The Perspectives of Iranian Women on Delayed Childbearing: A Qualitative Study.

BACKGROUND: Delayed childbearing is a growing trend in Iran. PURPOSE: This study explores the perspectives of women on delayed childbearing. METHODS: A qualitative study using a content analysis approach was conducted on data acquired using private semistructured interviews with 23 women aged ≥30 years who were childless or pregnant for the first time in an urban area of Iran. RESULTS: Three main themes were developed using conventional content analysis: "personal inclination," "perceived beliefs about delayed childbearing," and "social support." CONCLUSIONS: Although women in Iran hold favorable attitudes toward childbearing, a wide range of sociocultural and economic factors encourage these women to postpone their first pregnancy. The findings of this study are relevant and important for nursing and midwifery policy making in countries with cultural and contextual backgrounds similar to Iran.

Nursing students' perspectives and suggestions on patient safety--implications for developing the nursing education curriculum in Iran.

BACKGROUND: Nursing students' close involvement in knowledge development about patient safety will enhance the integrity of the current content of nursing education and pave the way towards developing a nursing curriculum that facilitates achieving a safer health-care system. OBJECTIVES: This study explores nursing students' perspectives and suggestions on developing patient safety aspects of the nursing curriculum in the context of Iranian culture. DESIGN: A qualitative methodology involving three focus groups with a purposive sample of 18 nursing students from a large Iranian nursing school, utilising directed semi-structured interviews generated data, which was analysed using the content analysis process. RESULTS: Two main themes emerged from content analysis: (1) "involving students fully in patient care" with subthemes 'building a trusting relationship between education and practice', and 'promoting inter-dependence between health-care providers', and (2) "structuring patient safety education" with subthemes 'transforming nursing routines to evidence-based care', and 'connecting care to patient safety issues'. CONCLUSIONS: The extent of students' involvement in clinical practice and clinical nurses' roles in student education in practice requires clarification. The curriculum needs to incorporate patient safety aspects throughout, and include interdisciplinary education to ensure compliance with patient safety policies. Moreover, successful implementation of such a curriculum necessitates cooperation from nursing practice and instructors to meet nursing students' expectations.

Facilitating safe care: a qualitative study of Iranian nurse leaders.

Aim The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background The health-care system's success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results The data analysis resulted in three main themes: 'providing environmental prerequisites for safe nursing practice', 'uniting and integrating health-care providers', and 'creating an atmosphere of safe care'. Conclusion The results indicate that to facilitate providing safe care, nurse leaders should improve nurses' working conditions, develop the nurses' practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers' professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.

Effect of nature-based sound therapy on agitation and anxiety in coronary artery bypass graft patients during the weaning of mechanical ventilation: A randomised clinical trial.

BACKGROUND: Weaning from mechanical ventilation is a frequent nursing activity in critical care. Nature-based sound as a non-pharmacological and nursing intervention effective in other contexts may be an efficient approach to alleviating anxiety, agitation and adverse effects of sedative medication in patients undergoing weaning from mechanical ventilation. OBJECTIVES: This study identified the effect of nature-based sound therapy on agitation and anxiety on coronary artery bypass graft patients during weaning from mechanical ventilation. METHODS: A randomised clinical trial design was used. 120 coronary artery bypass graft patients aged 45-65 years undergoing weaning from mechanical ventilation were randomly assigned to intervention and control groups. Patients in the intervention group listened to nature-based sounds through headphones; the control group had headphones with no sound. Haemodynamic variables, anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively. Patients in both groups had vital signs recorded after the first trigger, at 20 min intervals throughout the procedure, immediately after the procedure, 20 min after extubation, and 30 min after extubation. Data were collected over 5 months from December 2012 to April 2013. RESULTS: The intervention group had significantly lower anxiety and agitation levels than the control group. Regarding haemodynamic variables, a significant time trend and interaction was reported between time and group (p<0.001). A significant difference was also found between the anxiety (p<0.002) and agitation (p<0.001) scores in two groups. CONCLUSIONS: Nature-based sound can provide an effective method of decreasing potential adverse haemodynamic responses arising from anxiety and agitation in weaning from mechanical ventilation in coronary artery bypass graft patients. Nurses can incorporate this intervention as a non-pharmacological intervention into the daily care of patients undergoing weaning from mechanical ventilation in order to reduce their anxiety and agitation.

Validity and reliability of the scientific review process in nursing journals - time for a rethink?

