Development and psychometric properties of Iranian Women's Quality of Life Instrument (IWQOLI): mixed exploratory study.

BACKGROUND: To determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, that has credible validity and reliability, and its concepts are clearly defined and culturally appropriate. This study aimed to develop and assess the psychometric properties of "Iranian Women's Quality of Life Instrument (IWQOLI)". METHODS: The items of "IWQOLI" were generated from themes extracted (150 items) from a content analysis approach with the participation of 40 women. Face validity of the questionnaire with the participation of 10 women and content validity by 10 experts was approved. To determine the domains of the questionnaire, exploratory factor analysis (principal component extraction method) was performed. Internal consistency and test-retest reliability methods with 14-day intervals (30 women) were used to assess the reliability of WQOLI. RESULTS: After performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The IWQOLI score was significantly correlated with the SF-36 (r = 0.717, p < 0.001). Reliability was demonstrated with Cronbach's alpha coefficient of 0.919 for the entire scale (90-item). Consistency of the instrument was established with test-retest reliability with an interval of 2 weeks (intra-cluster correlation = 0.889, P < 0.001). CONCLUSIONS: The Iranian women's Quality of life Instrument "IWQOLI", consisting of 90 items representing 5 domains (sense of peace in life, sense of security, health responsibility, pleasant communication, received comprehensive support), demonstrated excellent psychometric properties, so it may be used for measuring women's QOL in practical research.

The financial transaction between counseling and nursing care service centers (CNCSCs) and their clients: a qualitative study.

BACKGROUND: Community-oriented nursing care is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian community for nearly two decades. Resource management, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions between CNCSCs and their clients. METHODS: This study has a qualitative design and was conducted on a total of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and direct observations and were analyzed using conventional qualitative content analysis. RESULTS: The analysis of the data led to the extraction of three main categories, including the flaunted atmosphere due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction. CONCLUSION: To increase affordability and satisfaction and expand private community-based nursing. Services, appropriate financial policies should be designed and applied that can lead to transparent and simple financial transactions with the clients by way of indirect monetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and be cost-effective for the clients, insurance companies and the health system.

Effect of establishing pain committee on the pain assessment skills of paediatric nurses.

Successful pain management relies on pain assessment. The purpose of this study is to investigate the effect of establishing pain committee on pain assessment skills of paediatric nurses. We used a quasi-experimental design. The study was conducted in surgery, emergency and orthopaedic wards of two teaching hospitals selected through simple random sampling. The intervention consisted of establishing a pain committee, the steps of which included organizing (3 months), holding workshop (five sessions) and clinical training (1 week). We found that the scores in the intervention group were significantly higher than those in the control group. Therefore, establishing pain committee in the management level of nursing improves nurses' pain assessment skills.

Investigating the Possibility of Nurse Prescribing Training Development in Nursing Education System in Iran.

PURPOSE: Adequate medical knowledge and skills are fundamentals for nurse prescribing authority development. This study will explore the potential for developing nurse prescribing training in Iran, where nurses currently lack prescribing authority despite their strong academic nursing education. METHODS: This is a study with two phases. At first, in a conventional qualitative content analysis method, with purposive and snowball sampling, from June 2021 to March 2023, 20 participants, including 16 nurses in different clinical, managerial, educational, and policy-making settings, three physicians, and one clinical pharmacist were interviewed. Unstructured interviews were conducted face-to-face or virtually as the situation required during the pandemic period due to Coronavirus disease, 2019 (COVID-19). Qualitative content analysis as developed by Elo and Kyngäs in 2008 was used for data analysis. In the second comparative analysis phase, four masters of science and one doctor of nursing curricula analyzed in the existence of the nurse prescribing prerequisite courses and these five curricula and two potential masters of science in community health and critical care nursing curricula were compared with John Hopkins University curricula. RESULTS: In the qualitative phase, two themes emerged: nursing education challenges and the potential for nurse prescribing training development. These were further broken down into four subthemes: inadequate nurses' knowledge in prerequisite nurse prescribing courses, unprepared educational infrastructure, treatment sector potentials, and educational potentials, with a total of 12 concepts identified. During the comparative phase, it was found that none of the nursing curricula had adequate prerequisite courses for nurse prescribing. However, the Community Health and Critical Care nursing curricula showed potential for developing nurse prescribing training. CONCLUSIONS: In the nursing education system, there are some challenges and potentials for prescribing training, and the community health and critical care nursing curricula have the potential capacity to prepare the graduated nurses to prescribe. It needs educational and managerial policies. More developmental research and pilot studies are recommended.

