The Impact of Loving-Kindness Meditation on Job-Related Burnout of Nurses Working in Neonatal Intensive Care Unit: A Randomized Clinical Trial Study.

Job-related burnout is one health outcome in nurses working in neonatal intensive care units (NICUs) due to the heavy workload, which results in negative physical and psychological consequences. One newly introduced approach to improve coping is loving-kindness meditation (LKM). Some studies have shown the effectiveness of the LKM on the mental health of nurses, though more evidence is required to support them. This study aimed to investigate the effectiveness of the LKM on job-related burnout of nurses working in NICU. This clustered controlled randomized clinical trial assessed job-related burnout before and after a month of practicing LKM guided through a virtual method. A total of 66 eligible NICU nurses from 2 referral children hospitals in Tehran were randomly assigned to 2 control (n = 33) and intervention (n = 33) groups. The intervention was performed 3 times a week for 1 month in the form of 20-minute audio files of LKM for the intervention group, and educational files on mental health during the COVID-19 pandemic were sent to the control group. The instruments used in this study were the demographic information questionnaire and the Maslach Burnout Inventory, which participants completed before and after the intervention. The mean difference in the overall scores of burnout before and after the intervention in the intervention group was significantly reduced (P = .003), but no significant difference was observed in the control group (P = .018). These findings support the benefit of LKM in NICU nurses in reducing burnout.

The Impact of Loving-Kindness Meditation on Compassion Fatigue of Nurses Working in the Neonatal Intensive Care Unit: A Randomized Clinical Trial Study.

Compassion fatigue is a common complication in nurses, which can lead to burnout, job dissatisfaction, and a decline in the quality of patient care. This study aimed to investigate the impact of loving-kindness meditation on compassion fatigue of nurses working in the neonatal intensive care unit (NICU). This cluster-blinded randomized clinical trial study was conducted on 66 NICU nurses in 2 educational hospitals selected. The intervention group received a 1-month online program for daily training and practice of loving-kindness meditation. The control group received miscellaneous files on mental health during the COVID-19 pandemic period. The Nursing Compassion Fatigue Inventory (NCFI) was filled out by the 2 groups, before and after the intervention. The results showed that the mean scores of the NCFI in the intervention group decreased significantly compared with before the intervention (P = .002). In comparison with the control group, there was a significant difference between the mean scores of the 2 groups after the intervention (P = .034). Among nurses working in NICU, loving-kindness meditation significantly reduces compassion fatigue after 1 month. These findings support the use of this intervention for nurses.

An integrative review of defining characteristic of the nursing diagnosis "spiritual distress".

AIM: The aim of this study was to identify the defining characteristics of spiritual distress (00066). DESIGN: This study was conducted by integrated review method using Broom method. METHODS: PubMed, ProQuest, Web of Science, Embase, Scopus, and Cochran Library, and Persian scientific databases were searched from January 2010 to December 2020. RESULTS: Twenty-one article and 74 defining characteristics were identified. 33 of these defining characteristics was mentioned in NANDA. The criteria with the highest frequency and repetition in articles were lack of peace, lack of hope, change in anger behaviour, lack of meaning in life, change in fear and crying behaviour, Concern about belief and values system and/or God. CONCLUSION: Some of the spiritual distress defining characteristics overlap with other nursing diagnoses, including anxiety and hopelessness. Clinical and content validation studies need to be conducted and the main criteria for diagnosing spiritual distress in different cultures and religions need to be identified.

Predictors of Perceived Family Sense of Coherence in Parents of Children with Cancer.

Objectives: Despite improvement in childhood cancer survival in recent decades, it is still an extremely challenging health condition for parents. The impacts of childhood cancer on the family as a whole are recently interested by researchers. Family coherence is one of these concepts and health-care providers need to understand the perception of parents of family coherence. This study aimed to assess the correlation between perceived family sense of coherence (SOC) in parents of children with cancer; with socio-demographic, psycho-emotional and family-related variables. Materials and Methods: This cross-sectional correlational study recruited 125 parents of children with cancer attending hospitals in Tehran in 2020, selected by convenience sampling method. The correlation between family SOC and demographic variables, chronic sorrow, coping behaviours, family functioning and social support was investigated using regression analysis. Results: The mean score perceived sense of family coherence in parents of children with cancer was higher in fathers (Beta = 0.17, P = 0.02), urban residents (beta = -0.2, P = 0.01) and homeowners (beta = -0.27, P = 0.001). The sense of family coherence had positive correlations with income grade (beta = 0.27, P = 0.006), coping behaviours (beta = 1.28, P = 0.002), social support (beta = 0.67, P = 0.001), negative correlations with the disturbance in family problem-solving (beta = -0.28, P = 0.006) and chronic sorrow (beta=-0.39, P = 0.001). Conclusion: The present study expanded the concept of family SOC in nursing knowledge and attracted the attention of the providers of family-centred care to the parents of children with cancer and their concerns, which directly and indirectly affect the entire family's health.

