The patients' lived experiences with equitable nursing care.

BACKGROUND: Equitable care is a fundamental value in the nursing profession. Healthcare workers have both a moral and professional duty to ensure that they do not discriminate. AIM: This study aimed to explore how patients perceive equitable nursing care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT: This descriptive phenomenological qualitative research study used purposeful sampling to select 17 patients from various departments of a general hospital in southern Iran. The participants were then interviewed using a semi-structured in-depth interview format, which aimed to delve into their experiences with equitable nursing care. The collected data were analyzed using Colaizzi's seven-step method and MAXQDA20 software. ETHICAL CONSIDERATIONS: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Ethics Committee of Jiroft University of Medical Sciences. FINDINGS: The data analysis of the study identified three main themes and six subthemes that were related to the experiences of patients with equitable nursing care. The first theme, equitable care, encompassed subthemes such as nurses' dedicated efforts to facilitate patient recovery and adherence to ethical behavior. The second theme, unconscious causes of inequitable nursing care, included subthemes such as unintentional discrimination stemming from organizational constraints and unconscious biases resulting from a lack of knowledge and skills. The third theme, discriminatory care, comprised subthemes such as deliberate discrimination based on personal traits and selective discrimination. CONCLUSION: The study findings indicate that achieving equitable nursing care requires a multifaceted approach. This includes effective hospital management, organizational reforms, and regulatory enhancements. Additionally, it is crucial to pay close attention to the needs of patients, enhance nurses' theoretical and practical skills in providing equitable care, fostering a culture of equality within healthcare settings, and consider the personality dimensions and moral characteristics of nurses.

The association between sexual function, quality of marital relationship and associated factors in women with a history of ectopic pregnancy: a cross-sectional study in Iran.

BACKGROUND: Ectopic pregnancy (EP) has many adverse effects on the relationship between couples. The present study aims to assess the association between sexual function (SF), quality of marital relationship (QMR) and associated factors in women with a history of EP. METHOD: This cross-sectional study was performed on 220 women with a history of EP in Kerman in 2022. Convenience sampling method was applied. Data were collected using the female sexual function index (FSFI) and the perceived relationship quality components scale (PRQC) questionnaires and were analyzed with descriptive and inferential statistics (median regression) in Stata software version 17. A P-value < 0.05 was considered statistically significant. RESULTS: Of the female participants, 20.4% had sexual dysfunction (SD). Longer duration of marriage (P = 0.045) and increase in the number of EPs (P < 0.001) were associated with a decrease in SF. A quarter of women experienced poor QMR. Increase in spouse age (P = 0.047), longer duration of marriage (P = 0.028), and increase in the number of EPs (P < 0.001) were associated with a decrease in QMR. There was a significant direct relationship between SF and the QMR (r = 0.857; P < 0.001). CONCLUSION: The present study showed a significant relationship between SF and the QMR in women with a history of EP. Therefore, SF and the QMR are necessary to be considered in future health promotion programs of these women.

The effect of mobile app-based self-care training on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women: a clinical trial study in Iran.

BACKGROUND: Educational interventions for self-care are a necessary solution to help postmenopausal women properly deal with menopausal problems. The present study aimed to investigate the effect of self-care training using an application on the quality of marital relations and the severity of menopausal symptoms in postmenopausal women in Iran. METHODS: In this study, 60 postmenopausal women selected using the convenience sampling method were divided into two groups, intervention and control, using simple random allocation (lottery). The intervention group used the menopause self-care application for eight weeks in addition to routine care, but the control group only received the routine care. The Menopause Rating Scale (MRS) and the Perceived Relationship Quality Components (PRQC) questionnaire were completed in two stages, before and immediately after eight weeks, in both groups. Data were analyzed using SPSS software (version 16), descriptive (mean and standard deviation), and inferential (ANCOVA and Bonferroni post hoc) statistics. RESULTS: The ANCOVA results showed that the use of the menopause self-care application decreased the severity of the participants' menopause symptoms (P = 0.001) and improved the quality of their marital relations (P = 0.001). CONCLUSION: Implementation of a self-care training program through the application helped improve the quality of marital relations and reduce the severity of postmenopausal women's symptoms, so it can be used as an effective method to prevent the unpleasant consequences of menopause. TRIAL REGISTRATION: The present study was registered at https://fa.irct.ir/ on 2021-05-28 (registration number: IRCT20201226049833N1).

