Care Process in Iranian Nursing Homes: A Grounded Theory Study.

Introduction: The need and use of long-term care services for older people has increased with their rising population and there is little information about the state of serving in nursing homes. This study aimed to identify the caring process in Iranian nursing homes. Methods: This qualitative study was conducted in three Iranian nursing homes using grounded theory approach. The participants included 28 individuals (14 older people and 14 caregivers). The data were collected using unstructured interviews up to data saturation, and analyzed by constant comparative method. Results: Fragmented care emerged as the core variable. The main factor for developing the core variable was 'experience-based caring'. Other factors included 'inappropriate structure for care' as contextual factors in the nursing homes environment and 'keeping instead of caring', 'dismal life', and 'up and down of the path' as strategies and consequences. Conclusions: The most common type of care was the routine and unplanned one with focusing on physical aspects. To improve a delivery care system for older people in nursing homes, proposing a care plan with focus on an integrated model of care in nursing homes, provision of instructions for treatment, as well as supervision and training caregivers to provide better care are necessary.

Information Seeking Experiences of Family Caregivers of Patients with Persistent Vegetative State: A Qualitative Study.

BACKGROUND: Providing care for patients in Persistent Vegetative State (PVS) by family caregivers without enough training and knowledge may be problematic both for the patients and for the caregivers. Therefore, the present study tries to explain the experiences of family caregivers of patients with PVS of seeking information needed to provide adequate care. MATERIALS AND METHODS: Twenty two participants, including 17 family caregivers and 5 professional caregivers were enrolled by purposive sampling into this qualitative content analysis study, carried out between 2013 and 2015. Unstructured interviews and field notes were used to gather the data. Data collection was stopped when data saturation was achieved. Data analysis was performed by content analysis based on Graneheim and Lundman's approach. RESULTS: As a result of the analysis of the collected data a main theme emerged labeled as "Seeking constructive education" with three categories including "Neglected requisite education," "Greedy search for useful education" and "Dynamic independence in care." CONCLUSIONS: In this study, information seeking by family caregivers of patients with PVS was constructive. Family caregivers insistently sought needed information from various sources. Ultimately, they found these insistent efforts beneficial and fruitful, because their efforts made them independent in providing care for their patients.

Evaluation of the Effect of Support-Training System of Peer Group on Promotion of Self-Care in ß-Thalassemia Major Patients in Southern Iran.

ß-Thalassemia (ß-thal) is a chronic illness and its complications make the patient less compliant with the treatment protocol. This study aimed to evaluate the effect of a support-training system of peer group on promotion of self-care in ß-thal major (ß-TM) patients. In this semi-experimental study, 112 ß-TM were randomly selected and assigned to the study and control groups. Seven ß-TM patients, who were physically, mentally and socially normal, were selected and trained as the peer group. Eight training sessions over 4 months were done by the peer group. The questionnaire with 50 questions was scored using the Likert scale, always with 1 point, sometimes 0.5 point and never 0 points. In the study group, before intervention, the mean score of the patients was 29.84 ± 6.16, which, after intervention, increased significantly to 37.14 ± 4.35, p < 0.001. In the control group, the overall mean self-care patients' score decreased significantly, from 29.76 ± 7.18 to 29.48 ± 7.02. No significant difference was observed between pre and post intervention in the control group in all aspects of self-care (daily activities, fitness and wellness, nourishment, stress relief, job and home environment, time management, expression and creativity, support, items supporting self-care, self-care of the sickness), but it was significant in the study group. The results revealed the positive impact of peer group in promoting self-care of ß-TM patients in the study group compared to the control group, which may be used as a frontline educational model in these patients.

The Resilient Care of Patients with Vegetative State at Home: a Grounded Theory.

