Cancer nurses' perspective of error disclosure from nurses to patients: A qualitative descriptive study.

PURPOSE: This study aims at exploring Cancer Nurses' Perspective of Error Disclosure. METHODS: This qualitative descriptive study was conducted in 2022, Iran. Data collection methods included observation (121 h), and semi-structured interviews (12 interviews with nurses, and nursing managers). Data analysis was performed using Graneheim and Lundman's approach. This study obtained ethical approval from Ethics Committee of Isfahan University of Medical Sciences. The COREQ checklist was used for study report. RESULTS: Data analysis resulted in three categories and nine subcategories: Error disclosure as a professional necessity (error disclosure as one of the patient's rights and error disclosure for self-and peer-learning), Error disclosure barriers (cancer-related factors, individual deterrents, nurses' intragroup culture, and organizational deterrents) and Error disclosure facilitators (culture of transparency, managerial support for error disclosure and development of error disclosure protocol). CONCLUSION: Creating a culture of error disclosure requires removing barriers, and providing facilitators. By reevaluating their professional performance and responsibilities, nurses may help foster a culture of error disclosure, and managers can do the same by encouraging employees and creating a clinical error disclosure manual. The promotion of an error disclosure to the patient culture may be greatly aided by managers. They facilitate this role by providing practical guidance (based on Iranian culture, needs and conditions of cancer patients and their families) to address nurses' concerns about managers' and the organization's negative responses.

The shadow of paternalism on patient-centeredness in oncology nursing care: A barrier of health-care promotion.

BACKGROUND: Patient-centered care (PCC) is a key component of high-quality care. Given the different effects of cancer on patients, patient-centeredness is very important in oncology nursing care. The aim of this study was to explore nurses' perceptions of the patient-centered in oncology nursing care. MATERIALS AND METHODS: This descriptive qualitative study was conducted in 2018-2020, Iran. Data collection methods included observation and semi-structured interviews. Patient, family, and nurse behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing managers (12 interviews). Data analysis was performed using Graneheim and Lundman's approach. RESULTS: Data analysis resulted in the emergence of four themes: "Organizational structure as a barrier to the PCC," "Lack of institutionalization of PCC in nurses," "Understanding and paying attention to the patient as PCC," and "Situational PCC." The final theme of this study is "PCC in the shadow of paternalism." CONCLUSIONS: The paternalism approach in the context of oncology nursing care has made the realization of PCC difficult. The first step to promote PCC is increasing nurses' awareness of the impact of paternalism on patient-centeredness. Providing patient-centered oncology nursing care requires changing attitudes, values, and behaviors at individual, professional, and organizational levels.

Development of a Patient Decision Aid to Help People Living with Inflammatory Bowel Disease.

BACKGROUND: Patient decision aid (PDA) is a tool, which helps the improvement of shared decisionmaking and is a part of the paradigm shift from physician-centered decisions to patient-centered shared decision making. In this study, we aimed to describe the process used to develop a PDA for facilitating shared decision-making about treatment in patients with inflammatory bowel disease (IBD) who need medication (corticosteroid, azathioprine, anti-TNF, and infliximab) or surgery. METHODS: The development process of PDA included: 1) The development of a prototype based on literature review and interview 2) 'Alpha' testing with patients and clinicians 3) 'Beta' testing in real conditions and 4) The production of a final version. This process took about 12 months (2019-2020). The participants were adult patients with IBD, gastroenterologists, and nurses. RESULTS: The final PDA contains four important sections: 1) Introduction about IBD disease, the purpose of developing PDA, and emphasis on shared decision-making 2) Benefits and risks of main medicines 3) The success rate as well as the incidence of complications after surgery, and 4) The conclusion about patients' satisfaction with PDA to choose the treatment options. Besides, PDA evaluation in the real world setting showed that 100% of physicians (n=4) and 86% of patients (n=12) were completely satisfied with the content of the PDA and considered it applicable and useful. CONCLUSION: This PDA can help patients participate in the shared decision-making process and select the best medical and surgical treatment methods. The feedback received from clinicians and patients showed their satisfaction with using the PDA.

