The effects of cold compress and transcutaneous electrical nerve stimulation on the pain associated with chest tube removal among patients with coronary bypass grafting.

BACKGROUND AND AIM: Chest tube removal (CTR) can cause severe acute pain which is usually described by patients as a painful experience. This study compared the effects of cold compress, transcutaneous electrical nerve stimulation (TENS), and combined cold compress-TENS on CTR-associated pain among patients with coronary artery bypass grafting (CABG). METHODS: This randomized controlled trial was conducted in 2018-2019 using a double-blind four-group design. Participants were 120 patients with CABG selected from Shafa hospital, Kerman, Iran, and randomly allocated to a cold compress, a TENS, a combined cold compress-TENS, and a placebo group (compress with room temperature) and TENS with an off TENS device. Each participant received the intervention for 15 min immediately before CTR. CTR-associated pain was assessed before, during, immediately after, and 15 min after CTR. Data were analyzed using the SPSS program (v. 22.0) at a significance level of less than 0.05. RESULTS: The data of 29 participants in the placebo group, 26 in the TENS group, 30 in the cold compress group, and 26 in the combined cold compress-TENS group was gathered. Baseline demographic and clinical characteristics and pain intensity scores of participants had no statistically significant differences among all four groups (P > 0.05). The mean score of pain intensity in all groups was at its highest level during CTR and gradually decreased afterwards, but this pain intensity reduction in the compress-TENS group was significantly greater than other groups (P < 0.001). CONCLUSION: Combined cold compress-TENS is more effective than separate cold compress and TENS in reducing CTR-associated pain among patients with CABG. Therefore, non-pharmacological methods such as combined cold compress-TENS are recommended for managing CTR-associated pain.

Investigation of the relationship between sleep-related parameters and metabolic syndrome (MetS) among youths in the Southeast of Iran.

BACKGROUND AND AIM: There are few studies and inconsistent findings on the role of sleep-related parameters in the development of metabolic syndrome (MetS) among youths. In this study, we aim to investigate the relationship between sleep-related parameters and MetS among youths in a large sample size in Rafsanjan, a region in the southeast of Iran. METHODS: The current cross-sectional study was performed on 3,006 young adults aged 15-35, who registered for Rafsanjan Youth Cohort Study (RYCS), as part of Rafsanjan Cohort Study (RCS)). In fact, RCS is a branch of the prospective epidemiological research studies in Iran (PERSIAN). In the present study, we included 2,867 youths after excluding some subjects with missing information on MetS components. MetS was diagnosed based on Adult Treatment Panel III (ATP III) criteria. Besides, data on sleep-related parameters were collected by self-report questionnaires. RESULTS: The overall prevalence of MetS was 7.74% among the participants. In addition, bedtime, wake time, napping, night shift work, and sleep duration per night and day had no association with the higher odds of having MetS. In contrast, long sleep duration at night was associated with the lower odds of high waist circumference (WC) (OR: 0.82,95% CI :0.67-0.99). CONCLUSION: In the present study, long sleep duration at night was associated with lower odds of central obesity. However, more longitudinal studies with the objective measurement of sleep-related parameters are needed to verify the associations reported in the current study.

Comparison the effect of valerian and gabapentin on RLS and sleep quality in hemodialysis patients: A randomized clinical trial.

INTRODUCTION: This study aimed to compare the effect of valerian and gabapentin on restless legs syndrome (RLS) and sleep quality in HD patients. METHODS: In this cross over clinical trial study, 40 HD patients allocated into a valerian and gabapentin group. In the first phase of the study, Group A received valerian and Group B received gabapentin 1 h before bedtime for 1 month. In the second phase, the two groups' treatment regimen was swapped. After a 1-month washout period, the same process was repeated on the crossover groups. RESULTS: After the first phase, the mean score of RLS was lower in the gabapentin group. But there was no statistically significant difference between the two groups in terms of sleep quality score before and after the first and second interventions. CONCLUSION: Gabapentin is more effective than valerian in improving RLS, but both are equally effective in improving sleep quality.

The effect of ketamine on preventing postpartum depression.

