Pediatric Ward Nurses' Caring Self-Efficacy Scale: Development and Validation.

BACKGROUND: No instrument specifically designed to investigate the caring self-efficacy of nurses in pediatric wards was found. The aim of the present study was therefore to develop a scale to evaluate pediatric wards nurse's caring self-efficacy. MATERIALS AND METHODS: In this study, an exploratory, sequential, mixed method was used in 2015 in Iran. Data collected from 27 semi-structured interviews with nurses in pediatric wards were analyzed using conventional content analysis. The initial version of the scale was obtained with 65 items. Face validity was determined using impact score and content validity using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The construct validity of the scale was investigated using exploratory factor analysis with 305 nurses in pediatric wards. The concurrent validity of the scale was acquired using the General Self-Efficacy Scale. Internal consistency and test-retest reliability were also examined. RESULTS: The scale-CVI (S-CVI) (average) was 0.85. The 14 items with a CVR and CVI of less than 0.51 and 0.70, respectively, were deleted and the final 51-item scale was approved. All 51 items had good impact score (>1.50). In the final scale, four subscales were extracted using construct validity. The concurrent validity of the scale was also obtained (r = 0.77, p < 0.001). The total Cronbach's α correlation coefficient of the scale was 0.96 and test-retest reliability was 0.98. CONCLUSIONS: The Pediatric Ward Nurses' Caring Self-Efficacy (PWNCSE) scale developed in this study is a practical, reliable, and valid scale to evaluate pediatric ward nurses' caring self-efficacy.

Research utilization process model: A cyclical, spiral, and developmental process to provide conclusive research knowledge in health professions education.

Background: Research utilization plays an important role in evidence-based practice. Health professions education is a research-based discipline. Conclusive research knowledge is ranked as high level of evidence in evidence-based practice. This study was conducted to develop a model to reach conclusive research knowledge in health professions education. Methods: This study was conducted in 2 phases. In the first phase, a qualitative content analysis of the literature was performed, which provided research utilization concepts to design a model. In the second phase, a group of 5 consultants of health professions education designed a preliminary model and revised it to develop an appropriate model for research utilization in health professions education. Results: The indicators mentioned in 24 documents were extracted and later categorized into 25 items. Then, 8 concepts emerged, including problem identification, research design and implementation, research reports, research publication, presentation, research access, adoption, and research use. These concepts were arranged to design a model for research utilization in health professions education. Conclusion: This study illustrated a cyclical, spiral, and developmental model to reach conclusive research knowledge. This model emphasizes both primary and secondary research projects to reach conclusive research knowledge. Also, it distinguishes between aligned transfer and cooperative presentation in research knowledge dissemination. This model reveals the importance of the process use in health profession education. Also, it distinguishes between use and misuse of research findings.

Design and psychometric properties of an instrument to assess metacognition in moral reasoning in medicine.

AIM: The present study aims at designing and assessing the psychometric properties of MCMR instruments to lead the medical ethics education to further goals and more definite steps. DESIGN: This is a cross sectional study. METHOD: This study was conducted in two phases; identifying the items and designing the instrument. In the preliminary phase, the qualitative study was carried out using conventional content analysis method. In the second phase, psychometric evaluation of instrument was done using face and content validity, construct validity and reliability. RESULTS: On the first phase of this study, 135 items were identified. After determining face and content validity, 111 items reached the stage of exploratory factor analysis. This instrumental analysis indicated the existence of 74 items and ten factors whose variance of the total is explained as 46.883%. Cronbach's alpha value was 0/75. And the intra-cluster correlation coefficient was 0.808.

The journey of thesis supervisors from novice to expert: a grounded theory study.

