Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study.

Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.

Stroke Survivors and Their Family Caregivers' Experiences of Health Information Seeking: A Qualitative Study.

Background: Stroke is a significant and unpredictable event that affects physical and mental functions. A useful approach to returning to a normal life is to seek out health information. This study aimed to explore the experiences from health information seeking in the stroke survivors and their family caregivers. Methods: This study was carried out using qualitative content analysis. Participants included five stroke survivors and fifteen family caregivers who were selected purposively from the Rofideh Rehabilitation Center and private physiotherapy centers in Tehran. Data were collected from semi-structured interviews. Data analysis was performed using Graneheim and Lundman's method manually in Word software. Sampling was carried out in 2021. Results: Two main categories were extracted 1): adapting and learning resulting from awareness including optimization of living environment and disease management, and 2) fear and inquietude on the information way including confused and insolvent in receiving information, and doubts about the accuracy of information. Conclusion: The health information seeking created adaptability and relative stability in some stroke survivors and their family caregivers. However, in others, there was still a sense of anxiety and uncertainty. Thus, understanding health information seeking experiences helps health policymakers and administrators to provide information and training based on evidence and individual needs of the client and family.

The effect of nigella sativa oil on the prevention of phlebitis induced by chemotherapy: a clinical trial.

INTRODUCTION: Phlebitis, that disrupts chemotherapy, is the inflammation of the vein and the most common complication of intravenous injection of chemotherapy drugs. AIM: the aim was determine the effect of topical application of N. sativa oil on the prevention of phlebitis caused by chemotherapy. METHODS: This single-blind clinical trial was conducted on 60 cancer patients. In the intervention group, five drops of N. sativa oil was applied on the distal area of the catheter, two times per day and every 12 hours from the first day of chemotherapy to the third day; no intervention was conducted for the subjects in the control group. RESULTS: Results showed that there was a significant difference between the two groups at 60 and 72 hours in regard with incidence of phlebitis. There was a statistically significant difference between the two groups at 12 and 72 hours in terms of severity (degree) of phlebitis. CONCLUSION: topical application of N. sativa oil is effective in the prevention of chemotherapy-induced phlebitis.

Learning Situations in Nursing Education: A Concept Analysis.

BACKGROUND AND PURPOSE: The nursing student requires opportunities to learn within authentic contexts so as to enable safe and competent practice. One strategy to facilitate such learning is the creation of learning situations. A lack of studies on the learning situation in nursing and other health care fields has resulted in insufficient knowledge of the characteristics of the learning situation, its antecedents, and consequences. Nurse educators need to have comprehensive and practical knowledge of the definition and characteristics of the learning situation so as to enable their students to achieve enhanced learning outcomes. The aim of this study was to clarify the concept of the learning situation as it relates to the education of nurses and improve understanding of its characteristics, antecedents, and consequences. METHODS: The Bonis method of concept analysis, as derived from the Rodgers' evolutionary method, provided the framework for analysis. Data collection and analysis were undertaken in two phases: "interdisciplinary" and "intra-disciplinary." The data source was a search of the literature, encompassing nursing and allied health care professions, published from 1975 to 2016. RESULTS: No agreement on the conceptual phenomenon was discovered in the international literature. The concept of a learning situation was used generally in two ways and thus classified into the themes of: "formal/informal learning situation" and "biologic/nonbiologic learning situation." Antecedents to the creation of a learning situation included personal and environmental factors. The characteristics of a learning situation were described in terms of being complex, dynamic, and offering potential and effective learning opportunities. Consequences of the learning situation included enhancement of the students' learning, professionalization, and socialization into the professional role. IMPLICATION FOR PRACTICE: The nurse educator, when considering the application of the concept of a learning situation in their educational planning, must acknowledge that the application of this concept will include the student's clinical learning experiences. More studies are required to determine factors influencing the creation of a successful learning situation from the perspectives of nurse educators and nursing students, clinical nurses and patients.

The effect of the emotional intelligence education programme on quality of life in haemodialysis patients.