Postpartum depression is a common disabling psychosocial disorder that could have adverse effects on the life of the mother, infant, and family. The present study was conducted to evaluate the effect of ketamine on preventing postpartum depression in women undergoing caesarian sections considering the relatively known positive effect of ketamine on major depression. The present double-blind, randomized clinical trial was conducted on 134 women undergoing scheduled caesarian sections. Participants were randomly allocated into two groups of control and intervention. To induce anesthesia, 1-2 mg/kg of body weight of Nesdonal and 0.5 mg/kg of body weight of ketamine were used in the intervention group, while only 3-5 mg/kg of body weight Nesdonal was administered in the control group. Data were gathered using the Edinburgh Postnatal Depression Scale (EPDS) in three stages: before the caesarian section and two and four weeks after the caesarian section. Data were analyzed using variance analysis with repeated measures and the Chi-square test. Results of the present study showed that the mean (± standard deviation) of the depression score in the intervention and control groups were 13.78±3.87 and 13.79±4.78(p = 0.98) before the caesarian section, 11.82±3.41 and 14.34±4.29 (p < 0.001) two weeks after and 10.84±3.48 and 13.09±3.79 (p = 0.001) four weeks after the caesarian section, respectively. Using ketamine in the induction of general anesthesia could be effective in preventing postpartum depression. However, further studies are required to strengthen these findings.

Telenursing: A step for care management in disaster and emergencies.

INTRODUCTION: Unusual impacts of disasters on normal living conditions pose challenges to the health system. Nurses who take care of disaster victims may face situations that make decision-making difficult; hereon, the use of new technologies can be a useful solution. The study aimed to identify the telenursing care during incidents and disasters. METHODS: The study was conducted at a medical science university in Iran from 2018 to 2019. This was a semi-structured interview-based qualitative study using content analysis. Eighteen nurses, nursing teachers, and emergency medical technicians were included in the study. Data analysis was performed using inductive content analysis and coding with MAXQDA (2010) software. The Lincoln and Guba (1985) trustworthiness criteria were used for the reliability and validity of the data. RESULTS: Telenursing in critical and supportive care was the main theme identified from data analysis. This theme included six main categories: (1) management of trauma, (2) technical skills, (3) care and decision-making in stressful situations, (4) management of patients with special needs, (5) life-saving intervention, and (6) psychological and emotional supports. CONCLUSIONS: Telenursing in disasters is the turning point of the care management of victims. In order to achieve this goal, nurses should acquire the relevant knowledge, skills, and abilities.

The Radio-Sensitizing Effect of Pharmacological Concentration of Ascorbic Acid on Human Pancreatic Cancer Cells.

BACKGROUND: Previous studies reported the inevitable destructive effects of radiotherapy on normal adjacent cells. Ascorbic Acid (AA) has been proposed as an effective anti-cancer agent with no obvious effects on normal cells. OBJECTIVE: The effects of Ascorbic acid in combination with radiotherapy on human pancreatic carcinoma cell line were studied. METHODS: The human pancreatic cancer cells were cultured and divided into four groups: control group (A) without any treatment, group B that received 2Gy radiotherapy alone, group C that was treated with 4mM AA alone, and group D that was co-treated with AA and radiotherapy. Cell viability, DNA fragmentation, expression of apoptotic genes, and Reactive Oxygen Species (ROS) production were determined in treated cells. RESULTS: There was a noticeable decrease in cell viability after treatment with AA (and/or) radiotherapy. All treated groups showed elevated ROS production, Bax/Bcl2 expression, DNA fragmentation, and cytotoxycity compared with the control group. Cells under combination therapy showed the most cytotoxicity. CONCLUSION: The results suggest that AA at a dose of 4mmol/l may be used as an effective radio-sensitizing agent in pancreatic cancer cell line.

Telenursing in Incidents and Disasters: A Systematic Review of the Literature.

INTRODUCTION: Disasters of any kind can affect public health severely. A shortage of health care specialists, such as physicians and nurses, during a disaster is a challenge for health care systems. The use of technology is 1 emerging strategy for addressing the continually increasing demand for care. Moreover, nurses may use technology in their roles. Therefore, the purpose of this study was to identify the application of telehealth, and more specifically telenursing care, in incidents and disasters. METHODS: This systematic review study was conducted on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English language international databases (PubMed, Scopus, Embase, Web of Science, and Google Scholar) were searched through November 2018. The quality of the studies was assessed using the International Narrative Systematic Assessment tool. RESULTS: Of the 5,759 titles identified in this search, 17 studies met the inclusion criteria. The important findings of this study were grouped into 3 main categories: clinical teams, disaster and communication types, and key outcomes of the telehealth programs used in disasters and incidents. We did not find any articles in the field of telenursing care during incidents. DISCUSSION: Providing health care during a disaster is essential, and technology is of vital importance for such care. Because of the shortage of specialized nurses in disaster areas, the presence of such a group in the telehealth program will provide a new window for care. Thus, telenursing offers a means of improving health care response.