Communication culture in cancer nursing care: an ethnographic study.

PURPOSE: This study aimed to explore the communication culture in nursing care of patients with cancer. METHODS: This ethnographic study was conducted in 2018-2019. Data were collected through participatory observation (318 h of observing nurses, patients, and family behaviors), semi-structured interviews (8 interviews with nurses), and informal interactions. Data were analyzed using Spradley's framework. RESULTS: The study results in five cultural components of "communication determinants," "experimental acquisition of communication skills," "gradual empathetic communication," "avoidant communication with patient," and "communication with family as caregiver." "Communication between nurse, patient and family is an experimental, gradual and avoidant relationship" was the study's cultural statement. CONCLUSION: In this study, the nurse-patient communication was influenced by factors related to the patient, the nurse and the care environment, and nurses acquired communication skills experimentally. There were two patterns of empathetic and avoidant communication between the nurse and the patient. For having high-quality care, nurses' behavioral patterns must be improved and changed in some cases. Nursing professors, managers, and nurses can use these results in training, hiring, orienting novice nurses, and empowering oncology nurses. Training communication skills to nurses and changing managers and nurses' approach to move from task-oriented care to holistic care help improve nurses' communication patterns.

Challenges to Family Caregivers in Caring for Gastric Cancer Patients from Perspectives of Family Caregivers, Patients, and Healthcare Providers: A Qualitative Study.

OBJECTIVES: Cancer affects both patients and their families. Sometimes, the effects of cancer on families are greater than its effects on patients. Family caregivers play significant roles in care for patients with cancer. Nonetheless, the data on the challenges they face in caregiving are limited. The present study explored the perspectives of patients with gastric cancer (GC), their family caregivers, and healthcare providers regarding family caregivers' challenges in caregiving to patients with GC. MATERIALS AND METHODS: This descriptive exploratory qualitative study was conducted in 2019-2020. Six GC patients, six family caregivers, three physicians, and five nurses took part for a total of twenty participants. Purposive sampling was performed, and data were collected through semi-structured interviews and continued up to data saturation. Conventional content analysis was used for data analysis. RESULTS: Caregivers' challenges in caregiving to patients with GC were grouped into five main categories, namely, lengthy process of GC diagnosis, delivery of bad news, management of physical symptoms, altered relationships, and psychological consequences, and 14 subcategories. CONCLUSION: Educating the public about the primary symptoms of GC and the importance of timely seeking medical care as well as using culturally appropriate protocols for delivering bad news is recommended. Empowering family caregivers for the effective management of GC symptoms and caregiving-related challenges are also recommended to reduce their caregiver burden.

Nutritional challenges of gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study.

PURPOSE: This study aims to explore the perceptions of gastric cancer patients, their family caregivers, physicians, and nurses of nutritional challenges. METHODS: Using a descriptive qualitative method, this study was conducted in 2019-2020. Twenty participants (6 patients, 6 family caregivers, 3 physicians, and 5 nurses) were selected through purposive sampling. Data was collected through in-depth semi-structured interviews and examined using qualitative content analysis. RESULTS: Data analysis revealed three categories, each with two subcategories: eating, an unpleasant experience that contains "a feeling like hyperemesis gravidarum" and "childish food excuses"; flexibility while adhering to a proper diet, which consists of "dietary dos and don'ts" and "nutritional leniency"; and nutrition with distress that contains "patient's sense of being an extra burden" and "provision of nutrition with suffering in caregivers." CONCLUSION: Because of the significant physical and psychological impact of nutritional problems on patients and their caregivers, the need to provide care and education to these patients and their families using a multidisciplinary team is becoming more important.

Caring Burden and Quality of Life of Family Caregivers in Patients Undergoing Hemodialysis: A Descriptive-Analytic Study.

