Standardized patients' experience of participating in medical students' education: a qualitative content analysis.

BACKGROUND: Standardized patients are considered a significant educational method in medical sciences and have been successfully employed for many years. This study was conducted with the aim of explaining the experience of standardized patients participating in the education of medical student. METHOD: A qualitative content analysis approach was used. This study was conducted at Standardized Patient Center, Tehran University of Medical Sciences, Tehran, Iran, May to February 2022. Fifteen standard patients were selected through purposive sampling with maximum variation. Semi-structured, in-depth, face-to-face interviews were conducted with standard patients. The average duration of the interviews was 60 to 90 min. Data were transcribed and analyzed using the Graneheim and Lundman approach. RESULTS: A passport for the future and duality of feelings were the two main themes identified in this study with six subthemes. One of the main themes was passport for the future with subthemes creative, participation in educating future generation, reflection and another theme was duality of feeling with subthemes feeling of value, guilty conscience, and fear of judgment by others. CONCLUSION: The participants expressed having mixed feelings about their role as standard patients. They felt conflicted because they were compensated for their participation, which made them worry about being judged by others and feel guilty about taking the fee. Therefore, it is recommended to conduct further studies in this area.

Harmony in hardship: Unveiling parental coping strategies with the challenges of child's hematopoietic stem cell transplantation.

PURPOSE: Pediatric Hematopoietic Stem Cell Transplant (HSCT) profoundly affects various dimensions of parents' lives. Effective coping strategies are essential for improving psychological well-being and overall quality of life. Therefore, this study aimed to explore parental coping strategies with their child's HSCT challenges. DESIGN AND METHODS: This qualitative study was conducted in Iran from February to November 2023, utilizing conventional content analysis with purposive sampling. For data collection, unstructured interviews were conducted, followed by in-depth semi-structured interviews with open-ended questions. Saturation was reached after analyzing qualitative data from 20 participants. RESULTS: Data analysis unveiled a main theme labeled "harmony in hardship". This overarching concept encapsulates the participants' endeavors to cope with the various hurdles and complexities stemming from their child's HSCT. This theme consisted of five categories: "emotional release", "positive coping", "avoidance coping", "spiritual coping", and "seeking support". CONCLUSION: Parents utilized multifaceted coping strategies to manage the complexities of their child's HSCT journey. Understanding these mechanisms is crucial as they can positively influence parents' psychological well-being and improve their overall quality of life. IMPLICATIONS FOR CLINICAL PRACTICE: Healthcare professionals should recognize the diverse coping strategies employed by parents of children undergoing HSCT and provide tailored interventions and support. Furthermore, implementing structured support programs and training initiatives for healthcare professionals can enhance their capacity to meet the diverse needs of parents during this challenging journey.

Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study.

Background: Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI. Materials and methods: A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding. Results: From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance". Conclusion: The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.

Parents' experiences of living with a child with cancer undergoing hematopoietic stem cell transplantation: a qualitative content analysis study.

Objectives: Pediatric Hematopoietic Stem Cell Transplant (HSCT) profoundly impacts the physical, psychological, and social aspects of parents' lives. Thus, this study aimed to explore the experiences of parents living with a child with cancer who undergoes HSCT. Methods: This qualitative study involved 20 parents of children with cancer who were undergoing HSCT at a referral hospital in Iran. Purposive sampling was used to select the participants from February 2023 to November 2023. In-depth semi-structured interviews, featuring open-ended questions, were utilized for data collection. Data analysis was performed using conventional content analysis. Results: Data analysis revealed two main themes. "Surrounded by hardships" and "Self-actualization." The first theme encompassed participants' experiences of facing difficulties in life after being aware of their child's need for HSCT. This theme consisted of four categories: "uncertainty about the child's future," "exhaustion from the child's treatment process," "worrying about the healthy child(ren)," and "helplessness." The second theme "self-actualization" included with two categories: "transformation in life's philosophy" and "acquisition of new capabilities." These categories highlighted the positive outcomes experienced by the participants following their child's HSCT. Conclusion: Our findings underscore the importance of healthcare providers being attuned to parents' experiences throughout their child's HSCT trajectory. It is crucial for healthcare providers to encourage parents to articulate their concerns and feelings and seek support from healthcare providers, family, and friends. The development of psychological support services in healthcare settings can facilitate tailored interventions to alleviate parents' difficulties.

Exploring the Experiences of Patients with Autoimmune Skin Diseases During the COVID-19 Pandemic.