Dispatcher-Assisted Bystander Cardiopulmonary Resuscitation (Telephone-CPR) and Outcomes after Out of Hospital Cardiac Arrest.

OBJECTIVE: To determine the effects of the implementation of the telephone cardiopulmonary resuscitation (T-CPR) program on the outcomes of out-of-hospital cardiac arrest (OHCA). METHODS: In this prospective study, Emergency Medical Service (EMS) dispatchers and all bystanders attending to patients with OHCA were included. The consensus sampling was carried out based on inclusion and exclusion criteria. The data collection tool was consisted of a demographic questionnaire for patients and bystanders accompanied by a checklist for CPR outcomes. Data were collected 6 months before and after the implementation of the T-CPR program and analyzed using SPSS version 18. RESULTS: The results revealed that the percentages of successful and unsuccessful CPR cases before the implementation of the T-CPR program were 28.1% and 71.9%, respectively. However, in total, 32% and 67.8% of the CPR cases were successful and unsuccessful, respectively, after the implementation of the mentioned program. The survival rate increased from 56.5% in the pre-intervention phase to 72.4% in the post-intervention one. In terms of the outcomes, brain complications decreased from 40% in the pre-intervention phase to 32.1% in the post-intervention one; however, the Chi-square test showed no significant difference in terms of CPR outcomes in the two time periods (p=0.797). CONCLUSION: According to the results, it is recommended that T-CPR programs be developed and dispatchers be trained in the area of this research. The results could be regarded as a guide to EMS managers, healthcare professionals, and the basis for further studies on this subject.

Comparing the effects of auricular seed acupressure and foot reflexology on neonatal abstinence syndrome: A modified double blind clinical trial.

BACKGROUND: The neonates of addicted women are at risk for neonatal abstinence syndrome. This study aimed to compare the effects of auricular seed acupressure and foot reflexology on neonatal abstinence syndrome among the neonates of addicted women. METHODS: Thirty one neonates of addicted women were purposively recruited and randomly allocated through coin flipping to receive either foot reflexology then seed acupressure or seed acupressure then foot reflexology. Interventions were performed in two successive days with a 12-h washout interval. Foot reflexology was applied for 15 min to the first horizontal zone of the sole while seed acupressure was applied for 24 h through attaching acupuncture-specific ear seeds to the posterior surface of the auricle on the SJ 17 acupoint. The symptoms of abstinence syndrome were assessed using Finnegan Neonatal Abstinence Scoring System before and after foot reflexology, and before, 15 min, and 24 h after the onset of the seed acupressure intervention. Symptom assessment was done by a research assistant who was blind to the study intervention. FINDINGS: The mean score of abstinence symptoms for the foot reflexology intervention significantly reduced from 10.32 ±â€¯2.10 at pretest to 7.87 ±â€¯2.04 at posttest (P < 0.001). Moreover, the mean score of abstinence symptoms for the seed acupressure intervention significantly reduced from 9.70 ±â€¯2.10 to 8.70 ±â€¯1.46 at the first posttest (P = 0.007) and 7.32 ±â€¯1.42 at the second posttest (P < 0.001). The change in the mean score of the foot reflexology intervention was significantly greater than the change in the mean score at the first seed acupressure posttest (P < 0.001) but did not significantly differ from the change in the second seed acupressure posttest (P = 0.880). CONCLUSION: Both foot reflexology and auricular seed acupressure has significant effects on abstinence symptoms. Of course, 15-min seed acupressure is less effective than 15-min foot reflexology, while 24-h seed acupressure is as effective as 15-min foot reflexology in alleviating abstinence symptoms.

Iranians' Perspective to Cosmetic Surgery: A Thematic Content Analysis for the Reasons.