BACKGROUND: Supervision is a well-defined interpersonal relationship between the thesis supervisors and their students. The purpose of this study was to identify the patterns which can explain the process of expertise attainment by thesis supervisors. We aimed at developing a conceptual framework/model to explain this development based on the experience of both students and supervisors. METHODS: We have conducted a qualitative grounded theory study in 20 universities of medical sciences in Iran since 2017 by using purposive, snowball sampling, and theoretical sampling and enrolled 84 participants. The data were gathered through semi-structured interviews. Based on the encoding approach of Strauss and Corbin (1998), the data underwent open, axial, and selective coding by constant comparative analysis. Then, the core variables were selected, and a model was developed. RESULTS: We could obtain three themes and seven related subthemes, the central variable, which explains the process of expertise as the phenomenon of concentration and makes an association among the subthemes, was interactive accountability. The key dimensions during expertise process which generated the supervisors' competence development in research supervision consisted maturation; also, seven subthemes as curious observation, evaluation of the reality, poorly structured rules, lack of time, reflection in action, reflection on action, and interactive accountability emerged which explain the process of expertise attainment by thesis supervisors. CONCLUSIONS: As the core variable in the expertise process, accountability must be considered in expertise development program planning and decision- making. In other words, efforts must be made to improve responsibility and responsiveness.

Explaining professionalism in moral reasoning: a qualitative study.

PURPOSE: Professionalism is one of the most fundamental elements in judgment and moral reasoning and also an essential skill accompanied by other technical and scientific skills in the medical staff. Awareness of ethical aspects involves the clinical decision-making for patients. Therefore, this study aimed at explaining the role of professionalism in moral reasoning. PATIENTS AND METHODS: This qualitative study was conducted on 17 faculty members and clinical students of medicine department. The participants were selected through purposive sampling method, and the data were collected via semistructured interviews after getting informed consent. Then, data were analyzed using conventional content analysis method. RESULTS: Three main categories and eleven subcategories were classified as follows: professionalism principles with four subscales such as communication with patients, trust building, satisfying the patients, and moralism; professional responsibility with four subscales such as fulfillment of duties, commitment to professional rules, maintaining professional position, and dignity of the patient; professional evidence with three subscales based on data analysis such as patient's participation in decision-making, personal and other's experiences, and professional knowledge. CONCLUSION: Training qualified people in medicine is one of the important missions of the professors. Improving the professionalism in students enables them in moral reasoning. Training professional principles, responsibility, and using professional evidence are the strategies used for job commitment in moral reasoning, and emphasis on how to train medical ethics will support graduates.

Triggers for reflection in undergraduate clinical nursing education: A qualitative descriptive study.

BACKGROUND: Reflection is a key component of effective teaching in baccalaureate nursing education. However, there are limited empirical studies into the factors which trigger reflection in undergraduate clinical nursing education. OBJECTIVES: This study aimed to explore reflection triggers in undergraduate clinical nursing education with a specific focus on verbalized reflection in spoken dialogues. METHODS: This qualitative descriptive study was conducted in 2017-2018. Participants were seventeen clinical nursing instructors, 32 nursing students, and nine newly graduated nurses who were purposively recruited from four universities and two hospitals in Iran. Data were collected via 26 in-depth semi-structured face-to-face interviews with clinical nursing instructors and newly graduated nurses and four focus group discussions with students. Conventional content analysis was used for data analysis. RESULTS: Reflection triggers fell into the following four main categories: conscious comparison of actions, confrontation with influential realities, emotional and moral involvement in patient care, and demanding accountability. CONCLUSION: This study suggests triggers for reflection in clinical nursing education. Instructors' use of reflection triggers can help students reflect on their actions and practice.

Begin Again and Continue With Life: A Qualitative Study on the Experiences of Cardiac Rehabilitation Patients.

