Transformational leadership in development of transformative education in nursing: a qualitative study.

BACKGROUND: Regarding the dynamic and increasing needs of communities, changes in the education system are essential to train competent healthcare professionals. The study aimed to explore the experience of educational directors, teachers, and students to gain insight into the implementation of educational transformative programs. METHOD: A qualitative approach with the grounded theory method was applied in this study. Twenty-four participants were selected by using a purposive and theoretical sampling method. The data were collected from April 2019 to May 2020 in nursing schools of Tehran, through in-depth semi-structured individual face-to-face interviews and field notes. Collected data were analyzed by Corbin and Strauss's (2015) approach. RESULTS: In this study, transformational leadership was extracted as the core concept. The core concept emerged from four sub-concepts including transformative management; educational policy requirements; providing a platform and community-centered education. CONCLUSIONS: Nurse educational directors need to achieve some competencies and capabilities for implementing transformative education in nursing schools. Also, achieving a transformative perspective by educational directors is essential.

Effective factors and challenges of forming transformational education in the nursing education system: a qualitative study.

OBJECTIVES: In the nursing education system, evolution is required to train qualified and professionally competent nurses who can face workplace challenges and evolving needs of societies. This study aimed to explore effective factors and challenges of the formation of transformational education in the nursing education system. METHODS: This was a qualitative study with a grounded theory approach. Twenty-four individuals participated through purposive and theoretical sampling. The authors collected data using semi-structured interviews and analyzed them by Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Los Angeles: Sage Publication grounded-theory method. RESULTS: Findings showed the process of formation of transformational education which encompasses four concepts including, "transformational leadership", "effective learning", "necessity of foresight in education", and "inhibitors of educational transformation". Transformational education is a complex and multidimensional education. CONCLUSIONS: Implementation of this education requires preparing transformational leaders, planning to empower faculty members and students, and preparing for the challenges facing the education system.

The stakeholders' perceptions of the requirements of implementing innovative educational approaches in nursing: a qualitative content analysis study.

BACKGROUND: Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing. METHODS: In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical saturation in extracted categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method. RESULTS: Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were 'novel educational policymaking', 'Innovative education-oriented platform', and 'managing barriers of innovative educational approaches'. CONCLUSIONS: Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial.

Family-centered empowerment process in individuals with spinal cord injury living in Iran: a grounded theory study.

STUDY DESIGN: This was a qualitative study using grounded theory method. OBJECTIVES: To explain the process of family-centered empowerment in a population of individuals with SCI living in Iran. SETTING: Brain and SCI Research Center, Social Welfare Center, and SCI Association of Tehran; Iran. METHODS: Participants were 19 persons with traumatic SCI, 13 family member caregivers, and 11 health care providers selected through purposeful sampling. Data were collected using face-to-face, semi-structured interviews, which were continued until data saturation. The interview data were methodically collected and analyzed using Strauss and Corbin's (1998) recommended method for grounded theory. Constant comparative analysis was simultaneously conducted through reviews of the interview statements, observations of behavior, interviewer field notes, and interviewer memos. The analysis was managed in MAXQDA software version 10. RESULTS: The process of family-centered empowerment following SCI included five categories: (1) disruption in the existential integrity of the individual; (2) constructive life recovery; (3) inhibitors of family-centered empowerment; (4) facilitators of family-centered empowerment, and (5) back on track. Constructive life recovery was selected as the core variable using the grounded theory method. This core variable identified the strategies most frequently used by the participants to cope with the challenges of SCI-related impairment, disability, and overall life management. CONCLUSIONS: Family-centered empowerment process in individuals with SCI living in Iran emerged from the data. The model includes early disruptions in the bio-psycho-social and vocational lives of individuals with SCI and their families, strategies for recovery post injury, inhibitors and facilitators of family-centered empowerment, the gradual return to work and daily activities, and the expected social roles for individuals with SCI.

A phenomenological study of the experience of domestic violence in Iranian women with HIV.

This study explores the lived experience of domestic violence in HIV-infected women in Iran using a qualitative phenomenological approach. Data were collected in 2014 through in-depth interview of twelve HIV-infected women purposefully selected from a counselling centre in Tehran. The qualitative data were analysed using a thematic analysis approach. The main theme that emerged was 'the sunset of life' - an emotional numbing and fragile marital relationship resulting from the violence suffered by the women. From this, three sub-themes expressing women's feelings of hopelessness were extracted: 'the destroyed life', 'being in the destiny prison' and 'living on the edge of annihilation'. The results revealed that although the experience of domestic violence had devastating effects on women's lives, HIV infection was the factor that forced them to remain trapped in violent relationships. The findings emphasize the importance of designing comprehensive violence prevention strategies tailored to meeting the needs of HIV-infected women in Iran.

