Quality of services in health education nurse-led clinics: an Iranian service providers and service recipients experience.

BACKGROUND: Patient education is a vital role of nurses in nurse-led clinics(NLCs). Since 2011, independent NLCs entitled health education Nurse-led clinics(HENLCs) have been established in Iran. In order for this newly developed service to be able to perform perfectly in implementation and evaluation, it should be explained based on one of the quality evaluation models. The objective of the study was to determine the dimension of service quality in HENLCs based on service providers' and service recipients' experience. METHODS: This research is a qualitative study of directed content analysis type conducted between May and November 2020. Twenty-nine participants who had rich experiences in the patient education in HENLCs were interviewed in this study. Asarroodi et al.'s (2018) qualitative content analysis method was used for data analysis, and MaxQDA software was used for data management. We used credibility, dependability, and Confirmability to confirm the trustworthiness of the study's findings. RESULTS: In this study service providers including managers, policymakers, decision-makers, nurses, physicians, and service recipients including patients and families participated. Seven generic categories, including (1) a competent and self-motivated nurse educator, (2) an easily accessible and comfortable environment, (3) informational-educational materials and health education equipment, (4) motivational facilities, (5) access to the health education support team, (6) organizational communication supporting the education process, and (7) receiving the patient education fee, constituted the main category of structure. Five generic categories, including (1) assessment and determination of the educational needs of the target group, (2) description of the nurse's duties, (3) teaching-learning methods, (4) patient referral, and (5) the process of preparing and publishing educational content, constituted the main category of process. One generic category called evaluation constituted the main category of outcome. CONCLUSION: Based on the results of this study, it is suggested to managers to pay attention to the dimensions of the quality model of Donabedian (SPO) in setting up and developing the performance of HENLCs, it is recommended that future quantitative studies based on the categories formed in this study evaluate the observance of the dimensions of structure, process and outcome.

Concept analysis of self-neglect in the elderly: a hybrid model.

PURPOSE: Clarifying the concept of elder self-neglect. METHODS: Researchers investigated the concept of elder self-neglect using a hybrid approach, including theoretical, fieldwork, and final analysis phases. After an extensive review of related literature to define the concept of self-neglect and describe its characteristics, the fieldwork phase was carried out to illustrate its empirical features. Accordingly, it led to the extraction of the elder self-neglect attributes from the first two phases. FINDINGS: Elder self-neglect includes "subjective and objective high-risk behaviors pertinent to physical and spiritual health as well as restricted social interactions, disregarding the living environment, and a lack of compliance to personal hygiene routines that the elderly demonstrate deliberately or unintentionally. Various factors can contribute to such behaviors, including individual features, poor physical performance, elderly-oriented psychological disorders, financial challenges, detrimental stressors, unsuccessful social interactions, inaccessible supportive resources, inadequate educational resources, and inappropriate cultural norms. Consequently, such behaviors result in impaired physical and psychological health status, higher risk of misbehavior, poor quality of life, extra caregiving-treatment burden, and affected mental security in society." CONCLUSION: Given that elder self-neglect is considered a relatively unknown concept in Iran, the study findings can pave the way for future extensive research in the Iranian context by clarifying the concept. It can play a significant role in developing related tools to design more efficient interventions and improve the quality of nursing care services. IMPLICATIONS FOR NURSING PRACTICE: The elder self-neglect concept can lead to numerous health-related disorders among the elderly in society. Nurses cannot deal with an unknown phenomenon without exploring and identifying its exact meaning. It is, therefore, imperative to illustrate the different dimensions of this concept to help create a deep understanding among the nurses and perform timely diagnosis and interventional procedures.

Health-related quality of life and related factors in patients with colorectal cancer in Iran: a systematic review.

Introduction: This systematic review aims to examine the health-related quality of life (QOL) in Iranian patients with colorectal cancer (CRC) and its related factors. Methods: A thorough, systematic search was conducted in different international electronic databases, including Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords such as "Colorectal neoplasm", "Colorectal tumors", "Colorectal cancer", "Quality of life", and "Life quality" from the earliest to 17 October 2022. The quality of the studies included in this systematic review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool). Results: There were 820 CRC patients in the five cross-sectional studies that made up this systematic review. The mean score of QOL in patients with CRC was 61.99 (SD=15.87) out of 100 based on EORTC-QLQ-C30, which indicates a moderate to good level of QOL. Factors such as age, gender, living conditions, level of education, occupation, monthly income, health insurance, physical activity, performance status, and comorbidities had a significant relationship with QOL in patients with CRC. Conclusion: In sum, the findings of the five studies that were a part of this systematic review revealed that Iranian patients with CRC had a moderate to good QOL. Therefore, managers and health policymakers can create psychological counseling programs with an emphasis on the factors affecting the QOL of patients in light of how crucial it is to raise patients' understanding of the long-term impacts of CRC and how they affect their QOL.