OBJECTIVE: To explore the experiences of patients with an autoimmune disease during the COVID-19 pandemic. METHODS: A total of 12 patients with autoimmune skin disease who were hospitalized in dermatology wards between 2021 and 2022 participated in this qualitative study. The researchers conducted in-depth, semi-structured interviews, which they analyzed using conventional content analysis. RESULTS: Data analysis revealed three main themes: changes in mental/psychological status, social impacts and financial problems, and physical consequences. These patients reported changes in mental/psychological status as their most important experiences. CONCLUSIONS: During a pandemic, it is important to manage the therapeutic course of patients who are at risk of infection, especially patients with autoimmune skin diseases, via appropriate planning.

Spiritual Health Consequences from the Iranian Adolescents' Perspective.

Spiritual health is a unique force that can influence the physical, mental, and social dimensions of life. In order to know the positive effects of spiritual health, it is necessary to explain the adolescents' experiences in this area. This study, therefore, aimed to investigate Iranian adolescents' experiences regarding the effects of spiritual health. This study was conducted based on a qualitative approach using content analysis. The data were collected through semi-structured interviews with 20 adolescents aged 14-18 years. Subsequently, the obtained data were analyzed using the Graneheim and Lundman method. In total, three major categories emerged from data analysis, including mental health promotion, self-control, and purposefulness in life. Considering the significant effects of spiritual health on adolescents' development, it is essential to pay attention to this dimension of health and develop plans to enhance it.

Effectiveness of a Supportive Program on Caregiver Burden of Families Caring for Patients on Invasive Mechanical Ventilation at Home: An Experimental Study.

The prevalence of patients on mechanical ventilation who are being supported at home is increasing. Due to these patients' complex and chronic conditions, the subjective burden on their family caregivers increases after discharge. The aim of this study was to evaluate the effectiveness of a supportive home care program on the caregiver burden of families caring for patients on invasive mechanical ventilation at home. Sixty patients hospitalized in three university-affiliated hospitals in Tehran, Iran between 7/2020 and 8/2021 were randomly assigned to one of two groups: A supportive home care program, and routine hospital education. The supportive home care program included six educational sessions delivered in the hospital before discharge, and home visits and continued education after discharge. Caregiver burden was measured using the Zarit Burden Interview. Results showed that caregiver burden increased significantly (p ≥ .001) after discharge without the supportive home care program intervention. Follow-up by nurses after discharge is essential to reduce the psychological burden of caring for patients on invasive mechanical ventilation at home.

Living with Mental Distress, Social Anger, and In-Group Commitment among Working Children: A Qualitative Study.

Background: Working as a child can have various effects on all aspects of children's health. Investigating and identifying issues related to the health of working children can be useful in promoting their health. Therefore, in this qualitative study, we examined issues related to the mental health and behavior of working children. Materials and Methods: This qualitative study was conducted in Tehran, Iran, in 2021 with the contractual content analysis approach. The main participants (N = 32) in this study were working children aged 10 to 18 years. To collect data, in-depth and semi-structured interviews were conducted with working children, their parents, and the center officials. In addition to the interview, some field notes were also taken from interactions between working children. After each interview, they were transcribed and coded. After 27 interviews, the data were saturated, no new code was extracted, and further interviews were conducted to ensure data saturation. Data analysis was performed based on the proposed method of Lundman and Graneheim. Results: The results revealed the three main categories of mental distress (fear and anxiety, depression, loneliness and isolation, decreased self-confidence, and decentralized mind), social anger (negative social role modeling, harassment and harm of others, reprehensible and antisocial behavior, disregard for the property of others, disrupted relationships, and violence), and in-group commitment (self-censorship outside the group, individual independence and group cohesion, and caring for the group). Conclusions: Most working children suffer from various forms of mental and behavioral issues, which, if not taken care of, can have irreparable consequences.

Evaluation of berberine pellet effect on clinical recovery time in COVID-19 outpatients: A pilot clinical trial.

Objective: Severe disease onset of COVID-19 may result in alveolar injury and respiratory failure. Apoptosis and inflammation are the main causes of respiratory distress syndrome. Berberine is used in medicine as an analgesic, anti-asthmatic, anti-inflammatory, and antiviral. In the current investigation, the effect of berberine on COVID-19 outpatients was studied. Materials and Methods: The present clinical trial was performed on 40 outpatients who were randomly assigned to berberine (300 mg, TID, 2 weeks) (n=19) or placebo groups (n=21). Both groups received standard therapy and they were monitored on days 3, 7, and 14 after the beginning of the therapy for clinical symptoms' improvement, quantitative CRP, lymphopenia, CBC, and SpO2. The severity and frequency of these symptoms and the level of the parameters were statistically compared between the two groups. Results: On days (0, 3, 7, and 14, there was no significant difference between the berberine and placebo groups in the improvement of clinical symptoms (cough, shortness of breath, nausea, loss of smell and taste, diarrhea, dizziness, sore throat, stomachache, body aches, and body temperature), quantitative CRP, lymphopenia, WBC, neutrophils, platelets, or SpO2. Conclusion: Berberine (300 mg, TID, two weeks) is ineffective in treating COVID-19. More research with a larger sample size is needed to investigate different berberine dosages in other pharmaceutical formulations.