AIM: This study investigated the effect of the emotional intelligence education programme on quality of life of haemodialysis patients. BACKGROUND: Nurses need knowledge development regarding the impact of educational strategies on patients' quality of life suffering from chronic diseases. METHODS: A pragmatic quasi-randomized controlled trial was conducted with 47 haemodialysis patients attending a university hospital in an urban area of Iran. The patients were randomly assigned to intervention (n=23) and control (n=24) groups. A socio-demographic questionnaire, the Cyberia-Shrink Emotional Intelligence Questionnaire, and the Kidney Disease Quality of Life-Short Form were used to gather data. The intervention group attended an educational programme on emotional intelligence that consisted of six-group discussion sessions. To ensure the continuity of learning and to measure the subsequent expected behavioural changes, the patients filled out the data collection tools six and 12weeks after the completion of the education programme. RESULTS: The mean score of quality of life in the intervention group was 39.94±15.88 in pre-test, 44.87±16.04 six weeks and 52.47±16.07 at the 12weeks after the intervention (p=0.032). CONCLUSION: The consideration of emotional intelligence educational strategies by nurses requires its incorporation into pre-qualifying nursing degrees and professional development programmes. Nurse managers need to lead nurses for applying emotional intelligence in daily practice with the aim of providing an holistic patient care.

The Comparison of Two Types of Relaxation Techniques on Postoperative State Anxiety in Candidates for The Mastectomy Surgery: A Randomized Controlled Clinical Trial.

BACKGROUND: Anxiety among patients after surgery can affect their physiological and psychological well-being. The aim of this study was to investigate and compare the effects of Benson's relaxation and rhythmic breathing techniques on postoperative anxiety in candidates for the mastectomy surgery. METHODS: This randomized controlled clinical trial study was conducted with ninety patients in 2013. The patients were hospitalized for the mastectomy surgery in three surgical wards in a teaching hospital, Tehran, Iran. They were randomly assigned into three groups: Benson's relaxation including the cognitive relaxation technique type, rhythmic breathing including the somatic relaxation technique type and control groups. According to the Davidson and Schwartz multi-process theory, the Benson's relaxation and the rhythmic breathing techniques have cognitive and somatic effects, respectively. One day before the surgery, the patients in the intervention groups were trained regarding relaxation and breathing techniques and were asked to perform the techniques under the supervision of the researcher in the night before the surgery. The cognitive somatic anxiety questionnaire was used to measure anxiety before the intervention and half an hour after recovery of consciousness after the surgery. Descriptive and inferential statistics were used for data analysis via the SPSS v.21 software. RESULTS: There were no statistically significant differences between the groups in terms of demographic characteristics. The application of both techniques reduced the level of patients' anxiety after the surgery. The patients in the Benson's relaxation technique group reported only the relief of somatic anxiety. However, the breathing technique patients reported a reduction in both cognitive and somatic anxiety. CONCLUSION: The Benson's relaxation and rhythmic breathing techniques can reduce postoperative anxiety in patients after the mastectomy surgery. Trial Registration Number: IRCT2014042017350N1.

Participation a Key Factor for Life Recovery After Disaster: A Grounded Theory Study in an Iranian Context.

BACKGROUND: Since life recovery after disasters is a subjective and multifaceted construct influenced by different factors, and survivors' main concerns and experiences are not clear, the researchers intended to explore this process. MATERIALS AND METHODS: This study was conducted in 2011 - 2014 based on the grounded theory approach. Participants were selected by purposeful sampling followed by theoretical sampling to achieve conceptual and theoretical saturation. Data were collected through interviews, observation, focus group discussion, and document reviews. Data were analyzed by Strauss and Corbin's (2008) recommended approach. RESULTS: Transcribed data from 26 interviews (managers, health care providers, and receivers), field notes, and other documents were analyzed, and 1,652 open codes were identified. The codes were categorized, using constant comparative analysis, into five main categories including reactive exposure, subsiding emotions, need for comprehensive health recovery, improvement of normalization (new normality achievement), and contextual factors. The process of life recovery after disaster was also explored. CONCLUSIONS: The results clarified a deep perception of participants' experiences after disaster. The path of life recovery after disasters involves participants' striving to achieve a comprehensive health recovery, which starts with the need for all-inclusive health recovery as a main concern; this is the motivator for a responding strategy. This strategy is participatory, and the process is progressive; achievement of a new normality is the final goal, with new development and levels of empowerment.

Avicenna's View on the Etiologies of Intestinal Obstruction.

