Exploring challenges among Iranian family caregivers of seniors with multiple chronic conditions: a qualitative research study.

BACKGROUND: It is believed that seniors with multiple chronic diseases are in dire need of support from their family caregivers; however, it can impose a significant burden on these caregivers. Therefore, it is imperative to take into account caregivers' needs, as covert patients, along with the needs of patients; besides, it is necessary to develop supportive and health promotion programs for them. There is a critical gap in the knowledge about health problems related to family caregivers of the growing population of these senior citizens. The present study aimed to explain the challenges imposed on family caregivers of seniors with several chronic diseases in Iran. METHODS: This study was conducted based on the conventional qualitative content analysis method. For this purpose, 13 family caregivers of seniors with several chronic diseases were selected using the purposive sampling method. The study population included those referred to two health centers and outpatient clinics of two public hospitals in Khorramabad, Iran. Data were collected through semi-structured interviews. Data analysis was performed along with data collection using inductive thematic analysis proposed by Elo and Kyngäs. Besides, Guba and Lincoln's criteria were used to ensure the trustworthiness of the data. RESULTS: The analysis of the obtained data led to the identification of challenges of family caregivers of the older patients with multiple chronic diseases; these challenges were classified into six main categories, including the impact of caregiving on family relationships, disruption of social relationships, disruption of personal and occupational plans, physical health-related issues, negative emotions, and dealing with the high costs of care. CONCLUSIONS: Given that family caregivers may face several challenges while taking care of seniors with multiple chronic diseases, healthcare providers should design and plan various interventions based on such challenges using a caregiver-centered approach.

Psychometric Properties of Nursing Manager Communication Competency Questionnaire (CCCQ): An Instrument Design Study.

Introduction: One of the most important factors that can enhance the efficiency and success of hospitals for achieving the objectives is the communication competency of nursing managers. Due to the lack of a local questionnaire to measure the communication competency of nursing managers, the present study has been conducted aimed to design and validate the Nursing Manager Communication Competency Questionnaire (NMCCQ). Method: First, after designing the questionnaire (production of primary items), based on the definition of the results of the study, the analysis of Schwartz, Barcott, and Kim's hybrid concept was performed and then it was evaluated. According to the definitions of the results of Schwartz, Barcott, and Kim's Hybrid concept analysis study, the questionnaire was designed and then it has been assessed psychometrically. Face validity with the opinion of 15 participants and content validity have been assessed using the opinion of 15 experts. Construct validity has been assessed by 300 nurses via completing the questionnaire using factor analysis. Results: First, a questionnaire with 83 items of qualitative data was made. After confirming content validity, the number of items reduced to 62 items. Exploratory factor analysis included five constructs of non-verbal communication skill, negotiation, reporting, communication ethics, and the application of communication knowledge, which consisted of 56 items that together accounted for 61.410% of the observed variance. Cronbach's alpha coefficient for constructs ranged from 0.862 to 0.987 and the intra-class correlation coefficient (ICC) ranged from 0.969 to 0.994. Conclusion: The results showed that nursing managers' communication competency questionnaire is a valid and reliable scale that can help managers select, assess, and appoint nursing managers. As a result, this tool can be used in future studies.

Competencies of charge nurses: a systematic review and thematic synthesis.

OBJECTIVE: To determine the competencies of charge nurses. METHODS: The systematic review and thematic synthesis study was done at Iran from1 Apr 2018 to 31 Jul 2018. Five electronic bibliographic database (Science Direct, Pro Quest, Scopus, Pub-Med, Scientific Information Database) were systematically searched for relevant literature published from 1980 to 2018. Content analysis was done to categorise competency of charge nurses. RESULTS: Of the 1285 articles, 24(1.86%) were reviewed. Through thematic synthesis, six themes identified were self-management, others' management, clinical competency, conceptual-cognitive competency, professional-legal competency and competency in communication. There is need to improve knowledge and skills in the domains of management, leadership, communication and perceptual/cognitive competency. CONCLUSIONS: The findings may help nurse administrators and nurse directors in designing training programmes for charge nurses who could improve their competencies.

The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study.