BACKGROUND: Currently, becoming beautiful is a value among Iranian society, although experts have suggested several complications of cosmetic surgery, but decision to have these surgeries has been dramatically increased in recent years. This increase has imposed high workload and costs on the health care system of the country. This study was conducted to explore the reasons why people perform cosmetic surgery in an Iranian context. METHODS: Twenty-one subjects from both sexes who were 22-52 year-old and had undergone face plastic surgery between 1-5 years ago were enrolled and semi-structured data was collected via open interviews, while qualitative content were analyzed utilizing conventional analysis methods. Data analysis considered the theme "my face, my destiny" which contained 2 subcategories of "obtaining a chance for a better life "and" obtaining acceptance in society". RESULTS: The participants considered cosmetic surgery as a blessing from God that played a major role in their future, so they accepted the risks of the surgery. CONCLUSION: Understanding experiences of these individuals may help health care team particularly nurses to consult them and other individuals who might think about doing cosmetic surgery through education to help them make a better decision for to do cosmetic surgery.

The effect of educating the clients of rehab centers on the frequency of methadone poisoning among children: a study from Iran.

Background Poisoning with methadone is considered dangerous and fatal, which can lead to decreased consciousness, coma, apnea and eventually death. Aims The present study was conducted to evaluate the effect of educating the clients of rehabilitation (rehab) centers on the frequency of methadone poisoning among children. Methods In the present semi-experimental study, the study population included all of the clients referred to the rehab centers in an urban area of Iran who received treatment with methadone. Samples were selected using the census method. The data gathering tool was a researcher-made questionnaire of which the content validity has been approved. To perform the educational program, educational brochures were distributed among all the rehab centers (33 centers) and one face-to-face educational session was conducted at each center. Six months after the intervention, the number of under 12 year-old children who were referred to hospital with methadone poisoning was calculated and compared to the same number from the 6 months prior to the study. Data were analyzed using SPSS 18. Results According to the results, the number of methadone poisonings during the 6-month period prior to the study was 29, while the same number during the 6-month period after the intervention was 9. Fisher's exact test showed a significant difference between the number of methadone poisonings before and after the intervention (p < 0.001). Conclusion The increased level of knowledge among the parents referred to rehab centers could decrease the rate of poisoning among their children. Therefore, performing this educational program is recommended for all the rehab centers.

The effectiveness of group hope therapy on the mental health of type II diabetic patients referred to the diabetes clinic in South East Iran.

Introduction Diabetes is a common disease that, besides affecting the physical health, also affects the mental health of patients. Therefore, promoting mental health along with drug therapy seems essential. The purpose of this study was to find the effectiveness of group hope therapy on the mental health of type II diabetic patients who were referred to the diabetes clinic of Imam Reza Hospital in Sirjan City. Materials and methods This was a semi-experimental study. The statistical population consisted of type II diabetic patients referred to a diabetes clinic in southeastern Iran. Forty subjects were selected according to the goals of study and inclusion criteria and were assigned into intervention and control groups. The intervention group received group hope therapy in eight sessions. The instrument was General Health Questionnaire (GHQ) and was completed by both groups before and after intervention. Data were analyzed using independent t-tests and paired t-tests. Results The results showed that the mental health after the group hope therapy significantly increased in the study group compared to the control group (p = 0.02). Conclusion The results showed that the mental health of diabetic patients is more favorable using group hope therapy. This method can be used in diabetic patients.

Comparison of Effects of Local Anesthesia and Two-Point Acupressure on the Severity of Venipuncture Pain Among Hospitalized 6-12-Year-Old Children.

The aim of the present study was to compare the effects of topical anesthesia and acupressure at the Yintang (Extra 1) and the Laogong (P-8) points on the severity of venipuncture pain among hospitalized 6-12-year-old children. A sample (n = 120) of 6-12-year-old hospitalized children was recruited from two teaching hospitals located in Rafsanjan, Iran. The children were allocated to the topical anesthesia, acupressure, and control groups. For children in the topical anesthesia and the acupressure groups, eutectic mixture of local anesthetic (EMLA) cream and two-point acupressure were used, respectively, prior to performing venipuncture, whereas children in the control group only received routine prevenipuncture care. The severity of venipuncture pain was evaluated 5 minutes after performing venipuncture by using the Face, Leg, Activity, Cry, and Consolability behavioral pain assessment scale. The findings revealed that pain severity in both experimental groups was significantly lower than that in the control group, whereas there was no significant difference between the experimental groups regarding pain severity. Although acupressure was as effective as topical anesthesia cream in alleviating children's venipuncture pain, nurses are recommending to use acupressure instead of pharmacological pain management agents because of its greater safety, cost-effectiveness, and applicability.