Factors related to advance directives completion among cancer patients: a systematic review.

INTRODUCTION: Advance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive regarding a person's future medical care. It is used when a person is unable to participate in the decision-making process about their own care. Therefore, the present systematic review investigated the factors related to ADs from the perspective of cancer patients. METHODS: A systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior. RESULTS: Out of 5900 research papers found, 22 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients' age was 62.04 ± 6.44. According to TPB, factors affecting ADs were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: "Lack of knowledge of the ADs concept" and "Previous experience of the disease", the subjective norm category includes three subcategories: "Social support and interaction with family", "Respecting the patient's wishes" and "EOL care choices". Also, the category of perceived control behavior was categorized into two sub-categories: "Decision-making" and "Access to the healthcare system", as well as external factors affecting the model, including "socio-demographic characteristics". CONCLUSION: The studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the palliative care practice, promoting the participation of health care professionals in ADs activities and creating an AD-positive attitude should be strongly encouraged.

Palliative care need in the Eastern Mediterranean Region and human resource requirements for effective response.

Integration of palliative care into health care systems is considered an ethical responsibility, yet no country in the Eastern Mediterranean Region (EaMReg) has achieved integration. Data on palliative care need and cost are crucial forEaMReg health care planners and implementers in the region. Using data from the Lancet Commission on Palliative Care and Pain Relief, we estimated the number of people in each EaMReg country who needed palliative care in 2015 and their degree of access. In three countries, we estimated the number of days during which an encounter for palliative care was needed at each level of the health care system. This enabled calculation of the number of full-time equivalents (FTEs) of clinical and non-clinical staff members needed at each level to administer the essential package of palliative care recommended by WHO. In 2015, 3.2 million people in the EaMReg needed palliative care, yet most lacked access to it. The most common types of suffering were pain, fatigue, weakness, anxiety or worry, and depressed mood. To provide safe, effective palliative care at all levels of health care systems, between 5.4 and 11.1 FTEs of trained and supervised community health workers per 100,000 population would be needed in addition to 1.0-1.9 FTEs of doctors, 2.2-4.3 FTEs of nurses, and 1.4-2.9 FTEs of social workers. Data from our study enables design of palliative care services to meet the specific needs of each EaMReg country and to calculate the cost or cost savings.

Needs Assessment and the Identification of Palliative Care Dimensions of the Essential Service Package for the Elderly with Alzheimer's Disease: A Mixed Exploratory Study.

AIM: This study was conducted with the aim of assessing the needs and determining the care dimensions of the essential palliative care service package for the elderly with Alzheimer's disease. METHOD: The mixed exploratory study was conducted in three phases. The first phase of the study was conducted in the form of a qualitative study and a literature review. This qualitative research was done through in-depth and semi-structured interviews with 19 qualified caregivers (11 informal caregivers and 8 formal caregivers) The samples were selected using the purposive sampling method by referring to hospitals, nursing homes, and active branches of the Alzheimer's Association in some provinces. In the second phase, the dimensions of palliative care were codified, and in the third phase, the prioritization and the validation of the dimensions of palliative care were performed in the form of two Delphi rounds. RESULTS: Based on the results of the first phase of the study, the care dimensions of the service package were placed in eight categories based on National Consensus Project. In the second phase, the needs of Alzheimer's patients were arranged in the form of a questionnaire consisting of 8 parts, with 180 indicators. Then, in the third phase, the dimensions of the palliative care essential package were designed with 74 items in the form of 4 dimensions. CONCLUSION: The dimensions of the essential service package of palliative care included a series of interventions as well as physical, psychological, cognitive, and spiritual support.

Factors Improving Oncology Nurse Role Performance in Providing Pediatric Palliative Care: A SWOT Analysis.

