Lumbopelvic manipulation alone versus combined with dry needling in physically active patients with patellofemoral pain syndrome: A randomized clinical trial.

INTRODUCTION: Patellofemoral pain syndrome (PFPS) is prevalent in physically active people. The multifactorial nature of PFPS necessitates multimodal treatment for this condition. The present study aimed to compare the efficacy of lumbopelvic manipulation alone versus manipulation plus dry needling in physically active patients with PFPS. METHOD: Thirty patients (18 women and 12 men) with a diagnosis of PFPS entered this randomized controlled clinical trial and were divided into two groups: lumbopelvic manipulation alone or lumbopelvic manipulation plus dry needling. The interventions were applied for 3 sessions every other day. Dry needling was performed on the quadratus lumborum and gluteus medius muscles. Pain intensity, Kujala score and side-plank time were recorded at baseline, post-intervention and 1 month after the intervention. RESULTS: The results of Friedman's test showed statistically significant differences in pain and function in participants during the study period, and post hoc tests revealed differences between the two groups in behavior of the marginal means (p < 0.001). CONCLUSION: The use of lumbopelvic manipulation plus dry needling in the quadratus lumborum and gluteus medius muscles may be more effective than manipulation alone in alleviating pain and promoting function in physically active patients with PFPS.

Effects of a home-based palliative heart failure program on quality of life among the elderly: a clinical trial study.

INTRODUCTION: One of the frequent issues that lowers elderly people's quality of life is chronic heart failure, a progressive and life-limiting disease. The purpose of this study was to evaluate the effects of home-based palliative care (HBPC) on the quality of life of elderly patients with heart failure who received discharge orders from hospitals affiliated with Kerman University of Medical Sciences in 2022. METHODS: One hundred heart failure patients were divided into two intervention and control groups for this randomized clinical trial study. The patients were then given the pre-test questionnaires, such as the demographic questionnaire and the Quality of Life Index (QLI) by Ferrans and Powers. The intervention group was given the home care plan. To measure the quality of life one month after the intervention, the quality of life questionnaire was lastly filled out by both groups following the last care session. Software called SPSS 22 was used to enter and analyze the patient data. RESULTS: The mean age for the elderly in the intervention and in the control groups were 69.46 ± 11.61 and 66.14 ± 12.09 years, respectively. The palliative care program at home made a statistically significant difference in the quality of life and all of its components in the elderly with heart failure in the intervention group immediately after the intervention and one month after the intervention compared to before (P < 0.001). As a result, its scores improved compared to the stage before the intervention. Additionally, a significant difference between the quality of life score and all of its components between the intervention's immediate aftermath and one month later was noted (P < 0.05). CONCLUSION: Home-based palliative care has a positive effect on the quality of life for elderly people who have heart failure, making it a worthwhile intervention to enhance their quality of life. TRIAL REGISTRATIONS: (IRCT20211213053389N1). Date of registration: (19/02/2022).

Concerns and Challenges of Living Donors When Making Decisions on Organ Donation: A Qualitative Study.

Background: Mental concerns of living donors can be a solid barrier to logical and informed decision-making for organ donation. The present study explores living donors' mental concerns and problems during the process of decision-making for organ donation. Materials and Methods: present study was performed using qualitative content analysis. Twenty-one participants were selected by purposive sampling. The data were collected and recorded through semistructured interviews and analyzed by MAX Qualitative Data Analysis software 12, based on Graneheim and Lundman's contractual content analysis method. Results: Data analysis extracted 425 codes, 13 subcategories, 3 main categories, and 1 core theme (conflict between doubt and certainty). The three main categories were individual barriers and concerns (faced by the donor), interpersonal concerns and barriers (experienced by the family), and socio-organizational concerns and barriers (at the community). Conclusions: Based on the results, donors have significant concerns and face major problems when deciding on organ donation. Therefore, health-care professionals should take into account organ donors' concerns, raise awareness of donor associations, and formulate policies to increase living donors' satisfaction.

The Effect of a Pre-Colonoscopy Education Program on Fear and Anxiety of Patients: A Randomized Clinical Trial Study.