Introduction: The care of patients in vegetative state at home is difficult because they need continuous medical interventions and extensive care. The present study aims to explain the process of home care of patients in vegetative state at home. Methods: This study was a qualitative research with a grounded theory approach. The participants were 22 people (included 17 family caregivers and 5 professional caregivers) who were enrolled in a purposive sampling. Data was gathered through unstructured interviews, observations and field notes. Data collection was continued to saturation. Data analysis was performed through the Strauss and Corbin 1998 approach. The MAXQDA10 software was used to facilitate data analysis. Results: The data analysis led to emerge four main concepts included "erosive care", "erosive expenditures", "seeking solver education" and "lasting hope" as the axes of the study. Participants' experiences showed that the main concern of family caregivers of vegetative patients was "playing an inevitable role in care", in which they did not hesitate to make any effort, and they tolerated all the problems and issues. Therefore, "resilient care" was extracted as the underlying idea of this study. Conclusion: The process of resilient care of vegetative patients at home showed planning by policy makers in health system is very important and underscored the necessity for supporting families and family caregivers of these patients. So some changes in the health system for this goal might include considering home care and supporting them in various aspects, especially information, financial and emotional dimensions.

The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: A qualitative study.

BACKGROUND: To respond to the growing and emerging needs of the people in the health sector, the nurses need to develop their working domain from the hospitals to the community and be prepared to provide entrepreneurial roles at different care levels. Thus, to discover how to identify entrepreneurial opportunities in the field of nursing entrepreneurship, a study was conducted with the aim of describing the experiences of Iranian entrepreneurs on the identification of proper opportunities in entrepreneurship. MATERIALS AND METHODS: This study was a qualitative research in which the Graneheim and Lundman's content analysis was used to collect and analyze the data. Thirteen entrepreneurial nurses were purposefully selected, and the data were collected by unstructured interviews. RESULTS: As a result of data analysis, three main themes were obtained including the resources for opportunity identification and opportunity assessment and identification of proper opportunities. CONCLUSION: The findings indicate how to identify entrepreneurial opportunities in the field of health by entrepreneurial nurses which is the first step in the entrepreneurial process. Therefore, the findings of this study can be used to educate nurses who are interested in entering the field of nursing entrepreneurship.

Perspectives and Experiences Related to Help-Seeking Behaviors: A Content Analysis Study of Iranian Patients With Multiple Sclerosis.

BACKGROUND: Patients with multiple sclerosis practice help-seeking behaviors largely because of the progression of this physically exhausting disease, which has far reaching psychosocial consequences and requires hospitalization during severe disease exacerbations. PURPOSE: The aim of this study was to describe the perspectives and experiences of Iranian patients with multiple sclerosis regarding help-seeking behaviors. METHODS: A qualitative design, based on the content analysis approach, was used. Data were drawn from unstructured interviews that were held with 23 participants, who were referred from two teaching hospitals and from the Multiple Sclerosis Society in Ahvaz, Iran. RESULTS: During the data analysis, four main themes emerged, including "reliance on God and recourse to the imams," "striving to gain caring knowledge," "a need for comprehensive support," and "attention to spiritual care." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Healthcare team members, especially nurses, should pay attention to perspectives of patients with multiple sclerosis and try to address these patients' help-seeking behaviors to provide high-quality care.The authors hope that the findings of this study will inform the construction of interventional strategies to improve nursing care and facilitate the provision of better support services for people with MS.

Nurses' commitment to respecting patient dignity.

BACKGROUND: Although respecting human dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing care. Therefore, the present study aimed to investigate nurses' commitment to respecting patient dignity in hospitals of Isfahan, Iran. METHODS: This descriptive-analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from different wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient-nurse relationships, privacy, and independence. All items were scored based on a five-point Likert scale. The collected data were analyzed using descriptive statistics and Chi-square tests. P < 0.05 were considered significant in all analyses. FINDINGS: Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection as moderate/good. Only 6.5% of the subjects rated it as excellent. The majority of the patients (84.4%) believed their independence was maintained. These subjects also approved of taking part in decision-making. CONCLUSION: According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing authorities and policy makers are thus required to introduce appropriate measures to improve the existing conditions.