BACKGROUND: Community-oriented nursing care is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian community for nearly two decades. Resource management, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions between CNCSCs and their clients. METHODS: This study has a qualitative design and was conducted on a total of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and direct observations and were analyzed using conventional qualitative content analysis. RESULTS: The analysis of the data led to the extraction of three main categories, including the flaunted atmosphere due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction. CONCLUSION: To increase affordability and satisfaction and expand private community-based nursing. Services, appropriate financial policies should be designed and applied that can lead to transparent and simple financial transactions with the clients by way of indirect monetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and be cost-effective for the clients, insurance companies and the health system.

Relative Tranquility in Ostomy Patients' Social Life: A Qualitative Content Analysis.

BACKGROUND: Ostomy significantly alters one's elimination pattern and can affect the individual in physiological, psychosocial and spiritual aspects. Over time, the ostomy patient's experience changes and they develop coping strategies to handle the new reality. The aims of this study sought Iranian ostomy patients' main problem, how they deal and the outcome of their efforts to manage that problem in their daily lives. METHOD: A qualitative content analysis was conducted involving twenty-seven ostomy patients that were chosen by purposeful sampling and referred to the Iranian Ostomy Association from October 2015 to June 2016. RESULTS: The mean age of the participants was 55 years, 15 were males, the major cause of ostomy was colorectal cancer and the colostomy was the most common type of ostomy, and nineteen of them between one and twenty years lived with an ostomy. Most of them were married, had bachelor degree and received adjuvant therapy, and few were employed. Guarantee indecisive to maintain a stable life with an ostomy and the possibility of ostomy disclosure unpredictability show relative tranquility in patients' social life. CONCLUSION: Because of the ostomy nature, there is not the possibility of full control over life with an ostomy and this issue is causing concerns in their family and social life.

Turbulent Atmosphere-Based Dominant Management Behavior of the Head Nurses in Clinical Wards: A Qualitative Study.

BACKGROUND: Nursing management is the most important aspect for providing high-quality nursing care. Therefore, skillful nursing managers, such as head nurses, are required to accomplish this goal. High-quality nursing care is one of the most important principles of health organizations to ensure society's health. OBJECTIVES: The goal of the conventional content analysis is to explain the dominant experienced-based behavior of the head nurses in clinical wards. MATERIALS AND METHODS: This study was conducted by applying a quality study approach with a common content analysis model (Granheim and Lundmen). The participants were 25 head nurses who were working in the wards of various hospitals in Zahedan City. They were selected via the purposeful sampling method. The data were collected thoroughly and continued until a saturation stage was reached. RESULTS: The result of data analysis was the theme "turbulent atmosphere-based management," which consists of five categories as follows: the work culture of the ward, job burnout, negligent evaluation, job conflict, and decision making with limited effects. CONCLUSIONS: The analysis of the findings of the present study through considering the defined categories demonstrated that, to modify and correct the turbulent atmosphere-based management, several important measures are required and need to be continually monitored.

Improved fatigue in individuals with multiple sclerosis after participating in a short-term self-care programme.

BACKGROUND: Fatigue is among the most common, yet least understood symptoms of Multiple Sclerosis (MS). The debilitating symptoms of MS can have adverse effects on the sufferer's self-esteem. We report the effect of a short-term self-managed graded exercise programme on fatigue and self-esteem of patients with MS. METHODS: Thirty-four (age range: 20-50, mean: 29.7 years; M:F 0.7:1.0) patients with MS who lived in Tehran and were not physically disabled entered the study. Self-esteem score was measured with the Persian translation of the Coopersmith Self-Esteem Inventory. Fatigue was evaluated with a visual analogue scale. The patients performed the self-managed techniques for 6 weeks. Self-esteem and fatigue were evaluated once more after the self-managed graded exercise programme. RESULTS: On paired sample test, the self-esteem score of the patients was significantly different before (53.9) and after (68.1) the self-managed graded exercise programme (P<0.0001). The score of fatigue was also significantly different before (4.59) and after (5.76) the intervention (P<0.0001). CONCLUSIONS: This study can provide us with important insights into our understanding of the potential for developing self-care training as an alternative in rehabilitation of the patients with MS. Self-managed graded exercise programme may be considered as an alternative to direct nursing services for patients with MS.