BACKGROUND: Cardiovascular diseases are a main cause of mortality worldwide. However, new diagnostic techniques and treatments have increased the rate of survival for patients with cardiovascular disease. Cardiac rehabilitation programs aim to maintain and enhance the quality of life of patients and improve the secondary prevention of coronary artery disease. Suboptimal participation in rehabilitation programs, early exit from these programs, and not achieving lasting changes are cardiac rehabilitation challenges that are associated with health issues, including the increased need for medication, repeated hospitalization, failure in the secondary prevention programs, and long waiting lists. Exploring the meaning of behavioral changes in the context of cardiac rehabilitation may facilitate the design of effective interventions that are critical to achieving the goals of cardiac rehabilitation programs. PURPOSE: This study explored the mechanisms that underlie behavioral changes within cardiac rehabilitation centers. METHODS: We used a descriptive qualitative approach, which is widely acknowledged as the best approach for eliciting in-depth descriptions of behavioral changes in the context of cardiac rehabilitation centers. Using purposive sampling, 15 men and 8 women with coronary heart disease were referred to the two cardiac rehabilitation centers participating in this study. The inclusion criteria were participation in four cardiac rehabilitation sessions and ability and willingness to participate. The data were collected using semistructured in-depth interviews, and the inductive thematic analysis method was used for analysis. RESULTS: "Trying to stay alive" and "begin again" arose as the two main themes related to behavioral change. These themes include the changes in cognition and values that lead to improvements in the process of behavioral change as a major outcome of cardiac rehabilitation. CONCLUSIONS: Using psychosocial interventions such as creating and strengthening hope and meaningful intrinsic motivation in the context of rehabilitation centers often helps deal with these challenges. "Trying to stay alive" may take place before referral to a cardiac rehabilitation center. Therefore, psychosocial nursing interventions such as motivational interviewing are designed to improve a process that may be already underway. Thus, stress and anxiety may be treated based on beliefs and emotions. The primary emphasis in cardiac rehabilitation should include changing the beliefs of the patient and motivating her or him to achieve sustainable behavioral change.

Altruism, the values dimension of caring self-efficacy concept in Iranian pediatric nurses.

BACKGROUND: Self-efficacy is the most influential among factors affecting nurses' performance. Yet, understanding of the constituent elements of the caring self-efficacy concept was not considered. This study was to introduce altruism as one of the main aspects of caring self-efficacy in pediatric nurses. MATERIALS AND METHODS: This is part of a larger study on the concept of caring self-efficacy conducted with qualitative content analysis approach in Iran. Participants included 27 clinical pediatric nurses and instructors, selected purposively. Data were collected using semi-structured interviews and analyzed using conventional content analysis method. RESULTS: Theme "altruism" as one of the main themes extracted from the analysis of the interviews in this study. This theme includes two main categories of "humanistic care" and "caring attitude." CONCLUSIONS: This paper introduces altruism as one of the values aspects of caring self-efficacy in pediatric nurses. Efficient nurse with features Humanistic care, through the provision of maternal care and family-centered care and caring attitudes resulting from religious beliefs and loving children to care for the children.

Exploring the Dominant Discourse of Baccalaureate Nursing Education in Iran.

INTRODUCTION: Understanding how academic dominant discourse is implicated in the shaping of nursing identity, professional aspirations and socialization of nursing students is useful as it can lead to strategies that promote nursing profession. MATERIALS AND METHODS: This is a qualitative research conducted through discourse analysis approach. Semi-structured interviews, focus group, and direct observation of undergraduate theoretical and clinical courses were used to collect the data. Participants were 71 nursing students, 20 nursing educators, and 5 nursing board staffs from five universities in Iran. RESULTS: Data analysis resulted in the development of four main themes that represent essential discourses of nursing education. The discourses explored are theoretical and scientific nursing, domination of biomedical paradigm, caring as an empty signifier, and more than expected role of research in nursing education discourse. CONCLUSIONS: The results indicated that academics attempt to define itself based on "scientific knowledge" and faculties seek to socialize students by emphasizing the scientific/theoretical basis of nursing and research, with the dominance of biomedical discourse. It fails to conceptually grasp the reality of nursing practice, and the result is an untested and impoverished theoretical discourse. The analysis highlights the need for the formation of a strong and new discourse, which contains articulation of signifiers extracted from the nature of the profession.

Self-Preservation in Both Sides: Pathology of Spiritual Care in Iran.