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.

Factors Influencing School Health in Elementary Schools in Isfahan, Iran: A Qualitative Study.

BACKGROUND: Students' health and future health of the community are related to providing health care in schools and since in every society, different contextual factors affect this matter, the present study aims to recognize the factors influencing the health care elementary students are provided with. METHODS: This qualitative content analysis was performed in 2014 in Isfahan. This study was conducted on school health instructors of elementary schools. Through targeted sampling, 15 health care providers, two mothers and 3 principals from 23 elementary schools were selected. Twenty-two semi-structured interviews were performed. Qualitative data analysis was done using qualitative content analysis. RESULTS: In this study, 3 concepts were extracted: family umbrella over health (with two sub-categories of 'family's social status and its effect on health' and 'family and health'), functional resources (with two sub-categories of 'opportunity', 'availability of resources for diagnosis') and health components (with two sub-categories of 'culture', 'the value of school health'). These contextual factors must be considered in providing health care for schools. CONCLUSIONS: Consideration of effective contextual factors on providing elementary students with health care can help improve health for this group.

The Lived Experience of Psoriasis Patients from Social Stigma and Rejection: A Qualitative Study.

BACKGROUND: Psoriasis is a common, chronic skin disease that causes challenges such as stigma and labeling from both the community and individuals due to its effects on appearance. OBJECTIVES: The objective of this study was to describe and explain the social stigma and rejection experienced by patients with psoriasis. PATIENTS AND METHODS: The present research is a qualitative study with a hermeneutic phenomenological approach conducted among psoriasis patients referring to the dermatology clinic and ward of Imam Khomeini hospital in Ahvaz, Iran between June and December 2014. In this study, 15 patients with psoriasis were selected by purposeful sampling, and they were asked to express their experience of stigma and rejection. The data were collected through in-depth semi-structured interviews, and Diekelmann and colleagues' method was used for data analysis. RESULTS: After analysis of interviews, four themes were extracted: lack of social support, unrealistic and inappropriate labeling, rejection and isolation, and feeling of absurdity and futility. These can be indicative of the patients' experience from social stigma and rejection phenomena. CONCLUSIONS: Patients' experiences of stigma and rejection phenomena indicated that all aspects of their lives are affected. Moreover, these findings highlight the significance of stigma and rejection concepts in providing better care to these patients.

Investigating the effect of an empowerment program on physical activity of the elderly in Rezaeian Health Center, Iran, in 2014.

BACKGROUND: Reaching geriatric period is one of the greatest successes in human Beings. The older adults are predisposed to risk of many diseases and disabilities, and physical activity is one of the most efficient methods to prevent geriatric period disorders. Therefore, the present study aimed define the effect of an empowerment program on physical activity of the elderly residing in Shahid Rezaian health care center in 2014. MATERIALS AND METHODS: This quasi-experimental study was conducted on 70 older adults, age 65 years and over, selected through convenient sampling and assigned to groups of study and control. Study group was divided into 5 seven-member subgroups and a one-hour session of physical exercises was administrated for them once a week for eight sequential weeks. All subjects evaluated before and after intervention by International Physical Activity Questionnaire. Subjects' physical activity was scored, based on the personal activity protocol,and the results were compared. Significance level was considered as P<0.05. RESULTS: Frequency distributions of the female subjects were 29 (82%) and 28 (80%) in study and control groups respectively. Mean (SD) scores of physical activity were 347.8 (174.1) and 321.7 (119.2) before intervention, and 641.3 (240.6) and 331.3 (101.5) after intervention in study and control groups respectively. Independent t-test showed a significant increase in physical activity score in study group, compared to control (t=4.06, P<0.001). CONCLUSIONS: The level of physical activity can be improved in the elderly through application of an empowerment program so as to take steps toward solving their immobility related problems and promoting their health through application of an empowerment program at this period of their life.

