Effect of assertiveness program on the drug use tendency, mental health, and quality of life in clinical students of Shahrekord University of Medical Sciences.

BACKGROUND: Students on campus are exposed to drug abuse and mental health disorders due to various challenges and motivating factors. This issue requires attention to interventions based on coping skills training. The present study was conducted with the aim to investigate the effect of an assertiveness program on the drug use tendency, mental health, and quality of life in clinical students of Shahrekord University of Medical Sciences in 2020. MATERIALS AND METHODS: This is a quasi-experimental study. Seventy clinical students (nursing, midwifery, and intern students) attending Ayatollah Kashani and Hajar teaching hospitals of Shahrekord were included into the study and randomly assigned into an intervention group and a control group. The assertiveness training program was implemented for eight 1-h sessions (one session per week for 2 months) for the intervention group, while the control group received no programs. Both study groups completed drug tendency questionnaire, depression, anxiety and stress scale, and quality of life questionnaire in pretest, posttest, and 2-month follow-up. The data were analyzed using SPSS software (v22), analysis of variance repeated measures, and t-test. RESULTS: The mean scores of drug use tendency (P = 0.26), stress (P = 0.31), anxiety (P = 0.29), depression (P = 0.43), and quality of life (P = 0.33) showed no statistically significant difference between the intervention and control groups in the pretest, but the scores of the drug use tendency, stress, anxiety, and depression were statistically lower and the score of quality of life was statistically higher than that of the control group in the posttest and 2-month follow-up (P < 0.05). CONCLUSION: The findings of the study showed that assertiveness skill training as a preventive program can reduce the students' tendency to addiction and improve their mental health and quality of life. Considering the effectiveness of the program, planners and policymakers can use it to plan for reducing the youth tendency to drugs.

An Investigation into the Relation of Coping Skills with Mental Health and Quality of Life in Family Members of Nurses During the COVID-19 Pandemic.

OBJECTIVES: During the coronavirus disease (COVID-19) pandemic, health care workers, including nurses and their family members, experienced various psychological problems. Coping skills may help them deal with the current challenge and maintain their mental health and improve their quality of life. Therefore, this study investigated the relation of coping skills with mental health and quality of life of the nurses' family members during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted on the family members of the nurses working at Hajar Hospital of Shahrekord dedicated to admission and hospitalization of COVID-19 infected patients using a census sampling method in 2020. Participation in this study was voluntary and finally 220 persons were included in this study. To prevent the spread of COVID-19 through respiratory droplets or contact, a weblog was created using blogging software that contained questionnaires for collecting data on demographic information, mental health (PHQ-9), coping skills (coping responses inventory [CRI], Billings & Moos), and quality of life (SF-36). The collected data were analyzed using descriptive and inferential statistical tests in SPSS software version 22 (IBM Corp, Armonk, NY). RESULTS: Of the 220 participants in this study, 101 participants were male and 119 were female. The mean age of the subjects was 35.78 years, and 56.4% of them had an academic education level. The Pearson correlation analysis showed a significant relationship between coping skills and mental health, quality-of-life items, total quality-of-life score, and demographic variables of participants (except education) (P < 0.05). This was a direct relationship in such a way that as the score of coping skills increases, so does the score of mental health and quality of life. Based on the results of regression analysis, the predictive power of mental health, coping skills, and education level was obtained to be 0.634. The coping skill variable was the strongest predictor (ß = 0.467), and after that, the mental health variable (ß = 0.421) had the highest predictive power. CONCLUSION: The obtained results showed that coping skill is the association between psychological health and quality of life such that the coping skill has a significant direct effect on psychological health and quality of life. The results also showed that, at the time of crisis, further attention should be paid to coping skills to develop and improve the quality of life and psychological health.

A comparative study into the effects of topical hot salt and hot sand on patients' perception of low back pain.

