Children's perspective of hope in living with leukemia: A qualitative study using drawing.

PURPOSE: This study aimed to explore children's perspective of hope in living with leukemia through the utilization of drawing-based interview technique. DESIGN AND METHODS: This qualitative study was conducted at the Children's Medical Center in Tehran with the participation of children aged 6 to 12 diagnosed with leukemia. The children were asked to prepare a drawing about hope then interviews were conducted face-to-face with each child after completing the drawing. Data analysis was conducted using the qualitative content analysis. RESULTS: In the collection of a total of 20 drawings from school-age children with leukemia, each drawings has different metaphors symbolizing hope. Five themes emerged including positive thinking, embracing the sanctuary of maternal affection and collective caring, the ethereal glow of joy, the melody of resilient soul, and navigating the way back to home. CONCLUSION: Hope from the child's perspective can be achieved in simple, possible and accessible ways, making it easier for the family, community and healthcare system to inspire hope in their lives with Leukemia. PRACTICE IMPLICATION: Health providers in pediatric oncology can integrate hope-based care interventions related to the factors influencing children's perspectives.

Experiences of women with cancer living in the rural areas of Iran during the COVID-19 pandemic: a qualitative study.

PURPOSE: This study aimed to explore the challenges of access to treatment and quality of life in female cancer survivors living in rural areas of Iran within the global pandemic context (COVID-19). METHODS: We conducted a qualitative exploratory study where we recruited nine female-identifying individuals diagnosed with cancer, 23 family members, and five healthcare providers from a hospital affiliated with the Birjand University of Medical Sciences in Iran. Data was collected using semi-structured interviews and analyzed using Braun and Clarke's reflective thematic analysis. RESULTS: The three themes constructed were lack of strength from fighting on two fronts (subthemes: (i) fear related to longevity and life span, (ii) disruption of emotional relationships and family functioning, (iii) loneliness and fear of the future, (iv) village culture and double whammy, and (v) isolation and rejection in a rural community); changes during treatment (subthemes: (i) confusion related to treatment and (ii) the hope found during treatment "bottlenecks"); and spiritual growth and clarifying values (subthemes: (i) patience and resilience and (ii) clarifying life values and opportunities when facing uncertainty about the future). CONCLUSION: This study highlights the importance of further evaluating interventions to mitigate barriers to supportive care for female cancer survivors living in rural areas with low-resource contexts during the COVID-19 pandemic.

Silent Mourning: Infant Death and Caring for Iranian Parents Under the Influence of Religious and Socio-cultural Factors.

Despite all the advances in healthcare technology and all the care services in the field of neonates, many infants die in neonatal intensive care units (NICUs). This qualitative study investigated socio-cultural factors influencing the care for bereaved parents in three main NICUs of northwest Iran between March 2018 and April 2019. The purposeful sampling method with the maximum variation was used, and data collection was continued until obtaining rich data to answer the research question. Twenty-eight interviews were conducted with 26 healthcare providers. The thematic analysis method was applied to analyze the data, and two main themes, including "Religious context as a restriction on the parental involvement in the infant's end-of-life care" and the "Socio-cultural challenges of the grieving process among parents", were generated accordingly. The religious and socio-cultural contexts in the NICUs of Iran are a restriction to the presence of parents at their infants' end-of-life phase, and health care providers are less inclined to have parents in the NICU at the time of infant death.

The Effect of Facilitated Tucking on the Pain Intensity Induced by Chest Tube Removal in Infants.