The attainment of physician's professional identity through meaningful practice: A qualitative study.

Background: Medical professional identity is how an individual perceives him/herself as a doctor. Formation of professional identity includes development, advancement, and socialization through social learning of specific knowledge, skills obtained while performing professional roles, practicing, and new attitudes and values. A qualitative study was performed to examine live experience of undergraduate medical science students with regards to obtaining professional identity. Methods: This qualitative study was performed using a conventional content analysis method. Participants were students who were studying medicine at Iran University of Medical Sciences. Sampling was done based on a purposeful sampling method. A total of 23 students took part in semi-structured interviews until data saturation was reached. The interviews were transcribed verbatim. Also, to develop themes, data were analyzed using conventional content analysis. Moreover, data management was done using MAXQDA software. Results: Based on data analysis, 2 main themes were as follow: meaningful medical practice" and "professional medical practice". The first theme had 3 categories: (i) self-insight; (ii) manner; and (iii) values and beliefs. The second theme had 2 categories: (i) professionalism; and (ii) holistic view of medicine. Conclusion: Certain individual characteristics and personality type were factors that affected participants' choice of their field of study. The participants' understanding of their profession was formed, not only by studying in the university through learning relevant knowledge, skills, and practice, but also by perceived attitude, views, and values in their profession.

Toward overcoming physical disability in spinal cord injury: a qualitative inquiry of the experiences of injured individuals and their families.

BACKGROUND: Spinal cord injury (SCI) is a life-changing experience for the individuals with SCI and their families. This study aimed to investigate physical strategies used for overcoming physical disability in individuals with SCI. METHODS: In this qualitative study, 17 SCI persons and 13 family caregivers were selected by a purposeful sampling. Settings of the study were Brain and SCI research (BASIR) center of Tehran University of Medical Sciences and Southern Social Welfare Center of Tehran and SCI Association of Tehran, Iran. Data were collected by face-to-face semi-structured interviews, which were continued until data saturation. The gathered data were concurrently analyzed by the content analysis method. RESULTS: The data analysis revealed one main theme (towards overcoming physical disability) and three sub-themes: 1) physical rehabilitation by various methods; 2) tendency towards the use of alternative medical methods; and 3) making effort for self-reliance. CONCLUSION: The participants used physiotherapy and occupational therapy as an effective and essential approach offered by the healthcare team. Some individuals with SCI with help of their family had invented simple rehabilitation equipment for help to their physical rehabilitation. However, most participants had referred to different complimentary medicine specialists based on advice friends and relatives and they often had spent a lot of time and money ineffectively. Therefore, they need training and support of the healthcare team as well as social support to achieve physical independence and physical recovery. Further research is suggested to investigate the barriers to achieving physical empowerment in people with SCI in Iran.

The childbearing experience of women with spinal cord injury in Iran: a phenomenological study.

STUDY DESIGN: This was a qualitative study conducted using an interpretative phenomenological approach. OBJECTIVES: This study investigated the experience of pregnancy and childbirth in women with spinal cord injury (SCI). SETTING: Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. METHODS: The data were collected using telecommunication and face-to-face semi-structured interviews with eight women with SCI. The study employed the interpretative phenomenological approach suggested by Van Manen in 2016 and thematic analysis to provide a comprehensive understanding of the childbearing experience of women with SCI. MAXQDA 10 software was used to manage the collected data. RESULTS: Five main themes have emerged from data analysis: "revivification", "fear and concern of motherhood with SCI", "flawed health care system", "maternal experience under a supportive umbrella", and "strengthening spirituality and religious belief". CONCLUSION: Childbearing had a positive effect on the family relationship, continuity of marriage, and quality of life following SCI. There are potential benefits in establishing a center that provides consultation on childbearing and childcare for women with SCI. Moreover, training for the medical team, which includes nurses, midwives, and specialists is highly recommended. Further research is needed to expand our understanding of childbearing from the perspectives of healthcare providers.

Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behavior questionnaire in persons with spinal cord injury.