The aim of this study was to create a deeper understanding of the variables that may restrain or progress spiritual care in Iran. This manuscript provides an in-depth description of barriers to delivering spiritual care by nurses as well as patients' compensatory mechanisms against deprivation from spiritual care termed "self-preservation in both sides" emerged from an empirical study. It brings issues such as structural, hierarchical, social and personal concerns, which may prevent advancing spirituality within health care, to light. Thirty-five participants, nurses (n = 10), patients (n = 22) and their relatives (n = 3), took part in this study, and data were analyzed using qualitative content analysis method. Being aware of these results may help nurses and healthcare professionals to engage with and overcome some of the structural, hierarchical and social variables affecting spiritual care.

Living under a cloud of threat: the experience of Iranian female caregivers with a first-degree relative with breast cancer.

BACKGROUNDS: Breast cancer is a global threat to all women, especially those having close relatives with breast cancer. Women who were caregivers to relatives with breast cancer are more vulnerable to stress caused by the perception of heightened risk of cancer. Because health measures and breast health are affected by cultural beliefs and social status, information about breast cancer should consider the cultural beliefs and values of the society. OBJECTIVES: This study explored the experiences of Iranian women who were caregivers to relatives with breast cancer. METHODS: In this qualitative content analysis study, 21 female caregivers of breast cancer patients were chosen by purposive sampling. Data were collected through interviews and analyzed using content analysis. RESULTS: Data analysis developed 3 categories: perception of the concept of risk, changing views about femininity, and management of perceived threat. Perception of the risk of breast cancer increased in caregivers, and they tried to manage the perceived threat. They considered the breast to be an important part of women's lives, and breast cancer in relatives changed their view of femininity. CONCLUSION: Understanding the experiences of breast cancer family caregivers in different cultures can help in planning, counseling, and effective intervention.

Discourse analysis: A useful methodology for health-care system researches.

Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular research strategy for researchers in various disciplines which has been little employed by health-care researchers. The methodology involves a focus on the sociocultural and political context in which text and talk occur. DA adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and productive qualitative methodology but has been underutilized within health-care system research. Without a clear understanding of discourse theory and DA it is difficult to comprehend important research findings and impossible to use DA as a research strategy. To redress this deficiency, in this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical background, DA types and analysis strategy. Finally, we discuss how affect to the ideological dimension of such phenomena discourse in health-care system, health beliefs and intra-disciplinary relationship in health-care system.

Threats to Pediatric Nurses' Perception of Caring Self-efficacy: A Qualitative Study.

BACKGROUND: Nurses are considered the largest and most important human resource for healthcare organizations. Self-efficacy as the main predictor of nurses' behavior plays an important role in nurses' professional behavior. However, the various dimensions and threats of caring self- efficacy concept have not been taken into consideration. OBJECTIVES: The present paper attempts to identify threats to self-efficacy as an important aspect of the concept of pediatric nurses' caring self-efficacy. MATERIALS AND METHODS: This study is part of a larger study on the caring self-efficacy concept that was conducted through content analysis and from a qualitative approach in 2014 in Iran. Twenty-seven nurses and pediatric clinical instructors participated in this research according to the purposive sampling method employed in the study. Data were collected through semi-structured interviews. The collected data were analyzed using the conventional content analysis method. RESULTS: "Threats to self-efficacy" was one of the main themes extracted from the interview analysis results in the present study. The theme consists of two main categories "individual barriers," including not having a caring attitude and not being interested in children, and "organizational barriers," including an inefficient educational system, not developing professional capabilities, non-valuation of the organization in a caring context, a poor rewards system, and inappropriate managerial policies. CONCLUSIONS: Nursing management and custodians of nursing trainings can break through the barriers to self-efficacy by knowing these factors and making changes in the educational programs and providing supporting policies. This can be an important step toward improving nurses' inefficacy and ultimately improving the provision of quality healthcare services.

The impact of health-related quality of life on the incidence of ischaemic heart disease and stroke; a cohort study in an Iranian population.

