Exploring the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting: An in-depth qualitative investigation.

Background: Utilizing the nursing process within clinical settings serves to enhance the scientific stature of the nursing field. Nonetheless, various research findings suggest that nursing internship students encounter difficulties when it comes to implementing the nursing process and may lack the necessary proficiency. Objectives: The aim of this investigation is to identify the perceptions of nursing internship students and their faculty mentors regarding the complexities and hindrances associated with implementing the nursing process within the clinical setting. Design: A qualitative content analysis. Participants: Nursing internship students and their faculty mentors from the Isfahan School of Nursing and Midwifery. Methods: In this study, individual interviews were conducted with 13 participants. The data for this study were gathered through these semi-structured interviews and subsequently analyzed using the Granheim and Lundman method. To ensure the validity and reliability of the data, the evaluative criteria of Lincoln and Guba were employed. Results: The obstacles unveiled in this study can be categorized into three primary domains, each with its own subcategories: 1-Student role ambiguity (1-1 Lack of practical autonomy; 1-2 Insufficient proficiency in the nursing process; 1-3 Motivational deficiency). 2- Organizational Challenges (2-1 Shortage of nursing staff; 2-2 Suboptimal interpersonal dynamics); And 3- Gradual Erosion of the Nursing Process. Conclusion: Recognizing the paramount importance of the nursing process in enhancing patient care quality is universally accepted. Therefore, it is imperative to systematically identify and tackle the challenges associated with its application. This study highlights that these challenges stem from various factors, including the multifaceted roles assumed by nursing students, organizational shortcomings within healthcare institutions, and the neglect or erosion of the nursing process in specific clinical settings. Addressing these issues is crucial for ensuring the effective utilization of the nursing process within the nursing profession and for optimizing patient care outcomes.

The effect of the clinical supervision model on nursing internship students' nursing process-based performance: an experimental study.

BACKGROUND: The nursing process is a systematic method for identifying the patient's problems and planning to resolve them. It is also a crucial pillar of high-quality nursing care. Nursing internship students may lack the necessary skills to implement the nursing process due to the increased independence, the absence of constant professorial supervision, and limited experience. The clinical supervision model is a method of clinical education that bridges the gap between theory and practice. OBJECTIVE: This study was conducted to investigate the impact of the clinical supervision model on the performance of nursing internship students in each of the five stages of the nursing process, as well as overall. METHOD: This experimental study was conducted in 2022. The 70 eligible internship students were conveniently selected and randomly assigned to either an intervention or a control group. In the present study, the clinical supervision model was implemented for the intervention group, while the control group received routine supervision. This was carried out over six sessions in three months. The data collection was conducted using a researcher-developed checklist of nursing process-based performance in both groups. Moreover, the Manchester questionnaire was used to evaluate the model in the intervention group. The variables considered as confounding factors included age, gender, marital status, number of monthly shifts, and grades of the nursing process credit completed in the third semester. SPSS version 16 software, descriptive statistics (frequency distribution, percentage, mean, and standard deviation), and analytical statistics (independent t-test, chi square, repeated measures Anova and LSD) were used to analyze the data. RESULTS: Intergroup analysis revealed that there was no significant difference between the scores of nursing process steps and the total score before the intervention in the control and intervention groups, as well as in baseline characteristics (P > 0.05). According to the intragroup analysis, the intervention group showed a significant increase in both the total scores and scores of nursing process steps over time (P < 0.001), whereas the control group exhibited contradictory results (P > 0.05). Finally, the "P-Value Intervention" demonstrated the effectiveness of this training model in improving the performance of the intervention group based on the nursing process compared to the control group. The mean score of the Manchester questionnaire in the intervention group was 136.74, indicating the high impact of implementing the clinical supervision model in the intervention group. CONCLUSION: The results indicated that the implementation of the clinical supervision model led to improved utilization of the nursing process by nursing internship students at all stages. Therefore, it is recommended that nurse educators utilize the clinical supervision model by providing feedback on errors in action during supervision sessions to enhance the quality of nursing care provided by nursing internship students and improve patient safety in clinical environment.

Effect of a supportive-educational program, based on COPE model, on quality of life and caregiver burden of family caregivers of heart failure patients: a randomized clinical trial study.

