The effects of a Namaste care program on quality of life: A pilot study in Iranian women with late-stage Alzheimer's disease.

The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings.

Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study.

BACKGROUND: Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services. METHODS: The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire. RESULTS: In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance. CONCLUSION: Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

Older adults' self-advocacy in patient safety: a cross-sectional study.

BACKGROUND: patient advocacy is a major nursing role, which is linked to supporting, encouraging and reinforcing self-advocacy in patients. Patient safety is an important nursing outcome, especially in older adults. AIMS: older adults' self-advocacy regarding patient safety behaviour and its relationship with some demographic characteristics were assessed. METHODS: a valid older adult patients' self-advocacy questionnaire, which included subscales of behaviour, self-efficacy, attitude and outcome efficacy (range of scores=0-63), was used. In this cross-sectional study, 230 patients aged over 60 years were selected using a stratified sampling method. FINDINGS: an association was found between total self-advocacy score (mean=40.16; SD=9.6) and rural living (ß=-0.168; P=0.016) using multiple linear regression analysis. Similar findings were found between questionnaire subscales and sex, rural living, occupation and age. CONCLUSION: older adults, especially women, those of advanced age and those in rural areas, may benefit from nursing interventions to improve their self-advocacy in patient safety.

Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

The assessment of safe nursing care: development and psychometric evaluation.

AIM: To develop an instrument for the assessment of safe nursing care (ASNC) within the Iranian context and psychometrically evaluate its reliability and validity. BACKGROUND: There is a need for a valid and reliable instrument to assess how nurses employ the components of safe nursing care in clinical practice in non-Western countries. METHOD: This methodological study was conducted in two phases: (1) a qualitative phase of instrument development, and (2) a quantitative phase of psychometric evaluation of the assessment of safe nursing care (ASNC). The instrument's content validity was assessed by experts in the field of safe nursing care. The reliability of this instrument was examined using internal consistency reliability and intra-rater reliability analysis. Exploratory factor analysis was then conducted to establish the instrument's initial construct validity. RESULTS: The instrument developed was a questionnaire with 32 items. The Cronbach's alpha of the scale was 0.92, and Intra-class Correlation Coefficient for intra-rater reliability was 0.78. Exploratory factor analysis resulted in a four-factor solution: (1) evaluation of nursing skills, (2) assessing the patient's psychological needs, (3) assessing the patient's physical need, and (4) Assessing nurses' teamwork. The four factors accounted for 63.54% of the observed variance. CONCLUSION: The ASNC can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of safe care, and its initial reliability and validity. IMPLICATIONS FOR NURSING MANAGEMENT: The ASNC can help nurse managers assess whether clinical nurses are prepared to apply their safe care skills in clinical practice. It can also be used by clinical nurses to assess their own and peers' practice to detect potential areas for improvement in nursing care and help nurse managers with planning appropriate quality improvement programmes.

Iranian nurses perspectives on assessment of safe care: an exploratory study.

AIM: To explore the perspectives and experiences of nurse instructors and clinical nurses regarding the assessment of safe nursing care and its components in clinical practice. BACKGROUND: Safe nursing care is a key aspect of risk management in the healthcare system. The assessment of safe nursing care and identification of its components are primary steps to establish patient safety and risk management and enhance the quality of care in clinical practice. METHODS: This was an interview study, with qualitative content analysis. Semi-structured interviews were conducted with 16 nurse instructors and clinical nurses including nurse managers chosen by purposive sampling based on theoretical saturation. Data collection and analysis were carried out simultaneously until data saturation was reached. RESULTS: Data analysis led to the extraction of four main themes: holistic assessment of safe nursing care; team working and assessment of safe nursing care; ethical issues; and challenges of safe nursing care assessment. CONCLUSION: Identifying these four components in the assessment of safe nursing care offers a contribution to the understanding of the elements of safe care assessment and the potential for improved patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: Safe care management requires the accurate and reliable assessment of safe nursing care and the need for strategies for reporting actual or potential unsafe care and errors to ensure patient safety.

Cardiac patients' perception of patient-centred care: a qualitative study.

AIM: The aim of this study was to explore cardiac patients' perception of patient-centred care. BACKGROUND: Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction. DESIGN: This study is a descriptive qualitative study. METHODS: Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews. FINDINGS: The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions. CONCLUSIONS: Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care. IMPLICATIONS FOR PRACTICE: Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care.

Nursing students' expectations regarding effective clinical education: a qualitative study.

This study aimed to describe the expectations of Bachelor of Science nursing students regarding what constitutes an effective clinical education. In this study, a semistructured interview process was utilized with 17 nursing students studying in sophomore, junior and senior years in training units of hospitals affiliated with Tehran University of Medical Sciences. Content analysis was employed to analyse the data. Data analysis led to identification of three main themes: (i) appropriate communication and interaction between instructors and students; (ii) incorporation of both theory and practice in clinical education, with two subthemes, one being the presence of the instructor as a factor for reducing the gap between theory and practice and the other being evaluation based on appropriate criteria; and (iii) having specialized instructors, with a specific emphasis on the instructor's knowledge and motivation as important factors in learning. The findings reveal the significant role of mentors in providing effective educational and clinical experiences. Therefore, mentors must strive to develop their knowledge and clinical behaviours according to students' needs in clinical settings.