STUDY DESIGN: Cross-sectional psychometric study. OBJECTIVE: To evaluate the reliability and validity of a spinal cord injury lifestyle scale (SCILS) and Health Behavior Questionnaire (HBQ) in the Persian language for persons with spinal cord injury (SCI). SETTING: Participants were selected among those referred to health centers and the Brain and Spinal Cord Injury Research Center. METHOD: In accordance with standard procedure for translation, two questionnaires, the SCILS and HBQ, were translated using a forward and backward translation approach by professional translators. Face validity of the questionnaires was assessed by ten persons with SCI and content validity was agreed upon by 12 professors from health care teaching universities. To test the final versions of both questionnaires, 97 persons with SCI were included using a consecutive sampling method. Other questionnaires were used to assess concurrent validity (secondary impairment checklist, as well as SCILS and HBQ) and convergent validity (impact of event scale revised, brief symptom inventory, beck depression inventory, and functional independence measure). RESULTS: Internal consistency of SCILS and HBQ, assessed by Cronbach's alpha, was 0.75 for SCILS and 0.85 for HBQ. Test-retest reliability intraclass correlations were 0.86 and 0.92 for SCILS and HBQ, respectively. The number of current secondary impairments had a significant and negative correlation with SCILS (r = -0.22, P < 0.001), but it was not correlated with HBQ. SCILS had a significant and strong correlation with HBQ (r = 0.65, P < 0.001). CONCLUSION: SCILS and HBQ can be used for measuring the health behavior of persons with SCI in Iran.

Hepatitis-related stigma in chronic patients: A qualitative study.

BACKGROUND: Hepatitis is one of health problems throughout the world. It has numerous consequences on patients' life. Stigma, depression, social marginalization and financial problems are some of the challenges in these patients. AIM: The purpose of this qualitative study was to examine hepatitis-related stigma and discrimination in patients living with chronic hepatitis in Iranian society. METHODS: This present study was designed as a qualitative method, and this article shows up the results of a qualitative research study undertaken with patients living with hepatitis in Iran. The study uses a content analysis method. A purposive sample of 18 patients was chosen. Data were collected through a semi-structured interview and field note that the researchers will take during participants' observation. Data analysis process was performed on the texts which were generated from verbatim transcripts of the participants interviews. RESULTS: Participants were between 18 and 61 years old. The main theme, Stigma, emerged from three themes during the process data analysis in this study. These themes were including fear to lose of family and social support, fear to present in public and fear of transmission. CONCLUSIONS: This research indicates that stigma presents major challenges not only for patients living with chronic hepatitis but also for nurses, other healthcare practitioners, family and social networks, institutions and society. The researcher suggests that interventions to reduce or eliminate stigma should require individual, structural, cultural thought, society and systemic changes.

Re-designing Orem's Self-care Theory for Patients with Chronic Hepatitis.

BACKGROUND: Hepatitis is an inflammatory disease which has many adverse effects on patients' life because of its chronic nature. Since Orem's theory of self-care is a grounded theory, the concepts and applications of this theory in patients with chronic hepatitis who have special needs may lead to some challenges. The purpose of this study was to explore self-care in patients with chronic hepatitis. METHODS/DESIGN: A directed content analysis was used in this qualitative study. Participants were recruited from a metropolitan area. Data were collected through semi-structured interviews. The verbatim transcripts of the participants' interviews were analyzed according to directed content analysis. RESULTS: In this study, four themes, suggested by Orem, were drawn from the data according to directed content analysis. The codes generated from the data were classified into concepts and then the concepts were assigned into these four themes. These themes were needs in the matrix of time and place, self-care agency, need for change in self-care and consequences of hepatitis. CONCLUSION: The use of Orem's self-care theory cannot meet the need for self-care in hepatitis patients because these patients have vital sexual, respect and belonging, physical, economical, and psychological-behavioral needs, and lack adequate knowledge about self-care. Consequently, the specific self-care model developed in this study helps health professionals identify self-care activities in patients with chronic hepatitis.

Disciplined care for disciplined patients: experience of hospitalized blind patients.

Blindness is a permanent condition that alters daily life of blind people. Interpretive phenomenology was used to understand lived experiences of the hospitalized blind people. "Disciplined care for disciplined patients" was one of the themes that emerged from the data. Provision of disciplined care can help health care professionals provide a holistic and comprehensive competent care for blind patients.

"Struggle against Bitter Life": Lived Experience of Iranian Nurses with HIV/AIDS.