Background: Due to the increasing prevalence of intestinal diseases, colonoscopy is considered a safe and fast diagnostic and treatment method for these patients. According to studies, most patients waiting for a colonoscopy experience fear and anxiety. This study aimed to investigate the effect of a pre-colonoscopy education program on the fear and anxiety of patients undergoing colonoscopy. Materials and Methods: This randomized clinical trial study was conducted on patients undergoing colonoscopy in hospitals in southeast Iran. A total of 90 participants were selected by convenient sampling and randomly assigned to two groups control (n = 45) and intervention (n = 45). The patients in the intervention group received nursing interventions before colonoscopy, while the patients in the control group received only routine care. The data were collected using a researcher-made fear of colonoscopy scale, its Cronbach's alpha coefficient (0.92), and the Spielberger State-Trait Anxiety Inventory. The data were analyzed with a Chi-square t-test and pair t-test. Results: The data showed that anxiety and fear of colonoscopy in the patients in the intervention group significantly decreased compared to the patients in the control group (p < 0.001). Conclusions: Using non-pharmacological methods before colonoscopy can reduce the fear and anxiety in patients who are candidates for this procedure and similar invasive procedures. The intervention performed in this study can be used together with other methods to control patients' fear and anxiety. Especially for nurses, It is recommended to do pre-colonoscopy education programs for these clients.

The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: a randomized controlled clinical trial.

INTRODUCTION: Dialysis causes many psychological and social problems, such as stress and inefficiency in patients, which should be considered in health promotion interventions. Therefore, this study aimed to determine the impact of stress management training on stress coping strategies and the self-efficacy of these patients in southeastern Iran. METHODS: This quasi-experimental study was a randomized controlled clinical trial was conducted on hemodialysis patients from December 2019 to January 2020. Patients who met inclusion criteria were selected with the convenience sampling method and divided into the two groups of intervention (n = 30) and control (n = 30) by using the block randomization method. Participants in the intervention group were trained in a stress management training program in 8 one-and-a-half-hour sessions, held twice a week. Data were measured with stress coping strategies and general self-efficacy questionnaires before, immediately, and 1 month after the intervention. SPSS18 was used for data analysis. RESULTS: The study results showed that the scores of stress coping strategies and the self-efficacy score in all their dimensions were significantly different between the intervention and control groups (P < 0.001). CONCLUSION: The present study results showed that stress management training programs promoted stress coping strategies and self-efficacy in hemodialysis patients. Health planners and nurses are recommended to use these easy, feasible, and inexpensive interventions to reduce stress and increase self-efficacy. Trial registration Iranian Registry of Clinical Trials (IRCT): IRCT20160914029817N10. Date of registration: October 7, 2021. URL: https://en.irct.ir/trial/58540 . Registration timing: a retrospective.

Palliative care needs of patients with multiple sclerosis in southeast Iran.

BACKGROUND: Due to the chronic nature of multiple sclerosis, palliative care can play a significant role in improving the quality of life and well-being of the affected patients. An essential step for developing appropriate palliative care for these patients is to determine the types of palliative care necessary, from different points of view. Therefore, this study was conducted to compare the palliative care needs from the nurses' and patients' points of view in southeast Iran in 2017. METHOD: This descriptive-analytical cross-sectional study was conducted on 154 nurses working in neurology wards of teaching hospitals associated with Kerman University of Medical Sciences and 132 patients with multiple sclerosis who were referred to these hospitals in southeast Iran. The data were collected using a questionnaire for assessing the palliative care needs of patients with multiple sclerosis. Pearson correlation coefficient, independent t-test, ANOVA, chi-square, and the Mann-Whitney and Kruskal-Wallis tests were used to examine the data. RESULTS: Both nurses and patients mentioned the palliative needs of patients with multiple sclerosis in terms of physical, social, spiritual, psychological, and economic dimensions, respectively, but the results showed that there was a significant difference between the two groups in all dimensions of palliative needs (P < 0.0001). CONCLUSION: Given the differences in how patients and nurses prioritize palliative care needs, it is essential to consider the different dimensions of palliative needs of patients with multiple sclerosis.

Iranian nurses' educational needs and competence in palliative cancer care.