As pressure to publish increases in the academic nursing world, journal submission numbers and rejection rates are soaring. The review process is crucial to journals in publishing high quality, cutting-edge knowledge development, and to authors in preparing their papers to a high quality to enable the nursing world to benefit from developments in knowledge that affect nursing practice and patient outcomes and the development of the discipline. This paper does not intend to contribute to the debate regarding the ethics of reviewing, but rather seeks to explore notions of how the quality of the reviewing process can be enhanced to benefit authors, the reviewers, and the state of nursing knowledge. Furthermore, a call is made to editors to devise strategies for aiding reviewers to attain higher validity and reliability within the reviewing process by establishing clear standards and expectations and to ensure published work is judged against industry norms for quality.

Clinical nurses' perceptions and expectations of the role of doctorally-prepared nurses: a qualitative study in Iran.

Nurses with doctorates are increasing in number throughout the world, yet the multitude of roles they play following graduation is unclear. The purpose of this study was to explore and describe clinical nurses' perceptions and expectations of the role of doctorally-prepared nurses in Iran. A qualitative study, using a content analysis approach was conducted with 43 clinical nurses chosen using a purposive sampling strategy. Oral, semi-structured and written interviews were used to generate data. During data analysis, three main themes emerged; "advantages of the doctoral degree", "clarification of doctorally-prepared nurses' role in clinical practice", and "unmet expectations of doctorally-prepared nurses". An understanding of the expectations of nurses on the role of doctorally-prepared nurses is needed to improve the collaboration between clinical nurses and doctorally-prepared nurses; remove misunderstandings on the abilities and skills of doctorally-prepared nurses; incorporate the expectations into doctoral education in order to facilitate their collaboration; and also remove the theory and practice gap through the utilisation of doctorally-prepared nurses' knowledge and skills in practice.

Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.

Iranian primigravid women's awareness of the risks associated with delayed childbearing.

OBJECTIVES: To explore older (35 years +) primigravid women's knowledge of the risks of delayed childbearing and to identify the characteristics of those with limited knowledge. METHODS: A cross-sectional survey involving 675 primigravid women in Tehran, Iran, using a cluster random sampling method at the first prenatal visit. A validated questionnaire assessed the women's awareness of delayed-childbearing risks. RESULTS: Women variously identified conception difficulties, gestational diabetes, hypertension, multiple birth, caesarean section, preterm delivery, stillbirth, Down's syndrome, congenital abnormality, and low birth weight, as associated with delayed childbearing. Awareness of infant risks ranged between 10 and 72%. Awareness of maternal risks were independently related to the women's educational levels (odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.12-3.38), planned pregnancy (OR: 1.87; 95% CI: 1.25-2.78) and maternal age ≥ 40 (OR: 1.24; 95% CI: 1.14-2.53). Women aware of infant risks were significantly likely to be aged ≥ 40 (OR: 1.87; 95% CI: 0.01-5.12), have post-graduate education (OR: 2; 95% CI: 1.90-4.42), and have a planned pregnancy (OR: 1.99; 95% CI: 1.03-5.12). CONCLUSION: Women are largely unaware of the potential complications of delayed childbirth. Understanding the risks is important for reproductive healthcare providers and policy makers in providing appropriate information to enable women to make informed decisions on the timing of conception.

Ethical issues in patient safety: Implications for nursing management.

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in 'the ethical imperative' of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers' decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

Effect of nature-based sounds' intervention on agitation, anxiety, and stress in patients under mechanical ventilator support: a randomised controlled trial.

BACKGROUND: Few studies have been conducted to investigate the effect of nature-based sounds (N-BS) on agitation, anxiety level and physiological signs of stress in patients under mechanical ventilator support. Non-pharmacological nursing interventions such as N-BS can be less expensive and efficient ways to alleviate anxiety and adverse effects of sedative medications in patients under mechanical ventilator support. OBJECTIVES: This study was conducted to identify the effect of the nature-based sounds' intervention on agitation, anxiety level and physiological stress responses in patients under mechanical ventilation support. METHODS: A randomized placebo-controlled trial design was used to conduct this study. A total of 60 patients aged 18-65 years under mechanical ventilation support in an intensive care unit were randomly assigned to the control and experimental groups. The patients in the intervention group received 90 min of N-BS. Pleasant nature sounds were played to the patients using media players and headphones. Patients' physiological signs were taken immediately before the intervention and at the 30th, 60th, 90th minutes and 30 min after the procedure had finished. The physiological signs of stress assessed were heart rate, respiratory rate, and blood pressure. Data were collected over eight months from Oct 2011 to June 2012. Anxiety levels and agitation were assessed using the Faces Anxiety Scale and Richmond Agitation Sedation Scale, respectively. RESULTS: The experimental group had significantly lower systolic blood pressure, diastolic blood pressure, anxiety and agitation levels than the control group. These reductions increased progressively in the 30th, 60th, 90th minutes, and 30 min after the procedure had finished indicating a cumulative dose effect. CONCLUSIONS: N-BS can provide an effective method of decreasing potentially harmful physiological responses arising from anxiety in mechanically ventilated patients. Nurses can incorporate N-BS intervention as a non-pharmacologic intervention into the daily care of patients under mechanical ventilation support in order to reduce their stress and anxiety.