Policy makers' viewpoints on implementation of the World Health Organization Framework Convention on Tobacco Control in Iran: A qualitative investigation of program facilitators.

BACKGROUND: The epidemic of smoking is a great concern of health systems. Moreover, the number of smokers is increasing worldwide and this has led to an escalating trend of morbidity, mortality, and burden of smoking-related diseases. Therefore, monitoring the implementation of tobacco control laws in different countries is of extreme importance. This study aimed to describe policy makers' experiences and perceptions of the facilitating factors of the implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in Iran. METHODS: This was a qualitative research in which data were collected through individual interviews. The participants included policy makers who were members of the national assembly for tobacco control. In this study, 13 unstructured interviews of about 45 to 60 minutes duration were conducted in an extrapolative manner. The qualitative content analysis method was applied until extrapolation of basic themes was complete. RESULTS: As a result of the analysis, the themes of performance through training, through research, through intersectoral collaboration, and through setting priorities emerged. The emerged themes connote some critical points that have key roles in promoting the effective implementation of the WHO FCTC. Furthermore, the main role of the health sector becomes predominant. CONCLUSION: The study findings suggested the managed and coordinated work as one of the main facilitating factors of the implementation of the WHO FCTC at a national level.

Iranian entrepreneur nurses' perceived barriers to entrepreneurship: A qualitative study.

BACKGROUND: To respond efficiently to the increasing and new needs of people in health issues, it is necessary for nurses to develop their knowledge from hospital to society and to be equipped to play entrepreneur role in different levels of care. The present study was conducted to describe Iranian entrepreneur nurses' perceived barriers to entrepreneurship, in order to identify the existing barriers. MATERIALS AND METHODS: This is a qualitative study in which Graneheim and Lundman's content analysis method was employed. Thirteen entrepreneur nurses were chosen purposively, and data were gathered by unstructured interviews. RESULTS: As a result of the data analysis, five major themes were extracted: Traditional nursing structure, legal limitations, traditional attitudes of governmental managers, unprofessional behaviors of colleagues, and immoral business. CONCLUSIONS: The findings of the present study show that Iranian nurses are confronted with various problems and barriers to enter entrepreneur nursing and keep going in this area. By focusing on such barriers and applying appropriate changes, policymakers and planners in health can facilitate nurses entering into this activity.

Caring in an atmosphere of uncertainty: perspectives and experiences of caregivers of peoples undergoing haemodialysis in Iran.

BACKGROUND: Chronic renal failure is one of the major causes of mortality and disability worldwide. Although dialysis treatment is considered as a life-saving treatment for these patients, their caregivers face various problems making the atmosphere of caring uncertain. AIMS: This study is aimed to explore and describe the experiences and perspectives of family caregivers of the patients undergoing haemodialysis. METHODS: In this study, 20 haemodialysis family caregivers were selected by purposeful sampling. Data gathering techniques in this research were in-depth and unstructured interview and field observation. The researchers used an inductive thematic analysis approach to analysing the interviews' data. FINDINGS: Three main themes emerged from the data indicating the patients' care are conducted in a state of uncertainty including constant struggle to learn, effort and adherence to the divine thread, and in disease's captivity. CONCLUSIONS: Caring in an uncertain atmosphere leads to decreased efficiency and quality of family caregivers' care. To promote and improve the efficiency of care, healthcare planners should pay attention to the challenges and perspectives of caregivers of the patients undergoing haemodialysis.

Design and Evaluation of Reform Plan for Local Academic Nursing Challenges Using Action Research.

