a modified and validated International Labor Office, the International Council of Nurses, World Health Organization, and Public Services International Questionnaire. RESULTS: Nurses, patients and relatives reported verbal abuse as the most common and sexual violence as the least common type of violence against nurses. Nurses mostly blamed factors associated with patients and their relatives as the cause of violence, whereas patients and their relatives blamed social factors. CONCLUSIONS: This study shows that violence is significantly prevalent in clinical settings, but its nature is differently perceived by nurses, patients and their relatives. This phenomenon requires further studies because knowledge of the causes of this difference could help to reduce and control violence. IMPLICATIONS FOR NURSING MANAGEMENT: It is necessary that nursing managers inform nurses about protocols for reporting all such cases in order to collect information, and based on a clear procedure, actively pursue reported cases and take the necessary measures to prevent violence against nurses.