Self-care in Patient with Major Thalassemia: A Grounded Theory.

Introduction: Self-care is the core concept of health care and may be considered as one's stabilization, and restoration as well as the improvement of his/her health and well-being. Looking at the process of Self-care from patients' perspective who suffer from thalassemia may assist the nurses and health care providers to facilitate the health process. Thus this study was conducted to discover the process of self-care in patients with major thalassemia. Methods: This qualitative study was conducted with grounded theory approach. 21 patients with major thalassemia from a Medical Research Center, supervised by Kerman Medical University, were selected through purposeful and theoretical sampling. Data were collected by unstructured interviews which lasted 30-60 minutes. These data were analyzed using the method of Corbin and Strauss. Results: The main theme of "struggling to improve life quality" that included the sub-themes of "focus on needs of illness, "activating resources" and "restoring a new identity with thalassemia" were extracted from the data. This theme implies that participants endeavor to strengthen their self- efficacy via thalassemia. "Looking for strengthening self-efficacy in light of thalassemia" was the core theme in this study. Conclusion: Facilitating the process of self-care in patients with major thalassemia requires that they be helped so that their self-efficacy, influenced by real life conditions, might be strengthened in light of thalassemia. Increasing public awareness and social support may affect the recognition of individual, family and society.

The effect of vibration on the severity of restless legs syndrome in hemodialysis patients.

Introduction: The restless legs syndrome (RLS) is a neurological disorder in patients undergoing hemodialysis. This syndrome causes individual's disturbed rest, discomfort, and stress, and secondarily to weakened functioning and disturbance in occupational activities and familial life. Objectives: The present study aimed at investigate the effect of vibration on the severity of the manifestation of symptoms of RLS in hemodialysis patients. Patients and Methods: This is an interventional before-after study conducted on 80 patients with RLS in hemodialysis wards of Yazd hospitals. The samples were selected randomly and intervention was performed on the patients as vibration for 10 minutes three times per week during 4 succeeding weeks. The questionnaire of severity of RLS was completed before the study and at the last day of intervention before and after vibration. The data were analyzed with SPSS 23 using descriptive statistics and paired t test (P<0.05). Results: Our findings showed that most patients were at the moderate level of severity of symptoms before (68.8%) and after (78.8%) intervention and there was a significant difference in the mean score of RLS between before (18.99) and after (12.82) intervention (P=0.001). Conclusion: Based on the results of this study, it can be concluded that vibration decreases the severity of symptoms of RLS in hemodialysis patients. Hence, it is recommended that vibration be used as a cost-effective and safe procedure to improve the symptoms of RLS in this group of patients.

Effect of Acupressure on Symptoms of Postoperative Ileus After Cesarean Section.

Postoperative ileus (POI) is a common complication after most abdominal surgeries including cesarean section. It is associated with longer hospitalization and increased medical costs. This study is a randomized controlled trial investigating the effect of acupressure, and low-cost noninvasive traditional treatment, on POI symptoms after cesarean section. A total of 120 patients were randomly divided into two groups; the treatment group received two sessions of acupressure (an hour after attending the women's division; and 3 hours after the first session), each lasting 20 minutes. The time of flatus and defecation, time to presence of bowel sounds, and duration of postoperative bed rest were monitored. Patients in the treatment group had a shorter time to presence of bowel sounds compared with those in the control group (p<0.001), as well as shorter time to first passage of flatus (p<0.001) and shorter postoperative bed rest (p=0.005). However, the time to first defecation was not statistically significant (p=0.311). Acupressure has potential positive impacts on attenuating POI symptoms after cesarean section, and can be used as a low-cost noninvasive nursing care to reduce POI incidence and intensity after cesarean section.

The sliding context of health: the challenges faced by patients with heart failure from the perspective of patients, healthcare providers and family members.