BACKGROUND: Heart failure (HF) is one of the most common and spreading diseases worldwide. As HF symptoms progress, it is affected the quality of life and the caregiver burden of the family. The present study aimed to determine the effectiveness of the supportive-educational program, based on the COPE (creativity, optimism, planning and expert advice) care model, on the quality of life and caregiver burden of family caregivers of HF patients. METHOD: This clinical trial was conducted on 90 caregivers of HF patients admitted to Isfahan in 2021. The samples were divided into experimental (n = 45 people) and control (n = 45 people) groups based on random allocation (card method). The experimental group received problem-solving skills based on the four components of the COPE model in six sessions during one month. to collect data, the 36-Item Short Form Survey (SF-36) and the Zarit Burden Interview (ZBI) were used in two groups before, after and three months after the intervention. RESULTS: There was a significant difference between the experimental and control groups regarding gender, but This confounding factor had no significant effect on the two components of quality of life and caregiver burden. There was a significant difference between the two groups in terms of the mean score of quality of life immediately(75.99),and three months after the intervention (78.78) (P < 0.05) and the mean score of care burden, immediately (16.60) and three months after the intervention (12.73) (P < 0.05). CONCLUSIONS: One of the important duties of nurses is to implement educational-supportive programs for patients after the discharge of patients, These programs are family-oriented remotely for their caregivers. TRIAL REGISTRATION: This study was registered by the Iranian Registry of Clinical Trials with decree code: IRCT20211128053202N1on 2022-02-20.

Exploring internship nursing students' experiences regarding the effect of supervision model implementation on medication safety: A descriptive qualitative study.

BACKGROUND: Medication safety is one of the main aspects of safe care in the nursing profession, which leads to increasing patient safety and preventing medication errors. Clinical supervision is an integral part of nursing education that leads to the professional and social development of nursing students. This study was designed with the aim of revealing the experiences of nursing internship students from the implementation of the clinical supervision model on medication safety. MATERIALS AND METHODS: This descriptive qualitative study was done in 2022. The participants were selected from nursing internship students (Last year undergraduate) of Isfahan University of Medical Sciences, Isfahan, Iran. Participants in this study were 15 nursing internship students selected using a purposeful sampling method. Data were collected using in-depth semi-structured interviews. The qualitative content analysis approach was used for data analysis. RESULTS: After analyzing the data, four categories, "promotion medication safety competence and knowledge," "development trust and respect climate," "outcome of feedback," and "role of clinical supervisor," and 10 subcategories were extracted from the participants' experiences. CONCLUSION: The implementation of the clinical supervision model led to an increase in the competence of nursing internship students in medication safety. The students believed that this educational method made them follow the principles of medication safety administration. The feedback provided in the clinical supervision sessions made students think about their clinical activities, understand the reason for their mistakes, and use the reliable nursing resources introduced by the supervisor to improve their performance.

A Critical Ethnographic Study of Families of Brain-Dead Patients: Their Experiences and Attitudes to Organ Donation.

Background: Despite the difficulty of making decisions providing facilitating mediators and removing barriers to making decisions about choosing the right path to donate the organs of brain-dead patients by families can assist in improving the services and help the lives of fellow human beings. This study aimed to explain the decision-making mediator for organ donation in families with brain-dead patients in a cultural context. Materials and Methods: This qualitative study with a critical ethnographic approach was conducted based on Carspecken's stages from August 2021 to March 2022. In this regard, 22 participants were selected through the purposive sampling method and considering the inclusion and exclusion criteria. Sampling was continued until data saturation. After obtaining the required ethical approval, data collection was performed through observation, semi-structured interviews, and document review. All data were recorded and managed using MAXQDA 18 software. Results: Based on the results, the main themes and subthemes of this study included "inefficient decision-making mediator" (the shadow of the socioeconomic situation on the medical status of organ recipients, as well as pessimistic influential individuals, social accountability, dialect difference, and ethnic beliefs) and "efficient decision-making mediator" (social learning, material, and spiritual motivation, mother role, and divine reward). Conclusions: The results of this study, derived from a cultural context, can be applied to carrying out future applied and empirical research. Moreover, they can be used in the field of various nursing roles, especially management, care, and education.