BACKGROUND: Removal of a chest tube is a painful procedure for infants. Medications, including narcotics, are used to control pain, but nonpharmacologic interventions are also effective in reducing pain during this procedure and are not associated with adverse effects. PURPOSE: To evaluate the additive effect of facilitated tucking to the use of morphine on infant pain associated at the time of chest tube removal. METHODS: This was a prospective, randomized control study. Sixty infants were randomized into 2 equal groups utilizing a coin flip. All infants received 0.05-mg/kg morphine 20 minutes before chest tube removal. The intervention group received facilitated tucking and the control group received standard care. Infant pain was measured using the Neonatal Infant Pain Scale. Pain was assessed at 3 time points by 2 independent evaluators: 5 minutes before, during, and 5 minutes after removal of the chest tube. Mann-Whitney and Fisher's exact (Chi-square) tests were used to compare the intervention and control groups. RESULTS: Pain scores were increased during chest tube removal for both the intervention and the control groups. Compared with the control group, pain scores for infants in the intervention group were less before, during, and after chest tube removal. IMPLICATIONS FOR PRACTICE: Facilitated tucking combined with morphine administration can be an effective additive intervention for pain control in infants during chest tube removal. IMPLICATIONS FOR RESEARCH: Evaluate the effect of the facilitated tucking on pain induced by chest tube removal in preterm infants. Preterm infants may respond differently to pain.

Cough in adolescent with cystic fibrosis, from nightmare to COVID-19 stigma: A qualitative thematic analysis.

PURPOSE: Cough is part of the daily life of patients with Cystic fibrosis (CF) and its most common symptom. This study explored the experiences of adolescents with CF in Iran during the COVID-19 pandemic in relation to their cough. DESIGN AND METHODS: In this qualitative study, we conducted 32 semi-structured interviews with 21 adolescents with CF. We analyzed the data thematically. RESULTS: We identified three main themes among adolescents with CF in relation to coughing: 1. Cough is a permanent companion; 2. Coughing raises fear of double stigma; 3. Patients' individualized coping strategies to deal with coughing. Participants complained that cough interrupted daily tasks and sleep, drew unwanted attention in public places, and elicited questions about whether they were COVID-19 patients or substance users-both highly stigmatized identities. CONCLUSION: Although coughing is a protective mechanism for CF patients, frequent coughing often causes major challenges, particularly during the COVID pandemic, when people were acutely sensitive and aware about coughing. During the COVID-19 pandemic, in addition to taking care of themselves and managing the disease, CF patients therefore had to also overcome issues related to social stigma and isolation. PRACTICE IMPLICATIONS: Healthcare workers play an important role in increasing public awareness about CF and its symptoms, including cough. During the pandemic, healthcare workers can help reduce the stigma of coughing through public education. Healthcare workers can actively communicate with patients to identify severe and ineffective cases of cough due to exacerbation of the disease and refer them to a specialist.

Caring for the Bereaved Parents in the NICU: Fathers-The Missing Piece of the Puzzle.

PURPOSE: Grief after infant death is a common experience of bereaved parents often seen in the neonatal intensive care unit (NICU). The NICU staff tend to focus more on the mother's support, and fathers are often not treated equally as mothers. This study aimed to investigate the circumstance of caring for parents facing infant death in NICUs. METHODS: Twenty-eight face-to-face in-depth interviews were conducted between March 2018 and April 2019 in the northwest of Iran. Participants were selected via purposive sampling. An inductive thematic approach was used for data analysis. RESULTS: Three main themes and 7 subthemes were extracted. The main themes were: "the father-the missing piece of the puzzle in the mourning process," "restricted presence of fathers due to religious and traditional beliefs," and "the father-the patience stone." CONCLUSION: Due to cultural-religious backgrounds, traditional beliefs, structural problems, and organizational restrictions, fathers in NICUs do not receive adequate support, particularly when faced with their infant's death. Bereaved fathers need to receive more support and attention from healthcare providers. Therefore, there is a need for changing the care providers' attitudes regarding the role of fathers and the quality of support that fathers should receive in the Muslim populations.

Fatalism, distrust, and breast cancer treatment refusal in Ghana.

Following recent advancements in science and technology, cancer treatment options have increased remarkably alongside improved survival rates. Yet, some individuals diagnosed with breast cancer refuse treatment. This study aimed to explore how breast cancer patients' personal beliefs and ideas influence their decision to refuse medical treatment. Thirteen participant interviews were selected from a larger cohort for a secondary analysis using the grounded theory approach. The decision to forgo medical treatment was influenced mainly by personal beliefs, which were framed as: 1. Triangle of religion, superstition, and ignorance, 2. Ghanaian traditional belief system, 3. My destiny, 4. Frail patient-staff relationships, 5. Futile appointments, and 6. Endless journey. Together, these fit into two overall themes-fatalism and poor communication patterns between healthcare providers and patients. Personal beliefs and managerial gaps within the health system mainly influence the growing trend of refusal of medical treatment among breast cancer patients in Ghana. These findings highlight the need for breast cancer education, professional counselling, and psychological support services.