BACGROUND: Low back pain (LBP) has been regarded as one of the musculoskeletal problems which is affecting more than three-quarters of individuals in their lifetime. Nowadays, various pharmacological and nonpharmacological therapies are employed for relieving and treating LBP. This study was conducted to compare the effects of topical hot salt and hot sand on patients' perception of LBP. MATERIALS AND METHODS: In this, quasi-experimental study patients with LBP referring to the orthopedic clinic of Shahrekord educational hospital were divided randomly into two interventions and one control group in 2020. All three groups were received naproxen cream and daily physiotherapy in the same manner, the interventional groups in addition either topical hot salt or topical hot sand. Data gathering tool for measuring patients' perception of LBP was the McGill Pain Short Form Questionnaire to be completed at the beginning, immediately at the end, and 2 months after the intervention. The data were analyzed using SPSS statistical software (version 21.0). RESULTS: Totally, 90 patients were randomized based on the table of random numbers (mean age 51.1 + 11.1), and finally, 87 patients completed the study. Patients' perception of LBP before the intervention was homogenous in hot salt, hot sand, and the control group The mean score of total pain experience before the intervention was 14.1 ± 11.3 for hot sand, 13.9 ± 10.7 for hot salt and 13.7 ± 10.1 for control group The mean scores of these three groups were not significant before the intervention (P > 0.05). The mean score of total pain experience immediately after the intervention was 6.7 ± 4.2 for hot sand, 5.2 ± 3.1 for hot salt and 13.9 ± 9.8 for control group. The mean scores of the hot sand group and the hot salt group were significantly decreased compared with control group (P > 0.05). The mean score of total pain experience two months after the intervention was 5.6 ± 3.27 for hot sand, 4.21 ± 2.14 for hot salt and 13.8 ± 10.4 for control group. Mean score of total pain experience in both intervention groups had significantly reduced two months after the intervention compared to control group (P ≤ 0.001); so that the effect of hot salt treatment on reducing total pain experience was larger than hot sand (P ≤ 0.001). The same trend was observed for VAS and Present pain intensity variables. CONCLUSIONS: The findings have revealed that the topical treatments with hot salt and hot sand could have a significant effect on the perception of LBP compared to those in the control group; whereas hot salt might be stronger effects than hot sand on reducing LBP.

Exploring the Concept of Spiritual Sensitivity from the Perspectives of Healthcare Providers in Iran.

Spiritual sensitivity (SS) is defined as attention to the available spiritual values in a conflicting situation and awareness of one's roles and responsibilities in that situation. It helps differentiate between the right and the wrong and leads to sound practice. This study explored the concept of SS from the perspectives of healthcare providers in Iran. This qualitative study was carried out in 2017-2019 using conventional content analysis. Twenty-two physicians, faculty members with clinical work experience, and healthcare providers were purposefully recruited. Data were collected using unstructured interviews and were analyzed using conventional content analysis. Participants' experiences of the concept of SS were grouped into three main themes, namely sense of value, spiritual growth and morale boosting, and SS as a motivator for purposeful service delivery. The findings of the present study will help healthcare managers develop programs for improving healthcare providers' spiritual sensitivity and also will help healthcare providers develop spirituality-based holistic care plans.

The effect of COVID-19 epidemic on the mental health of nurses' family members.

BACKGROUND: The COVID-19 epidemic is a global health crisis that, in addition to physical health, has affected the mental health of all individuals, especially health-care workers, including nurses and family members. In this regard, the present study aimed to investigate the effect of COVID-19 epidemic on mental health of nurses' family members. MATERIALS AND METHODS: The present descriptive-analytic and cross-sectional study was conducted in 2020 year on family members of nurses working in Hajar Hospital for admission and hospitalization of patients with COVID-19, after obtaining the necessary permits and coordination. To prevent the spread of COVID-19 through respiratory or contact droplets, a blog was designed to collect data using software. Participation in this study was voluntary. Data collection tools included consent, demographic questionnaire, and mental health questionnaire (Patient Health Questionnaire-9). Data were analyzed by SPSS version 22. RESULTS: Findings of this study showed that out of 208 family members of nurses participating in this study, 96 were male and 112 were female and their mean age was 35.78 years, and 55.3% of the participants had university education. Their mean mental health score was 12.91 ± 3.75, so that 22.6% of people had mild depression, 71.4% of people had moderate depression, and 1.8% of people had severe depression. Independent t-test showed that there is a statistically significant relationship between mental health and gender and marital status (P < 0.001). Furthermore, one-way analysis of variance test showed that there is a significant relationship between mental health and age (P < 0.001); this test also showed that there is no relationship between education and mental health (P = 0.75). CONCLUSION: The results indicate that the mental health of nurses' family members is affected by the challenges of COVID-19 epidemic time, so that many of them suffer from some degree of depression. Therefore, supporting this population requires urgent action.