AIM: This study was conducted to determine the competence and educational needs of Iranian nurses in the field of palliative cancer care. METHOD: This cross-sectional study was performed on nurses working in oncology departments of hospitals in Kerman, in southeast Iran. The data were collected using nurses' core competence in palliative care inventory and a questionnaire for assessing the educational needs of nurses in the field of palliative cancer care. Pearson correlation coefficient, Independent t-test, ANOVA and Linear regression were used to examine the data. RESULTS: 210 nurses participated in this study and the response rate was 98.13%. The results showed that the mean score of educational needs in palliative cancer care was 3.6±0.7. The highest average score was observed in the mental and psychological (3.83±0.89) dimensions, and the lowest in the social dimension (3.34±0.84). The mean score of nurses' competence in palliative cancer care was 1.78±0.51. The highest mean score was related to interpersonal skills (2.28±0.74), and the lowest mean score belonged to the use of Edmonton symptoms evaluation (1.10±1.27). There was a low significant and inverse correlation between nurses' competence and their educational needs. (P<0.001, r=- 0.242). CONCLUSION: This study showed that Iranian nurses have the need for palliative cancer care training. Therefore, it is necessary to assign a higher priority to the evaluation of the clinical competence and educational needs of nurses in different healthcare centres.

Family achievements in struggling with schizophrenia: life experiences in a qualitative content analysis study in Iran.

BACKGROUND: The challenges of living with and taking care of a patient with schizophrenia can lead to positive changes depending on the experiences and reactions of family caregivers. Such changes may directly affect the family performance and the patient's recovery stage. Present study aimed to explain the positive experiences reported by family caregivers of patients with schizophrenia. METHODS: The present study is a qualitative study of content analysis. Data were collected using semi-structured and in-depth interviews with 15 family caregivers of patients with schizophrenia referring to one of the psychiatric hospitals in Zahedan, Southeast part of Iran. Purposive sampling method was applied and data analysis was conducted using conventional content analysis proposed by Graneheim and Lundman. RESULTS: Data analysis created a theme entitled "family achievements in struggling with schizophrenia". This theme included four categories including Developing positive personality traits in family members, Strengthening family ties, developing insight into the life, and social mobility. CONCLUSIONS: The results provided insights that the experience of taking care of patients with schizophrenia led to positive consequences for family caregivers. Thus, it is recommended that psychiatrists or consultants help families rely on positive experiences and share these experiences with families with a newly-suffered patient.

Effect of media messages on health-promoting lifestyle of acute coronary syndrome patients: A randomized clinical trial.

BACKGROUND: Patient education is a key factor in promoting the health of people with acute coronary syndrome (ACS), and the effective use of technology can play an important role in this regard. This study aimed to determine the effectiveness of education using media messages on the lifestyle of patients with ACS. MATERIALS AND METHODS: The present clinical trial was conducted on 91 cases with ACS admitted to the cardiac ward of Afshar Hospital in Yazd, Iran, during 2018-2019, who were randomly assigned to control and intervention groups. The former only was provided with routine training before discharge, while the latter, in addition to routine training before discharge, received education on social networking and sending text/visual messages. At baseline and 3 months after the intervention, the Walker's Lifestyle Questionnaire was completed. The independent t-test, paired t-test, and Chi-square test were employed for data analysis. RESULTS: The average lifestyle value of the intervention group was significantly higher compared with the control group after the intervention (P < 0.001). Moreover, the lifestyle score was significantly different pre- and post-intervention in the intervention group (P < 0.001). CONCLUSIONS: Education using media messages is useful to promote the lifestyle in cases with ACS, which seems effective in planning the follow-up for these patients.

Comparison of the Relationship Between Sexual Function, Marital Adjustment, and Life Satisfaction in Diabetic and Non-Diabetic Women.

BACKGROUND: Sexual function is important for diabetic women because it has a special effect on the quality of life. This study was conducted to compare the relationship of sexual function, marital adjustment, and life satisfaction between diabetic and non-diabetic women. METHODS: This cross-sectional study was done in Kerman, Iran, from August 2018 to November 2019. The study sample included 300 diabetic women and 300 non-diabetic women. Data gathering tools included a demographic questionnaire, Rosen female sexual function index (FSFI), Spanier Dyadic Adjustment Scale (DAS), and Diner satisfaction with life scale. Data were analyzed through SPSS 15, using descriptive statistics, independent-t test, ANOVA, and Pearson tests. The significance level was considered 0.05. RESULTS: The mean scores of marital adjustment, female sexual function index, and satisfaction with life scales in diabetic women were 90.98±23.33, 19.04±9.77, and 13.4±3.21; also, they were 120.34±33.34, 27.82±10.17, and 16.3±5.89 in non-diabetic women, respectively. Statistically significant differences were found between the scores of marital adjustment (P=0.001), female sexual function index (P=0.001), and satisfaction with life (P=0.001) in diabetic and non-diabetic women. The female sexual function index was correlated with life satisfaction and marital adjustment. CONCLUSION: Diabetic women experience sexual dysfunction because of their special condition, which negatively influences life satisfaction and marital adjustment. Healthcare providers should pay much more attention to this issue. They can provide educational packages on sexual issues for diabetic women. They should also support these women and their spouses to improve their quality of life.