CONTEXT: Bowel obstruction is one of the most common causes of acute abdomen. Because of heterogeneity of patients' population and variety of causes, therapeutic strategies are not standardized, so treatment of intestinal obstruction is a surgical challenge in many cases. A traditional medicine approach could help detect some issues that were ignored by modern medicine. One of the major schools of medicine, with a history of several thousand years, is Iranian traditional medicine. In this regard, Avicenna, who lived in the medieval period, has had a great influence on the medical knowledge of the world by writing an encyclopedia of medicine entitled "Qanun of Medicine." EVIDENCE ACQUISITION: The aim of this study was to investigate Avicenna's views on the causes of intestinal obstruction and comparing them to modern medicine views. This is a review study on an Iranian traditional textbook of medicine by Avicenna, entitled "Qanun of Medicine" (in short "Qanun"). We used Qanun in its original language (Arabic) along with its Persian translation. It consists of 5 books. Part 16 of the third book talks about intestinal anatomy and introduces some intestinal diseases such as "qoolinj" and "ilavos." Intestinal obstruction can be a kind of "qoolinj" or "ilavos" disease. All intestinal obstruction etiologies in Qanun are searched in international and Iranian databases (Scopus, ISI, SID, and Iranmedex) and similar causes in modern medicine will be discussed in this article. RESULTS: According to Qanun, 16 causes are involved in intestinal etiologies of bowel obstruction such as "reeh," mucoid phlegm, abdominal hot and dry distemperament, decreased bile secretion, job, and so on while modern medicine considers some of them, for instance, volvulus, intestinal herniation, worm, intestinal pseudo-obstruction, and opiate. CONCLUSIONS: Attention to the similar causes of intestinal obstruction in modern medicine and traditional medicine is the starting point for investigation of noninvasive diagnostic and therapeutic methods that have been mentioned in Qanun. In addition, etiologies which are missed in modern medicine can open new doors to the researchers and gastroenterologists for the study, diagnosis, and prevention of the disease.

From margins to centre: an oral history of the wartime experience of Iranian nurses in the Iran-Iraq War, 1980-1988.

BACKGROUND: The extensive nature of the Iraq-Iran war converted to a human tragedy with large casualties; it has affected nursing discipline dramatically. AIM: To analyse the history of the wartime experience of Iranian nurses in Iran-Iraq War. METHOD: The current study was conducted with oral history. The study sample consisted of 13 Iranian nurses who served in the war zones during the wartime. Purposive and snowball sampling were used to recruit the participants. During the face-to-face interviews, participants were asked to describe their experience in the war zones during the war years. Data collection and analysis took place from April to August 2013, when saturation was reached. All interviews were tape recorded and transcribed and then analysed with thematic content analysis. RESULTS: Finally, five themes and 18 subthemes emerged from data analysis of significant statements from 17 interviews. The five emerged themes included (1) 'From margin to centre', (2) 'Development of referral care', (3) 'Personal and professional growth and development', (4) 'The emerging pillar of culture in war nursing' and (5) 'Threats to nursing at the war'. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Nursing in Iran at wartime has a difficult path to development. There are powerful implications for clinical practice. It is recommended to continue collection, archiving and analysing the wartime experiences of Iranian nurses.

First encounters with instructors: the experiences and perceptions of nursing students in Iran.

BACKGROUND: The first encounter between an instructor and his/her student influences the development of their mutual relationship. This phenomenon has received little attention in the literature within the context of nursing education. PURPOSE: This study explores and describes qualitatively the subjective experience and perceptions of nursing students related to their first encounter with instructors in both classroom and clinical settings. METHODS: A purposeful sampling method was utilized to select 15 nursing students from a nursing school in Iran to participate in semistructured interviews. Data were analyzed using a qualitative content analysis approach. RESULTS: Data analysis identified three main themes: (a) preexisting expectations, with the four subthemes of socially shared expectations, personal expectations, profession-related expectations, and reputation-directed expectations; (b) student's judgment, with the three subthemes of assessing the instructor, assessing criteria, and good or bad beginning; and (c) future interactions, with the two subthemes of constructive decisions and destructive decisions. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results show that the initial student-instructor encounter is a process in which students rely heavily on preexisting expectations to assess and judge the initial interaction with their instructor. The findings of this study may help nursing instructors in various national and cultural settings increase their awareness of the factors that influence their first encounters with students. Greater awareness may help positively shape student perspectives of the instructor's role and encourage students to collaborate with the instructor in the teaching and learning process in order to create a better outcome for both.

Impact of disaster on women in Iran and implication for emergency nurses volunteering to provide urgent humanitarian aid relief: A qualitative study.

BACKGROUND: Men and women are equally affected by disasters, but they experience disaster in different ways. To provide new knowledge and promote women's involvement in all phases of the disaster management, we decided to capture the perspectives and experiences of the women themselves; and to explore the conditions affecting Iranian women after recent earthquake disasters. METHODS: The study was designed as a qualitative content analysis. Twenty individuals were selected by purposeful sampling and data collected by in-depth, semi-structured interviews analysed qualitatively. RESULTS: Three main themes were evident reflecting women's status after disaster: individual impacts of disaster, women and family, and women in the community. Participants experienced the emotional impact of loss, disorganisation of livelihood and challenges due to physical injuries. Women experienced changes in family function due to separation and conflicts which created challenges and needed to be managed after the disaster. Their most urgent request was to be settled in their own permanent home. This motivated the women to help reconstruction efforts. CONCLUSIONS: Clarification of women's need after a disaster can help to mainstream gender-sensitive approaches in planning response and recovery efforts.