PURPOSE: This study identifies challenges to the first nurse training program for undergraduate nursing students at a nursing and midwifery school in Iran using a collaborative approach in order to improve the program. METHODS: Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. The participants were 148 individuals from nursing academic and clinical settings, including administrators, faculty members, students, and staff nurses. We obtained approval from the research deputy and ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran for this study. RESULTS: Lack of coherence in the educational program and implementation of the program, inadequate communication between management inside and outside the organization, insufficient understanding of situations by students, and improper control of inhibitors and use of facilitators in teaching and in practice were among the major challenges in the first training process in the context of this study. After classification of problems, the educational decision-making authorities of the school developed an operational program with stakeholder cooperation to plan initial reforms, implementation of reforms, reflection about the actions, and evaluation. Comparison of student satisfaction with the collaborative learning process versus the traditional method showed that except for the atmosphere in the clinical learning environment (p>.05), the mean differences for all dimensions were statistically significant. CONCLUSIONS: The results confirm the overall success of the revised partnership program, but stressed the need for further modification of some details for its implementation in future rounds.

Self-medication and its Effective Modifiable Factors among Elderly Referred Health Care Centers in Shahr-e-Kord in 2015.

INTRODUCTION: Drug overuse is a serious problem for health care, and one of the biggest problems for the socio-economic well-being of different communities. The elderly tend to use more drugs due to changes in their cognitive and physiological factors. One of the best ways to evaluate the health level of elderly people is to evaluate their self-medication. This study was conducted to investigate self-medication among the elderly in Shahr-e-Kord. METHODS: This cross-sectional study was conducted on 350 people older than 65 in Shahr-e-Kord in 2015. Sampling was done in two stages. In the first stage, the city of Shahr-e-Kord was divided into four areas using geographical maps. Eighty-eight people were selected from each area. The research instrument was a questionnaire called the Health Belief Model (HBM). The data were analyzed using SPSS version 20, the chi-squared test, the independent-samples t-test, and the Pearson correlation coefficient. RESULTS: No significant relationship was observed between the prevalence of self-medication with demographic variables and level of awareness. But there was a significant difference between sensitivity, perceived severity, and perceived barriers and educational level. There also was a significant difference between the perceived benefits and their income level. There also was a significant difference between the level of awareness, sensitivity, severity, benefits, and barriers of people with and without a history of self-medication (p < 0.05). CONCLUSION: Due to the adverse effects of self-medication and the high prevalence of this activity among the elderly, it is recommended that a training program be developed and implemented to change the knowledge and beliefs of the elderly about self-medication.

Sense of coherence as a mediator of health-related quality of life dimensions in patients with breast cancer: a longitudinal study with prospective design.

BACKGROUND: In our previous study, we found that the degree of sense of coherence (SOC) and baseline ratings of several dimensions of health-related quality of life (HRQoL) were the most important predictors of HRQoL changes 6 months after the pre-diagnosis period of breast cancer. To find a way to explain these findings, the aim of this study was to explore the mediating effect of the SOC between ratings of HRQoL dimensions before final diagnosis, and ratings of the same dimensions at the 6 months follow up, within a sample of women with breast cancer. METHODS: A longitudinal study with a prospective design at baseline (T1) and 6 months later (T2) was conducted on 162 women with breast cancer. To measure HRQoL dimensions three different questionnaires, the European Organization for Research and Treatment of Cancer QLQ-30, the SF-12 Health Survey version 2 and the Health Index were applied at T1 and T2 to cover both diagnostic-specific and generic dimensions. Measurement of the SOC as a mediator was done by the SOC-13 scale. RESULTS: Mediational analyses on eight significant pairs of HRQoL dimensions showed that the degree of SOC totally mediated variations of global quality of life (p < 0.001) as well as cognitive and social functioning (p <0.05) scores between T1 to T2. Changes in the scores of emotional functioning (p < 0.01), fatigue (p < 0.05), financial difficulties (p < 0.05), well-being (p < 0.001), and mental health component (p < 0.001) were partially mediated. The degree of SOC explained 16% to 45% of the variances in HRQoL dimensions at T2. CONCLUSIONS: The mediating pathway of the SOC in the context of this study appears to be the key to understanding how a higher sense of coherence as an inner resource may serve as a protective psychological factor in the adaptation process of the patients. Clinicians might consider coherence-oriented structure of the SOC and the connection between the SOC and HRQoL data in intervention plans from the first visit onwards. It may assist the identification of women who are at greater risk for maladaptation to the breast cancer trajectory.