What is strategic management?

AIM: To discuss the theoretical concept of strategic management and explore its relevance for healthcare organisations and nursing management. BACKGROUND: Despite being a relatively new approach, the growth of strategic management within organisations has been consistently and increasingly promoted. However, comprehensive definitions are scarce and commonalities of interpretation are limited. METHOD: This paper presents an exploratory discussion of the construct of strategic management, drawing on the literature and questioning its relevance within health-care organisations. EVALUATION: Literature relating to strategic management across a number of fields was accessed, drawing primarily on meta-studies within management literature, to identify key concepts and attempt to present a consistent definition. The concept within health care is explored in relation to nursing management. CONCLUSIONS: Inconsistency in definitions and utilisation of key concepts within this management approach results in the term being loosely applied in health-care organisations without recourse to foundational principles and a deep understanding of the approach as a theory as opposed to an applied term. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are increasingly asked to adopt the 'next-best-thing' in managerial theories, yet caution needs to be taken in nurses agreeing to use systems that lack an evidence base in terms of both efficacy and relevance of context.

Global nurse leader perspectives on health systems and workforce challenges.

AIM: As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. BACKGROUND: Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. EVALUATION: Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. KEY ISSUES: Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. CONCLUSION: There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future. IMPLICATIONS FOR NURSING MANAGEMENT: Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies.

Iranian nurses self-perception -- factors influencing nursing image.

AIM: The purpose of this study was to describe the perspectives of Iranian nurses regarding factors influencing nursing image. BACKGROUND: Nursing image is closely tied to the nurse's role and identity, influencing clinical performance, job satisfaction and quality of care. Images of nursing and nurses are closely linked to the cultural context in which nursing is practised, hence, this study explores how Iranian nurses perceive the factors that influence their own image. METHODS: A descriptive study using a survey design was conducted with 220 baccalaureate qualified nurses working in four teaching hospitals in an urban area of Iran. A Nursing Image Questionnaire was used and analysed using descriptive and inferential statistics. RESULTS: In the domains of 'characteristics required for entry to work', 'social role characteristics of nursing' and 'prestige, economic and social status, and self image' the nurses had negative images. 'Reward' and 'opportunity for creativity and originality' were factors that least influenced choosing nursing as a career. The presence of a nurse in the family and working in the hospital had the greatest impact on the establishment of nurses' nursing image. CONCLUSION: Improving the nursing profession's prestige and social position as well as providing the opportunity for creativity and originality in nursing practice will change the self-image of Iranian nurses, facilitating effective and lasting changes in nursing's image. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are well-placed to influence nurses' perceptions of nursing's image. Given the finding that thinking about leaving a job positively correlates with holding a negative nursing image, nurse managers need to consider how they can work effectively with their staff to enhance morale and nurses' experience of their job.

A South African perspective: current position and challenges in health care service management and education in nursing.

AIM: The present study discusses the current context of South African nurse managers' working environment, exploring the challenges of disease demographics, service change and development, and educating a nursing workforce to meet healthcare delivery demands. BACKGROUND: Post-apartheid South Africa has a legacy of inequalities in access to healthcare; increasingly poor morbidity and mortality demographics; and inadequate numbers of qualified nurses to provide a service to meet the Millennium Development Goals outlined by the Government in 2010. EVALUATION: The present study discusses the current position and developments pertaining to nursing management relating to both healthcare challenges and educating a nursing workforce. KEY ISSUES: Collaborative action by various stakeholders in the development of nursing management will ensure a nursing workforce and service environment fit-for-purpose in delivering the healthcare outcomes envisaged in the transformed South Africa in the future. CONCLUSION: Different role players are involved in critical issues regarding the management and education of nursing in South Africa. Nurse managers are central to the success of service redesign, delivery and education. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to influence policy decisions regarding nursing service design and delivery, and the education required to prepare the next generation of practitioners for these new services.