Design and psychometric evaluation of epilepsy-related apathy scale (E-RAS) in adults with epilepsy: a sequential exploratory mixed methods design.

BACKGROUND: Apathy in patients with epilepsy is associated with a wide range of consequences that reduce the patient's ability to perform social functions and participate in self-care and rehabilitation programs. Therefore, apathy is one of the important diagnoses of the healthcare team in the process of caring for epileptic patients and its dimensions need to be examined and recognized. Therefore, appropriate instruments with the sociocultural milieu of each community should be provided to health care providers. The aim of the present study was to design and measure epilepsy-related apathy scale (E-RAS) in adults with epilepsy. METHODS: This study of sequential exploratory mixed methods design was conducted in Iran from April 2019 to December 2019. In the Item generation stage, two inductive (face-to-face and semi-structured interviews with 17 adult epileptic patients) and deductive (literature review) were used. In item reduction, integration of qualitative and literature reviews and scale evaluation were accomplished. For Scale Evaluation, face, content, construct [exploratory factor analysis (EFA) (n = 360) and confirmatory factor analysis (CFA) (n = 200)], convergent and divergent Validity and reliability (internal consistency and stability) were investigated. RESULTS: The results of EFA showed that E-RAS has four factors, namely, motivation; self-regulatory; cognition and emotional-effective. These four latent factors accounted for a total of 48.351% of the total variance in the E-RAS construct. The results of CFA showed that the 4-factor model of E-RAS has the highest fit with the data. The results of convergent and divergent validity showed that the values of composite reliability (CR) and average variance extracted (AVE) for the four factors were greater than 0.7 and 0.5, respectively, and the value of AVE for each factor was greater than CR. The Cronbach's alpha coefficient for the whole scale was obtained 0.815. The results of the test-retest showed that there was a significant agreement between the test and retest scores (P < 0.001). CONCLUSION: E-RAS is a multidimensional construct consisting of 24 items, and has acceptable validity and reliability for the study of epilepsy-related apathy in adult epileptic patients.

Development and psychometric evaluation of the perceived care tension questionnaire for caregivers of hemodialysis patients: A mixed method study.

BACKGROUND: The complex, multifaceted care environment and the threatening situation of caring for hemodialysis patients cause tension in their family caregivers. Due to the severe tension, family caregivers are likely to ignore their basic needs and only pay attention to the patient's needs and related issues. This study was conducted with the aim of designing and evaluating the Perceived Care tension Questionnaire for Caregivers of Hemodialysis Patients (PCTQHFC). MATERIALS AND METHODS: The present study was a sequential exploratory mixed methods study of scale development variant conducted in two phases: qualitative and quantitative. This study was conducted in 2019 in Shahrekord. The qualitative phase included item development and scale development. In the quantitative phase (Item Analysis), the validation characteristics of the tool were examined using face, content and construct validity, and its reliability by internal consistency and stability. Findings were performed using software SPSS 18. RESULTS: Principal components analysis with orthogonal rotation to generate factors, showed that five factors, namely emotional exhaustion, inadequate social support, care burden, confusion and ambiguity and lack of adaptability skills had an eigenvalue of higher than 1, so that they explained, respectively, 75.98%, 61.36%, 72.49%, 76.33%, and 70.31% of the total variance. The internal consistency was obtained 0.811 and the inter-class correlation coefficient for the whole instrument 0.832. CONCLUSION: PCTQHFC is a culturally appropriate measure with strong psychometric properties. The instrument designed in this study measures the care tension of hemodialysis patients. Therefore, researchers, health-care providers, and community health policymakers can plan and implement interventions to reduce the tension of caregivers of hemodialysis patients by analyzing and identifying the tensions of caregivers.