From Margins to Center: An Oral History of the Wartime Experience of Iranian Nurses in Iran-Iraq War, 1980-1988.

Abstract Background: The extensive nature of the Iraq-Iran war converted to a human tragedy with large casualties; it has affected nursing discipline dramatically. Aim: To analyze the history of the wartime experience of Iranian nurses in Iran-Iraq war. Method: The current study was conducted with oral history. The study sample consisted of 13 Iranian nurses who served in the war zones during the wartime. Purposive and snowball sampling were used to recruit the participants. During the face-to-face interviews, participants were asked to describe their experience in the war zones at the war years. Data collection and analysis took place from April to August 2013, when saturation was reached. All interviews were tape recorded and transcribed and then analyzed with thematic content analysis. Results: Finally, 5 themes and 18 subthemes emerged from data analysis of significant statements from 17 interviews. The five emerged themes included (1) "From margin to center," (2) "Development of referral care," (3) "Personal and professional growth and development," (4) "The emerging pillar of culture in war nursing," and (5) "Threats to nursing at the war". Conclusion and relevance to clinical practice: Nursing in Iran at wartime has a difficult path to development. There are powerful implications for clinical practice. It is recommended to continue collection, archiving, and analyzing the wartime experiences of Iranian nurses.

Supporting adolescents with type 1 diabetes mellitus: a qualitative study.

Without sufficient support, type 1 diabetes mellitus often disturbs patients' normal lives. This study describes and explores the support that Iranian adolescents with type 1 diabetes mellitus experienced. Semistructured interviews were conducted with ten adolescents, seven family members, one dietitian, one nurse, and one school nurse. Participants were chosen using purposive sampling from two teaching hospitals and one high school in two urban areas of Iran. Using standard procedures for content analysis, three main themes were identified: maintaining a normal life; receiving tangible, informational, and emotional support from the family and society; and advancement of life toward normalization. The cornerstone of maintaining a normal life for adolescents with type 1 diabetes mellitus is to adopt an active role in taking care of themselves within their systems of support.

The perceived information in obtained from the informed consent in Iranian patients with cancer in clinical studies.

OBJECTIVE: One of the basic issues in clinical studies is to receive the informed consent; that is to say, all the activities applied in patient's involvement in the information, decision-making, ability and volunteering in diagnosis, cure and care. In as much as most cancer patients require information about their individual needs, the present study is conducted to determine the perceived information from the informed consent of clinical studies in cancer patients. METHODS: This is a descriptive study. Fifty cancer patients hospitalized for participating in the clinical study was chosen according to the convenience sampling. Tools used in this research included the questionnaire (individual and social features) and the check list about patient's right and cancer patient's information before and after receiving informed consent in clinical studies (10 items on a Likert rating scale). To validate the study, content and formal validation was used. Data in this research were analyzed using descriptive statistics (frequency, mean and standard deviation) and the software of SPSS 16. RESULT: In general, the mean of the scores obtained from cancer patients' perceived information before completing the informed consent of the clinical studies was 14 ± 3.5 and after consent of the clinical studies was 16 ± 2.4. The cancer patients' perceived information before and after consent of the clinical studies was weak. CONCLUSIONS: Based on the findings of the present study, the rate of the information the cancer patients received, before completing the informed consent form, was low, but after completing the informed consent form this rate was again low. Therefore, conducting similar and wider studies is recommended to unveil the factors affecting perceiving information and how to promote the quality of the informed consent in other hospitals in Iran.

Humanistic approach to nursing education: lived experiences of Iranian nursing students.

The nurse teachers tried to have a complete understanding of the educational contents, to transfer knowledge to nursing students better, and to facilitate the process of education. The purpose of this study was to explore the lived experiences of Iranian nursing students regarding the characteristics of academic nurse teachers. In this hermeneutic phenomenological study, data were collected via in-depth, semi-structured interviews with 12 Iranian nursing students and the audio-taped and transcribed interviews analyzed according to Van Manen´s method. The main theme emerged during data analysis, was "humanistic approach to nursing education". The theme was extracted from 2 sub-themes including 'ethical necessities' and 'effective interaction'. The findings present greater understanding of humanistic approach to nursing education.

Components of equity-oriented health care system: perspective of Iranian nurses.