BACKGROUND: Caring role, especially in chronic diseases, has a negative impact on the health of family caregivers and can affect their quality of life. Therefore, this study aimed to investigate the care burden and quality of life in family caregivers of hemodialysis patients and their relationship with some characteristics of caregivers and patients. METHODS: This study was conducted as a descriptive-analytic study in Isfahan from January to February 2017. Sampling was done using census. The number of participants was 254. The data gathering tools consisted of a three-part questionnaire including demographic characteristics, the Zarit questionnaire for caring burden, and SF-36 quality of life questionnaire. Data were analyzed using descriptive statistics, Pearson correlation coefficient test, Spearman's coefficient, ANOVA, and univariate general linear regression. A significant level of 5% was considered. RESULTS: The mean scores of the quality of life and caring burden were 30.54±9.89 and 44.98±6.82, respectively in caregivers. The age of the patient under care (P<0.001), cost of medications (P=0.008), and hours of care in 24 hours (P<0.001) had a significant relationship with care givers' quality of life. Also, univariate general linear regression revealed that care burden had a significant relationship with the quality of life (P=0.003). CONCLUSION: Family caregivers who experienced more caring burden had a low quality of life. The researchers suggest that supportive and educational programs should be designed and implemented for this group of patients and their caregivers.

Exploring the challenges of clinical education in nursing and strategies to improve it: A qualitative study.

BACKGROUND: Clinical education is the heart of professional education in nursing. The perspective of nursing students and clinical nursing educators as the main owners of teaching-learning process are of determinants affecting clinical education process. This study was conducted to explore and to describe the clinical education problems and strategies to improve it from the perspective of nursing students and clinical nursing educators. MATERIALS AND METHODS: The study was conducted using a descriptive qualitative method in 2017. Participants included 35 baccalaureate nursing students and 5 clinical nursing educators from nursing faculty of Isfahan University of Medical Sciences, Isfahan, Iran. Participants were selected using purposeful sampling method. Data were collected through semi-structured individual interviews and used qualitative content analysis for analysis. RESULTS: The 2 main categories, 7 subcategories, and 19 sub-sub categories extracted from interviews. The two categories were "challenges of clinical education in nursing with four subcategories: fear, insufficient readiness of student, incompetency of clinical educators, unpleasant atmosphere of clinical environment," and "strategies for improving clinical education of nursing with three subcategories: the use of nursing education models and methods, improvement of communication between faculty and practice, and holding orientation stage at the beginning of training." CONCLUSIONS: The findings show that clinical strategies, including employing experienced clinical educators, attempting to enhance the learning environment, developing the relationship between faculty and practice, participation of clinical nurses in clinical education, paying attention to entering behavior, and holding orientation stage at the beginning of training, can improve clinical education of nursing.

Patient Safety Culture in Intensive Care Units from the Perspective of Nurses: A Cross-Sectional Study.

BACKGROUND: One of the goals of nursing is providing safe care, prevention of injury, and health promotion of patients. Patient safety in intensive care units is threatened for various reasons. This study aimed to survey patient safety culture from the perspective of nurses in intensive care units. MATERIALS AND METHODS: This cross-sectional study was conducted in 2016. Sampling was done using the convenience method. The sample consisted of 367 nurses working in intensive care units of teaching hospitals affiliated to Isfahan University of Medical Sciences. Data collection was performed using a two-part questionnaire that included demographic and hospital survey on Patient Safety Culture (HSOPSC) questionnaire. Data analysis was done using descriptive statistics (mean and standard deviation). RESULTS: Among the 12 dimensions of safety culture, the nurses assigned the highest score to "team work within units" (97.3%) and "Organizational learning-continuous improvement" (84%). They assigned the least score to "handoffs and transitions"(21.1%), "non-punitive response to errors" (24.7%), "Staffing" (35.6%), "Communication openness" (47.5%), and "Teamwork across units" (49.4%). CONCLUSIONS: The patient safety culture dimensions have low levels that require adequate attention and essential measures of health care centers including facilitating teamwork, providing adequate staff, and developing a checklist of handoffs and transitions. Furthermore, to increase reporting error and to promote a patient safety culture in intensive care units, some strategies should be adopted including a system-based approach to deal with the error.