Nursing students and faculty perception of academic incivility: A descriptive qualitative study.

BACKGROUND: Incivility is one of the significant challenges that affect nursing education. Uncivil behaviors have a significant upward trend compared to the past in nursing education. This study was conducted to explore academic incivility from the perspective of nursing students and faculty. MATERIALS AND METHODS: This study was conducted in 2021 using a descriptive qualitative method. Fifteen baccalaureate nursing students and six faculty were selected using purposeful sampling method. Data was collected through in-depth semi-structured interviews, and a qualitative content analysis was applied for data analysis. RESULTS: Data analysis revealed four categories, namely, ineffective teaching-learning, inapposite/unreasonable requests, behaviors disrupting mutually respectful environment, and academic dishonesty, and 14 subcategories. CONCLUSION: To reduce incivility, closer attention needs to be paid to the admission of faculty as well as training them to use effective communication techniques and interactive teaching methods. In addition, nursing students must be provided with the training about uncivil behaviors. Furthermore, clear and precise rules and regulations concerning incivility incidence should be developed and implemented in the universities.

Comparison of Vascular Complications after Arterial Sheath Removal using Manual Compression Method and ClampEase Method in Patients Undergoing Coronary Angiography.

Introduction: Angiography stands as the paramount and definitive diagnostic method for coronary artery disease. However, akin to various other invasive procedures, it may carry a multitude of complications. This study sought to assess the incidence of vascular complications post-arterial sheath removal, comparing the use of a ClampEase device against manual compression. Methods: This quasi-experimental clinical trial involved patients undergoing angiography at the post-angiography ward in Isfahan, Iran. A total of 91 patients were selected through convenience sampling and randomly assigned to either the manual compression or ClampEase device groups. Monitoring common vascular complications like hemorrhage, hematomas, and ecchymosis occurred up to 24 hours post-arterial sheath removal. Data were collected using a digital scale model DM3, a transparent flexible ruler, and a questionnaire named 'vascular complications after angiography.' Analysis was performed using SPSS software version 13. Results: Statistical analysis revealed that, when compared to the manual method, compression with the ClampEase device led to fewer vascular complications in patients and a quicker return to homeostasis. Conclusion: The findings underscore that the ClampEase method is a safer alternative with fewer vascular complications than the manual compression method. This discovery has implications for reducing hospital costs and length of stay. The ClampEase device is associated with a swifter time to hemostasis, contributing to enhanced patient comfort and acceptance.

Components of Compassionate Care in Nurses Working in the Cardiac Wards: A Descriptive Qualitative Study.

Introduction: Compassion is the essence and the core of nursing care. Nurse's affectionate and emotional work leads to many caring behaviours that are considered to be the basis of caring with kindness. The purpose of this study was to describe the components of compassion care in nurses working in the cardiac ward. Methods: This descriptive qualitative study was conducted in the medical and surgical cardiac wards of the selected hospital affiliation to Isfahan University of Medical Sciences in 2020- 2021. The participants were 36 nurses, 20 patients and 8 family members that selected using purposive sampling. Data collection was conducted through, in-depth semi-structured interviews; focus group discussions, and the field notes. Data analysis was carried out using the qualitative content analysis approach proposed by Graneheim and Lundman. Results: The results of this study are presented in one main category, four sub categories including "using verbal and non-verbal language to express feelings", "doing empathy activities", "organizing patient-centered care", and "adhering to the cultural context", and twelve sub- sub categories. Conclusion: The patient-centered emotional discourse is the main issue in shaping the compassion care in nurses. Nursing managers can have a significant role in achieving care with affection by preparing appropriate work environment, paying attention to lack of nursing staff, ensuring the principles defined in compassion care, and supporting nursing staff. Teaching the concept of compassion, patient-centered care in the clinical setting are among the most important issues that should be considered.

Design, development, and evaluation of a self-care program for women with osteoporosis: The protocol of a mixed-method study.