Resources of learning through hidden curriculum: Iranian nursing students' perspective.

BACKGROUND: Students tend to internalize and perpetuate the patterns of behavior and the values surrounding them. Review of literature showed that there are several student learning sources through the hidden curriculum, but they have not been identified in nursing yet. Hence, the purpose of this study is explanation of learning resources in the hidden curriculum in the view of baccalaureate nursing students. MATERIALS AND METHODS: This qualitative study was carried out in 2012 with the participation of 32 baccalaureate nursing students in Nursing and Midwifery College of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran by purposeful sampling strategies. Data were collected by semi-structured interviews and continued to the level of data saturation and themes' emergence. Data analysis was performed through inductive content analysis method. RESULT: "Instructor as the unique learning element," "various learning resources in the clinical setting," and "instructive nature of the education environment" were extracted as the main themes, each of which incorporated some categories. CONCLUSION: Baccalaureate undergraduate nursing students learnt the hidden curriculum by the resources such as instructors, resources existing in the clinical setting, and the university campus. Therefore, more research is recommended for the identification of other resources. In order to promote positive messages and reduce the negative messages of the hidden curricula running at academic and clinical settings, nursing educators and nurses need to learn more about this issue in the nursing profession.

Multiple Victims: The Result of Caring Patients in Vegetative State.

BACKGROUND: Having a patient in a vegetative state in the family is a complicated and stressful experience. Caring for such patients with complete disability at home is very challenging. OBJECTIVES: The present study aimed to explore the outcomes of caring for patients in a vegetative state for families and caregivers at home. PATIENTS AND METHODS: In this qualitative study, 16 vegetative patients' caregivers were selected through purposive sampling. Unstructured interviews and observations were used for data gathering. Data collection was continued until saturation of data and emergence of the main themes. Data analysis was performed by the content analysis method. RESULTS: The analysis of the gathered data led to three themes: "lost main caregiver", "affected caring partner" and "affected family". Each theme had some subthemes and subcategories. CONCLUSIONS: The three emerged themes in this study showed that all the family members of vegetative patients, depending on their responsibilities, were affected by physical, mental, social and economic issues.

Improvement of the First Training for Baccalaureate Nursing Students--A Mutual Approach.

BACKGROUND: Examination of problems and application of strategies appropriate for clinical education and learning, especially nursing clinical principles and skills internship can improve educational process and satisfaction of nursing students. The aim of the current study was to revise the current status of the fundamentals of nursing course and implement an improvement plan (2012-2014). PARTICIPANTS & METHODS: The present study reports the three rounds of a participatory action-research study with a mutual cooperation approach and focus group discussion, with participation of 104 stakeholders. Content analysis approach was used to analyze the data obtained in focus discussion interviews. In addition, evaluation and reflection were done during the operating rounds, with the participation of all members, including students, were involved. This research program was approved by Shahid Beheshti University of Medical Sciences in Tehran-capital of Iran, at the Research Deputy of Nursing and Midwifery School and ethics committee of the university. RESULTS: The findings of qualitative study detected Lack of consistency in planning and implementation of curriculum, inadequate intra/extra-organizational communication management, inadequate student understanding of situation, improper control of restrictors and improper use of facilitators in teaching and in clinical setting, were among major challenges in clinical skills and principles internship process in the context of this study. Educational decision-making authorities of the School developed an operational program within national curriculum framework through cooperation and reflection in clinical skills and principles training program. CONCLUSION: Planning Fundamentals of Nursing training in partnership with all those involved in practice and education, together with students involved can be effective in reducing educational failures, gap between theory and practice, and in students' accountability and satisfaction.