Evaluating the effect of Pender's health promotion model on self-efficacy and treatment adherence behaviors among patients undergoing hemodialysis.

INTRODUCTION: Health promotion through lifestyle improvement is an important topic that has received considerable attention from the scientific community worldwide. This study aimed to determine the effect of Pender's health promotion model on self-efficacy and treatment adherence behaviors of hemodialysis patients in Shahrekord, Iran, in 2018-2019. METHODS: This quasi-experimental study was performed on 70 hemodialysis patients who were attending routine hemodialysis sessions in Hajar hospital in Shahrekord. Individuals were selected by simple random sampling and randomly assigned to two groups of control and intervention. In the preintervention stage, all patients completed a questionnaire that was prepared to collect demographic information and measure health-promoting behaviors, self-efficacy, and treatment adherence. The intervention group participated in eight sessions of a health promotion model-based education program. Both groups were asked to complete the questionnaire again immediately after the intervention and also 2 months later. RESULTS: The repeated measures analysis of variance (ANOVA) showed a significant difference between the two groups in terms of the extent of change in mean scores over the three measurement stages (before the intervention, after the intervention, and 2 months after the intervention) (P < 0.001). A statistically significant difference was observed between the two groups in terms of self-efficacy scores in the postintervention and follow-up stages (P < 0.05). The repeated measures ANOVA also revealed a significant difference between the two groups in terms of the extent of change in mean treatment adherence scores over the three measurement stages (P < 0.001). CONCLUSION: Considering the positive effects of the program on patients undergoing hemodialysis, it is recommended to use the program to promote the well-being of these patients without time restrictions.

The effects of the Fordyce's 14 fundamentals for happiness program on happiness and caregiver burden among the family caregivers of patients with epilepsy: A randomized controlled trial.

BACKGROUND: Caregiving to patients with epilepsy (PWE) is often very stressful for family caregivers and puts a heavy caregiver burden (CB) on them. The aim of this study was to evaluate the effects of Fordyce's fourteen Fundamentals for Happiness Program on happiness and CB among the family caregivers of PWE. METHODS: This randomized controlled trial was conducted on seventy family caregivers of PWE. Participants were purposively recruited from the Comprehensive Health Center in Shahrekord, Iran, and randomly allocated to either an intervention or a control group. Participants in the control group received conventional health-related educations in four one-hour group sessions, while participants in the intervention group received the Fordyce's fourteen Fundamentals for Happiness Program in eight one-hour group sessions. Happiness and CB in both groups were assessed at three time points, namely before, immediately after, and two months after the intervention. Data were analyzed using the SPSS program (v. 18.0). FINDINGS: There were no significant differences between the control and the intervention groups regarding participants' demographic characteristics and their pretest mean scores of happiness and CB (P > 0.05). The mean scores of happiness and CB in the control group did not significantly change (P > 0.05), while the mean score of happiness significantly increased and the mean score of CB significantly decreased in the intervention group across the three measurement time points (P < 0.05). Consequently, the mean score of happiness in the intervention group was significantly greater than the control group and the mean score of CB in the intervention group was significantly less than the control group at both posttests (P < 0.01). CONCLUSION: The Fordyce's fourteen Fundamentals for Happiness Program is effective in significantly increasing happiness and reducing CB among the family caregivers of PWE. Healthcare providers and policy makers can use this program to reduce problems among these family caregivers.

Effect of education based on "PRECEDE" model on self-care behavior in hemodialysis patients.

