ABSTRACT
Religious, economic, political, social, and cultural factors influence professional autonomy in nursing, and differ from country to country. The aim of this study was to explain barriers and facilitators of professional autonomy in the experience of clinical nurses. This qualitative study was conducted on 19 clinical nurses and nursing managers selected based on purposive sampling from January 2018 to December 2019. Data were collected through semi-structured interviews, which continued until data saturation was reached. Conventional content analysis based on the Graneheim and Lundman approach was used to analyse the data. Data were categorised into 34 subcategories, 8 main categories, and two main themes, which were titled as facilitators of professional autonomy (professional, organisational, and individual factors, and effective communication) and barriers to professional autonomy (professional, organisational, and personal barriers, and inappropriate communications). The results discussed a set of facilitators and barriers faced by Iranian nurses in clinical settings. Professional organisations can play a key role by enhancing professional autonomy facilitators and increasing professional support for nurses. Another finding was the importance of training nursing staff to be competent and autonomous, beginning right from the college years.
ABSTRACT
Chronic illnesses affect people's life span. Nowadays it involves not only elderly, but also the middle aged and the young. Because they result in disabilities, many of these diseases have significant effects on the quality of life of the affected persons. One of these chronic and disabling diseases is multiple sclerosis. It is seen mostly in young adult. This illness is characterized with inflammation in white matter, demyelization and geliosis of cerebllar cells that causes multiple neurological disorder and long term disability. The goal of this research was to determine the effect of rehabilitation process on the quality of life in multiple sclerosis patient referred to neurological clinics of Shiraz University of medical sciences in 2005. For the assessment of the quality of life, a standard questionnaire which included 12 aspects of quality of life was used. Also the degree of disability was determined with the use of Expanded Disability Status Scale [EDSS]. A total sample of 75 patients affected by multiple sclerosis was randomly divided into two groups, case [35] and control [45]. At first the patients completed the quality of life questionnaire and their EDSS scores were determined. The rehabilitation intervention was performed on the patients based on their individual needs which included 10 sessions of physiotherapy, 5 sessions of education and 2 sessions of group therapy. The control group received only conventional treatment [medical therapy]. The quality of life and EDSS score in an interval of one month, three months and of one to three months were determined and compared in both groups. Results showed that the patients in the case group showed statistically significant increase, one month after intervention, in 7 aspects of quality of life and no statistical significant difference was observed in other aspects. Besides, during three months after intervention, significant difference was observed in all quality of life aspects. Although in the control group there was a statistically significant decrease in 5 aspects of quality of life one month after the intervention, there was no such a decrease in other aspects. Moreover, a statistically significant decrease was observed in 5 aspects of the quality of life in control group three months after intervention. Noticeably, the case group maintained an increase in 11 aspects one to three months after intervention. The patients' ESDD score in the case group before one month and three months after the intervention did not show any significant difference with the pre-intervention stage. No significant difference was observed one month after intervention while a significant decrease was observed after three months and in the interval of one to three months of intervention [p=.03 ,p=.009].In general, the results of this research showed the process of rehabilitation would increase the quality of life and life satisfaction in multiple sclerosis patients. Furthermore, this process improves patients' abilities in doing their daily living activities, although the process does not affect patients' EDSS score. Therefore, we recommend that the process of rehabilitation be considered as a part of the treatment program of multiple sclerosis patients