Development and validation of an instrument to measure pediatric nurses' adherence to ethical codes.

BACKGROUND AND AIM: The nature of pediatric settings may encounter nurses with more complicated ethical issues. A code of ethics guides nurses to act and decide ethically as a profession. Also, there is always a need to evaluate amount nurses adhere to this code of ethics, using valid and reliable instruments. This study aimed to develop a questionnaire and assess its psychometric properties to measure pediatric nurses' adherence to the code of ethics. METHODS: In this methodological research study, firstly, the questionnaire was developed based on an extensive review of the related literature and the theoretical framework of nursing ethics. A panel of experts (n = 12) reviewed the preliminary questionnaire qualitatively and quantitatively (using CVI and CVR). A conveniently selected sample of 156 nurses working in pediatric wards in three hospitals filled out the questionnaire. The psychometric process included determining sample size and data adequacy using KMO and Bartlette's test of sphericity; exploratory factor analysis (principal component method with Promax rotation); item analysis; and Cronbach's alpha coefficient. Also, the Interclass Correlation Index (ICC) value was determined using a two-week interval test-retest method on 30 eligible nurses. RESULTS: The CVI and CVR for the entire questionnaire were 0.85 and 0.78, respectively. The CVI and CVR of all items were reported higher than 0.59 and 0.8, respectively. Cronbach's alpha of the 28-items instrument was 0.92. Extracted six factors explained 65.31% of the total variance, and the values of the item correlations with the total questionnaire showed good internal consistency (0.52 to 0.90). The items of each factor were evaluated to determine the values they represent. Accordingly, the factors were named beneficence, nonmaleficence, human dignity, autonomy, informed consent, and honesty. The ICC value was 0.99. CONCLUSIONS: The developed instrument is acceptable and has good reliability and validity. It can be used to assess the amount of pediatric nurses' adherence to the code of ethics by managers, teachers, and researchers.

"Human as an Embodied Spirit": A Proposed Conceptual Model for Nursing Based on Iranian Mysticism and Wisdom.

Most nursing models are developed based on Western philosophy. The conceptual model of "human as an embodied spirit" based on Iranian mysticism and wisdom is presented in this article. This conceptual model was developed in 2 phases: first, using a derivation process, the concepts of the model were developed. Next, in a synthesis process, the conceptual model was constructed. Definitions and descriptions of each of the concepts of the model-the constitution of the physical body, the composition of graded soul, knowledge-based interventions, love-based interventions, balance, and harmony-and the relations between these concepts are presented in the article. This model gives equal value to the art and the science of nursing and integrates all dimensions of human being and related health problems in such a way that they can be explained and approached as a continuum. The next step is the testing of this model followed by the development of guidelines for education and practice.

The Impact of an Online Mindfulness-Based Stress Reduction Program on Sleep Quality of Nurses Working in COVID-19 Care Units: A Clinical Trial.

The coronavirus disease-2019 (COVID-19) epidemic is associated with impaired sleep quality in nurses for several reasons. The present study aimed to determine the effect of an online mindfulness-based stress reduction (MBSR) program on improving the sleep quality of nurses working in the COVID-19 care units. In this randomized controlled clinical trial study, all nurses in the 2 COVID-19 patient care units were randomly assigned to the control and intervention groups. The MBSR program was implemented online for 7 weeks for the intervention group by a trainer. The Pittsburgh Sleep Quality Index (PSQI) was completed online by the participants in both groups before and after the intervention. The results of the data analysis indicated that the intervention improved the scores of subjective sleep quality, sleep latency, and sleep efficiency in the intervention group. In the control group, there was a significant increase in the scores of subjective sleep quality, daily performance, and the total index score in the posttest. Besides, there was a significant difference between the 2 groups in only 2 components of sleep latency and subjective sleep quality. The MBSR program can be an effective intervention to improve the sleep quality of nurses working in COVID-19 intensive care units who are at risk of sleep quality disorders in stressful situations.

Perspectives of Afghan refugee mothers on the experience of caring for a child with cancer: a qualitative analysis.