Critical care nurses' understanding of the concept of patient-centered care in Iran: a qualitative study.

This study explores the perception of nurses working in critical care units about the patient-centered care, which is a crucial factor in attaining quality in nursing care. A qualitative exploratory study with conventional content analysis was used. Three main themes were extracted from the data: from accepting to understanding the patient; improved care as the result of skill and expertise; and adherence to patients' rights charter.

Implementation of evidence-based nursing practice for diabetic patients: an Iranian experience.

Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice.

Nursing image: an evolutionary concept analysis.

A long-term challenge to the nursing profession is the concept of image. In this study, we used the Rodgers' evolutionary concept analysis approach to analyze the concept of nursing image (NI). The aim of this concept analysis was to clarify the attributes, antecedents, consequences, and implications associated with the concept. We performed an integrative internet-based literature review to retrieve English literature published from 1980-2011. Findings showed that NI is a multidimensional, all-inclusive, paradoxical, dynamic, and complex concept. The media, invisibility, clothing style, nurses' behaviors, gender issues, and professional organizations are the most important antecedents of the concept. We found that NI is pivotal in staff recruitment and nursing shortage, resource allocation to nursing, nurses' job performance, workload, burnout and job dissatisfaction, violence against nurses, public trust, and salaries available to nurses. An in-depth understanding of the NI concept would assist nurses to eliminate negative stereotypes and build a more professional image for the nurse and the profession.

Nurses' experiences of uncertainty in clinical practice: a descriptive study.

AIM: This paper is a report of a qualitative descriptive study of nurses' experiences of uncertainty in clinical practice. BACKGROUND: Uncertainty as a complex phenomenon is inherent in many nursing and medical encounters and can vary along different dimensions. Despite the existence of studies on the theoretical definitions of uncertainty, few studies have been conducted to explore nurses' experiences in this regard and strategies employed by them to encounter situations of uncertainty in nursing practice. METHODS: Semi-structured interviews were conducted in 2009 with 18 female bachelor's degree nurses working in a teaching hospital in an urban area of Iran. Content analysis was used to identify themes. FINDINGS: The data analysis resulted in three main themes: 'unclear domain of practice', 'compatibility with uncertainty', 'psychological reactions to uncertainty'. The second theme consisted of two categories: 'losing sensitivity' and 'avoiding trouble'. The themes were not mutually exclusive or independent, but rather overlapping and intertwined. The themes and their related categories summarized the nurses' experiences of uncertain situations and the way they used to present efficacious care and meet patients' needs in spite of being immersed in uncertainty. CONCLUSION: Enhanced awareness and increased understanding about uncertainty can be important factors in improving nursing work environment and the quality of care presented to patients. The findings will be helpful for nurse managers to educate and prepare nurses in order to encounter uncertain situations in practice.

Patients' understandings and feelings of safety during hospitalization in Iran: a qualitative study.

The purpose of this study was to explore patients' understandings and feelings of safety during hospitalization. A qualitative design using a thematic analysis approach was used to gather and analyze the understandings of 19 patients (11 male and 8 female) hospitalized in medical and surgical wards of a teaching hospital in an urban area of Iran. After employing purposive sampling for the selection of participants, semistructured interviews were held for data collection. Three main themes emerged from the data analysis: from attention to recovery, becoming hopeful of life, and maintaining life routines. The second theme consisted of two subthemes: not to be forgotten and becoming optimistic toward health-care settings. Supporting mechanisms designed to improve the feeling of safety in hospitalized patients should consider the patient as a whole and emphasize the humanistic aspect of patient care. In addition we conclude that nurses need to learn to assume a leadership role in patient safety.

Effect of evidence-based education on Iranian nursing students' knowledge and attitude.

To adopt an evidence-based approach to education there is a need for research-based evidence to support its effectiveness. This study investigated the impact of evidence-based education on the knowledge and attitude of nursing students. In this quasi-experimental study, all nursing students (n = 41) studying the courses of musculoskeletal and gastrointestinal systems were chosen and assigned randomly to intervention and control groups. The groups were taught through an evidence-based or traditional approach. Students' knowledge and attitude were then evaluated. Data were gathered by three knowledge and two attitude questionnaires with multiple choice and Likert scales and then analyzed. It was shown that there was a significant difference between the average scores for attitude of the groups, but there was no statistically significant difference between the average scores of knowledge. The results suggest the evidence-based approach might be used as a complementary approach to nursing education. It was not only as effective as the usual method but also led to the acquisition of particular skills by students. The results can be used to formulate programs to design and implement evidence-based nursing education.

Clinical decision-making in senior nursing students in Iran.