Design, Implement, and Evaluate a Short-term Blended Training Program on Nursing Students' Disaster Response Self-efficacy in Iran.

OBJECTIVE: This study aimed to design, implement, and evaluate a training program on nursing students' disaster response self-efficacy. METHODS: This study was conducted using a pre-test, post-test, and follow up design. A total of 92 nursing students participated in the study. The developed program was implemented both theoretically (online) and practically (in person). Nursing students' disaster response self-efficacy was measured using the Disaster Response Self-Efficacy Scale that was filled out 1 week before the intervention, and 2 months after the intervention by the students. The students' satisfaction with the program and their views on the program were also surveyed. RESULTS: Overall score and all items score had significant improvement in short-, and long-term except in 1 item (item 22). The highest increase in score was related to practical items and referral for psychiatric treatment (items 7, 8, 10, and 18) and the lowest increase was related to communication and ethical skill items (items 20, 21, and 22). It is possible that the students had a higher perception of communication and ethical skills even before the training. Most of the students were satisfied with the program. CONCLUSIONS: A training intervention that can provide theoretical materials online, as well as face-to-face practical programs, can increase nursing students' disaster response self-efficacy.

The design and psychometric evaluation of the Supportive-Care Needs Scale (ZOKH-SCNS29) in patients living with cancer.

BACKGROUND: Understanding the needs of cancer patients and planning to meet these needs is a major concern of the health system. AIM: The present study aimed to design and conduct a psychometric evaluation of supportive-care needs scale in patients with cancer. METHODS: This study was conducted in both qualitative and quantitative stages. In the qualitative phase, the questionnaire items were generated by analysing the data from 16 interviews, after which, face, content and construct validity were tested. To construct the validity, the questionnaire was completed by 229 cancer patients. The reliability of the questionnaire was assessed by internal consistency. Data were analysed using SPSS (version 18). FINDINGS: In this study, 4 factors were extracted from 29 items through exploratory factor analysis: 'Need to be understood by the spouse and family' (10 items), 'Need to manage existential and psychological challenges' (7 items), 'Need to manage lack of knowledge about the disease' (7 items), 'Need organisational-therapeutic support '(5 items). These factors accounted for 50.1%. of the total variance. Internal consistency was 0.88, and also the Cronbach's alpha coefficient was also 0.89 after construct validity for the scale items'. The Cronbach's alpha was 0.91 after the construct validity. CONCLUSION: The findings of the present study showed that this supportive care needs scale is a valid and reliable scale for identifying the supportive care needs of patients with cancer.

Prevalence of self-medication among the elderly: A systematic review and meta-analysis.

BACKGROUND: Self-medication is the use of unprescribed drugs to treat a disease. Elderly self-medication can be more dangerous compared to other age groups because of changes in organ functions that occur due to senescence. This study aimed to estimate the prevalence of self-medication in the elderly, its related factors, and common drugs used in this regard. MATERIALS AND METHODS: Electronic databases such as PubMed, Scopus, and Web of Science were searched between January 2016 and June 2021. The search strategy was built on two core concepts: "self-medication" and "aged". The search was limited to original articles in the English language. A random effect model was used to estimate the pooled prevalence of self-medication. Heterogeneity among studies was assessed using both the I2 statistic and the χ 2 test. Also, a meta-regression model was used to investigate the potential sources of heterogeneity of the studies. RESULTS: Out of 520 non-duplicate studies, 38 were included in the meta-analysis. Self-medication in the elderly ranged from 0.3% to 82%. The pooled proportion of self-medication was 36% (95% CI: 27%-45%). The result of the χ 2 test and the I2 index (P < 0.001, I2= 99.90%) revealed notable heterogeneity among the included studies in the meta-analysis. The meta-regression showed a significant association between the sample size (adjusted ß = -0.01; P = 0.043) and the pooled proportion of self-medication. CONCLUSION: The prevalence of self-medication in the elderly is high. Education through mass media to raise awareness about the dangers of self-medication can help solve this problem.