Moral Distress and Perception of Futile Care among Nurses of Neonatal Care Units.

Objectives: Moral distress (MD), which is affected by several factors such as futile care provision and is considered the cause of adverse effects such as job dissatisfaction and decreased care quality, is a new concept attracting increasing academic interest. This study aims to assess the correlation between nurses' perception of futile care and MD in neonatal care units. Material and Methods: This descriptive-correlational study was carried out among 115 nurses working in the neonatal intensive care units and neonatal special care units of two hospitals in West Azerbaijan Province during 2020. A demographic information form, the 21-item MD-Pediatric version scale, and the 17-item perception of futile care questionnaire were used to collect data and analysed using SPSS 16 software. Results: The results confirmed the direct correlation between MD and the perception of futile care. In addition, MD and the nurses' perceptions of futile care were estimated to be moderate. Conclusion: The results of this study provide evidence to emphasise the need for further studies to investigate other causes of MD in neonatal units and find the solutions to make the work environment more ethical. Furthermore, the results provide the platform needed for hospital and university managers to make the necessary decisions and create the required changes in the educational curriculum of nursing students and provide the appropriate courses for neonatal unit nurses to improve their ability to cope with the MD caused by providing futile care.

War on Two Fronts: Experience of Children with Cancer and Their Family During COVID-19 Pandemic in Iran.

INTRODUCTION: The COVID-19 pandemic affects all age groups and presents differently in children from adults. Children who contract the virus while suffering from cancer may face unique health challenges than their counterparts. This study aimed to investigate the perspectives of children with cancer and their family in this era of the COVID-19 pandemic. METHODS: In this qualitative study, a total of 21 participants were interviewed. They include five children, thirteen mothers, a father and three pediatric oncology nurses. The study setting was a Pediatric Hospital in Tehran, Iran. RESULTS: Three main themes were identified through thematic analysis. 1) Swinging on the path of fear to adaptation, 2) Left-alone at emotional distances, 3) Care system confusion, and decreased quality of care. CONCLUSIONS: The COVID-19 pandemic has burdened children living with cancer and their families in varying ways. Their experiences show a new insight on how to improve their quality of life during these difficult times.

The Challenges of Implementing Family-Centered Care in NICU from the Perspectives of Physicians and Nurses.

PURPOSE: The purpose of this study was to investigate physicians' and nurses' perspectives on the challenges of implementing the FCC in the neonatal intensive care unit. DESIGN AND METHOD: The study employed a qualitative design to conduct five focus groups with 25 nurses and 15 physicians (n = 40). All of the nurse participants identified as female; 73% held a bachelor's degree in nursing and 59% had been working as a neonatal nurse for >10 years. Of the physicians, 55% identified as male, 43% held positions as neonatologists and 39% had a minimum of 3 years of experience in neonatal intensive care. RESULTS: Three themes, power imbalance, psychosocial issues, and structural limitation, and related sub-themes were constructed using thematic analyses. CONCLUSION: The implementation of family-centered care in the neonatal intensive care unit in Iran is shaped by the health care provider, cultural, legal and operational challenges. To optimize effective and sustained implementation, these influential factors must be addressed. IMPLICATIONS: Organizational, managerial and operational changes are required for FCC implementation. Nurses and physicians are well-positioned as leaders and facilitators of family-centered care implementation within the neonatal intensive care unit.

Factors Moderating the Influence of Intergenerational Contact on Ageism: A Systematic Review.

The authors conducted a systematic review of factors that moderate the influence of intergenerational contact on ageism. MEDLINE (using PubMed), EMBASE, Scopus, Web of Science, and Proquest databases were searched, using terms and keywords including intergenerational conflict, intergenerational relation, intergeneration gap, and ageism, and no date restrictions. The search yielded a total of 247 articles, of which 23 met eligibility criteria for the review. Findings revealed that the experience of ageism for older adults is widespread and highly prevalent in Western and Eastern countries. In addition, culture, age, and gender played important roles in young people's decisions to contact older adults. These factors were important moderators of intergenerational relationships and ageism. Robust, trans-disciplinary research is needed to examine factors related to intergenerational relations, particularly with older adults in clinical populations. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 48-55.].