OBJECTIVE: Palliative care is provided by an interdisciplinary team in which, nurses play an important role, and improving their role performance can be effective in providing high-quality care. This study aimed to explore the factors related to improving oncology nurses' role performance in providing pediatric palliative care. METHODS: This qualitative study was conducted using semi-structured interviews with 22 nurses, physicians, hospital supervisors, children, and their parents from September 2022 to January 2023. Data analysis was performed based on conventional content analysis proposed by Elo and Kyngas using MAXQDA 2020. Finally, subcategories of each main category were summarized in the SWOT analysis matrix. RESULT: Data analysis led to the extraction of 1250 codes, three main categories (nurse-related factors, child and family-related factors, and organizational factors), five generic categories, and 32 subcategories that were ultimately classified in the SWOT analysis matrix. CONCLUSION: This study showed that oncology nurses' role performance in providing palliative care is influenced by many internal and external factors. In this regard, in order to improve their role performance, increasing knowledge among nurses, nursing students, and the community on integrating pediatric palliative care topics into the nursing curriculum, fair access to palliative care services, drug accessibility, financial support, and further research are recommended.

Caring ability and its related factors in the family caregivers of patients with cancer.

BACKGROUND: Caregivers of cancer patients experience a variety of challenges caused by the prolonged burden of care. Many of these caregivers do not have the necessary knowledge, skills and caring ability to fulfil their caring role. Therefore, healthcare providers should support them in learning to provide high-quality care. Evaluating caregivers' ability will be the first step of this supportive programme. AIM: The aim of this study was to determine the caring ability of the caregivers of cancer patients and its related factors. METHODS: This descriptive correlational study was performed with 271 caregivers of cancer patients who were selected through convenience sampling conducted from July to December 2021 in selected hospitals in Tehran, the capital city of Iran. The data were collected using the caring ability of family caregivers of patients with cancer scale (CAFCPCS), which was developed by Nemati et al (2020). In addition, the stability reliability coefficient was calculated to be ICC=0.93. Data analysis was performed through Statistical Package for the Social Sciences (version 26), using descriptive and inferential statistics and correlation coefficient tests at a significance level of 0.05. RESULTS: The mean score for the caring ability of the family caregivers of cancer patients in this study was 91.86±7.59. The mean total score of caring ability scale had a statistically significant correlation with the type of cancer and the duration of patient care (P-value=0.05). CONCLUSION: The results of the study demonstrated that the family caregivers of cancer patients do not have the necessary knowledge and awareness to perform their caring role effectively. Therefore, it is recommended to empower caregivers and use strategies to improve their trust, especially in caregivers who oversee patient care for a significant period of time.

Evaluation and comparison of knowledge translation patterns in selected countries with Iran: A comparative study.

BACKGROUND: One of the main issues related to the inefficiency of the health system is the lack of sufficient communication between researchers and health policymakers regarding the exchange of the latest findings and the use of inappropriate evidence to manage cases. The knowledge translation removes this disconnect. MATERIALS AND METHODS: In this comparative study, to obtain appropriate data on the status of knowledge translation, refer to the databases of reputable centers and governments and the knowledge translation models were reviewed in the title of main articles, abstracts, guidelines, and reports of reputable international organizations between 2005 and 2020. The origin of the models was determined, then the countries with the largest number of models were selected and analyzed using Walt and Gilson's "Policy Triangle framework in four dimensions: context, content, process, and actors." RESULTS: All the three countries have politically, socially, and economically made knowledge translation one of their policy priorities. Iran's centralized health system is a major obstacle. The USA and Canada have clear strategies and coherent and practical infrastructures that implement the knowledge translation in the form of operational plans. In contrast, in Iran, it has been enough to establish the knowledge translation centers at the level of universities and knowledge translation websites. In Iran, the Ministry of Health and universities of medical sciences play a direct role, but in Canada, they also use knowledge broker to apply knowledge. CONCLUSION: Iran is building capacity in the field of knowledge translation. That the implementation of interventions with the cooperation of macro policymakers can strengthen it.

The development of practice standards for patient education in nurse-led clinics: a mixed-method study.

