A Qualitative Study on Cancer Care Burden: Experiences of Iranian Family Caregivers.

The aim of this study was to explore the experiences of Iranian family caregivers with regard to the burden of caregiving. This is in the context of illuminating and identifying the experiences of family members from different contextual perspectives. In this qualitative study, purposive sampling was conducted in 2016. Data were collected using semistructured interviews and were analyzed using content analysis. Data analysis identified 4 categories and 8 subcategories: (1) burnout (physical problems and psychoemotional stress), (2) role conflict (balancing caring roles and family responsibilities; failure in professional or educational roles), (3) health system tensions (inadequate support from health professionals; ignorance of family members in health structure), and (4) social challenges of cancer (economic burden; taboo of cancer). In conclusion, nurses need to provide individualized support and counseling that address the sources of burden. This highlights the benefit of training health care professionals to provide culturally sensitive support based on family caregivers' needs and circumstances.

Trapped like a butterfly in a spider's web: Experiences of female spousal caregivers in the care of husbands with severe mental illness.

AIMS AND OBJECTIVES: To explore the experiences of female spousal caregivers in the care of husbands with severe mental illness. BACKGROUND: Family involvement in the care of patients with chronic illness is essential to provide a backbone of support for them. However, little is known about how female spousal caregivers are confronted with challenges while taking care of their husbands with severe mental illness. DESIGN: An exploratory qualitative study. METHODS: Fourteen female spousal caregivers of people with severe mental illness (defined here as schizophrenia, schizoaffective disorders and bipolar affective disorders) were recruited using purposive sampling and were interviewed using a semistructured in-depth interview method. Data were analysed by conventional content analysis until data saturation was achieved. RESULTS: Care of a husband with severe mental illness had a disruptive influence on the emotional relationships of the family and resulted in emotional detachment over time. Despite the caregivers' struggle to protect their families, the lack of supportive resources caused emotional exhaustion. Caregiving tasks interfering with their many other responsibilities, along with being a reference for family matters, led to loss of self. Consequently, they experienced psychological distress because of the transition to a caregiver role without any supportive resources. CONCLUSION: Constant caring, without supportive resources, forced them to do various roles and manage other issues within the family. Being unprepared for a caregiving role led to the psychological distress of female spousal caregivers. Therefore, adequate information, education and supportive resources must be provided for spouses to facilitate their transition to caregiving roles. RELEVANCE TO CLINICAL PRACTICE: It is necessary to pay close attention to the spousal caregivers' own mental health problems while they care for their mentally ill husbands. Mental health professionals should adopt a new approach to the prioritisation and planning of policies that support both family caregivers and patients.

Barriers to Family Caregivers' Coping With Patients With Severe Mental Illness in Iran.

The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers' experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers' ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient's isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.

Getting the most out of your clinical placement.

This article discusses what to expect from clinical placements, what you will learn, techniques to enhance your experience, and handling a placement that is not going well.

Using more healthcare areas for placements.

The need for private, voluntary and independent placements in nursing programmes has become more important in recent years due to changes in where health services are delivered. These placements can be used effectively within nursing programmes to show students the realities of healthcare, and to challenge myths and attitudes. Dedicated time and resources need to be provided to discover and maintain these placements, and to ensure appropriate, high-quality learning opportunities. This article presents the findings of a national Higher Education Academy workshop, held at the University of Derby in November 2012. It explores three key issues discussed at the workshop: current practice and opportunities for learning; myths, attitudes and solutions; and maintaining the quality of placements. The use of PVI placements is seen as valuable and a set of recommendations are provided to assist in their use.

Are newly qualified nurses prepared for practice?

BACKGROUND: While many people find starting a new job stressful, the transition from student to newly qualified nurse comes with additional pressures, as being unprepared could harm patients. AIM: To investigate whether newly qualified nurses in the UK feel prepared for practice, exploring their experiences and expectations as they make the transition from student to registered practitioner. METHOD: A review of the literature was carried out to look at newly qualified nurses' experiences of becoming staff nurses within adult nursing, and to identify if there were gaps in that body of knowledge that could be addressed to support them. RESULTS: There is still a significant gap between theory and practice and ward managers' expectations of newly qualified nurses can be unrealistic. Some newly qualified nurses learnt to cope with being "thrown in at the deep end" but this is not always the best way of making the transition to becoming a staff nurse. The pressures of a busy ward environment means that soon-to-be qualified students are being treated as part of the workforce, and their learning needs are not a priority. CONCLUSION: Introducing a mandatory preceptorship programme would assist in smoothing the transition from student to staff nurse.

Does the risk of reprisal prevent nurses blowing the whistle on bad practice?