Nurses' and Physicians' Experiences of the NIDCAP Model Implementation in Neonatal Intensive Care Units in Iran.

PURPOSE: The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) provides comprehensive newborn focused family-centered care in the Neonatal Intensive Care Unit (NICU). The purpose of this study was to investigate nurses' and physicians' experiences of implementing the NIDCAP model to optimize its implementation for both caregivers, infants, and families in the NICU. DESIGN & METHODS: A purposes sample of 11 nurses and four physicians participated in this qualitative study. Data were collected by face-to-face and semi-structured interviews and analysis were guided by principles of thematic analysis as per Graneheim and Lundman (2004). RESULTS: Six themes and 20 sub-themes were constructed during data analysis. These included; NIDCAP as a milestone, Helping to rebuild the core of the family, Caregiver excellence, Realism towards the feasibility of NIDCAP, Proper managerial position of NIDCAP specialists in the health system, and Caring for the caregiver. CONCLUSIONS: The findings of this study highlight how NIDCAP provides a comprehensive and effective care model for premature infants, with the goal to promote neonatal growth and development while also facilitating the self-efficacy of caregivers. Implementation of the NIDCAP model requires attention to be paid to social context, infrastructure, adjustment of the program according to the facilities and resources of each country, and the needs of caregivers. PRACTICE IMPLICATIONS: Health care resources are required to sustain NIDCAP specialists and a favorable environment as the necessary conditions for its multidimensional application across NICU units around the world.

Fathers: The Lost Ring in the Chain of Family-Centered Care: A Phenomenological Study in Neonatal Intensive Care Units of Iran.

BACKGROUND: The basic principles of family-centered care in neonatal intensive care unit (NICU) include the unlimited presence of parents and their participation in infant's care. Nurses play a central role in encouraging parental attachment with their infant. PURPOSE: This study was carried out with the aim of understanding NICU nurses' lived experiences of family participation in family-centered care. METHODS: This interpretative phenomenological study was conducted on the basis of Heideggerian philosophy. The data were collected using semistructured interviews and field notes and analyzed through the 7-stage Diekelmann, Allen, and Tanner approach. FINDINGS: Two overarching themes emerged including "mother's centrality in the care chain" and "fathers; the lost ring in the care chain" each of which consisted of 3 and 4 subthemes, respectively. Interviews indicated that in Iran's NICUs, conditions for the presence of parents were appropriate for the mothers and they were encouraged to engage in family-centered care but the fathers' participation was limited due to traditional attitudes, cultural-religious background, and difficulties relating to the hospitals' organizational rules. IMPLICATIONS FOR PRACTICE: Fathers' participation in family-centered care seems to be enhanced through providing facilities, altering the organizational rules, attempting to modify traditional social attitudes, and educating parents and nurses. IMPLICATIONS FOR RESEARCH: Future research should explore the experience of mothers and fathers of infants in NICU in Iran to achieve a comprehensive understanding of their role in family-centered care.

Human identity versus gender identity: The perception of sexual addiction among Iranian women.

This qualitative study was conducted to explore the images of personal identity from the perspective of women with sexual addiction. The data required for the study were collected through 31 in-depth interviews. Sensing a threat to personal identity, dissatisfaction with gender identity, dissociation with the continuum of identity, and identity reconstruction in response to threat were four of the experiences that were common among women with sexual addiction. Painful emotional experiences appear to have created a sense of gender and sexual conflict or weakness in these women and thus threatened their personal identity and led to their sexual addiction.

The relationship of prenatal maternal depression or anxiety to maternal caregiving behavior and infant behavior self-regulation during infant heel lance: an ethological time-based study of behavior.