BACKGROUND AND OBJECTIVE: Patients undergoing hemodialysis due to multiple drug therapies, special diet plans, and need to acquire the ability to adapt to physical and mental disabilities require special monitoring. The PRECEDE-PROCEED model is a process for behavior change and can lead to the promotion of self-care behavior. The aim of this study was to evaluate the effect of a health promotion program based on the PRECEDE-PROCEED model on self-care behaviors in hemodialysis patients. METHODS: This was a clinical trial study that was performed on 67 patients undergoing hemodialysis in Lordegan Hospital that has been distributed in two groups randomly. Data were collected using self-care assessment form according to the PRECEDE-PROCEED model. Based on the results of this questionnaire, five educational sessions were held in the fields of knowledge, attitude, enabling factors, reinforcement, and behavioral factors for the samples. Data were analyzed using descriptive and analytical statistics with SPSS version 21 software. RESULTS: According to statistical analysis before intervention, no significant difference was observed between the mean scores of self-care among the two groups. However, instantly and 3 months after intervention, the mean score of self-care (P = 0/03), knowledge, attitude, reinforcement factors, and behavioral factors (P < 0.05) significantly increased in the experimental group. CONCLUSION: Based on the results of this study PRECEDE-PROCESS model, the health promotion program increased the mean self-care score of hemodialysis patients. This program has been able to improve their self-care behaviors by changing knowledge, attitudes, and reinforcement and behavioral factors of patients and is recommending as an application in the nursing of these patients.

Evaluating the Effect of Family-Centered Intervention Program on Care Burden and Self-Efficacy of Hemodialysis Patient Caregivers Based on Social Cognitive Theory: A Randomized Clinical Trial Study.

BACKGROUND: Caregivers of hemodialysis patients spend a large amount of time providing care to these patients while tolerating fatigue and stress. This study evaluated a family-centered empowerment program on the care burden and self-efficacy of hemodialysis patient caregivers based on social cognitive theory. METHODS: In this randomized clinical trial, 70 family caregivers of hemodialysis patients in Isfahan, Iran, were selected and randomly allocated to intervention and control groups, in 2015-2016. Two questionnaires were used to collect the family caregivers' characteristics, care burden, and self-efficacy, and patients' negative and positive outcomes expectancies. Data were analyzed using SPSS before, immediately after, and 2 months after the intervention. RESULTS: There was no significant difference in the mean scores of care burden, positive outcomes expectancies, negative outcomes expectancies, and self-efficacy between the two groups before the intervention. However, there were significant differences in the post-test and follow-up data analyses (P<0.05). CONCLUSION: Given the degenerative nature of chronic kidney disease, it can be considered as a source of long-term and chronic stress for caregivers. Therefore, by implementing an empowerment program, caregiving behaviors can be improved, positive outcomes expectancies can be increased, and negative outcomes expectancies can be reduced.

Identification of Concepts of Spiritual Care in Iranian Peoples with Multiple Sclerosis: A Qualitative Study.

Living with multiple sclerosis (MS) often needs attention combined with receiving the holistic care. Attention to spiritual care dimension is one of the most important aspects of care for these patients. This study aims at exploring and explaining dimensions of spiritual care for MS patients in care system of Iran. This study is conducted to explore the concept of spiritual care in care system of Iran during 2015-2016. Purposive sampling is done on 25 participants through unstructured interviews and observation of obtained data through conventional content analysis approach. Four themes of participants' experiences in spiritual care include restoration of identity essence and nature; disease as a factor for nearness to God; giving meaning to life; and disease as a facilitator for self-purification. Clear understanding of spiritual care dimensions and promoting knowledge in MS nurses as the caregivers play important roles in achieving the goals of health among patients in different cultures and religions. Given the results of this study, the themes such as the restoration of identity essence and nature, the disease as a factor for nearness to God, giving meaning to life and the disease as a facilitator for self-purification play important roles in explaining the concept of spiritual care in patients with MS. Therefore, the MS nurses and other health professionals need to effectively and successfully integrate the concept of spiritual care with their professional performance by deep understanding of this concept and try to provide holistic care to respond to MS patients' intertwined needs.