Relationship Between the Psychological Distress and Spiritual Well-Being in Pregnant Women Exposed to Domestic Violence: A Cross-Sectional Study in Iran.

Maternal psychological distress is often associated with domestic violence. Spiritual well-being can affect the psychological capacity to deal with distress. This study aimed to investigate the relationship between psychological distress and spiritual well-being in pregnant women exposed to domestic violence. This cross-sectional study was conducted on 305 pregnant women subjected to domestic violence in southern Iran. The participants were selected using the census method. Data were collected using the Spiritual Well-being Scale (SWB), the Kessler Psychological Distress Scale (K10), and the Hurt, Insult, Threaten, Scream (HITS) screening tool (short form) and were analyzed with descriptive and inferential statistics (t-test, ANOVA, the Spearman correlation coefficient, and multiple linear regression) in SPSS software version 24. The mean scores ± standard deviation of the participants' psychological distress, spiritual well-being, and domestic violence were 24.68 ± 6.43, 79.89 ± 18.98, and 11.24 ± 1.5, respectively. The results showed that psychological distress had a significant negative correlation with spiritual well-being (ρ = - 0.84, P < 0.001) and domestic violence (ρ = - 0.73, P < 0.001). The results of the multiple linear regression analysis also showed that spiritual well-being and domestic violence could predict the psychological distress of pregnant women who were exposed to domestic violence, which explained 73% of the psychological distress in the participants. According to the study results, spiritually oriented education can be provided for women to reduce their psychological distress. Also, it is recommended that necessary interventions be used to reduce domestic violence and empower women to prevent it.

Exploring the experiences of nurses caring for patients with COVID-19: a qualitative study in Iran.

BACKGROUND: The coronavirus disease (COVID-19) is now a major public health emergency in the world. Nurses as key members of the COVID-19 patient care team are exposed to most challenges caused by the disease. As exploring the experiences of nurses as patient supporters and caregivers can play an important role in improving the quality of care for patients with COVID-19 disease, the present study explored the experiences of nurses caring for patients with COVID-19. METHODS: The study employed a qualitative design. This study employed purposive sampling to select 10 nurses with bachelors and master's degrees in nursing who were taking care of patients with COVID-19 in ICUs or inpatient wards in southern Iran. Data were collected through semi-structured interviews. The collected data were analyzed using the qualitative content analysis procedure proposed by Graneheim and Lundman. RESULTS: The analysis of the data revealed four main themes and ten sub-themes: A) physical, psychological, and social burden of care (excessive workload; fear, anxiety, worry; unpleasant social experiences; compassion fatigue) B) unmet needs (personal needs and professional needs) C) positive experiences (pleasant social experiences and inner satisfaction), and D) strategies (problem-solving strategies and stress symptom mitigation strategies). CONCLUSIONS: An analysis of the themes and subthemes extracted in this study suggested that the nurses who participated in this study faced many personal and professional challenges. Therefore, health officials and specialists need to pay special attention to nurses' challenges and needs.

Experiences of family caregivers of patients with COVID-19.

BACKGROUND: Family caregivers of patients with COVID-19 face many challenges that affect their physical and mental health. AIM: The aim of the present study was to explore experiences of family caregivers of patients with COVID-19. METHODS: This phenomenological study was performed based on 13 family caregivers who had experience in home caring for patients with COVID-19. Data were collected through purposive sampling with in-depth semi-structured interviews. The Colaizzi's 7-step method was used to determine themes. The MAXQDA10 software was used to manage qualitative data analysis. RESULTS: Thirteen family caregivers participated. Five main themes describe family caregivers' experiences of caring for patients with COVID-19: nature of the disease; unmet needs; unpleasant physical, psychological, and social experiences; care facilitators and positive experiences. CONCLUSION: Information and financial support for COVID-19 should be provided to family caregivers. Also, community members should embrace patients and family caregivers and reinforce the positive experiences of caregivers.

Development and psychometric testing of nursing students' perceptions of clinical stressors scale: an instrument design study.