Equity in health is one of key objectives in health care systems world wide. This study aimed to explain the perspective of Iranian nurses about equity in the health care system. A qualitative exploratory design with thematic analysis approach was used to collect and analyze data. Using a purposeful sampling helped the researchers to recruit 16 eligible participants. Data were collected via in-depth semi-structured interviews. Five main categories were extracted through data analysis process including (1) inequity against the nurse, (2) the recommended patient, (3) no claim for equity-oriented care in health system, (4) physicians' dominancy system; and (5) the need to define criteria to measure equity-oriented care. All health care systems around the world struggle to establish equity-oriented care. In perspective of Iranian nurses, the reform of structures in the health system is possible through providing the context of equitable care for caregivers and care recipients. Health system should commit the flow of equity at all of its levels. It should utilize policies to claim equity and consider the interests of all beneficiaries. Furthermore, certain criteria should be defined for equity-oriented care in the health care system, and also provides the possibility to measure and monitor it.

Liver transplant recipients quality of life instrument: development and psychometric testing.

BACKGROUND: Liver transplantation is a life-saving intervention for many patients with end-stage liver disease. In the past, evaluation of successful liver transplantation was based on patients' survival rate. However, in recent years this evaluation has been based on patients' quality of life. Various instruments have been developed to evaluate patients' quality of life. Nonetheless, scholars still believe that it is crucial to develop a standardized and disease specific instrument for evaluating the quality of life in liver transplant recipients. OBJECTIVES: The aim of this paper was to describe the development and psychometric testing process of a quality of life instrument specific to liver transplant recipients. MATERIALS AND METHODS: Initial items of this instrument were extracted from a conventional content analysis study, and then were completed with findings of related international literature. The face validity was assessed by interviewing with four liver transplant recipients, and the content validity was evaluated by eleven experts in the field of transplantation. The construct validity was achieved by involving 250 liver transplant recipients through exploratory factor analysis method, and reliability was calculated by Cronbach's alpha. RESULTS: Three main factors with 40 items were extracted from the exploratory factor analysis: Health Satisfaction, Concerns, and Complications. Reliability of the instrument was confirmed (alpha = 0.922). CONCLUSIONS: Given the special considerations regarding liver transplant recipients, this questionnaire is more accurate in evaluating the success of liver transplantation.

Life recovery after disasters: a qualitative study in the Iranian context.

INTRODUCTION: Planned and organized long-term rehabilitation services should be provided to victims of a disaster for social integration, economic self-sufficiency, and psychological health. There are few studies on recovery and rehabilitation issues in disaster situations. This study explores the disaster-related rehabilitation process. METHOD: This study was based on qualitative analysis. Participants included 18 individuals (eight male and ten female) with experience providing or receiving disaster health care or services. Participants were selected using purposeful sampling. Data were collected through in-depth and semi-structured interviews. All interviews were transcribed and content analysis was performed based on qualitative content analysis. RESULTS: The study explored three main concepts of recovery and rehabilitation after a disaster: 1) needs for health recovery; 2) intent to delegate responsibility; and 3) desire for a wide scope of social support. The participants of this study indicated that to provide comprehensive recovery services, important basic needs should be considered, including the need for physical rehabilitation, social rehabilitation, and livelihood health; the need for continuity of mental health care; and the need for family re-unification services. Providing social activation can help reintegrate affected people into the community. CONCLUSION: Effective rehabilitation care for disaster victims requires a clear definition of the rehabilitation process at different levels of the community. Involving a wide set of those most likely to be affected by the process provides a comprehensive, continuous, culturally sensitive, and family-centered plan.

Perceived clinical constraints in the nurse student-instructor interactions: a qualitative study.

UNLABELLED: Effective student-instructor interactions impact the quality of nursing clinical education. There are a myriad of different factors related to clinical settings that affect these interactions and they have received less attention in nursing studies. Identifying clinical constraints that impact the nursing student-instructor relationships will help nursing instructors to manage clinical learning situations in a more effective manner. OBJECTIVE: The goal of this study was to identify the primary factors that influence the student-instructor interactions within clinical settings. METHODS: A purposeful sampling strategy was applied to recruit 18 nursing students and instructors to participate in qualitative, semi-structured interviews. In order to identify relevant themes of transcribed interviews, qualitative content analysis was utilized. RESULTS: Data analysis resulted in the development of five main themes that represent essential interaction constraints in clinical contexts. These themes include: outsiders' eyes, dominance of act, close contact, clinical workplaces' disputes, and instability and uncertainty. CONCLUSIONS: The results of this study can serve to improve the understanding and practice of international clinical nursing instructors within the clinical education context. The behaviors that emerged were based on clinical constrains and an awareness each can serve to enhance the instructor-student relationship.