Experience of nursing students about the barriers to patient education: a qualitative study in Iran.

PURPOSE: Patient education is a dynamic and continuous process that should be implemented during the entire time of hospital stay and even afterward. Studies have shown the typically poor quality of patient education in Iran and its failure to convey the required knowledge and skills to patients. The purpose of this study was to survey the experience of nursing students in regard to the challenges of patient education in hospitals. METHODS: This qualitative study was conducted using the conventional qualitative content analysis approach on a sample of 21 undergraduate nursing students (4th semester and beyond), which was drawn from the Qom Nursing and Midwifery School through purposive sampling with maximum variation. Data were collected through semi-structured interviews conducted over a period of 45 to 75 minutes, and were analyzed using the conventional qualitative content analysis. RESULTS: Results were derived from the experiences of 21 nursing students (nine males, 12 females) about the research subject. The primary themes identified in the study were the student-related, patient-related, instructor-related, education environment-related, and curriculum-related barriers to patient educations. CONCLUSION: Participants believed that patient education in Iranian hospitals is faced with many challenges. Nursing instructors and curriculum planners should ensure more emphasis on patient education at the initial semesters of nursing education curriculum and make sure that it is included in the evaluation of students. Hospital officials should provide a dedicated education environment with suitable facilities, tools, and atmosphere for patient education. Also, special education programs need to be developed for less educated patients.

Dedication in Caring of Hemodialysis Patients: Perspectives and Experiences of Iranian Family Caregivers.

BACKGROUND: Although dialysis treatment is considered as a life-saving treatment for chronic renal failure patients, the caregivers face challenges in caretaking of these patients. OBJECTIVES: This study is aimed to explain the perspectives and experiences among caregivers of the patients undergoing hemodialysis in Iran. METHODS: A qualitative design, based on a thematic analysis approach, was used to reach the study aim. In this study, 25 hemodialysis family caregivers were selected by purposeful sampling. The data were gathered through in-depth and unstructured interview and field observation and analyzed by the inductive thematic approach. RESULTS: The three main themes were generated from the analysis of the data indicating that the caregivers face challenges such as heavy burden of care, tension in care, and emotional exhaustion. CONCLUSION: Caretaking of the hemodialysis patients is constantly accompanied with challenges and concerns regarding the effective care for patients. Health-care providers need to address these concerns based on both patient- and caregiver-focused approaches, rather than only patient focused, to the design and planning for helping the patients and their caregivers.

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.

A study of stigma among Iranian family caregivers of patients with multiple sclerosis: A descriptive explorative qualitative study.

AIM: This study was done to investigate the experiences of family caregivers of people with multiple sclerosis (MS) about stigmatization in Iranian health care context. BACKGROUND: Stigmatization has been observed obviously among patients with MS but few studies have been conducted on stigma among the family caregivers of these patients. METHODS: This qualitative study with thematic analysis was done to explore this issue. Fourteen family caregivers of patients with MS were selected by purposive sampling. The data were collected through in-depth and unstructured interviews. RESULTS: Four main subthemes emerged from the analysis of the transcripts: "feeling shame", "fear of being ridiculed by others", "ignored by family" and "concealing disease to be secure against the perceptions of disease". CONCLUSIONS: Healthcare professionals should be encouraged to inform caregivers about social engagement strategies and to train them on the management of stigma as an important factor for the reduction of their social problems.

Effect of Fordyce Happiness Model on depression, stress, anxiety, and fatigue in patients with multiple sclerosis.