BACKGROUND: In clinical environments, nursing students experience a range of stressors that can affect their health, learning, and quality of patient care. This study aimed to develop a Nursing Students' Perceptions of Clinical Stressors Scale (NSPCSS) and to evaluate its psychometric properties. METHODS: This exploratory, sequential mixed-method study was conducted in 2 phases. In the qualitative (item generation) phase, NSPCSS items were generated using the data collected from semi-structured interviews and a literature review. In the quantitative (psychometric evaluation) phase, face, content, construct, convergent, and discriminant validity and reliability of the scale were tested. To evaluate construct validity, exploratory and confirmatory factor analyses were performed on the data collected from 430 nursing students. Reliability was also assessed through internal consistency and composite reliability. RESULTS: In this study, 6 factors were extracted from 30 itemes through exploratory factor analysis: (1) instructor's limited competence in clinical environments, (2) inappropriate clinical environment, (3) inadequate knowledge and skills, (4) inefficient education in clinical planning, (5) instructor's inappropriate conduct, and (6) concerns about the characteristics of nursing career. These factors accounted for 58.8% of the total variance. The results of the confirmatory factor analysis suggested the goodness-of-fit indices was acceptable. Furthermore, the internal consistency and composite reliability indices of all factors were greater than 0.7. CONCLUSIONS: The NSPCSS is a valid and reliable instrument for assessing clinical stressors among nursing students.

Perceived Stress Among Iranian Nursing Students in a Clinical Learning Environment: A Cross-Sectional Study.

BACKGROUND: Nursing students experience a high level of stress in clinical settings. This study aimed to investigate the stress perceived by Iranian nursing students in the clinical learning environment and its relationship with the characteristics of students. METHODS: In this cross-sectional study, 430 nursing students who had passed at least 1 clinical training unit were recruited from universities in the Southeast of Iran using the census method. Data were collected by administering a demographic and researcher-made questionnaire to assess the perceived clinical stress. Demographic characteristics included age, sex, marital status, year of study, interest in the field, and previous semester average. Data were analyzed using independent t-test, ANOVA, and correlation coefficient test (α < 0.05). RESULTS: The mean score of overall stress experienced by the participants was 92.08±16.8 (out of 160), which was at a moderate level. Based on the study results, the most stress-inducing factors for students were instructors' limited clinical competence and instructors' inappropriate conduct. Gender (p = 0.01), fathers' education (p = 0.01), mothers' education (p = 0.01), interest in the field (p = 0.01), and year of study (p = 0.01) had a significant effect on the mean score of perceived clinical stress. CONCLUSION: The results of this study showed a moderate level of stress among the students. Also, instructors' limited clinical competence and inappropriate conduct were 2 factors that caused the highest perceived stress among nursing students more than other factors.

The relationship between clinical dishonesty and perceived clinical stress among nursing students in southeast of Iran.

BACKGROUND: Clinical dishonesty is a complex problem that threatens the health and safety of patients. This study aimed to investigate the relationship between clinical dishonesty and perceived clinical stress in nursing students. METHOD: This cross-sectional correlational study was conducted on 395 nursing students from 4 nursing colleges. The data were collected using a demographic information questionnaire, Nursing Student's Perception of Clinical Stressors, and a 12-item researcher-made questionnaire to evaluate the frequency of clinical dishonesty in the previous semester, the frequency of witnessing dishonest behavior among peers, and the perceived severity of unethical behavior. RESULTS: In this study, 89.1% of the students stated that they had committed at least one dishonest clinical behavior in the previous semester. The frequency of clinical dishonesty was significantly correlated with the frequency of observing dishonesty among peers (r = 0.053, p<0.01), perceived severity of unethical behavior (r = - 0.4, p<0.01), and perceived stress of students in the clinical setting (r = 0.28, p<0.01). Moreover, there were significant differences in the frequency of clinical dishonesty by gender (p = 0.006), the interest in the field of study (p = 0.004), and academic year (p = 0.002). CONCLUSION: The frequency of clinical dishonesty among nursing students is high and needs attention. Furthermore, considering the positive relationship between dishonesty and perceived clinical stress, it is essential to teach effective strategies to nursing students to empower them to cope with clinical stress.

General and reproductive health outcomes among female greenhouse workers: a comparative study.