Organizational Learning: The Missing Link to Promote Nurses' Professional Self-Efficacy.

INTRODUCTION: Nurses are one of the important sources of organizational learning, and the main elements of knowledge transfer in hospitals. They can play a major role in the process of organizational learning. One of the factors affecting nurses' learning is self-efficacy. OBJECTIVE: The aim of this study was to evaluate the association between organizational learning and professional self-efficacy among nurses. METHODOLOGY: A cross-sectional study was conducted among 150 nurses in Ali Ibn Abitaleb Hospital in Zahedan City, Iran in 2018, selected by simple randomized sampling. Tools used were the Neefe Organizational Learning Questionnaire (Neefe, 2001), and Riggs and Knight's Self-Efficacy Questionnaire (1994). RESULTS: The results showed a significant positive correlation (p <0.05) between self-efficacy scores and the organizational learning dimensions of systems thinking, team learning, and shared vision. Linear regression analysis showed that these three dimensions of organizational learning predicted 16.1% of the professional self-efficacy variations. DISCUSSION: Organizational learning has a direct relationship with nurses' professional self-efficacy. Promotion of organizational learning characteristics in hospitals will enhance nurses' self-efficacy.

Effectiveness of psycho-educational counseling on anxiety in preeclampsia / Eficácia do aconselhamento psicoeducacional sobre a ansiedade na pré-eclâmpsia

Abstract Introduction Preeclampsia is a serious complication during pregnancy that not only influences maternal and fetal physical health, but also has maternal mental health outcomes such as anxiety. Prenatal anxiety has negative short- and long-term effects on pre- and postpartum maternal mental health, delivery, and mental health in subsequent pregnancies. Objective To investigate the effectiveness of individual psycho-educational counseling on anxiety in pregnant women with preeclampsia. Methods This was a randomized, intervention-controlled study involving two governmental hospitals in the municipality of Sirjan, Kerman, from January 30 2017 to March 31 2017. A total of 44 pregnant women with preeclampsia were assessed. The women were randomized into two groups: control (n=22) and intervention (n=22). The intervention consisted of two sessions of individual psycho-educational counseling. The level of anxiety was measured using the Spielberger State-Trait Anxiety Inventory (STAI) as pretest before the first session and as posttest after the second session during the hospitalization period. Results There was a significant reduction in the anxiety level after the counselling sessions in the intervention group (p<0.005). In addition, there was a slight increase in the anxiety level in the control group after the study. Conclusion According to the results, psycho-educational counseling can significantly reduce the anxiety level in pregnant women with preeclampsia. Therefore, it is recommended that healthcare providers provide this type of therapeutic intervention for pregnant women after hospitalization, in order to reduce their anxiety level and its subsequent negative outcomes. Clinical trial registration: IRCT2017082029817N3.

Resumo Introdução A pré-eclâmpsia é uma complicação séria durante a gravidez que não apenas influencia a saúde física da mãe e do feto, mas também tem consequências para a saúde mental materna, por exemplo ansiedade. A ansiedade pré-natal tem efeitos negativos e de longo prazo sobre a saúde mental da mãe antes e após o parto, sobre o parto, assim como sobre a saúde mental em gestações subsequentes. Objetivo Investigar a eficácia do aconselhamento psicoeducacional individual com relação aos níveis de ansiedade em gestantes com pré-eclâmpsia. Métodos Este foi um estudo randomizado, controlado, que envolveu dois hospitais governamentais na cidade de Sirjan, Kerman, de 30 de janeiro de 2017 a 31 de março de 2017. Um total de 42 gestantes com pré-eclâmpsia foram avaliadas. As mulheres foram randomicamente divididas em dois grupos: controle (n=22) e intervenção (n=22). A intervenção consistiu de duas sessões de aconselhamento psicoeducacional individual. O nível de ansiedade foi medido usando-se o Spielberger State-Trait Anxiety Inventory (STAI) antes da primeira sessão (pré-teste) e após a segunda seção (pós-teste), durante o período de hospitalização. Resultados Houve uma redução significativa no nível de ansiedade após as sessões de aconselhamento no grupo intervenção (p<0,005). Além disso, houve um discreto aumento no nível de ansiedade no grupo controle após o estudo. Conclusão De acordo com os resultados deste estudo, o aconselhamento psicoeducacional pode reduzir de forma significativa o nível de ansiedade em gestantes com pré-eclâmpsia. Assim, recomenda-se que os profissionais de saúde ofereçam esse tipo de intervenção terapêutica para gestantes após a hospitalização, a fim de reduzir o nível de ansiedade e seus desfechos negativos. Registro do ensaio clínico: IRCT2017082029817N3.