OBJECTIVE: The aim of study was to evaluate the impact of health-related quality of life (QoL) on the occurrence of ischaemic heart disease (IHD) and stroke using a validated questionnaire. METHODS: We followed the 3,283 subjects, aged ≥ 35 years and without history of cardiovascular events (CVE) over four years from 2007 to 2011 from the Isfahan cohort study. The World Health Organization QoL questionnaire (WHOQOL-BREF), which contains four separate domains, was used to assess QoL. Incidence rates of IHD and stroke were recorded during follow-up. Socioeconomic demographic data including marital state, educational level, occupation, income and place of living and metabolic risk factors such as diabetes mellitus (DM), hypertension (HTN), dyslipidaemia, body mass index and smoking were also recorded. RESULTS: More IHD (42%) and stroke (57%) patients were illiterate; while the educational status was significantly different only in the IHD group (P = 0.000). Differences in income and occupation were notable in patients with stroke and IHD, respectively, compared to subjects without them (P < 0.050). DM and HTN were significantly higher in IHD and stroke patients in comparison with subjects without CVE (P = 0.000). Two-way multivariate analyses of covariance test after age, educational status and metabolic risk factors adjustment showed that subjects with stroke had a significantly higher score in all QoL domains in comparison with individuals without stroke (P < 0.050). There was no significant association between QoL domains and IHD incidence (P > 0.050). CONCLUSION: This study indicates that there is no association between QoL and IHD incidence although there was a significant relationship between higher QoL and incidence of stroke.

Transition to the new role of caregiving for families of patients with breast cancer: a qualitative descriptive exploratory study.

BACKGROUND: Families, especially in Eastern and Muslim countries, routinely accept the responsibility of caring for cancer patients. This study describes the transition to the new role of caregiving from the perspective of family caregivers in Iran as part of the current trend of recognizing the experiences of family members of breast cancer patients from different cultural perspectives. MATERIALS AND METHODS: A descriptive exploratory qualitative research approach was used to investigate the experiences of family caregivers of patients with breast cancer in the transition to caregiving. The subjects were 23 family caregivers of breast cancer patients referred to cancer centers at Isfahan University hospitals who were selected by purposive sampling. Data was gathered through in-depth interviews. Interview transcripts were analyzed using conventional content analysis with an inductive approach. RESULTS: Data analysis identified the following categories: grasping a new situation without preparation, perceived inefficiency, infinite absence, and abandoned in the role. Caregivers believed that they were not prepared for their new circumstances and did not have the necessary competence and capabilities to meet the challenges of caregiving. They experienced negative consequences resulting from the difficult responsibility of caregiving. Moreover, they believed that they received limited support from relatives, health-care providers, and the community. CONCLUSION: The transition to the new role of caregiving is affected by experiences specific to the conditions of the caretakers. When these conditions can be understood and identified, it is possible to provide detailed information for policymaking and planning for family-centered care.

Positive changes after breast cancer: A qualitative study.

INTRODUCTION: Traumatic events such as breast cancer along with negative effects on patients also have positive effects. These cases have been studied less in Iran. Therefore, this study was conducted with the aim of explanation of positive changes after breast cancer by using a qualitative approach. MATERIALS AND METHODS: This qualitative study was conducted in 2012 in one of the specialized centers for cancer affiliated to Isfahan University of Medical Sciences. In this study, it was interviewed with 19 women with breast cancer about positive changes after cancer by using individual, open and deep methods. The interviews were analyzed with conventional content analysis method. RESULTS: The titles of the three major categories were included as behavioral changes to maintain and promote health (acquisition of health information and adopting promoting health behaviors), spiritual development (attention to the God and sense of meaning in life, revising the values and priorities, strengthening moral and behavioral traits) and personal growth and flourish (feeling empowerment, confidence and efforts to achieve the goals and desires). These three categories have led to emerge themes in this study as the "Awakening after cancer." CONCLUSIONS: The results of this study indicated positive changes after breast cancer. Considering such changes while providing care and consulting to patients with breast cancer in addition to facilitate and accelerate positive changes will be prompted to provide care and proper and influential consulting to promote patient health.