BACKGROUND: Agricultural activities as well as exposure to pesticides could have many adverse effects on health status and reproductive outcomes especially in reproductive aged greenhouse workers. The present study aimed to compare the general and reproductive health outcomes between female greenhouse workers and housewives. METHODS: This cross-sectional study was conducted on 645 females of reproductive age. They were categorized into two groups according to occupation in greenhouse (308 female greenhouse workers as exposed group and 337 housewives as control group). Participants were interviewed using a questionnaire about reproductive outcomes and occupational status. Clinical measures include blood pressure (BP), pulse and respiratory rate (PR and RR), body mass index (BMI) and hematological parameters. Mann-Whitney U test was used to assess differences between two groups in quantitative variables. Chi-square or Fisher's exact tests was used to determine the differences in the distribution of categorical variables. Data was analyzed using SPSS software version 16. RESULTS: The average daily working hours of the greenhouse workers were 6.94 ± 1.99 h. Only 44.3% of them used personal protective equipment. Data revealed that the rate of spontaneous abortion, infertility, low birth weight (LBW), abnormal births and preterm birth were significantly higher among the greenhouse workers compared to the control group (p ≤ 0.05). The average number of female infants in greenhouse workers was significantly higher than the control group (p ≤ 0.05). Clinical measurements indicated an increase in RR of greenhouse workers and mean of BMI was decreased in them. Hematological parameters demonstrated that there was a significant increase in white blood cells (WBC) and significant decrease in hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC) among the female greenhouse workers compared to the control (p ≤ 0.05). CONCLUSION: Local government efforts is needed to address associated issues including acute effects on health and long-term health risks, resulting from pesticide exposure to greenhouse workers, and gender differences should be considered. Also, occupational health and safety training is necessary and can be helpful in reducing adverse reproductive outcomes.

El efecto del entrenamiento grupal en asertividad sexual sobre la asertividad sexual de las alumnas: Un estudio cuasi-experimental / The Effect of Group sexual assertiveness training on Sexual assertiveness of Female Students: A quasi-experimental study

Sexual relation is a very important part of the marital relationship. Any problem in the marital relationship affects the family and society cohesion. This study aim to determine the effect of Group sexual assertiveness training on Sexual assertiveness of Female Students. This quasi-experimental pre and posttest study was conducted on 80 married female students of Sistan and Baluchestan University (southeast of Iran), from 1 July 2018 to 30 March 2019.Students were selected and randomly allocated in the two intervention and control groups. The intervention group received group sexual assertiveness training in the 4 two-hourly sessions over a period of two weeks. The control group did not receive any training. The data were collected before and 12 weeks after the intervention by Hurlbert's sexual assertiveness questionnaire, and then were analyzed. After the implementation of group sexual assertiveness training, the mean score of sexual assertiveness significantly increased in the intervention group compared to the control group (p=0.01). It is recommended to add sexual assertive training to the pre-marriage education, especially in cultures in which women have a low level of sexual assertiveness

Caregiver Burden and Spiritual Well-being in Caregivers of Hemodialysis Patients.

The number of hemodialysis patients is increasing worldwide, and the caregivers of these patients experience a great burden. This study was conducted to examine the relationship between caregiver burden and spiritual well-being in caregivers of hemodialysis patients in Kerman, Iran. This correlational study was conducted on 382 caregivers of hemodialysis patients. Data were collected using the Caregiver Burden Inventory (24 items) and Ellison and Paloutzian 20-Item Spiritual Well-being Questionnaire. Data were analyzed by descriptive and inferential statistics (t test, ANOVA, Spearman correlation, and linear regression analysis) in SPSS 20 software. The findings showed that 45 (11.8%) caregivers had mild, 214 (56%) moderate, and 123 (32.2%) high caregiver burden. Furthermore, 1 (0.3%) caregiver had mild, 349 (92.4%) moderate, and 32 (8.4%) high spiritual well-being. Also, Spearman correlation test showed a significant reveres relationship between caregiver burden and spiritual well-being scores (p < 0.001, r = - 0.41). Moreover, the results of the regression analysis showed that the patient's income, frequency of patient dialysis per week, and patient's need to receive care and spiritual well-being were predictors of caregiver burden, which explained 41% of the burden in caregivers. The results of this study revealed that spiritual well-being was negatively related to caregiver burden and was one of its predictors. Therefore, spirituality can be used as a low-cost and effective intervention to reduce the caregiver's burden.