Effectiveness of psycho-educational counseling on anxiety in preeclampsia.

INTRODUCTION: Preeclampsia is a serious complication during pregnancy that not only influences maternal and fetal physical health, but also has maternal mental health outcomes such as anxiety. Prenatal anxiety has negative short- and long-term effects on pre- and postpartum maternal mental health, delivery, and mental health in subsequent pregnancies. OBJECTIVE: To investigate the effectiveness of individual psycho-educational counseling on anxiety in pregnant women with preeclampsia. METHODS: This was a randomized, intervention-controlled study involving two governmental hospitals in the municipality of Sirjan, Kerman, from January 30 2017 to March 31 2017. A total of 44 pregnant women with preeclampsia were assessed. The women were randomized into two groups: control (n=22) and intervention (n=22). The intervention consisted of two sessions of individual psycho-educational counseling. The level of anxiety was measured using the Spielberger State-Trait Anxiety Inventory (STAI) as pretest before the first session and as posttest after the second session during the hospitalization period. RESULTS: There was a significant reduction in the anxiety level after the counselling sessions in the intervention group (p<0.005). In addition, there was a slight increase in the anxiety level in the control group after the study. CONCLUSION: According to the results, psycho-educational counseling can significantly reduce the anxiety level in pregnant women with preeclampsia. Therefore, it is recommended that healthcare providers provide this type of therapeutic intervention for pregnant women after hospitalization, in order to reduce their anxiety level and its subsequent negative outcomes. Clinical trial registration: IRCT2017082029817N3.

What is the supporting role of health care providers from the perspective of patients with renal allograft rejection? A qualitative study.

Coping with the new conditions for patients with renal allograft rejection is a complex phenomenon influenced by a number of factors. It appears that the supportive role of health care providers in many aspects is 1 of the most important factors in patient satisfaction, increased quality of life, and application of proper coping mechanisms. This study explored the perceptions of patients with renal allograft rejection about the supportive role of health care providers. This study was conducted with a qualitative research approach and content analysis. Participants were 19 patients with renal allograft rejection in teaching hospitals in southeastern Iran who were selected by purposive sampling. Data were collected through semistructured interviews and analyzed by qualitative content analysis. During content analysis, 2 categories emerged: empathy and emotional support and educational counseling. These themes reflect the nature of patient perceptions of the supportive role of health care providers. The findings suggest that the supportive role of health care providers plays an important role in the promoting a feeling of comfort, reliability, and security in patients with renal allograft rejection and improves their coping mechanisms. These findings give health care providers greater motivation to provide comprehensive care from knowledge of their supportive role.

A survey on teamwork status in caring for patients with heart failure: A cross-sectional study.

As a result of the complex nature of chronic heart failure (HF), these patients require an interprofessional team approach for care and treatment. This is because an interprofessional approach can manage resources more effectively and improve treatment efficacy. This research was done to evaluate the status of teamwork in caring for HF patients. In this cross-sectional study, the views of 308 members of the care team were collected through the use of Team Assessment Questionnaire (TAQ). The mean and standard deviation of teamwork was 2.4 ± 0.3. There was a significant difference between the teamwork status (total TAQ score) and age, gender and job experience (p < 0.05). The highest mean was for the team leadership dimension of the questionnaire (2.5 ± 0.5) while the lowest was for team foundation (2.4 ± 0.3). Results indicated that the status of teamwork is almost moderate. Teamwork in caring for HF patients was influenced by many factors, including age, gender, and job experience. Teamwork can be enhanced by establishing the equality of women and men's rights, continuous training and attention to proportional age and gender combinations.

Invisible cobwebs in teamwork-Impediments to the care of patients with heart failure: A qualitative study.