The Assessment of Cytotoxicity, Apoptosis Inducing Activity and Molecular Docking of a new Ciprofloxacin Derivative in Human Leukemic Cells.

The fluoroquinolone class of antibiotics includes derivatives of the drug ciprofloxacin. These substances have recently been advocated for the treatment of cancer. In the current study, we examined the cytotoxicity and apoptosis-inducing potential of a novel synthetic ciprofloxacin derivative in the human myeloid leukemia KG1-a cell line. With an IC50 of 25µM, this ciprofloxacin derivative, 7-(4-(2-(benzhydryloxy)-2-oxoethyl) piperazin-1-yl)-1-cyclopropyl-6-fluoro-4-oxo-1,4 dihydroquinoline-3- carboxylic acid (4-BHPCP), was an active drug. Through Hoechst 33,258 staining and Annexin V/PI double staining experiments, the apoptotic activity of the 4-BHPCP was assessed morphologically. Real-time quantitative PCR was used to assess changes in the expression level of certain apoptosis-related genes, including Bcl-2, Bax, and Survivin (qRT PCR). The results of the qRT PCR analysis demonstrated that 4-BHPCP promotes apoptosis in the KG1-a cell line by down-regulating Survivin and Bcl2, up-regulating Bax, and increasing the Bax/Bcl2 transcripts in a time-dependent manner. These results imply that this novel chemical may be a promising therapy option for acute myeloid leukemia.

Understanding the Impact of COVID-19 on Angioplasty Service and Outcome of Patients Treated for Chronic Limb-Threatening Ischaemia: A Single-Centre Retrospective Cohort Study.

We evaluated the impact of COVID-19 restriction on the angioplasty service and outcome of chronic limb-threatening ischaemia (CLTI) patients undergoing lower-limb angioplasty in a UK secondary care setting. Consecutive patients were analysed retrospectively. Pre-COVID-19 (08/2018-02/2020), 106 CLTI patients (91% Fontaine 4; 60% diabetes mellitus) and during COVID-19 (03/2020-07/2021) 94 patients were treated (86% Fontaine 4; 66% diabetes mellitus). While the average monthly number of patients treated did not change, the proportion of day cases significantly increased (53% to 80%), and hospitalised patients decreased. Patients treated in ≤14/5 days after referral significantly increased to 64/63%. Kaplan-Meier survival analysis (30-day/1-year) showed that neither wound healing nor mortality were significantly changed during COVID-19. In day cases, 1-year but not 30-day major amputations significantly increased, and clinically driven target-lesion revascularisation decreased during COVID-19. One-year mortality was significantly worse in hospitalised compared to day cases (14% vs. 43%) at similar wound healing rates (83% vs. 84%). The most frequent known cause of death was infectious disease (64%), while cardiovascular (21%) was less frequent. Despite COVID-19 restrictions, a safe and effective angioplasty service was maintained while shortening waiting times. Very high mortality rates in hospitalised patients may indicate that CLTI patients need to be referred and treated more aggressively earlier.

Can addressing family education improve outcomes of patients under home invasive mechanical ventilation? A randomized controlled clinical trial.

The use of home mechanical ventilation is increasingly developing. The present study aimed to examine the effect of a family-centered training program on patients under home invasive mechanical ventilation. A total of 60 adult patients under invasive mechanical ventilation were selected and randomly allocated into two groups. The supportive home care program consisting of six training sessions using a teach-back technique and follow up training at home. The rate of hospital readmission and mortality in the intervention group was significantly lower than the control group(P = .02 and P = .03, respectively). Moreover, the home caregivers' level of knowledge in the intervention group was significantly higher than that of the control group(P = 0/000). In addition, implementing the intervention effectively increased home caregivers' ability of functional skills. Therefore, comprehensive preparation of the patient and family before discharge and coherent support and continuity of care after discharge with the effective presence of nurses.