Iranian Nursing Students' Experience of Stressors in Their First Clinical Experience.

The first clinical experience is a turning point in the educational journey of nursing students as it marks the beginning of their professional development. This experience is often stressful for students. This study was conducted mainly to research, describe and interpret nursing students' perceptions of stressors in the clinical environment in their first clinical experience. The present phenomenological study selected seven nursing students through purposive and snow balling sampling and questioned them in semi-structured interviews. The data acquired were analyzed by Colaizzi's method. The following themes emerged in this study: 1- the sense of inadequacy, 2- being ignored, 3- ineffective communication, 4- prevailing sadness and 5- ambiguity. The results of the present study showed that nursing students experience several sources of stress in their first clinical experiences. Hence nursing administrators should diligently evaluate and rectify nursing students' clinical stressors.

Coping strategies of nursing students for dealing with stress in clinical setting: A qualitative study.

BACKGROUND: Nursing students in the clinical setting experience a high level of stress. The understanding of people involved in nursing education, from coping strategies of nursing students with clinical stress, is highly important for any kind of planning in this field. OBJECTIVE: To explore the coping strategies of Iranian nursing students with stress in a clinical setting. METHODS: This qualitative content analysis study was carried out with twenty nursing students who were selected using purposive sampling at the Razi nursing and midwifery school in Kerman, in Iran during a ten-month period in 2016. Data were collected using semi-structured face to face interviews, and analyzed through Graneheim and Lundman's qualitative content analysis method. RESULTS: "Seeking well-being" as the main theme and three categories of "Active confrontation with stress", "mastering the mind and body" and "avoidance" were obtained from data analysis. CONCLUSION: The exploration of nursing students' experiences of coping with clinical stressors, increases students' awareness of their coping strategy. The academic authorities in recognizing the coping strategies of students with stress in clinical setting, can provide necessary training on effective coping strategies for students.

POSTOPERATIVE PAIN: MANAGEMENT AND DOCUMENTATION BY IRANIAN NURSES.

BACKGROUND: Pain is one of the most common symptoms experienced by patients after surgeries. Inadequate postoperative pain management is an international problem and the need to improve its management is well documented. The aim of the study was to assess nursing reports related to the patients' pain intensity and quality, concomitant symptoms, use of scales in pain assessment, and compliance with the national guideline after surgery. METHODS: This study was a retrospective cohort; samples were nurse records of patients who had elective surgery. RESULT: Only 6% of the patients' pain records included pain intensity which was not measured with standard scales. More than half of all injections were opioid analgesic which is in contrast to the guidelines of the Iranian Ministry of Health. Pain assessment was higher in women and by nurses with more than 15 years of working experience. CONCLUSION: to conclude, the patients' pain was not assessed properly in terms of intensity, quality, and associated symptoms. Therefore, training and motivating nurses is very important in this context and should be incorporated in nurses' academic and continuous educational courses.

THE ASSESSMENT OF CAREGIVER BURDEN IN CAREGIVERS OF HEMODIALYSIS PATIENTS.

BACKGROUND: Chronic renal failure is among the chronic disease which due to persistence of the disease and long treatment process has various effects on the physiological, psychological, functional ability, lifestyle changes, and independence status of the patient and his family. This may result in the burden feeling in caregivers. According to the importance of the subject, this study is to assess the level of caregiver burden in caregivers of hemodialysis patients. METHODS: This is a cross-sectional analytical descriptive study that was conducted in 2014 on the caregivers of hemodialysis patients. Research instruments were consisted of two parts: demographic data check list and caregiver burden questionnaire. Data were analyzed by SPSS statistical software and Pearson correlation coefficient tests. A p value of less than 0.05 was considered statistically significant. RESULTS: In this study, 72.5% of caregivers reported moderate to severe levels of caregiver burden. A significant relationship was observed between gender of the patient with caregiver burden score of (p=0.031) and type of the income with caregiver burden score of (p=0.000). Caregivers of male patients and patients with inadequate income had a higher caregiver burden score. CONCLUSIONS: Our results showed that more than half of the caregivers of hemodialysis patients had moderate to severe levels of caregiver burden, therefore it is worthy that health officials and nurses pay special attention to this issue by communicating with these patients and their caregivers.