Nursing Care Challenges for Patients Suffering from COVID-19 from Nurses' Perspective in Iran: A Descriptive Qualitative Study.

Background: Encountering the coronavirus disease 2019 (COVID-19) pandemic, nurses face many challenges due to various strategies and resources that can compromise the quality of care. This study aimed to identify nursing care challenges for patients with COVID-19 from nurses' viewpoint in Iran. Materials and Methods: This descriptive qualitative study was conducted in one of the main admission centers in Isfahan to treat patients with COVID-19. Data were collected through semi-structured in-depth interviews with 19 nurses from April 2020 to June 2020. The recorded interviews were transcribed and then analyzed through inductive content analysis. Results: The challenges of nursing care for patients infected with COVID-19 from the nurses' viewpoint were categorized into 11 subcategories and four main categories: work overload in disaster (lack of nurses with adequate clinical qualification and restrictions on the compliance of the infection control protocols), immersion in an ocean of psychological and social tensions (personal and family tensions, work environment tensions, perception of organizational injustice, and social stigma), quality of care in fragile condition (self-preservation rather than patient care and contradictory patient care standards), and disaster preparedness, response, and management (passive resource management, information system challenges, and lack of guideline-supported protocols). Conclusions: The findings of this study suggest that policymakers should actively participate in supporting nurses in the form of reducing physical and mental stress in pandemics such as COVID-19. Having the right perception of the challenges nurses face in such crises can contribute to providing patient safety, improving the quality of care, maintaining organizational resources, and properly managing the disaster.

Exploring the reasons for theory-practice gap in emergency nursing education: A qualitative research.

BACKGROUND: Nursing is a scientific profession, based on theory and art of care. However, the theory-practice gap has become the biggest challenge of this profession and decreases the quality of service both in teaching and practice. Thus, it seems necessary to search for these reasons in situations such as emergency department - which has an effective role in patients' health. OBJECTIVES: The objectives of this study were to find the perceived reasons for the theory-practice gap in the process of emergency nursing education from the perspective of professors, nurses, and students, as well as doctors, since they cooperate with nurses and students in the training environment. METHODS: A qualitative study was carried out; this included 18 deep, semi-structured interviews in 7 months with the people involved in the process of emergency department apprenticeship alongside with observing the activities of stakeholders. The data analysis was done in accordance with content analysis method including three steps of preparation, organization, and reporting. RESULTS: The perceived reasons for theory-practice gap were classified into 13 secondary categories. At the end of data analysis, five main categories of student, instructor, environment, culture, and the organizational process, and finally, two themes of "input" and "process" emerged. CONCLUSIONS: Nursing students in emergency department face a number of challenges in implementing theory into practice which stems from the faculty as an academic environment and the hospital as an educational environment. These underpinning reasons for the theory-practice gap influence the quality of nursing education and care delivery in emergency department. Hence, decreasing the theory-practice gap lies in the amendment of any of these factors.

Bridging the theory-practice gap in Iranian emergency nursing education.

BACKGROUND: The theory-practice gap is one of the important challenges of treatment, health, and educational systems. It is affected by different factors like students, teachers, and the clinical environment. This gap has consequences for education, as well as the treatment and health services systems. Thus, it is necessary to find effective strategies to reduce it. Therefore, the present study was conducted with the aim to find strategies to reduce the theory-practice gap in emergency nursing education in the view of stakeholders. METHODS: A qualitative research was conducted, including 18 semi-structured interviews and 3 focus group sessions with the stakeholders in a school of nursing and an educational hospital. Content analysis method was used to analyze the collected data. RESULTS: The strategies to reduce the theory-practice gap in emergency nursing education were divided into 6 primary categories, 2 main categories and 1 theme of action to change. From among the 69 strategies presented to the focus groups, the participants acknowledged 28 strategies as practical and effective. Furthermore, the participants held that it was necessary to have reformative and developmental actions in line with care, supervision, evaluation, and educational processes in order to reduce the gap between theory and practice in emergency nursing education. CONCLUSION: The theory-practice gap is affected by many different factors. Thus, the people involved must pay attention to every influential factor in order to reduce the consequences, and use effective cooperative strategies by taking into consideration the human resources, infrastructures, processes, and the administrative culture in faculty and clinical environments.