BACKGROUND: Osteoporosis, the fourth most common disease in the world, affects the elderly and postmenopausal women and imposes a great financial and social burden on individuals and society. Furthermore, it has a significant impact on the quality of patients' life. This study tries to take an effective step toward improving the quality of patients' life by developing and evaluating the self-care program of women with osteoporosis. MATERIALS AND METHODS: In this research, a hybrid sequential design of quantitative and qualitative type consisting of three phases is used. This mixed-method study aimed to develop and evaluate a self-care program for women with osteoporosis. CONCLUSION: Familiarity with the needs of these patients and the use of self-care programs and considering social, cultural, and psychological factors could be effective steps to improve the health of women with osteoporosis. These steps can improve the quality of life and reduce the costs of treatment for this group of women.

Assessment of medication administration of nurses in medical cardiac wards and its relationship with some demographic characteristics: An observational study.

BACKGROUND: Unsafe medication administration and medication errors pose a threat to medication safety. Safe medication is one of the most important nursing practices that plays an important role in preventing medication errors. The aim of this study was to assess the medication administration of nurses in cardiac wards and its relationship with some demographic characteristics. MATERIALS AND METHODS: The present study was conducted as an observational study in 2021 with the 60 nurses who working in the medical cardiac wards of one selected hospital affiliated with the Isfahan University of Medical Sciences. Data were collected using three-part tools (demographic information, medication checklist (55 items), and documentation checklist (8 items). The checklist was completed by the observer after observing the nurses' medication administration. Data analysis was conducted using descriptive and inferential statistics in the SPSS software (version 16, SPSS Inc., Chicago, IL, USA). A P < 0.05 was considered statistically significant. RESULTS: The mean total score of the principles of injection and oral medication administration were 82.53 ± 10.75 and 75.76 ± 9.62, respectively. The mean score of the principles of injection and oral medication administration in the morning shift was significantly higher than the evening and night shifts (P < 0.001). The relationship between the mean score of the principles of injection medication (r = 0.234, P = 0.067), oral medication (r = 0.222, P = 0.083), and the nurses' work experience no significant. The rate of adherence to the principles of medication administration in the premedication administration stage was higher than during and after drug administration. CONCLUSION: Although the mean score of medication administration of nurses in the medical cardiac wards was at the desired level, it is necessary to monitor and plan by nursing managers to improve medication administration. Reducing the number of night shifts, adhering to accreditation programs in the hospital, continuous monitoring of nurses in terms of compliance with the principles of medication are among the proposed solutions to improve the safe medication in nurses.

Evaluating the performance characteristics of different antimicrobial susceptibility testing methodologies for testing susceptibility of gram-negative bacteria to tigecycline.

BACKGROUND: The current emergence of multi-drug resistance among nosocomial pathogens has led to increased use of last-resort agents including Tigecycline (TGC). Availability of reliable methods for testing TGC susceptibility is crucial to accurately predict clinical outcomes. We evaluated the influence of different methodologies and type of media on TGC susceptibility of different gram-negative bacteria of clinical origin. METHODS: The TGC susceptibility of 84 clinical isolates of Klebsiella pneumoniae (n = 29), Escherichia coli (n = 30), and Acinetobacter baumannii (n = 25) was tested by broth microdilution (BMD), Etest, agar dilution (AD) and disk diffusion (DD) methods using Mueller Hinton agar from Difco and Mueller Hinton broth (MHB) from two different manufacturers (Difco and Condalab). FDA TGC susceptibility breakpoints issued for Enterobacteriaceae were used for interpretation of the results. RESULTS: MICs determined by BMD using MHB from two suppliers showed a good correlation with overall essential agreement (EA) and categorical agreement (CA) being 100% and 95% respectively. However, a twofold rise in BMD-Condalab MICs which was detected in 50% of the isolates, resulted in changes in susceptibility categories of few isolates with MICs close to susceptibility breakpoints leading to an overall minor error (MI) rate of 4.7%. Among the tested methods, Etest showed the best correlation with BMD, being characterized with the lowest error rates (only 1% MI) and highest overall EA (100%) and CA (98.8%) for all subsets of isolates. AD yielded the lowest overall agreement (EA 77%, CA 81%) with BMD in a species dependent manner, with the highest apparent discordance being found among the A. baumannii isolates. While the performance of DD for determination of TGC susceptibility among Enterobacteriaceae was excellent, (CA:100% with no errors), the CA was lower (84%) when it was used for A. baumannii where an unacceptably high minor-error rate was noted (16%). No major error or very major error was detected for any of the tested methods. CONCLUSIONS: Etest can be reliably used for TGC susceptibility testing in the three groups of studied bacteria. For the isolates with close-to-breakpoint MICs, testing susceptibility using the reference method is recommended.