PURPOSE: This study was conducted to investigate the effect of Fordyce Happiness Model (FHM) on depression, stress, anxiety, and fatigue in MS patients. METHODS: In this clinical trial, 140 MS patients assigned to experimental and control groups. Depression, anxiety, stress, and fatigue were measured by Depression Anxiety Stress Scale-21 and Piper Standard Scale before and immediately and three months after the implementation of FHM. The data were analyzed by SPSS 18. RESULTS: Independent t-test indicated that total scores of stress, depression, and fatigue of the two groups were not significantly different before the intervention but were significantly different after the intervention (P˂0.05). Moreover, anxiety scores of the two were not significantly different after the intervention (P˃0.05). CONCLUSION: FHM can assist MS patients to manage their disease and associated problems in life. Besides that, since FHM is efficient and costless, it can be incorporated into the health interventions for MS patients.

COPING SKILLS OF IRANIAN FAMILY CAREGIVERS' IN CARETAKING OF PATIENTS UNDERGOING HAEMODIALYSIS: A QUALITATIVE STUDY.

BACKGROUND: Coping skills enable caregivers to establish and maintain supportive relationships with the haemodialysis patients they care for. These skills are very important in terms of social support, promotion of mental health and social and family relations. The aim of this study is to investigate the coping skills of Iranian family caregivers as they take care of patients undergoing haemodialysis. METHODS: Twenty participants were selected for the study through purposive sampling. The data gathering techniques used for the research were in-depth and unstructured interviews. The researchers used an inductive thematic analysis approach to analyse the data generated from the interviews. RESULTS: Four main themes emerged from the data: help-seeking skills, self-nurturing skills, time management skills and stress management skills. CONCLUSION: The focus of attention was on the stress management coping skills of the caregivers of haemodialysis patients together with their ability to cope with complex problems. Healthcare providers, by taking into account these skills and strategies of empowerment, can help other caregivers of haemodialysis patients cope with their heavy care conditions and better define their purposes in caretaking.

The Effectiveness of Assertiveness Training on the Levels of Stress, Anxiety, and Depression of High School Students.

BACKGROUND: Adolescence is a transition period from childhood to early adulthood. Because of the immense pressure imposed on adolescents due to the complications and ambiguities of this transition, their level of excitement increases and sometimes it appears in the form of sensitivity and intense excitement. OBJECTIVES: This study aimed at determining the effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students. MATERIALS AND METHODS: This quasi-experimental study was conducted on high school students of Isfahan in academic year 2012 - 13. A total of 126 second grade high school students were collected according to simple random sampling method and divided into two groups: experimental with 63 participants and control with the same number. Data gathering instruments included a demographic questionnaire, Gambill-Richey assertiveness scale, and depression anxiety stress scales (DASS-21). Assertiveness training was carried out on the experimental group in 8 sessions; after 8 weeks, posttest was carried out on both groups. Statistical tests such as independent t test, repeated measures ANOVA, Chi-square test, and the Mann-Whitney test were used to interpret and analyze the data. RESULTS: The Chi-square and Mann-Whitney tests did not show significant statistical differences between the two groups in terms of demographic variables (P ≥ 0.05). Repeated measures ANOVA showed no significant difference between the mean scores for assertiveness before (100.23 ± 7.37), immediately after (101.57 ± 16.06), and 2 months after (100.77 ± 12.50) the intervention in the control group. However, the same test found a significant difference between the mean score for assertiveness in the experimental group before (101.6 ± 9.1), immediately after (96.47 ± 10.84), and 2 months after (95.41 ± 8.37) implementing the training program (P = 0.002). The independent t test showed no significant difference in the mean score for anxiety and stress between two groups before the assertiveness training program; however, 2 months after the intervention, the mean score for anxiety in the experimental group was found significantly lower than the control group. As for the mean score for depression, the independent t test showed no significant difference between two groups before training; however, despite the decrease in the mean scores for depression in the experimental group following the intervention, the difference was not significant (P = 0.09). CONCLUSIONS: The results of the current study show that conducting assertive training in high school students decreases their anxiety, stress, and depression. Given that high school years are among the most sensitive stages of one's life plus the fact that conducting such training programs besides their safe and low cost nature are effective and practical, it is highly recommended that such programs be carried out among high school adolescents.

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.