Dying with dignity: a concept analysis.

AIMS AND OBJECTIVES: This article is a report of an analysis of the concept of dying with dignity. BACKGROUND: Dignity is an important component of providing care for dying patients and their families. Nevertheless, given that this concept is poorly defined, concept analysis is one of the best ways to define and clarify the concept of death with dignity with the aim to enhance its application in clinical practice, research and education. DESIGN: A search of multiple nursing and social sciences databases was undertaken, including Academic Search Complete, Science Direct, ProQuest, Scopus, Medline, PubMed, EBSCO, Ovid, Noormage, Cinahl, Magiran, PsycINFO and SID. METHODS: After an extensive review of the literature from 1998-2014, about 14 related articles were included in the study. Based on these articles, the applications, attributes and experimental results of and references to death with dignity were recorded. RESULTS: Based on this analysis, the most important attributes of this concept included respect for privacy, respect, spiritual peace and hope. The antecedents of this concept included consideration of moral values during caregiving, preservation of human dignity as a patient right and professional ethics, and belief in the dignity of self and others, consideration of culture in providing end-of-life care. The consequences of this concept included a sense of peace in the patient and their family, peaceful death and provision of patient privacy and comfort. CONCLUSION: The concept of patient dignity has been referred to in many contexts. However, considering the dignity of dying patients commensurate with their culture is the most important component of care provided by nurses to facilitate a peaceful death. RELEVANCE TO CLINICAL PRACTICE: Respecting the dignity of the patient results in the reduction of her/his suffering and prepares her/him for a comfortable death.

Reviewing the effect of nursing interventions on delirious patients admitted to intensive care unit of neurosurgery ward in Al-Zahra Hospital, Isfahan University of Medical Sciences.

BACKGROUND: Disease is an abnormal process that affects all aspects of the human life. The hospital environment and particularly the intensive care unit (ICU) causes stress in the patient and hi/her family. Delirium, due to its sudden onset and startle, unconsciousness, memory impairment, illusion and dynamic or sedentary behaviors, is known as one of the stressor agents. Despite its high prevalence and the high cost complications such as long term mechanical ventilation, hospital pneumonia, pressure ulcer, prolongation of hospitalization in the hospital or the intensive care units, performance reduction and increase in mortality, this disorder remains unknown in most cases. In line with the other treatment team members, nurses should also participate in controlling the discountable factors, helping patients to cope with uncontrollable factors and using pharmacological methods to manage the delirium and feature their own unique capacity more through quick recognition, reviewing the causes and providing scientific care in improving the quality of patient care and improving the patients' health status. Hence, this study aimed to review the effect of nursing interventions on delirium of the patients admitted to ICU of the neurosurgery ward in Al-Zahra hospital in Isfahan. METHODS: A two-group multi-stage clinical trial study was carried out on 40 patients with hyperactive delirium admitted to ICU. The questionnaire included demographic data, Richmond Agitation Sedation Scale to assess the irritability rate and study method and also cognitive confusion in intensive care unit to determine delirium status of the study population. Simple sampling method was conducted and the study samples were randomly divided into two intervention and control groups. The following nursing interventions performed on the intervention group: assuring, emotional support, clear information and effective communication with the patients and their families and also allowing family visits twice a day. In the control group, the sample received the normal and routine ICU cares. The irritability and delirium severity status of the samples were analyzed on the day of admission and the fifth day using descriptive and inferential statistical methods and also SPSS software. RESULTS: Statistical analysis showed that although there was no significant difference between the groups on the first day of admission in terms of the irritability and delirium severity status, this was significant on the fifth day of the study. Wilcoxon test in the intervention and control groups indicated a significant difference between the study subjects in terms of the irritability and delirium severity status on the first day of admission and the fifth day which indicated the reduction in the irritability severity. But, this reduction was higher in the intervention group than in the control group. Furthermore, McNemar test showed that the number of the subjects with delirium in both groups reduced on the fifth day compared to the first day of admission and there was a significant difference between these two days, the number of samples without delirium in the intervention group was almost two times higher than that in the control group on the fifth day. CONCLUSIONS: Nursing interventions are considered as one of the non-pharmacological methods in treating delirium and by using these methods appropriately in ICUs, the patients' hypoactive delirium can be reduced.