BACKGROUND: Sensitive and responsive maternal caregiving behavior strengthens infant self-regulatory capacities (HL), but this regulatory role may be diminished in some mothers with second-trimester prenatal exposure to depression and/ or anxiety (MDA). This study examined maternal and infant behavior during infant heel lance (HL) when mothers had or did not have MDA. Ethological methods and micro-analytic approaches capable of distinguishing and comparing time-based patterning in maternal and infant behavior were used to clarify biological mechanisms, such as MDA, that may underlie observed behavior. Aims were to examine group differences in caregiving behavior between mothers with and without MDA 5 min Pre-HL and 5 min Post-H, and relationships between MDA, maternal caregiving behavior and infant pain behavior self-regulation, concurrently. METHODS: At second trimester, mothers were assessed for symptoms of mild-severe depression or anxiety. Mothers whose scores exceeded predetermined cut-off scores on one or more of the mental health measures were allocated to the MDA-exposure group, those below to the non-MDA-exposure group. Reliable observers, blinded to MDA status and study phases, coded video records of the caregiving behavior of each study mother for the full duration of the 5 min Pre-HL and 5 min Post-HL study phases. Group differences and associations between mean measures of maternal mental health scores, time-based measures of maternal behavior, and time-based measures of infant pain behavior regulation (previously coded) were concurrently analyzed using comparative and correlational statistics. RESULTS: MDA-exposed mothers spent significantly more time not embracing, engaging or responding to infant cues than maternal controls Pre-HL and Post-HL. MDA was associated with atypical maternal caregiving behavior, which in turn was related to atypical infant pain behavior self-regulation during and after the HL. CONCLUSION: Our findings have implication for practice. We recommend inclusion of mothers with MDA and their infants in interventions that strengthen the early mother-infant interaction and mother's regulatory caregiving role. MDA and maternal caregiving behavior must be considered in future infant pain studies to examine if they confound effectiveness of mother driven caregiving interventions for neonatal pain. We highlight the importance of examining maternal mental health throughout the perinatal and postnatal trajectory, and particularly the newborn period.

The Wall of Silence: Perceived Barriers to Gender-Based Violence Disclosure among Women in the Perinatal Period.

STUDY BACKGROUND: Gender-based violence is a global concern. The perinatal period is a crucial time for early identification of the harmful impact of violence on the well-being of both mothers and infants. However, it has been observed that many women choose not to disclose their experiences to their healthcare providers. PURPOSE: To gain insight into this issue, a study was conducted to explore the perspectives of both survivors and healthcare providers regarding the barriers to disclosure. METHODS: Through the utilization of a thematic analysis approach, a total of 28 interviews were conducted, involving 12 survivors and 16 healthcare providers. RESULTS: Data analysis revealed barriers to disclosure at the individual, community, and healthcare system levels. CONCLUSION: Health-care providers have a pivotal role in creating an atmosphere where women are encouraged to break the silence and a paradigm shift in the health system approach towards GBV is necessary.

How to Facilitate Disclosure of Violence while Delivering Perinatal Care: The Experience of Survivors and Healthcare Providers.

Gender-based Violence (GBV) during the perinatal period is a serious concern as it is associated with many adverse outcomes for both the mother and the baby. It is well known that violence is under-reported. Thus, official statistics (both police reports and survey data) underestimate the prevalence of violence in general and during the perinatal period specifically. In this study conducted in Canada, we sought to explore the barriers to and facilitators of women disclosing their experiences of GBV within healthcare services to safely facilitate more disclosure in the future and reduce the harms that arise from GBV. We used thematic analysis to analyze in-depth interviews with 16 healthcare providers (nurses, midwives and physicians) and 12 survivors of GBV. The data reflect three main themes: "raising awareness of gender-based violence", "creating a shift in the healthcare system's approach toward gender-based violence" and "providing support for survivors and care providers." Our findings suggest that the healthcare system should increase its investments in raising awareness regarding GBV, training healthcare providers to respond appropriately, and building trust between survivors and healthcare providers. Healthcare providers need to be aware of their role and responsibility regarding identifying GBV as well as how to support survivors who talk about violence. Expanding a relationship-based approach in the care system and providing support for both survivors and health care providers would likely lead to more disclosures.