The Effect of the Neuman Systems Model on Anxiety in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial.

BACKGROUND: Coronary artery bypass graft (CABG) surgery is the most commonly used surgical procedure for patients with coronary artery disease. Anxiety is a significant psychological problem associated with CABG surgery that may reduce related treatment outcomes. PURPOSE: This study was designed to investigate the effect on anxiety of applying the Neuman Systems Model in patients awaiting and undergoing CABG surgery. METHODS: A single-blind, parallel-group randomized controlled trial was conducted on patients scheduled to receive coronary artery bypass surgery in an urban area of Iran. Seventy participants were enrolled using a convenience sampling method and randomly assigned to either the intervention group (n = 35) or the control group (n = 35). Participants in the intervention group received intervention in accordance with the Neuman Systems Model format, including meetings held at three levels of prevention. Patients' anxiety was measured using the State Anxiety Inventory before the intervention, immediately after the intervention, and at discharge time. The chi-square test, Fisher's exact test, independent sample t test, one-way repeated measures analysis of variance test, and Fisher's least significant difference were used to analyze the data. RESULTS: No significant difference was found between the mean anxiety scores of the two groups before the intervention (p = .48, t = 0.71). However, the mean anxiety score of the intervention group was significantly lower than that of the control group immediately after the intervention (p = .008, t = 2.73) and at discharge time (p = .007, t = 2.77). CONCLUSIONS: The Neuman-based program is an effective and low-cost intervention that may be applied to reduce anxiety in patients awaiting and undergoing CABG surgery. This program may be a good guide in providing healthcare services.

Compassion Satisfaction and Fatigue in Cardiovascular Nurses: A Cross-sectional Descriptive Study.

BACKGROUND: Cardiovascular nurses play a key role in improving the treatment outcomes in patients. Compassion satisfaction and fatigue influence the quality of nursing care. Thus, it is important to examine the levels of compassion satisfaction and fatigue in cardiovascular nurses. This study was performed to determine compassion satisfaction and fatigue in cardiovascular nurses. MATERIALS AND METHODS: This cross-sectional, descriptive study was conducted with a single-stage design on 200 cardiovascular nurses who were randomly selected from among nurses working in four educational hospitals in Isfahan, Iran, in July-October 2018. Data collection was conducted using the Professional Quality Of Life Scale (version 5) (ProQOL- version 5) with 30 items in the three subscales of compassion satisfaction, burnout, and Secondary Traumatic Stress (STS). The results were analyzed using descriptive and inferential statistics in SPSS software. RESULTS: The results indicated the high mean (SD) score of 41.39 (5.54) for compassion satisfaction and the moderate mean (SD) scores of 26.93 (4.62) and 26.69 (5.90) for burnout and STS, respectively, in more than two-thirds of the nurses. Pearson correlation coefficient showed no significant relationship between the nurses' age, level of education, work experience, and monthly working hours and scores of compassion satisfaction, burnout, and STS, and total compassion fatigue score (p > 0.05). Work experience was directly related to STS score (r = 0.18,p = 0.01). However, it had no significant relationship with compassion satisfaction and burnout (p > 0.05). CONCLUSIONS: The results showed that the score of compassion satisfaction was high and fatigue was moderate in the cardiovascular nurses. Further research seems necessary to enhance compassion satisfaction and reduce fatigue in nurses.

Family's Supportive Behaviors in the Care of the Patient Admitted to the Cardiac Care Unit: A Qualitative Study.