BACKGROUND: Cancer in children causes many challenges for the family. When a refugee family experiences it, its impacts may be different and more specific considerations for care may be needed. AIMS: This study aimed to explore the experiences of Afghan mothers living in the Islamic Republic of Iran who had a child with cancer. METHODS: This was a qualitative study, conducted in 2017, of Afghan refugee women with children diagnosed with cancer and referred to a cancer referral hospital in Tehran; they were selected through purposive sampling. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was reached. Conventional content analysis was done. MAXQDA 10 was used for organizing the data. RESULTS: Nine Afghan mothers were interviewed. They were aged 24-44 years and the children were aged 2-9 years. A primary theme called "passive acceptor" was found with five subthemes: chronic suffering, health issues, lack of skills, maladaptive coping and enthusiasm. The mothers were struggling to cope with the challenges of caring for a child with cancer both financially, physically and emotionally. CONCLUSION: In spite of many issues in common with similar groups in other countries, Afghan mothers appear to need to greater assistance when it comes to seeking help and understanding for the care for their child with cancer, possibly because of cultural barriers to self-empowerment. Tailored care plans are recommended for Afghan refugee mothers in the Islamic Republic of Iran.

How Hospital Tours Affect Preoperative Anxiety in Mothers with Children Undergoing Open-Heart Surgery in Iran: A Quasi-Experimental Study.

BACKGROUND: Parents tend to experience considerable amounts of anxiety before their children undergo open heart surgery. This study was conducted to assess the effects of taking a hospital tour on preoperative anxiety in the mothers of children undergoing open heart surgery. METHODS: In this quasi-experimental study, 96 mothers from Shahid Modarres Hospital in Tehran, Iran, during April to December 2018, were selected through convenience sampling and were assigned to three groups using simple randomization. The oral instruction group (N=32) attended two oral instruction sessions; the hospital tour group (N=32) participated in tours of the operation room and intensive care unit; the control group (N=32) was prepared according to the ward's routine. Preoperative anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale and the State Trait Anxiety Inventory. Data were analyzed in SPSS-20. The ANOVA, paired t-test and Tukey's test were used for the data analysis. The level of statistical significance was set at P<0.05. RESULTS: The mothers' anxiety about surgery (F=30.99, P≤0.001) and their scores of state anxiety (F=6.02, P<0.001) differed significantly among the three groups after the intervention. A significant difference was observed between the oral instruction and control groups (P<0.001) and the hospital tour and control groups (P<0.001) regarding the surgery-related anxiety scores. A significant difference was also observed between the oral instruction and control groups (P=0.002) regarding the mothers' state anxiety scores. CONCLUSIONS: The results suggest the greater efficiency of oral instructions versus hospital tours. Nurses can use oral instructions for reducing surgery-related anxiety and state anxiety of mothers before their toddlers' open heart surgery.Trial Registration Number: IRCT20180904040944N1.

Translation, Cultural, and Age-Related Adaptation and Psychometric Properties of Persian Version of "Quality of Dying and Death" in Nurses Working in Neonatal Intensive Care Units.

BACKGROUND: Death and dying care is an area with less attention in nursing. This even is evidenced as more challenging in some populations such as neonates. Neonatal intensive care unit (NICU) nurses should be aware of the quality of care they provide for dying neonates and their families to find the areas which need attention. OBJECTIVE: The aim of this study was to assess the psychometric features of the Quality of Dying and Death (QODD) questionnaire in NICU nurses in Tehran, the capital city of Iran. METHODS: This methodological study was conducted in 2017. For this purpose, using census method, 130 NICU nurses working in selected hospitals participated. After the backward-forward translation, based on the method proposed by the International Test Commission, the psychometric properties of the Persian QODD were examined through the assessment of the face, content and construct validity, internal consistency, and stability. RESULTS: Final Persian QODD's content and face validity were accepted through a qualitative method. In the confirmatory factor analysis, the original version of QODD was not confirmed. Subsequently, an exploratory factor analysis was carried out in which phrases were included in three dimensions (symptom control, preparation for death of neonate, and professional attention) that explained 75% of the variance. Cronbach's alpha values ranged from 0.82 to 0.88 for these three dimensions. The intraclass correlation coefficient (ICC) was ICC = 0.94 between two tests performed with a 2-week interval on twenty eligible nurses. CONCLUSIONS: The Persian version of QODD has acceptable psychometric properties in nurses working with the neonatal population and can be used to investigate the NICU nurses' opinion on the QODD provided in NICU patients.