AIMS AND OBJECTIVES: To understand the challenges faced by patients with heart failure. BACKGROUND: Heart failure is a clinical syndrome that is increasing across the globe. People affected with it encounter various problems that reduce their quality of life and well-being. Therefore, identifying the challenges faced by patients with heart failure is necessary for health care and treatment plans. DESIGN: This study was performed using the qualitative research approach and content analysis method. METHODS: Data were collected using semistructured interviews and notes in the field of 21 Iranian participants, namely 12 patients with heart failure, three cardiologists, three nurses and three members of patient family. The data were analysed using Lundman and Graneheim qualitative content analysis. RESULTS: The results of this study were revealed in the form of a theme: 'sliding context of health' in which the following three categories 'perceived threat of health and life', 'the struggle between doubt and certainty' and 'in the downward slope of quality of life' reflect the experiences of patients faced with heart failure. CONCLUSIONS: The findings of this study showed that it is necessary to identify the challenges of facing heart failure, in order to support and educate patients with heart failure. Patients do not take care of themselves based on the fact that these challenges affect them psychologically and physically, and as such, the new situations are often misunderstood, thereby resulting in frequent recurrence of symptoms, mandatory hospitalisations and reduced quality of life. RELEVANCE TO CLINICAL PRACTICE: Nurses, as the first line of health care, play an important role in identifying problems and supporting patients with heart failure. By acquiring knowledge and listening to the complaints of patients, interventions can be developed to improve their situation.

Spirituality: A Panacea for Patients Coping with Heart Failure.

BACKGROUND: Many patients with heart failure grapple with related problems that threaten their feeling of well-being and quality of life. Patients look for ways to cope with the new situation. The present study aimed to explore religious coping from the perspective of patients with heart failure. METHODS: This qualitative study used the content analysis of the semi-structured interviews. The data were collected from 18 participants referring to training hospitals in Kerman University of Medical Sciences in southeastern Iran. The data were analyzed using Lundman and Graneheim qualitative content analysis. RESULTS: The main theme of "Spiritual coping, a dominant strategy" was extracted with two categories: 1- "religious belief" having the sub-categories of "inner faith" and "search of meaning" 2- "connection to God as the supreme power" with sub-categories of "seeking healing through supplication and rituals", "worship as a barrier to the flood of problems", and "submission to and trust in God". CONCLUSION: The findings suggest that a spiritual strategy helps the patients effectively to cope with heart failure. Patients learn to use religious beliefs and faith to accept the reality of the disease and its stages and to manage their condition with patience, tolerance, and hope calmly and confidently for a bright future.

The Role of Nurses in Coping Process of Family Caregivers of Vegetative Patients: A Qualitative Study.

BACKGROUND: Vegetative state (VS) occurs through return of the brain stem after coma state. After hospital discharge, responsibility of caring for VS patients is transferred to their families, which causes a high burden on them. Nurses have an important role in helping the family caregivers to meet their needs and cope with difficulties. To explore the role of nurses during coping process of family caregivers of VS patients. METHODS: This study is a part of a larger qualitative study which was performed in Kerman province, Iran during 2014- 2015. Purposive and theoretical sampling was used. 14 caregivers participated in the study. Data were gathered using face-to-face in-depth interviews and managed by MAXQDA 10 software. Analysis was done through constant Comparative Method. RESULTS: Three themes of "nurse as a pursuer teacher", "nurse as a compassionate caregiver", and "nurse as a supporter" were derived from analysis that represent various roles of a nurse in the coping process of family caregivers of vegetative patients during the care process. CONCLUSION: Nurses can play an effective role in improving the caregivers' well-being by considering the importance of training at discharge time and during home care, helping families in providing care and support them during care process.

Defective support network: a major obstacle to coping for patients with heart failure: a qualitative study.

BACKGROUND: Heart failure as a chronic disease poses many challenges for a patient in his or her everyday life. Support in various aspects of life positively affects coping strategies and influences the well-being and health outcomes of heart failure patients. Inadequate support may lead to a worsening of symptoms, increased hospital readmissions, psychological disorders, and a reduced quality of life. OBJECTIVE: This study explored obstacles to coping related to support for heart failure patients as viewed by the patients themselves and their family members and caregivers. DESIGN: This qualitative study was conducted using content analysis. The 20 Iranian participants included 11 patients with heart failure, three cardiologists, three nurses, and three family members of heart failure patients selected through purposive sampling. Data were collected through semi-structured interviews and analyzed using the Lundman and Graneheim qualitative content analysis method. RESULTS: During data analysis, 'defective support network' developed as the main theme along with four other categories of 'inadequate family performance', 'inadequate support by the healthcare team', 'distorted societal social support', and 'inadequate welfare support'. CONCLUSION: The findings of the current study can assist health authorities and planners in identifying the needs of patients with heart failure so as to focus and plan on facilitating their coping as much as possible by obviating the existing obstacles.