Introduction: A life-threatening illness can cause the involvement of family members and the imposition of psychological and physical stress on them. Certainly, the family is a very valuable resource in patient care and plays an important role in maintaining the emotional support and patient's recovery. The aim of this study was to explain the family members' supporting behaviors of the patient admitted to the cardiac special units. Methods: This qualitative study was performed in the cardiac special units in Isfahan. The number of participants was 20, including 5 nurses, 8 family members, and 7 patients. The data were collected through interview and observation by purposive sampling. Then, the data were analyzed by Graneheim and Lundman's qualitative content analysis method. The study lasted 12 months. Results: Data analysis showed that family's support can be classified into three levels, including support by the therapeutic alliance (attempts to console and reassure, restoration of selfesteem, diminishing patient's insensitivity, commitment to the patient, and visiting the patient ), participatory information (obtaining reliable information from the nurse, active role in providing meaningful information about the patient's prognosis), practical and instrumental support (searching for economic support resources, providing the patient with the necessary equipment, trying to do the right care taking into account the family culture). Conclusion: Understanding family's supportive behaviors can help improve counseling and planning for quality care of patients admitted to the cardiac care units (CCUs).

Modifying Stressors Using Betty Neuman System Modeling in Coronary Artery Bypass Graft: a Randomized Clinical Trial.

Introduction: Coronary artery disease (CAD) is one of the major causes of mortality all over the world. In this relation, coronary artery bypass grafting (CABG) is one of the most important treatments for CAD patients. However, it leads to a lot of stress in the patient. The aim of this study was to use the Neuman model to moderate the stressors in patients undergoing coronary artery bypass graft. Methods: This study was a randomized clinical trial of two groups performed on patients admitted to the coronary artery bypass graft; and the study completed with 64 patients. The intervention was performed by the researcher according to the format of the Neuman Model, which included the investigation of the stressors, and the determination of the goals and strategies for the actions. Intrapersonal, interpersonal, and extra personal factors were evaluated using a Revised Cardiac Surgery Stressor Scale (RCSSS). The intervention program was designed by the researcher based on prevention levels using scientific resources. The collected data were analyzed in SPSS ver. 13 using descriptive and inferential statistics. Results: Before the intervention, the mean score of the stressors was not significantly different between the two groups. But immediately after the intervention and before discharging the intervention group, it was significantly less than the control group. Conclusion: Using a Neuman-based program as an effective and low-cost intervention can moderate the stressors and reduce the stress of patients awaiting coronary artery bypass graft. This theory can be a good guide to offering the roles needed to provide health services in the community.

Effect of an educational intervention based on BASNEF model on treatment adherence after coronary artery bypass surgery: A randomized clinical trial.

BACKGROUND: Coronary artery bypass graft (CABG) surgery is the most effective treatment for cardiovascular disease (CVD). Adherence to treatment after CABG surgery is very important. One of the educational models used in this regard is the BASNEF (Belief, Attitudes, Subjective Norms, and Enabling Factors) model. The present study aimed to assess the effect of an educational intervention based on BASNEF model on adherence to treatment in patients after CABG surgery. METHODS: The present study was a randomized clinical trial. In this study, 72 patients who had undergone CABG surgery participated in the two intervention and control groups. Patients in the intervention group took part in 4 40-minute educational sessions based on BASNEF model after discharge. The patients in both groups completed the Modanloo Adherence to Treatment Questionnaire (MATQ) and a researcher-made BASNEF model questionnaire before the intervention, after the educational intervention, and at the 3-month follow-up. Data were analyzed using independent t-test, chi-square test, Man-Whitney test, and repeated measures analysis of variance (ANOVA). Mauchly's sphericity test was used for testing sphericity and the Greenhouse-Geisser correction was used in the case of lack of sphericity. All P-values of less than 0.05 were considered significant. RESULTS: The total score of the MATQ and its subscales had significantly improved in the intervention group after the intervention compared with the control group (P < 0.050). In addition, the mean scores of the model constructs (knowledge, attitude, behavior intention, subjective norms, and enabling factors) had significantly improved after the intervention in the intervention group in comparison with the control group (P < 0.050). CONCLUSION: The educational intervention based on BASNEF model improved adherence to treatment in patients after CABG surgery. Moreover, the model constructs improved in the intervention group in comparison with the control group after the intervention.

Compassionate Care Challenges and Barriers in Clinical Nurses: A Qualitative Study.