Comparison of the perspectives of managers, employees and clients regarding the individual barriers of family planning counseling in healthcare centers of isfahan in 2012.

BACKGROUND: Family planning is a lifestyle that is selected voluntarily and is based on the knowledge, attitude and responsible decision making by couples in order to promote the health and welfare of the family and the advancement of the society. In this regard, family planning counseling plays an important role in making informed decisions if used properly and in a responsible way. Detection of individual barriers in family planning counseling based on the viewpoints of managers, employees and clients who are key participants in the healthcare service provision is a major step towards appropriate planning to modify or eliminate such barriers. OBJECTIVES: The present study was conducted with the goal of comparing managers', employees' and clients' viewpoints about individual barriers in family planning counseling in health care centers in Isfahan in 2012. PATIENTS AND METHODS: This was a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 employees and 126 clients in medical health care centers in Isfahan in 2012. The managers and employees were selected by census sampling, and the clients were recruited through convenient random sampling. The data collection tool was a researcher-designed questionnaire, which was designed in two sections of fertility and personal characteristics, and viewpoint measurement. Descriptive and inferential statistical tests were used to analyze the data. RESULTS: The obtained results showed significant differences between mean scores of viewpoints in three groups of managers, employees and clients concerning individual barriers in family planning counseling. In addition, most of the managers, employees and clients reported individual barriers as an intermediate level barrier in the process of family planning counseling. CONCLUSIONS: Results indicate that subjects in three studied groups hold different views regarding the individual barriers in family planning counseling. This difference in the perspectives may be a factor that affects the quality of the provided services. Therefore, it is necessary for the healthcare providers to consider the main concerns of their clients regarding family planning.

The effect of a supportive educational program based on COPE model on caring burden and quality of life in family caregivers of women with breast cancer.

BACKGROUND: The family caregivers of the people with cancer such as breast cancer experience a decrease in their quality of life and an increase of their caring burden. In most of the cases, the researchers consider the quality of life and physical and psychological problems in patients with cancer and pay less attention to the family caregivers. To reduce the caring burden imposed to the caregivers and improve their quality of life, supportive strategies such as problem solving can be used. These interventions may have benefits for the caregivers although the research results are contradictory. The aim of this research was to determine the effect of a supportive educational program, based on COPE model, which focuses on creativity, optimism, planning, and expert information on individuals, on the caring burden and quality of life in the family caregivers of women with breast cancer. MATERIALS AND METHODS: The present study is a clinical trial, which was conducted in Seyed-Al-Shohada Hospital of Isfahan University of Medical Sciences and a private center of chemotherapy in 2012. In this study, researchers investigated the effect of a supportive educational program based on COPE model on the caring burden and quality of life in the family caregivers of women with breast cancer. This supportive educational program included two hospital visits and two telephone sessions based on COPE model for 9 days. A total of 64 patients were selected based on the inclusion criteria and randomly assigned into two groups. Data were collected by use of Caregiver Quality of Life Index-Cancer (CQOL-C), World Health Organization Quality of Life - Bref(WHOQOL-Bref)_, and Zarit caring burden at the beginning of the intervention and a month after the intervention. RESULTS: The results showed that in the experimental group, the mean score of physical, mental, spiritual, environmental domains and overall quality of life in the family caregivers was significantly increased compared to the control group, but there was no change in the social domain of quality of life in the two groups. In the experimental group, the mean score of caring burden among the caregivers was significantly decreased compared to the control group. CONCLUSION: Results of the present study suggested that a supportive educational program can improve physical, mental, spiritual, environmental domains and overall quality of life. It can also decrease the caring burden in the family caregivers of women with breast cancer. Further studies are needed to evaluate the impact of these interventions on quality of life and caring burden in the family caregivers of women with breast cancer undergoing other cancer treatments.