Family caregivers of children with cystic fibrosis: supportive care needs - scoping review.

BACKGROUND: Cystic fibrosis (CF) in children requires complex and time-consuming daily care, presenting significant challenges for families and caregivers. Family caregivers caring for children with CF report diverse and complex needs. OBJECTIVE: This review aimed to identify the supportive care needs of family caregivers of children with CF. REVIEW METHODS: This scoping review was conducted to identify the supportive care needs of family caregivers for children with CF using the methodology proposed by Arksey and O'Malley. The Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews checklist was used as a guide. The inclusion criteria included full-text quantitative and qualitative English articles from January 2000 to Apr 2024. DATA SOURCES: Structured searches were conducted using Magiran, MEDLINE (PubMed), Scopus, ScienceDirect, SID (Science Information Database), Web of Science and Google Scholar search engines. FINDINGS: A search across six databases, including Magiran (96), PubMed (680), Scopus (828), ScienceDirect (972), SID (Science Information Database) (47) and Web of Science (409), identified 3032 records. An additional 1185 related articles were found through a manual search of the reference lists and the Google Scholar search engine bringing the total to 4217. Out of 4217 initial articles, 21 eligible articles were reviewed. The findings from this study indicated that family caregivers of children with CF face multidimensional needs requiring comprehensive attention and support including educational/informational, psychological/emotional, spiritual, social, family-related, health and child development and growth needs. CONCLUSION: Addressing the needs of family caregivers of children with CF requires a multidimensional approach including multidisciplinary team support across various domains.

Development and validation of a supportive programme for family caregivers of children suffering from cystic fibrosis: protocol for a sequential exploratory mixed-methods study.

INTRODUCTION: Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran. METHODS AND ANALYSIS: A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study. ETHICS AND DISSEMINATION: This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.

A randomized controlled trial on the impact of a specialized training program on anxiety and perceived pain in infertile women undergoing hysterosalpingography.

Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p < 0.05). These findings support the use of structured training interventions to improve the overall experience and outcomes for patients undergoing HSG.Trial Registration Number: IRCT20150905023897N4.

The process of challenge formation in Iranian nursing education: A grounded theory study with model presentation.

BACKGROUND: Nursing education faces many challenges that must be identified and removed to improve nursing education and promote the quality of nursing care. Identifying the challenges of nursing education helps to solve or correct the weaknesses and achieve educational goals, which ultimately help to train skilled professionals capable of providing higher quality care to patients. The present study was conducted with the aim of explaining the experiences of nursing tutors in regard to the process of challenge formation in nursing education in Iran. MATERIALS AND METHODS: This is a qualitative study with a grounded theory approach that was conducted in two stages. In the first stage, which took about 9 months, 18 experienced nursing tutors with managerial positions were selected by purposeful sampling from universities across the country. Data were collected through semi-structured interviews, field notes, observation, and memos. Data analysis was done by Corbin and Strauss method through MAXQDA software version 10. In the next step, using the method of Walker and Avant (2011), concepts and statements were gathered within a whole and a model was presented. RESULTS: Twelve male university tutors and six female tutors participated in this study. The mean age of the participants was 45.38 ± 2.1 years, and their mean work experience was 18.66 ± 3.8 years. The findings showed that the challenges of nursing education could be categorized into three categories (defective educational cycle, efforts to restore the educational structure, and learning is a member of educational family), and 12 subcategories. After analyzing the data, trying to provide a need-based education was determined to be the central theme of this study. The components of model developed in this study were presented in the three axes of improving the tutor's teaching skills, managing the situation and educational facilities, and facilitating student's participation in the education process and decision-making. CONCLUSION: Identifying barriers and facilitators of need-based education in health policy making can enable nurses to build a better future for their nursing position. To provide need-based education, it is necessary to create a suitable ground and platform for proper education. Such platform and ground are a necessity of educational, therapeutic, and community environments. To achieve this goal, it is recommended to improve the professional capabilities of tutors and support educational organizations.

Qualitative study of humanization-based nursing education focused on role modeling by instructors.

This study explored the perspectives and experiences of Iranian nursing students and nursing instructors about role modeling. Using a purposeful sampling strategy, 22 nursing students and seven nursing instructors were recruited from five nursing schools in Tehran. Three focus-group discussions and two individual semi-structured interviews with nursing students, and seven semi-structured interviews with nursing instructors, were conducted to gather data. A qualitative content analysis approach was utilized and three main themes emerged during data analysis: "attempt to promote emotional development,""attempt to promote spiritual development," and "attempt to promote intellectual development." It was concluded that understanding the factors influencing role modeling will be helpful for developing strategies to integrate role modeling into nursing education so as to promote the quality of nursing education in Iran.