Clinical decision-making is the basis for professional nursing practice. This can be taught and learned through appropriate teaching and clinical experiences. Unfortunately, it has been observed that many graduates are unable to demonstrate suitable clinical decision-making skills. Research and study on the process of decision-making and factors influencing it assists educators to find the appropriate educational and clinical strategies to teach nursing students. To explore the experience of nursing students and their view points regarding the factors influencing their development of clinical decision-making skills. An exploratory qualitative approach utilizing grounded theory methods was used; focus group interviews were undertaken with 32 fourth year nursing students and data were analysed using constant comparative analysis. Four main themes emerged from the data: clinical instructor incompetency, low self-efficacy, unconducive clinical learning climate and experiencing stress. The data indicated that students could not make clinical decisions independently. The findings of this study support the need to reform aspects of the curriculum in Iran in order to increase theory-practice integration and prepare a conductive clinical learning climate that enhances learning clinical decision-making with less stress.

Accreditation of nursing clinical services: Development of an appraisal tool.

Aim: This study aimed to determine comprehensive and applicable indicators for assessing the quality of nursing clinical services. Design: Methodological research. Methods: The checklist was designed in three phases (conceptualization, item generation and item reduction). In the first phase, a qualitative study using conventional content analysis was performed to clarify the concept of accreditation of clinical nursing services. In the second phase, using the views of experts was obtained in phase 1 and then by a review of the literature, related items were extracted, and item pool was formed. In the last phase, validity and reliability of the checklist were examined. Result: Based on three phases (Conceptualization, Item Generation and Item Reduction), the accreditation indicators of clinical nursing services were extracted in three dimensions including structure, process and outcome at two levels of organizational (including structural and outcome indicators) and individual performance appraisal (process indicators) in 19 main categories.

Iranian nurses' constraint for research utilization.

BACKGROUND: This paper identifies the views of Iranian clinical nurses regarding the utilization of nursing research in practice. There is a need to understand what restricts Iranian clinical nurses to use research findings. The aim of this study was to identify practicing nurses' view of aspects which they perceived constrain them from research utilization that summarizes and uses research findings to address a nursing practice problem. METHODS: Data were collected during 6 months by means of face-to face interviews follow by one focus group. Analysis was undertaken using a qualitative content analysis. RESULTS: Findings disclosed some key themes perceived by nurses to restrict them to use research findings: level of support require to be research active, to be research minded, the extent of nurses knowledge and skills about research and research utilization, level of educational preparation relating to using research, administration and executive challenges in clinical setting, and theory-practice gap. CONCLUSION: This study identifies constraints that require to be overcome for clinical nurses to actively get involved in research utilization. In this study nurses were generally interested to use research findings. However they felt restricted because of lack of time, lack of peer and manager support and limited knowledge and skills of the research process. This study also confirms that research utilization and the change to research nursing practice are complex issues which require both organizational and educational efforts.

The spectrum of barriers to and facilitators of research utilization in Iranian nursing.

AIM: The focus of the study is the identification of barriers to and facilitators of research utilization in nursing practice from the perspective of Iranian nurses. BACKGROUND: In Iran, research utilization is a new phenomenon thus our knowledge with regard to those factors that promote or discourage research use is limited. No overall picture of the state of research utilization in Iran therefore exists. METHOD: A descriptive design is used. The questionnaire was distributed to 410 nurses from educational hospitals and nursing schools affiliated with Tehran Medical Sciences University in Iran. RESULTS: The major barriers to research utilization were that the nurses do not have time to read research; facilities are inadequate for implementation; and nurses do not feel they have enough authority to change patient care procedures. Findings revealed a number of facilitators which were categorised into two main groups of human resources and individual/organisational factors. CONCLUSION: The healthcare system in Iran does not provide the incentive for nurses to engage in research or to avail themselves of research findings. Also, time is the major issue owing to a nursing shortage. If research utilization is to increase in Iran, therefore, the most important organisational change that needs to occur is the provision of available facilities for nurses to use research evidence. RELEVANCE TO CLINICAL PRACTICE: Key factors that need attention in implementing research results into practice are suggested. Clearly, identification of barriers and facilitators is useful potentially to overcome barriers and enforce facilitators and this could ultimately improve nursing practice.

Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses.

BACKGROUND AND PURPOSE: Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. METHODS: Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. RESULTS: Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." IMPLICATIONS FOR PRACTICE: Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

Motherhood challenges and well-being along with the studentship role among Iranian women: A qualitative study.

This study purposed to explore and describe the experiences of Iranian female students with the role of motherhood. This 2015 qualitative study used purposeful sampling to select 20 student mothers aged 24-50 who were studying at a state or non-state university in an urban area in northwest Iran. Data was collected through individual semi-structured interviews and analysed using a qualitative content analysis approach. Three main themes were developed during data analysis: "simultaneous management", "facilities", and "barriers". The management of maternal and family affairs by female students in universities where motherhood is not supported is a challenge. The significance of mother-student roles must be emphasized and support and education provided for women to gain skills useful in playing these roles. Policy makers should devise strategies for bringing change to the traditional perspective that motherhood and educational responsibilities cannot be met at the same time by one person.