BACKGROUND: Despite the introduction of legislation to protect people who report poor or unsafe practice, whistleblowing can still have serious consequences for nurses. AIM: To review the literature on whistleblowing in healthcare, and explore the barriers to reporting poor practice. METHOD: Studies focusing on whistleblowing in healthcare were used to assess the safety of incident reporting, and to determine what prevented nurses from reporting poor practice. RESULTS: Four major themes were identified as the main barriers to whistleblowing in healthcare: experience of the nurse; confidentiality and reporting processes; incident severity; and personal beliefs. CONCLUSION: Reprisal for whistleblowing remains a major concern for nurses. Patient safety could be improved by prioritising confidentiality and creating an environment where nurses feel safe to report poor practice.

A preceptorship toolkit for nurse managers, teams and healthcare organisations.

The transition from student to newly qualified nurse can be challenging. A period of preceptorship is recommended to support newly qualified nurses in their new work environment, and to give them time to adapt and gain confidence. Researchers have developed a toolkit based on previous research that contains several resources that nurse managers, teams and organisations can use to develop and improve preceptorship for newly qualified nurses. The toolkit includes an organisational support tool, a managerial support framework, a supernumerary time tool and a local culture of support tool. This article describes these resources and gives an example of how the toolkit can be adapted locally.

Acceptability of intrapartum ultrasound by mothers in an African population.

INTRODUCTION: Intrapartum ultrasound is gaining high acceptance by many women as another method for assessing labour progression. Despite growing evidence of the effectiveness of ultrasound in labour, the acceptance of intrapartum ultrasound has not been previously investigated in black Africans. AIM: This study aimed to determine women's acceptance of intrapartum ultrasound and their preference for transperineal ultrasound or digital vaginal examination (digital VE) in Ghana. METHODS: An analytical cross-sectional study was conducted among mothers who had had both digital VE and transperineal ultrasound during labour in a tertiary hospital. Information about their sociodemographic characteristics, experience with, and preference for ultrasound or digital VE in labour using a pretested structured questionnaire was obtained. Their experiences were categorised as 'tolerable, 'quite uncomfortable' or 'very uncomfortable'. Categorical variables were compared using Fisher's exact test. A p value < 0.05 was considered statistically significant. RESULTS: Altogether, 196 women were recruited into the study. The mean age of the women was 26.7 years (standard deviation, 4.6 years). Nearly half (47%) of the women had never delivered before. Significantly more women considered transperineal ultrasound to be more tolerable than digital VE (66% vs. 40%; p < 0.001). Almost all the women (97.5%) described their experience with transperineal ultrasound to be better than digital VE, and would choose transperineal ultrasound over digital VE in the future (98.5% vs. 1.5%; p < 0.001). DISCUSSION: The findings of this study are comparable to those of other related studies reported recently. This research confirms high acceptance of ultrasound in labour by mothers from different countries and across continents, implying that cultural differences do not influence women's responses to and interest in intrapartum ultrasound. CONCLUSION: Most women found ultrasound in labour to be more tolerable than digital VE. Whenever possible, transperineal ultrasound should be provided as an alternative to digital VE during labour.

Comparing intrapartum ultrasound and clinical examination in the assessment of fetal head position in African women.

INTRODUCTION: We aimed to examine the agreement between intrapartum ultrasound and digital vaginal examination in assessing the occiput position in black African women who were in the first stage of labor and to evaluate the influence of ruptured membranes on this agreement. MATERIAL AND METHOD: This was a cross-sectional study conducted in a teaching hospital in Ghana. Transabdominal ultrasound determination of the fetal head position was compared with digital vaginal examination of women in labor. The agreement between the two methods was examined with Cohen's kappa statistics. RESULTS: Altogether, 196 women in active labor were studied. The fetal head position could not be determined by digital vaginal examination in 62 cases (32%) while ultrasound could determine all. Moderate agreement (kappa = 0.4) was obtained in the 134 cases determined by both methods. Agreement on the occiput posterior position was very low (kappa = 0.1). Agreement on the occiput posterior position was not significantly different in ruptured versus intact membranes. CONCLUSION: This study shows poor agreement between ultrasound and digital VE on the occiput posterior position in black African women who were in the first stage of labor. Again, over 85% of fetal head positions that could not be determined by digital vaginal examination were occiput transverse and posterior positions. This confirms that digital vaginal examination has difficulty in detecting malpositions, with no significant influence of intact or ruptured membranes. Ultrasound is therefore more useful than digital vaginal examination whenever malposition is suspected in the first stage of labor.

Sonographic parameters for diagnosing fetal head engagement during labour.