Lived sexual experience of health workers on the Iranian frontline of the fight against the COVID-19 pandemic: A qualitative content analysis.

Background: Lifestyle changes due to the COVID-19 pandemic may affect individuals' sexual lives and probably their sexual function. The present study aimed to explain the sexual lived experiences of health workers on the Iranian frontlines of the fight against the COVID-19 pandemic. Materials and methods: The present study was qualitative research using the conventional qualitative content analysis method. It was conducted in the city of Ramsar, Iran, in 2022. The data were collected using 12 in-depth personal interviews and a purposive sampling method. Lundman and Granheim's method was used to analyse the data. Results: The analysis of the data in the first phase of the research led to 60 initial codes, 7 subcategories, 3 main categories (concerns about health risks, sexual dissatisfaction, and sexual facilitators and barriers), and one theme (unhealthy lifestyle due to sexual dissatisfaction). Conclusion: The present study revealed new and different dimensions of the sexual experiences of health workers on the frontlines of the fight against the COVID-19 pandemic [concerns about health risks, sexual dissatisfaction, sexual facilitators, and sexual inhibitors]; these dimensions are based on the Iranian context and culture that can be considered to enhance sexual pleasure and the physical and mental health of health professionals that have an impact on improving patients' and people's health status in society.

Determination of empowerment score in type 2 diabetes patients and its related factors.

OBJECTIVES: To assess empowerment score in type 2 diabetic patients. METHODS: A descriptive - correlation study was performed for a period of four months in 2011. Study population was type 2 diabetic patients referred to Omolbanin, Diabetic Center in Isfahan, cultural capital of Iran. Hundred and sixty diabetic patients met the inclusion criteria and were all included in the study. Patient's empowerment was measured by DES (Diabetes Empowerment Scale) self-report scale with subscales reflecting three areas including Managing the psychosocial aspect of diabetes (9 items), Assessing dissatisfaction and readiness to change (9 items) and Setting and achieving diabetes goal (10 items). Collected data was analyzed by using SPSS software version 11.5. RESULTS: Participants were between the ages of 38 and 78 with a mean of 48.67 +/- 7.99 years. There were 49.4% males, 87.5% were married, and 44.9% had education of diploma and higher. Mean duration of diabetes was 5.62 +/- 3.81 years. In all 46.9% participants had borderline metabolic control according to World Health Organization criteria. Using Diabetes Empowerment Scale, three conceptual domains of 'Managing the psychosocial aspect of diabetes', 'Assessing dissatisfaction and readiness to change' and 'Setting and achieving diabetes goal' were measured and scored for each patient. The average score of each domain was 27.15 +/- 8.20), (29.03 +/- 10.40), (31.95 +/- 11.70) respectively. 'Setting and achieving diabetes goal' was considered as the most important domain in measuring diabetes self-management. Diabetes empowerment level showed a significant relationship between variables such as educational level (p<0.001), gender (0.007), age (p<0.001), and duration of diabetes (p<0.001). Pearson correlation coefficient also revealed that empowerment of type 2 diabetic patients has a reverse relationship with HbA1c (r = - 0.75, p 0.001). Furthermore, ordinal regression test revealed that having diploma and higher education (p=0.005), and optimal and borderline HbA1c (p<0.001) were effective factors in empowering diabetic patients. CONCLUSION: Empowerment is psychosocial self-efficacy. Healthcare professionals and researches have introduced 'self-empowerment' as a key element in managing chronic diseases. When it comes to diabetes, empowerment implies an approach that attempts to enhance the ability of patients to actively understand and influence their own lives and health status. It seems that patients with diabetes can be empowered to manage their chronic disease if they are actively informed and educated.

Improve the cervical cancer prevention behaviors through mobile-based educational intervention based on I-CHANGE model: study protocol for a randomized controlled trial.