AIM: This study was done to explore team member's perception regarding impediments to the care of patients with heart failure (HF). BACKGROUND: Complex, chronic HF patients require interprofessional teams to address their multiple health needs. Working in a team has some challenges in achieving goals. Sociocultural differences in Iranian therapeutic team members causes some impediments to provide effective care in the form of a team. METHODS: Data were collected through unstructured in-depth interviews with 58 team members in caring for the patients with HF. The interviews were transcribed verbatim and analyzed using content analysis. RESULTS: Twelve subcategories and 5 categories were formed: inefficient supportive network, inadequacy of training and treatment, affectability and variability challenges for the team, arduous working conditions, and heavy physicians shadow on nursing. The final theme emerged as "Invisible cobwebs in teamwork." CONCLUSION: Despite teamwork being an efficient way of achieving goals, several impediments like a cobweb hinder it from becoming fully exploited. Teamwork has a desirable output when all the members feel the same sense of authority and see themselves in an integrated team and managers have a crucial role in removing these impediments.

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.

Spirituality: A Panacea for Patients Coping with Heart Failure.

BACKGROUND: Many patients with heart failure grapple with related problems that threaten their feeling of well-being and quality of life. Patients look for ways to cope with the new situation. The present study aimed to explore religious coping from the perspective of patients with heart failure. METHODS: This qualitative study used the content analysis of the semi-structured interviews. The data were collected from 18 participants referring to training hospitals in Kerman University of Medical Sciences in southeastern Iran. The data were analyzed using Lundman and Graneheim qualitative content analysis. RESULTS: The main theme of "Spiritual coping, a dominant strategy" was extracted with two categories: 1- "religious belief" having the sub-categories of "inner faith" and "search of meaning" 2- "connection to God as the supreme power" with sub-categories of "seeking healing through supplication and rituals", "worship as a barrier to the flood of problems", and "submission to and trust in God". CONCLUSION: The findings suggest that a spiritual strategy helps the patients effectively to cope with heart failure. Patients learn to use religious beliefs and faith to accept the reality of the disease and its stages and to manage their condition with patience, tolerance, and hope calmly and confidently for a bright future.

The Role of Nurses in Coping Process of Family Caregivers of Vegetative Patients: A Qualitative Study.

BACKGROUND: Vegetative state (VS) occurs through return of the brain stem after coma state. After hospital discharge, responsibility of caring for VS patients is transferred to their families, which causes a high burden on them. Nurses have an important role in helping the family caregivers to meet their needs and cope with difficulties. To explore the role of nurses during coping process of family caregivers of VS patients. METHODS: This study is a part of a larger qualitative study which was performed in Kerman province, Iran during 2014- 2015. Purposive and theoretical sampling was used. 14 caregivers participated in the study. Data were gathered using face-to-face in-depth interviews and managed by MAXQDA 10 software. Analysis was done through constant Comparative Method. RESULTS: Three themes of "nurse as a pursuer teacher", "nurse as a compassionate caregiver", and "nurse as a supporter" were derived from analysis that represent various roles of a nurse in the coping process of family caregivers of vegetative patients during the care process. CONCLUSION: Nurses can play an effective role in improving the caregivers' well-being by considering the importance of training at discharge time and during home care, helping families in providing care and support them during care process.

The sliding context of health: the challenges faced by patients with heart failure from the perspective of patients, healthcare providers and family members.

AIMS AND OBJECTIVES: To understand the challenges faced by patients with heart failure. BACKGROUND: Heart failure is a clinical syndrome that is increasing across the globe. People affected with it encounter various problems that reduce their quality of life and well-being. Therefore, identifying the challenges faced by patients with heart failure is necessary for health care and treatment plans. DESIGN: This study was performed using the qualitative research approach and content analysis method. METHODS: Data were collected using semistructured interviews and notes in the field of 21 Iranian participants, namely 12 patients with heart failure, three cardiologists, three nurses and three members of patient family. The data were analysed using Lundman and Graneheim qualitative content analysis. RESULTS: The results of this study were revealed in the form of a theme: 'sliding context of health' in which the following three categories 'perceived threat of health and life', 'the struggle between doubt and certainty' and 'in the downward slope of quality of life' reflect the experiences of patients faced with heart failure. CONCLUSIONS: The findings of this study showed that it is necessary to identify the challenges of facing heart failure, in order to support and educate patients with heart failure. Patients do not take care of themselves based on the fact that these challenges affect them psychologically and physically, and as such, the new situations are often misunderstood, thereby resulting in frequent recurrence of symptoms, mandatory hospitalisations and reduced quality of life. RELEVANCE TO CLINICAL PRACTICE: Nurses, as the first line of health care, play an important role in identifying problems and supporting patients with heart failure. By acquiring knowledge and listening to the complaints of patients, interventions can be developed to improve their situation.