The purpose of this study was to investigate the diagnostic performance of the head-perineum distance, angle of progression, and the head-symphysis distance as intrapartum ultrasound parameters in the determination of an engaged fetal head. Two hundred and one women in labour underwent both ultrasound and digital vaginal examination in the estimation of fetal head station. The transperineal ultrasound measured head-perineum distance, angle of progression, and head-symphysis distance for values correlating with digital vaginal examination head station. Using station 0 as the minimum level of head engagement, correlating cut-off values for head-perineum distance, angle of progression, and head-symphysis distance were obtained. Receiver operating characteristics were used in determining the diagnostic performance of these cut-off values for the detection of fetal head engagement. With head-perineum distance of 3.6 cm the sensitivity and specificity of sonographic determination of engaged fetal head were 78.7 and 72.3%, respectively. A head-symphysis distance of 2.8 cm also had sensitivity and specificity of 74.5 and 70.8%, respectively, in determining engagement, whilst an angle of progression of 101° was consistent with engagement by digital vaginal examination with 68.1% sensitivity and 68.2% specificity. Ultrasound shows high diagnostic performance in determining engaged fetal head at a head-perineum distance of ≤3.6 cm, head-symphysis distance of ≤2.8 cm, and angle of progression of ≥ 101°.

Intrapartum ultrasound assessment of cervical dilatation and its value in detecting active labor.

INTRODUCTION: We aimed to examine the agreement between ultrasound and digital vaginal examination in assessing cervical dilatation in an African population and to assess the value of ultrasound in detecting active labor. METHOD: A cross-sectional study was conducted in a teaching hospital in Ghana between April and September of 2016. Anterior-posterior and transverse diameters of cervical dilatation were measured with ultrasound and the mean value was compared with digital vaginal examination in 195 women in labor. Agreement between methods was examined with correlation coefficients and with Bland-Altman plots. Active labor was defined when cervix was dilated ≥ 4 cm with vaginal examinations. ROC curve analysis was conducted on the diagnostic performance of ultrasound in detecting active labor. RESULTS: Data were analyzed in 175 out of 195 (90%) cases where ultrasound could clearly visualize the cervix. The remaining 20 cases were all determined by digital vaginal examination as advanced cervical dilatation (≥ 8 cm), advanced head station (≥ + 2), and with ruptured membranes. The Pearson correlation coefficient (r) was 0.78 (95% CI 0.72-0.83) and the intra-class correlation coefficient was 0.76 (95% CI 0.69-0.81). Bland-Altman analysis obtained a mean difference of - 0.03 cm (95% CI - 0.18 to 0.12) with zero included in the CI intervals, indicating no significant difference between methods. Limits of agreement were from - 2.01 to 1.95 cm. Ultrasound predicted active labor with 0.87 (95% CI 0.75-0.99) as the area under the ROC curve. CONCLUSION: Ultrasound measurements showed good agreement with digital vaginal examinations in assessing cervical dilatation during labor and ultrasound may be used to detect active labor.

Attributes of Iranian new nurse preceptors: A phenomenological study.

Preceptors should possess attributes which help them in successfully performing the demanding and challenging role in the preceptorship. This research utilises a qualitative hermeneutic phenomenological approach to explore the attributes of new nurse preceptors. Six preceptors of a teaching hospital in Northwest of Iran who were selected by means of purposive sampling. Data were collected during eight months from July 2014 to March 2015 through in-depth semi-structured personal interviews. Interviews were recorded and transcribed and then were analyzed with the interpretive approach using the Diekelmann's seven-stage method in the MAXQDA10 software environment. Findings included two main themes "feeling proud and honored" and "professionalism" with subthemes including empathy, being nonjudgmental, patience, and spirit of self-sacrifice. The spirit of self-sacrifice was a unique attribute revealed in this research. Preceptors possessed several important attributes which are usually stressed in the literature as selection criteria for preceptors. These attributes could be further drawn upon when selecting new preceptors. Preceptors are role models. Existence of the spirit of self-sacrifice among preceptors could contribute to transferring of such spirit to new nurses and future preceptors as well as to preceptors' patience with challenges of their role. Effective preceptorship needs preceptors who possess specific professional and personal attributes. These attributes could be drawn upon more objectively in the process of selection, preparation and evaluation of preceptors by clinical and educational nursing managers.

Challenges in the clinical education of the nursing profession in Iran: A qualitative study.

INTRODUCTION: Clinical education is an important part of nurse training. It provides students with the opportunity to gain useful experience and has a key role in their professional preparation. The importance of clinical education in nursing students' professional performance means that identifying the challenges in this field is crucial. AIM: The goal of this study is to identify challenges in the field of clinical nurse education. DESIGN: A qualitative content analysis study. SETTING: A faculty of Nursing and Midwifery, in Iran 2017. PARTICIPANTS: Nine student nurses, three qualified nurses and two nursing educators. METHODS: This study has been applied to various depths of interpretation. Semi-structured interviews were used to collect the data. Nine student nurses, three qualified nurses and two nursing educators were interviewed. RESULTS: The analysis of the interviews generated five categories. Two main themes were extracted as challenges in the clinical training of nursing professionals: 1. Inefficient educational structure and 2. Inefficient professional performance environment. CONCLUSION: Considering the inadequate professional performance environment and defective educational structure, designing and delivering lessons with clear goals is essential. Using objective and measurable scales for evaluating educational standards, the use of empowered instructors with high communicational skills is useful for increasing students' motivation and interest toward clinical education and solving existing challenges.