Levels of unmet needs among adolescents and young adults (AYAs) impacted by parental cancer.

PURPOSE: In this study, we aim to assess types and levels of psychosocial needs in adolescents and young adults (AYAs) who have a parent with cancer. And define and describe the variables analyzing the demographic characteristics. METHODS: This descriptive study with cross-sectional design was conducted on 217 participants from five hospitals in Tehran. By use of the "Offspring Cancer Needs Instrument," in adolescents and young adults who had the inclusion criteria, information about the psychosocial needs were collected. Also, a demographic questionnaire was completed by the participants. Mean and standard deviation calculated for each domain and overall scores. Independent t test and one-way ANOVA was used for the comparison of needs' mean and demographic variables. RESULTS: Total scores' mean was 126 and among domains, the "information" got the highest and the "support from friends" the lowest mean. Among demographic variables, we found a relationship between parent education (p value = 0.007), treatment statue (p value = 0.015), parent gender (p value = 0.018), and parent-child relationship (p value = 0.027) with the level of psychosocial needs. CONCLUSIONS: In this target group of adolescents and young adults, the need for "information" is the strongest domain of psychosocial need during parent cancer trajectory.

Nursing adherence to ethical codes in pediatric oncology wards.

BACKGROUND: The nature of children's cancer comes with lots of ethical issues. Nurses are encouraged to adhere to ethical codes in their practice. OBJECTIVES: This study aimed to compare the perspectives of nurses and mothers of children with cancer regarding the adherence of nurses to ethical codes. RESEARCH DESIGN: In this descriptive-comparative study, a researcher-made questionnaire was used to assess the amount of adherence to Iranian nurses' code of ethics in perspectives of pediatric oncology nurses and mothers. As a convention, the total scores were categorized as optimal, average, and low adherence. PARTICIPANTS AND CONTEXT: A total of 200 mothers and 60 nurses in pediatric oncology wards of five major hospitals in Tehran, Iran, participated in 2016. ETHICAL CONSIDERATIONS: Organizational approval by the university and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process. FINDINGS: Results showed the mean score of the adherence to ethical codes by nurses, as per the nurses is 86.71 (12.57) and as per the mothers is 78.67 (16.09). The highest frequency for "Low adherence" and "Optimal adherence" to code of ethics by nurses were "Respect for individual autonomy and decision-making" (mothers, 72% and nurses, 70%) and "Commitment to confidentiality" (mothers, 64% and nurses, 74%), respectively. This revealed a significant difference between the responses of the nurses and the mothers (p = 0.001). DISCUSSION: The results support the other studies in Iran about the difference between the perspectives of patients and nurses about adherence of nurses to ethical codes. CONCLUSION: Integration of family-centered and conventional care in addition to more attention to the education of professional ethical principles could be helpful to improve the ethical performance of nurses in oncology pediatric wards.

The main nursing metaparadigm concepts in human caring theory and Persian mysticism: a comparative study.

Metaparadigm concepts comprise the central issues in a discipline. Fawcett has named person, health, environment and nursing as the four main concepts of nursing that need to be comprehensively defined. The Human Caring Theory is significant because of its focus on the spiritual dimension of human beings. The aim of this study was to comparatively explain three of the main metaparadigm concepts of nursing in the Human Caring Theory and Persian mysticism, and find the similarities and differences that can help develop the theory and its application in societies with a theistic point of view. This comparative documentary study was done in two phases. First, a concept analysis was performed to find the attributes, antecedents and consequences of the concepts of human being, environment and health in the two fields of Persian mysticism and Jean Watson's Human Caring Theory. Then they were apparently and deductively compared with each other. In spite of some similarities between the two perspectives, Persian mysticism was found to provide more comprehensive conceptualizations of the three main concepts of nursing.

Psychometric Properties of the Persian Version of the Offspring Cancer Needs Instrument (OCNI)

Aim: The offspring cancer needs instrument (OCNI) was developed specifically for assessing unmet psychosocial needs of adolescents and young adults who have a parent with cancer. The aim of this study is to examine the psychometric properties of the Persian version of this instrument. Methods: For this methodological study, translation of OCNI into Persian was conducted using translation and back-translation and revision in line with the developer of the instrument. Then, face and content validity, construct validity, internal consistency and stability of the Persian version of the instrument were examined with a population of 188 adolescents and young people having a parent with cancer in five hospitals in Tehran, Iran. Data were analyzed using SPSS version 16 and LISREL 8.5. Results: The final Persian version of the instrument demonstrated face and content validity proven by expert and participant reviews. Confirmatory factor analysis confirmed construct validity of the instrument and its seven subscales. Cronbach's alpha was 0.96 for the total instrument and 0.76-0.93 for its seven subscales. The intraclass correlation coefficient (ICC) calculated to evaluate the test-retest reliability, was 0.83. Conclusions: The Persian version of OCNI has acceptable psychometric properties. It can be used for measuring psychosocial unmet needs in adolescents and young adults in Persian language populations who have a parent with cancer.