BACKGROUND: Compassion is the heart of nursing care. Barriers to compassion in nursing may be influenced by the prevailing culture and religion of a society. Determining the barriers to providing compassion-based care would help nurses to plan better and more appropriate interventions. This study aimed to explore the challenges and barriers to compassionate care in nurses. MATERIALS AND METHODS: This ethnographic study was performed in 2014-2016. The study participants consisted of 40 nurses, 16 patients, and 8 family members in medical and surgical wards. Data collection was performed through observations and interviews. Data analysis was performed based on Strauss and Corbin's constant comparative method. RESULTS: Data analysis defined three themes as the challenges and barriers to compassionate care; challenges and barriers related to the contextual environment of hospitals, sociocultural challenges and barriers, and challenges; and barriers related to staff. CONCLUSIONS: This study described the challenges and barriers to compassionate care. Therefore, to eliminate these barriers and challenges, corrective action should be taken by managers. Attention to teaching the concept of compassion and patient-centered care and increasing the number of nurses and positive attitude toward the nursing profession in clinical environment can be effective in providing compassionate care.

Contextual Facilitators and Maintaining of Compassion-Based Care: An Ethnographic Study.

BACKGROUND: Compassion is an important part of nursing. It fosters better relationships between nurses and their patients. Moreover, it gives patients more confidence in the care they receive. Determining facilitators of compassion are essential to holistic care. The purpose of this study was to explore these facilitators. MATERIALS AND METHODS: This ethnographic study was conducted in 2014-2015 with 20 nurses, 12 patients, and 4 family members in the medical and surgical wards. Data collection was done through observations and in-depth semi-structured interviews with purposive sampling. The study was carried out in 15 months. Data analysis was performed using constant comparison based on Strauss and Corbin. RESULTS: Data analysis defined three main themes and eight subthemes as the fundamentals of compassion-based care. Nurses' personal factors with subcategories of personality, attitudes, and values and holistic view; and socio-cultural factors with subcategories of kindness role model, religious, and cultural values are needed to elicit compassionate behaviors. Initiator factors, with subcategories of patient suffering, patient communication demands, and patient emotional and psychological necessity are also needed to start compassionate behaviors. CONCLUSIONS: The findings of this study showed that nurses' communication with patients is nurse's duty in order to understand and respect the needs of patients. Attention should be paid to issues relating to compassion in nursing and practice educational programs. Indeed, creating a care environment with compassion, regardless of any shortcomings in the work condition, would help in the development of effective nursing.

Four hour ambulation after angioplasty is a safe practice method.

BACKGROUND: During the last 3 decades, there were increasing tendency towards angioplasty because of its benefits. But, this procedure has its acute problems like bleeding and formation of hematoma in the removal place of the sheet. Based on researchers' clinical experiences, patients need a time of 8-12 hours for bed rest after coronary angioplasty. Recognizing desirable time for bed rest after angioplasty and remove the arterial sheet forms the foundation of related researches in the world. Getting out of bed soon after angioplasty, causes more comfortable feelings, less hospitalization period, fewer side effects of prolonged bed rest and less hospitalization expenses. Regarding less time for bed rest after angioplasty, the aim of this study was to assess the effect of the time of getting out of bed after angioplasty on the complications after removing the sheet in coronary angioplasty patients. METHODS: This was an experimental clinical study conducted in one step and two groups. Samples were included 124 angioplasty patients (62 in each group) who were chosen randomly from the CCU of Shahid Chamran hospital of the Isfahan University of Medical Sciences in 2007. Data were gathered by observing and evaluating the patients, using a questionnaire and a checklist. After angioplasty, patients from the intervention group were taken out of bed in 4 hours and patients from the control group were taken out of bed in 8 hours. After taking out of bed, patients were examined for bleeding and formation of hematoma in the place of taking out the arterial sheet. Data were analyzed using descriptive and inferential statistics via SPSS software. RESULTS: Results showed no meaningful difference between the two groups after getting out of bed (p > 0.05) regarding relative frequency of bleeding (p = 0.50), formation of hematoma (p = 0.34) and average diameter of hematoma (p = 0.39). CONCLUSIONS: Results of this study showed that reducing the bed rest time to 4 hours after removing the arterial sheet of size 7 do not increase bleeding and formation of hematoma in the removal place of the sheet. So, those angioplasty patients who do not have critical clinical condition and their vital symptoms are stabilized will be able to get out of bed 4 hours after removing the sheet.