BACKGROUND: Applications of mobile technologies (mHealth) have the potential to reduce health inequalities, give patients more control over their health, and improve health care's cost-effectiveness. The widespread use of mobile phones offers us a new way to prevent cervical cancer. The objective of the study was to design and develop a mobile phone application (app) that aims to conduct a behavioral intervention for women and to evaluate the efficacy of the app-based intervention. METHODS: This study involves 5 phases. In the first phase, understanding women's perspectives will be identified using a qualitative approach based on the I-Change model. In phase 2, the results from the qualitative approach and requirement prioritization through providing experts' perspectives will be done. The main outputs of this phase will be resulted in prioritizing the main measurable effective variables of the I-Change model. Phase 3 will be processed for the development and psychometric of an assessment tool regarding selected constructs. In phase 4, the App framework and content development will be performed. In phase 5, a three-armed, parallel-design randomized controlled trial will be conducted on women. Two hundred ten women will be randomly assigned to three groups including two intervention groups and one control group. The intervention groups included the following: (1) a mobile application and (2) a digital book. The data will be evaluated using tools designed and constructed in phase 3 of the study at baseline in 3-month follow-up assessments. The impact of the two interventions on cervical cancer prevention behaviors through mobile-based educational intervention will then be evaluated. DISCUSSION: A theory-based health education program using a mobile app to improve cervical cancer-preventive behaviors will be implemented for the first time in Iran. With an effective health mobile-based educational design, it is very important to determine whether Iranian women will be motivated to adhere to preventive behavior related to CC. TRIAL REGISTRATION: Iranian Clinical Trial Register IRCT20181205041861N3. Registered V2.0 on 26 October 2021.

The Effectiveness of Implementing Family-Centered Empowerment Model on Irrational Thoughts of Iranian Infertile Women: A Randomized Clinical Trial.

Introduction: Infertility is one of the main problems of the family and is one of the factors that determine the identity and personality of Iranian infertile women. Family-centered empowerment model is a step toward increasing the self-efficacy of patients and enabling them to take responsibility of their illness. This study aimed to determine the effectiveness of applying family-centered empowerment model on irrational thoughts of Iranian infertile women. Methods: This study was a randomized clinical trial conducted on 80 infertile women and their husbands that were randomly divided into two intervention and control groups. Irrational Parenthood Cognitions questionnaire was given to the intervention and control groups to complete before and 3 months after the intervention. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of irrational thoughts' scores in the control group before and after the study were 33.92 (5.98) and 33.20 (6.83) respectively, and in the intervention group were 34.55 (5.61) and 19.97 (3.52), respectively. The result of independent t-test showed a significant reduction in irrational thoughts of women in the intervention group after the family-centered empowerment model intervention. Conclusion: The family-centered empowerment model after three months of continuous implementation was able to effectively reduce the irrational thoughts about having children in infertile women.

The effect of family-centered empowerment model on the quality of life of adults with chronic diseases: An updated systematic review and meta-analysis.

BACKGROUND: Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases. METHODS: Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16. RESULTS: Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P < 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P < 0.001). CONCLUSION: FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.

Struggling to create new boundaries: a grounded theory study of collaboration between nurses and parents in the care process in Iran.

AIM: To develop a substantive grounded theory of nurse-mother interaction in the care of chronically ill children in hospital setting. BACKGROUND: Interaction between nurses and parents is critical in paediatric hospital settings. This area of practice in developing countries has been under-researched. METHOD: The qualitative research design of grounded theory methodology was used to develop a theory of nurse-parent interaction within the child care. Registered Nurses (n=17) and mothers of chronically ill children (n=14) from two central paediatric hospital in Iran participated in this study. In-depth interviews with nurses and mothers were conducted using theoretical sampling between July 2007 and August 2008. The data were analysed using constant comparative analysis. FINDINGS: 'Struggling to create new boundaries' as a core variable was a dominant socio-psychological process that was manifesting itself within three stages: facing up to and perceiving the environmental pressures, balancing nurse's duties, and controlling the nurse-parent boundary in the care. CONCLUSION: It is concluded that nurses and parents need a care model, which addresses their collaboration and improved interpersonal relationship and clearly defines the boundary of their roles based on the needs of both sides while allowing parents to choose their role in these defined boundaries and providing parent education with aim to empower them for care at home.

Practical intervention on quality of life of anemic girls and their mothers.

BACKGROUND: Anemia is the most prevalent disease in teenage girls and like other chronic diseases not only affects different aspects of their quality of life (QOl) but also quality of life of their parents. OBJECTIVE: The aim of present study is investigating the effectiveness of family centered empowerment model (FCEM) on adolescent girls with anemia and their mother's quality of life. METHODS: Semi-experimental practical research is performed by choosing 60 girls with anemia and their mothers classified in two case and control groups based on random allocation in Tehran city. The eight sessions of educational program based on educational needs of girls & mothers in case group done for two months. The post test was carried out 1/5 month after the end of intervention through QOl questionnaire in case and control groups. Data analysis was performed using statistical methods including t-test, paired t-test. RESULTS: There was no significant difference in the QOl in adolescent girls and their mothers between the two case and control groups before intervention (P=0/473 & P=0/94 respectively). While, after the intervention independent t-test showed a significant difference between the two case and control groups (P>0/001). CONCLUSIONS: Findings showed that the FCEM promote the QOl in adolescent girls with anemia and their mothers. It is recommended that extensive studies be performed on the effectiveness of this model for other chronic diseases in different age groups.