Objectives: The impact of HIV/AIDS on the healthcare system in many countries, particularly in developing countries is significant. Due to the high prevalence of HIV/AIDS in these countries, remarkable number of nurses have contracted HIV through their work. HIV/AIDS poses a major threat to people's physical and emotional health status as well as their social well-being and it has overwhelming effects on personal and social lives of HIV-positive people. HIV-positive nurses, like other patients, are subject to many stresses, but because of their special professional and social conditions they may bear more psychological and social burdens. Materials and methods: A hermeneutic phenomenological approach was used to examine the everyday experiences of nurses who suffer HIV/AIDS. To conduct the study, six methodical steps which developed by van Manen (1990) applied in the process of the inquiry. Eight HIV-positive nurses were recruited and selected through a purposive sampling method. Data was collected by conducting 12 face-to-face in-depth semi-structured interviews with participants, two women and six men who became HIV-infected through occupational exposure. A thematic analysis method was used to extract themes and sub-themes. Results:Through thematic analysis of transcriptions, two main themes 'past, not passed' and 'struggle against bitter life' emerged. We found that the daily life of HIV/AIDS nurses is like a limbo between the past and the present. They are constantly trying to push themselves from this limbo of death to life. Conclusion:According to the results, participants were immersed in bitter memories of their past, which has always cast a dark shadow over their lives. Their lived space surrounded by many bitterness and adversities, yet they have the enthusiasm to move on with their lives and struggle day-to-day to maintain their relative health and have their job as a nurse. As result, management of HIV/AIDS is not only about fighting the virus, but it imposes many issues and problems on nurses, which should be given more attention and support.

Struggle Turning Back to Professional Nursing Practice in Iran: A Qualitative Study.

BACKGROUND: Current nursing shortage is becoming more complicated because of turnover intention among nurses. Most of the inactive nurses in Iran after a long time for various rations Returned To Professional Nursing Practice (RTPNP). Because the RTPNP program does not exist in Iran to prepare inactive nurses returning to practice, this study aimed to explore the strategies that contribute to preparing nurses for RTPNP. MATERIALS AND METHODS: The present study was a part of the findings of a larger grounded theory study that lasted about 9 months from April 2019 to December 2019. The data were collected through semi-structured interviews with participants after signing an informed consent form. The average interview duration was 40 minutes. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Participants included eight nurses, two education supervisors, two matrons, and two head nurses. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method. RESULTS: Struggle turning back to PNP was the main category that emerged from four categories of "seeking learning resources," "return to practice support," "getting used to a practice," and "building a new family life" from the data analysis process. CONCLUSIONS: Returners struggle to get prepared for providing PNP to clients if there is no definite process of RTPNP. Organizational support and RTPNP programs are efficient strategies and could help these returners get prepared for PNP.

Effect of a Breathing Exercise on Respiratory Function and 6-Minute Walking Distance in Patients Under Hemodialysis: A Randomized Controlled Trial.

BACKGROUND: Pulmonary disorders and poor functional capacity are common complications in patients under hemodialysis. Although breathing exercise is frequently prescribed to improve respiratory function, its efficacy in this patient community is not well established. PURPOSE: Our study was designed to determine the effectiveness of a breathing exercise on respiratory function and 6-minute walk (6MW) distance in patients under hemodialysis. METHODS: A randomized controlled trial approach was used. The sample consisted of 52 patients under hemodialysis from a university teaching hospital in Iran. The experimental group (n = 26) received the breathing exercise program and was encouraged to perform incentive spirometry for 2 months. The control group (n = 26) received only routine hospital care. The respiratory function test and 6MW test were performed at baseline and at 2 months after the intervention (posttest). RESULTS: The two groups were homogeneous in terms of respiratory function parameters, 6MW distance, and demographic characteristics at baseline. Forced expiratory volume in 1 second and forced vital capacity were significantly better in the experimental group compared with the control group at 2 months after intervention. No significant difference was found in 6MW distance between the groups at the 2-month posttest. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 2-month breathing exercise effectively improved pulmonary function parameters (forced vital capacity, forced expiratory volume in 1 second) in patients under hemodialysis but did not affect 6MW distance. Hemodialysis nurses should strengthen their clinical health education and apply breathing exercise programs to reduce the pulmonary complications experienced by patients under hemodialysis.

Promoting patients health in intensive care units by family members and nurses: A literature review.