Religious Coping in Iranian Mothers of Children With Cancer: A Qualitative Content Analysis.

OBJECTIVE: Religious coping is one of the most frequently used coping methods in parents of children with cancer. This study aims to explain dimensions of religious coping in mothers of children with cancer in Iran. METHODS: In this qualitative content analysis, using purposeful sampling, 8 mothers of children with cancer were selected and interviewed. When saturation was achieved, data were analyzed through directed content analysis. Primary and secondary codes were placed in prelabeled categories and subcategories based on Pargament's religious coping theory. RESULTS: The participants of the study used coping methods in 4 of the 5 objectives of religious coping, that are meaning, control, comfort, and intimacy with others and closeness to God. Three of the most frequent used coping methods by the participants were "Punishing God Reappraisal," "Pleading for Direct Intercession," and "Benevolent Religious Reappraisal," respectively. None of the participants used religious coping methods for its function of "life transformation." CONCLUSIONS: As suggested by Pargament's theory of religious coping, the dynamic, multidimensional process of religious coping has a culture-based pattern with unpredictable outcomes. Despite many similarities between religious coping in a Shia Muslim society and other studied ones, some differences are observed. Further studies are needed to show the potential evidence of the concept in relation to cultural diversity and religious differences.

Experience of chronic sorrow in mothers of children with cancer: A phenomenological study.

PURPOSE: Chronic sorrow is a multidimensional concept experienced by mothers of children suffering with chronic conditions, e.g. cancer. Little is known about the concept of chronic sorrow and related issues/experiences among mothers of children with cancer living in Iran. This study aimed to explore the concept of chronic sorrow, based on the lived experiences of chronic sorrow experienced in a group of Iranian mothers of children with cancer. METHODS: In this hermeneutic phenomenological study, 8 mothers of children with cancer participated in semi structured, in-depth interviews about their experiences of chronic sorrow. Interviews continued until data saturation was reached. All interviews were recorded, transcribed, analyzed, and interpreted using the seven steps of the Dickelman et al.'s phenomenological approach. RESULTS: The three main themes that emerged from mothers' experiences of chronic sorrow related to their child's cancer were "climbing up shaky rocks," "religious fear and hope," and "continuous role changing." Each of these themes consisted of several subthemes. Besides the possibility of growth and coping with the chronic condition of a child which has been seen in other studies on chronic sorrow experiences, religious issues were more profound than what has reported in Western studies. Also the ambiguous prognosis and uncertain process of the cancer in children had made the experience of chronic sorrow more unique. CONCLUSION: The results of this study show that the experiences of mothers of children with cancer in Iran are not specific to them, but are better comprehended in their traditional socio-cultural context.

Chronic Sorrow in Mothers of Children With Cancer.

Chronic sorrow, a progressive, persistent, and endless feeling of grief, is seen in parents of children with chronic diseases. This study aimed to investigate chronic sorrow in mothers of children with cancer in selected hospitals in Tehran, Iran. It also sought to clarify the relationships between chronic sorrow and some demographic characteristics. In this descriptive, cross-sectional study, 264 mothers attending 3 pediatric teaching hospitals in Tehran were selected using convenience sampling. The subjects completed a demographic questionnaire and Kendall Chronic Sorrow Questionnaire (Persian version). Data were analyzed with descriptive and inferential (Mann-Whitney and Kruskal-Wallis tests) statistics in SPSS 16.0. The mean score on the Kendall Chronic Sorrow Questionnaire was 76.39 ± 15.81. Chronic sorrow was likely present or present in 97.7% of the mothers (n = 252). The mean scores on the Disparity, Sadness, and Getting Along subscales were 30.26 ± 104.209, and 33.38 ± 42.777, respectively, and the mean score for coping was 12.75 ± 11.922. The relationships between most demographic characteristics and scores on the Kendall Chronic Sorrow Questionnaire were not significant. Chronic sorrow is a concept experienced by families of children with cancer. The health care provider's knowledge about this concept and its components can facilitate the development of better support and treatment programs and lead to improved quality of life for children and their families.