Women's Quality of Life in Iran: A Mixed Method Study.

BACKGROUND: Quality of life drives from the individuals' perceptions of their position in life long and allows holistic assessment of the effects of health conditions beyond the symptoms, signs, and complications. This study aimed to assess the quality of life and recognize females' point of view about the quality of life aspects. Hence, perhaps it could be a step toward improving women's health status. MATERIALS AND METHODS: This study was an explanatory mixed method research one which was conducted in the two following steps. In the quantitative step, five hundred women aged 15-49 years were selected from varied zone of Tehran Province, using cluster random sampling method. In order to assess the quality of life, Short Form SF-36 instrument was used. In the qualitative step, forty women were selected by purposive sampling in a different range of quality of life based on the result of the first step. Data were collected through semistructured, in-depth individual interviews, which continued up to data saturation point. Data analysis was performed through conventional content analysis. RESULTS: Among different aspects of quality of life, the highest and the lowest means (SD) were related to physical functioning mean (SD) 70.58 (24.52) and general health 67.72 (27.66), and mental health 55.27 (30.22) and social functioning 57.02 (30.62), respectively. From the interviews, three main themes were extracted as the following: (i) financial support, (ii) informational support, and (iii) service-based social support. CONCLUSIONS: The present study revealed that Tehranian women do not have high experience related to the quality of life; however, a sense of receiving support from different sources could help them to wrestle with a complicated condition in everyday life.

Exploring the concept of social support as a key factor in young women's quality of life.

BACKGROUND: According to the fact that women make up half the population of each community and are considered as a family health center, exploring the factors promoting their quality of life and health must be prioritized. OBJECTIVE: This study aimed to understand the meaning of social support in young women's life. METHODS: Participants were 40 Iranian youth women who were selected by purposive sampling from the capital of Iran, Tehran. Interviews were carefully recorded and concurrent with data collection, analysis was done using conventional content analysis method. After securing the data saturation, interviews were finished and data were categorized by eight stages of zhang technique. RESULTS: From the interviews three main themes were identified: (i) financial support; (ii) informational support, and (iii) service-based social support. DISCUSSION: Awareness about aspects of social support in women' life could help health care providers and politicians in Iran to provide more effective programs to promote QOL and as a result total health of women.

Parental participation and mismanagement: a qualitative study of child care in Iran.

The purpose of this study was to explore parents' and nurses' experiences of parental participation in child care in hospitals in Iran. Using thematic analysis, the data were collected through interviewing 14 parents and 11 nurses from two pediatric hospitals. The results showed that four major themes emerged, including the necessity of a parent's presence, the unplanned and informal delegation of care to the parents (which itself had five subthemes: the parents as nurses, the delegation of care without sufficient and planned parental training, informal parent-to-parent support, the continuum of parents' willingness to participate, and the neglect of parents' needs), the inconsistency of care, and the parents as informal evaluators of care. Based on the study's findings, effective communication by nurses with parents is required. Nurses need to make an ongoing assessment of parents' wishes for involvement and negotiate care accordingly, with enough support and supervision to warrant quality of care.

Self-Efficacy of People with Chronic Conditions: A Qualitative Directed Content Analysis.

BACKGROUND: Given the increasing prevalence of chronic illnesses and their complications, supporting and empowering chronically ill patients seems crucial. Self-efficacy is considered as a predictor for empowerment. The purpose of this study to explore of different aspects of self-efficacy among persons with chronic physical conditions based on the Family-Centered Empowerment Model (FCEM). METHODS: this qualitative study is part of a larger study; sequential exploratory mixed-method for designing an instrument for the FCEM was conducted from May 2015 to March 2016 in two university hospitals. The sample was 22 participants, including chronically ill patients, family caregivers, and nurses. Data were collected through personal semi-structured interviews. Data analysis was performed concurrently with data collection through directed qualitative content analysis. RESULTS: after determining the self-efficacy attributes in the family-center empowerment model, a category matrix was developed and the codes are placed in subcategories of the matrix. Most participants were female (58.0%), with a mean age of 49.50 years. The final analysis yielded a total of 247 units of analysis dispersed in eight subcategories belonging to four generic-categories. CONCLUSIONS: the findings of this study represent the dimensions of chronically-ill individuals' self-efficacy that can be used to develop and implement programs for empowering chronic ill patients.