INTRODUCTION: Educating patients and families about self-care is one of the important roles of nurses in Nurse-led clinics (NLCs). NLCs need standards for guiding the practice of nurses. A standard is an authoritative statement that sets out the legal and professional basis of nursing practice. This paper seeks to report the development of practice standards for patient and family education in NLCs. METHODS: This project used a Sequential-Exploratory mixed methods design. Before the study, we conducted a literature review to identify gaps. Directed content analysis was used in phase 1. The second phase involved two focus groups. The third phase involves two rounds of modified Delphi. RESULTS: Twenty-nine participants were interviewed, and 1816 preliminary codes were formed in phase 1. 95 standards were grouped into three main categories (structure, process, and outcome). In the first focus group, experts eliminate 32 standards. Experts eliminate 8 standards after the second stage of the focus group. After two rounds of Delphi, the final version of the standard consists of 46 standards (13 structure, 28 process and 5 outcome). CONCLUSIONS: Nurses and institutions could benefit from practice standards for patient education in the NLCs, which consist of 46 statements in three domains, as a guide for clinical activities and a tool to gauge the quality of patient education in NLCs. The developed standards in this study can guide new and existing NLCs and help them evaluate ongoing activities. Providing patient education in NLCs based on standards can improve patients' outcomes and promote their health.

Determining the psychometric properties of safety attitudes questionnaire in NICUs.

INTRODUCTION: This study aimed to translate and assess the psychometric properties of the Persian version of the "Safety Attitude Questionnaire" in the NICUs. METHODS: In this psychometric study, the "Safety Attitude Questionnaire" was translated into Persian. Then this version was used for psychometric evaluation. For this purpose, the qualitative face, content validity and construct validity were performed by confirmatory factor analysis. Internal consistency and stability reliability were calculated. Data were analyzed using SPSS and AMOS software. RESULTS: Face validity was also performed with a slight change in four items. The factor structure of the tool was determined by confirmatory factor analysis. Fit indices were appropriate. Internal consistency reliability in the whole questionnaire was 0.65 and the stability reliability was calculated to be 0.64. DISCUSSION AND CONCLUSION: "Safety Attitude Questionnaire" has appropriate psychometric properties and can be used in NICUs.

Barriers to Applying Integrative Oncology from the Perspective of the Care Providers in Iran: A Mixed-Methods Study.

OBJECTIVE: The present study aims to explain and determine the use of integrative oncology from the perspective of the care providers in Iran. DATA SOURCES: This mixed-methods study is a convergent type of study with quantitative and qualitative phases that have been performed simultaneously. The quantitative phase was a descriptive study that was conducted through convenience sampling. With the use of a psychometrically evaluated questionnaire with 10 items, 202 nurses and physicians were included in the study to assess their views on the integration of traditional and complementary medicine (TCM) within supportive cancer care. The qualitative part of the study was conducted through semistructured interviews with 11 care providers. The interviews were analyzed through conventional content analysis and the method proposed by Graneheim and Lundman with the use of MaxQDA software. CONCLUSION: After the quantitative and the qualitative data were combined, we identified four main categories as the important dimensions of using TCM: patients' main expectations of TCM services, reasons for using these services, existing challenges and barriers, and recommendations and strategies to improve the interaction between physicians and patients to facilitate the use of integrative oncology . IMPLICATION FOR NURSING PRACTICE: Although cancer patients use TCM due to a wide range of expectations, there are many barriers to integrative oncology in Iran. Therefore, it is necessary to pay attention to the benefits of conventional medical and TCM treatments, conceptualize integrative oncology, and try to meet the existing challenges.

Explanation of near-death experiences: a systematic analysis of case reports and qualitative research.

Background and objective: Some individuals report a near-death experience (NDE) after a life-threatening crisis, which refers to a range of subjective experiences related to impending death. This experience is a phenomenon with transcendental elements, which leads to deep permanent changes in both the individual and the social lives of the NDEr's. Therefore, this study aims to review the near-death experiences of individuals with different religious and cultural views. Methodology: This is a systematic analysis study. All the case report, case series and qualitative research studies which presented patients' NDE experiences were included in the study, without language restrictions, and in the period of 1980-2022. The stages of screening, selection, data extraction, and quality assessment have been gone through by two of the researchers. Data analysis and synthesis has been done qualitatively. JBI Critical Appraisal Checklist tool was used to evaluate the quality of the included studies. Findings: After the initial search, 2,407 studies were included, 54 of which underwent final examination. The total number of the NDEr's in the studies was 465 men, women, and children. Among these studies, 27 were case reports, 20 were case series, and 7 were qualitative studies. Near-death experiences have been categorized into 4 main categories and 19 subcategories. The main categories include emotional experiences (2 subcategories), cognitive experiences (4 subcategories), spiritual and religious experiences (4 subcategories), and supernatural experiences [9 subcategories in two categories (out of body experiences, and supernatural and metaphysical perceptions)]. Conclusion: The most frequent near-death experiences were supernatural experiences, especially the experience of leaving the body. The basis and the content of the patterns mentioned by the NDEr's are similar, and the differences are in the explanation and the interpretation of the experience. There is a common core among them such as out-of-body experiences, passing through a tunnel, heightened senses, etc. Therefore, correct knowledge of near-death experiences leads to providing helpful answers to patients.