BACKGROUND: Hospitalization in intensive care units (ICUs) can cause physiological and psychological challenges for patients and their family members. Using a family-centered approach in provision of visiting hours promotes the health of patients. The purpose of this study is to review the perception of nurses and family members of patients in ICUs about visiting their patients. METHODOLOGY: The published articles in the last 10 years from 2008 to 2018 on the perception of nurses and family members of patients in critical care units about visiting their patients searched for in databases including ScienceDirect, PubMed, Cochrane, Google Scholar, SID, Scopus, CINAHL, OVID, IRANDOC, and Magiran using keywords "family members perception," "nurses' perception," "intensive care units," and "visiting" in English and Farsi, and finally, 15 articles were selected. RESULTS: Results showed that nurses do not have appropriate viewpoint about visiting patients in ICUs, and they discussed and outlined the barriers of visiting patients given the benefits of family members' presence. CONCLUSION: There are several limitations on the process of family members visiting their patients in the ICUs. It is essential to modify the nurses' attitudes and remove the organizational limitations in this area.

Nursing education in the path of globalization: Promotion or challenge?

Globalization has been attracted by great literature and papers of many disciplines in recent years. Although globalization has considerable social, political, and economic effects, it has turned to an important challenge in health-care systems. Nursing, as the largest part of the health system in the world, has also been affected by globalization. The purpose of the present paper is to critique globalization and its impacts on the nursing profession. This review article was conducted by searching for reliable internet resources in the English language on the impact of globalization on nursing. Published articles were searched until 2018, and related articles were extracted in three stages: 1-selection of articles by reading abstract, 2-selection with an overview of the text, and 3-selection with a full review of the article's text. According to the literature of globalization, we categorize and discuss the nursing areas that are affected by globalization in nine areas: global nursing development, nurses emigration,information interchange and interactions in nursing, higher education in nursing, professional territory, nursing specialization, professional ethics, management and supervision, and professional independence. The intensity of globalization effects on the nursing profession has not been the same in all societies, and factors such as compliance of society, culture, and technology are among the most important factors that affect it. Globalization is an inevitable process and brings with itself many prominent promotions such as global nursing development and important challenges such as nursing emigration and ethical issues.

Interpersonal Communication among Critical Care Nurses: an Ethnographic Study.

Introduction: Interpersonal communication in critical care units is one of the most important factors due to complicated and critical conditions of patients. Nurses' confrontation with ethical distresses and conflict resolution techniques are often influenced by the culture governing these units. This study aimed to explore interpersonal communication culture among critical care nurses. Methods: A focused ethnographic approach was used to conduct study in Iran. The research method was based on the research evolutionary cycle model recommended by Spradley (1980). Data were collected over six months through purposeful sampling and semi structured interviews (n=18) and participation observation (n=43). The data were obtained over six months of observation and interview with participants. Data analysis was done by Spradley method and was interpreted to discover the meaning units from the obtained themes. MAXQDA10 was used to manage data. Results: Five major domains of observations and high-level consensus were extracted in this study, including grouping, work-life interaction, professionalism, organizational atmosphere and experience. Conclusion: Development of interpersonal communication culture is influenced by various factors. Besides, the working models and nurses' use of workspace are indispensable components of effective communication at workplace. The findings of this study can be helpful in determining appropriate strategies and practices to resolve communication problems among nurses by specifying challenges, thereby leading to proper communication among nurses, promoting this communication and finally providing high quality and more effective care.

Using intelligent interaction to manage student-supervisor conflict: A qualitative study.

INTRODUCTION: Student-supervisor conflict is inevitable in an academic setting. The purpose of the present study aimed to argue that using intelligent interaction as an appropriate strategy to manage the student-supervisor conflict in Iranian nursing schools. MATERIALS AND METHODS: This qualitative study was a part of larger grounded theory research. Data were collected by conducting a semi-structured interview with nine nursing students and five supervisors who were selected by purposeful sampling in the current investigation. Data analysis was done through the recommended method of Corbin and Strauss (2015). RESULTS: Intelligent interaction was extracted as one of the main categories for managing student-supervisor conflict. Intelligent interaction consisted of four subcategories including use a logic strategy, competent role play, flexible and smart selection, and getting help from other sources. CONCLUSION: Intelligent interaction is an appropriate strategy to resolve and manage the supervisor-student conflict in the Iranian academic setting. It is suggested that universities must consider intelligent interaction in developing a policy-procedure process for managing the student-supervisor conflict in Iranian academic settings.

Exploring the process of turning back to professional nursing practice in Iran: A grounded theory.

BACKGROUND: The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost-effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice. MATERIALS AND METHODS: This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi-structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method. RESULTS: In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The "transformed competence" as the core concept and the four main concepts of "feeling alienated with the new environment," "getting prepared for restart," "gradual maturity in clinical practice," and "components of organizational culture" were extracted from the data analysis process. CONCLUSION: The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.