Behavioral Change Challenges in the Context of Center-Based Cardiac Rehabilitation: A Qualitative Study.

BACKGROUND: Cardiovascular disease is chronic and often a sign of long-standing unhealthy lifestyle habits. Patients need support to reach lifestyle changes, well-being, join in social and vocational activity. Thus, patient responsibility should to be encouraged to provide quality as well as longevity. Cardiac rehabilitation programs aid patients in the attainment of these objectives. However, research shows that behavioral change following the diagnosis of a chronic disease is a challenge. OBJECTIVES: We sought to determine behavioral change challenges in patients with cardiovascular disease to improve intervention programs. PATIENTS AND METHODS: Using a descriptive qualitative approach, we collected the data using 30 in-depth semi-structure interviews. Thematic analysis was conducted to identify themes from the data. RESULTS: Three sources of behavioral change challenges emerged regarding the nature of cardiac disease and the role of the individual and the family in the recovery process. These challenges acted at two levels: intra- and interpersonal. The intrapersonal factors comprised value, knowledge and judgment about cardiovascular disease, and self-efficacy to fulfill the rehabilitation task. Family overprotection constituted the principal component of the interpersonal level. CONCLUSIONS: Behaviors are actually adopted and sustained by patients are so far from that recommended by health professionals. This gap could be reduced by identifying behavioral change challenges, rooted in the beliefs of the individual and the family. Therefore, culturally-based interventions to enhance disease self-management should be considered.

Exploring the environment of clinical baccalaureate nursing students' education in Iran; A qualitative descriptive study.

INTRODUCTION: Today's students are the nurses of tomorrow. They need appropriate clinical learning opportunities in order to shape their professional identity, attitudes and values. Despite undeniable progresses of nursing education in Iran, the quality of the clinical education in Iran is not favorable. There is a need to explore the environment of clinical baccalaureate nursing students' education for developing, maintaining and enhancing the quality of clinical program. METHOD: This is a qualitative study and was conducted based on content analysis multimethod design. Data were collected by individual interviews, focus groups and direct observations. 54 nursing students and 8 clinical educators from the four geographically diverse universities in the Iran composed the study sample. A purposive sampling was used. RESULT: Five themes were emerged from data analysis including; ambiguity in the nursing care role, routine-based nursing care, uncritical and dependent thinking climate, incompetency of clinical educators and patient education as important component of nursing. CONCLUSIONS: The findings of this study describe a clearer understanding of the real environment of the clinical education in Iran. All of themes that emerged from the study play an important role in student learning and nursing education. It is crucial to pay more attention to reconsider care concept as an operational component of nursing, maximize meaningful learning opportunities, reevaluate clinical instructor as role models and prepare effective operational plan to combine theoretical and evidence based knowledge with clinical practice.

Pediatric nurses' perception of factors associated with caring self-efficacy: A qualitative content analysis.

BACKGROUND: Nurses, who are considered to form the largest group of professional healthcare providers, face the challenge of maintaining, promoting, and providing quality nursing care and to prepare themselves to function confidently and to care effectively. Among the factors affecting nursing performance, self-efficacy has been expected to have the greatest influence. However, the concept of caring self-efficacy was not considered and no research has been done in this field in Iran. This study was conducted to explore and identify the factors described by pediatric nurses as related to caring self-efficacy. MATERIALS AND METHODS: This is a qualitative study conducted through content analysis in 2013 in Iran. Twenty-four participants were selected through purposive sampling method from pediatric nurses and educators. Data were collected through semi-structured interviews. Data were analyzed using conventional content analysis method. RESULTS: The analysis of the interviews in this study led to the development of four main themes: (1) Professional knowledge of children caring, (2) experience, (3) caring motivation, and (4) efficient educational system as the factors influencing caring self-efficacy perception of pediatric nurses. CONCLUSIONS: This article presents the factors associated with the perception of caring self-efficacy in pediatric nurses' perspective. This finding can be used by nursing administrators and instructors, especially in the area of pediatric caring, to enhance nursing professional practice and the quality of pediatric caring.