Exploration of the Strategies of Iranian Nurses in Providing Palliative Care to Children with Cancer: A Qualitative Study.

AIM: This study aimed to explain the strategies of Iranian nurses in providing palliative care to children with cancer. METHOD: This study is a qualitative research with an approach to the conventional content analysis. The main participants were nine nurses working in ward pediatric oncology. Also based on data analysis, five parents of children, two children, one social worker, one physician, one psychologist, and one nutritionist were also included. Data were collected through semi-structured interviews and observation and were analyzed by the Elo and Kyngäs approach. Lincoln and Guba criteria were used for the trustworthiness of data analysis. RESULTS: Three conceptual categories were developed with qualitative analysis: "prevention and relief of pain and physical symptoms", "spontaneous compassion", and "strengthen parental resilience"; that were derived from the main categories: "attention to precautionary considerations," "friendly relationship of nurses with parents of children, create enjoyable moments, spontaneous assistance," "facilitate coping with current situation, perceived confrontation with child death." CONCLUSION: In this study, the results showed that nurses' strategies in providing palliative care to children with cancer were a combination of professional and spontaneous strategies.

Validation of post-traumatic growth inventory in mothers with the experience of having the NICU-Hospitalized newborns "validation of post-traumatic growth inventory".

AIMS: Investigating post-traumatic growth (PTG) in mothers with the experience of having a preterm newborn hospitalized in the NICU requires a valid tool. This study aims to determine the validity and reliability of the Farsi version of the post-traumatic growth inventory (PTGI) in mothers with the experience of having their newborns hospitalized in the NICU. DESIGN: This study was methodological research. METHODS: In this study, 250 mothers who had newborns with a history of NICU hospitalization during the last 3 to 12 months and had visited paediatric clinics of the selected hospitals in Tehran with the aim of having their children's condition examined were selected through convenience sampling. The data were collected using a demographic information questionnaire and PTGI. The face validity, the construct validity (confirmatory factor analysis), and the internal consistency reliability of the inventory were measured using SPSS V22 and LISREL V8.8. RESULTS: According to appropriate values for factor analysis fit indices (FI = 0.94, RMSEA = 0.07, IFI = 0.94, NFI = 0.93, RFI = 0.91, NNFI = 0.93, SRMR = 0.07), 21 items and 5 factors were confirmed for this inventory. Furthermore, Cronbach's alpha coefficient of this inventory was measured as α = 0.94. CONCLUSION: According to favourable psychometric properties, the Farsi version of PTGI is a suitable tool for studying PTG in mothers with the experience of having preterm newborns in the NICU. Using PTGI can help nurses in planning family-centered care interventions to reduce the impact of the mental trauma caused by the preterm newborn's hospitalization in parents. PATIENT OR PUBLIC CONTRIBUTION: Mothers who had newborns with a history of NICU hospitalization during the last 3-12 months.

Molecular detection of Neospora caninum in chicken meat and eggs in Iran.

Neospora caninum is an obligatory intracellular protozoan parasite, phylum Apicomplexa. Canids are definitive hosts and different animals can be intermediate hosts. Neospora DNA has been also detected in humans, recently. This study aimed to understand the infection rate of N. caninum in chicken meat because consumption of raw and undercooked meat can be the main risk factor for canine neosporosis. Investigation of Neospora vertical transmission to the eggs is also important. One hundred chicken legs, and fifty eggs from free-range chickens, and fifty eggs from industrial chickens were collected from different stores in Semnan city, Iran. Deoxyribonucleic acid (DNA) of samples was extracted, and the Nested-PCR (polymerase chain reaction) on Neospora internal transcribed spacer (ITS-1) gene was performed. Neospora caninum DNA was detected in eight out of one hundred (8%) chicken legs, and no eggs were infected. These results revealed that N. caninum infection in chicken meat for the first time in Iran. For the investigation of Neospora vertical transmission to eggs, more studies will be necessary. Indoor carnivores should be fed, and humans should be consumed well-cooked chicken meat to prevent infection.