Strategies used by Iranian nursing students for adjusting to internship: a qualitative study.

BACKGROUND: The internship setting is a highly challenging one for nursing students, and working in such an environment requires adjustment. Knowledge of the adjustment strategies used by students enhances the body of nursing knowledge and can help nursing officials adopt appropriate decisions to strengthen the students' effective adjustment skills and increase the benefits reaped from their internship. The present study was conducted to explore the strategies used by nursing students to adjust to internship. METHODS: A total of 19 senior nursing interns (7 Female, and 12 Male) were selected by purposive sampling with maximum variation from one of the nursing and midwifery schools affiliated to a large metropolitan medical university in northern Iran. Data were collected using audio-taped semi-structured face-to-face interviews over an 18-month period and were carefully transcribed and analyzed using the Graneheim & Lundman qualitative conventional content analysis approach. The researchers analyzed the data in MAXQDA 10 software. RESULTS: Four main categories and eight subcategories emerged from the data analysis. Main categories include efforts to achieve clinical competency, efforts to be sociable or accepted, self-management and reaction to conflicts. CONCLUSION: All the participants attempted to attain adjustment by adopting strategies such as achieving clinical competence, trying to be sociable or accepted, self-management, and reaction to conflicts depending on the conditions of internship. Officials should help nursing students use effective strategies and achieve adjustment.

Mixed-methods study protocol for exploring the perception of nurses' resilience in the COVID-19 pandemic: Designing, implementing and evaluation of intervention.

BACKGROUND: While the necessity for interventions to build resilient nurses in the COVID-19 pandemic is recognized, there is disagreement about the effective methods for achieving this. AIM: We present our research protocol that describes plans to design and test an interventional program for promoting nurses' resilience. DESIGN: This sequential exploratory interventional mixed-methods study is conducted in three phases (qualitative, intervention design, and quantitative). METHODS: It was funded from May 2021 for 24 months. In phase 1, we explored strategies for promoting resilience in the COVID-19 pandemic from nurses' perspectives (through semi-structured interviews). In phase 2, we will design an interventional program for promoting nurses' resilience (using the qualitative phase and literature review results). We will assess the program's effectiveness on nurses' resilience in a randomized controlled trial in phase 3. DISCUSSION: Given the different experiences of nurses of resilience in COVID-19, our innovative program can guide future research to enhance nurses' resilience based on specific situations.

Explaining the educational challenges in the path of cultural competence: The experiences of Iranian nursing students.

BACKGROUND: Cultural care is necessary for healthcare settings due to the presence of culturally diverse clients. Nursing students face different challenges in the path of cultural competence. PURPOSE: This study aimed to characterize nursing students' educational challenges in achieving cultural competence. METHOD: Data were collected through interviews with 14 nursing students, 2 faculty members, and 2 nurses working in educational and clinical centers affiliated to Kerman University of Medical Sciences in southeastern Iran. The Graneheim and Lundman approach was used to conduct purposeful sampling and analyze data. RESULTS: Data analysis revealed the theme of nurses' educational challenges with cultural competence with four major categories: the neglect of cultural competence in educational approaches, the lack of importance of culturally congruent care in clinical settings, poor intercultural communication, and insufficient skill in cultural humility. CONCLUSION: The present study shows numerous barriers to nursing students' cultural competence, which impair their learning and care for culturally diverse patients.

Broken Toughness: Iranian Older Adults' Perceptions of Abuse.

BACKGROUND: Older people abuse includes intentional or unintentional conduct or omission of a specific behavior by a trusted person that causes injury or distress to older people. This study described older peoples' perceptions of abuse in Iranian society. METHODS: This qualitative study applied a conventional content analysis method to understand the perceptions of abuse among older Iranian people. Twenty older residents were selected by purposeful sampling. Data were collected through in-depth, semi-structured, and face-to-face interviews. The six-step Graneheim and Lundman content analysis method guided data analysis. MAXQDA software version 10 was used to manage the data. RESULTS: The data analysis led to the identification of three main themes: broken toughness, hidden abuse, and exploitation. The first theme had two sub-themes: domination and disturbed peace and tranquility. CONCLUSION: Abuse resulted from a combination of causes and factors. Abuse was hidden in many cases and was not limited to physical abuse. The other examples of abuse included disrespect, deprivation of authority, disturbed tranquility, and financial exploitation of older adults.

Challenges of and corrective recommendations for healthcare-associated infection's case findings and reporting from local to national level in Iran: a qualitative study.

BACKGROUND: The accuracy of health care-associated infections (HAIs) statistics in many countries is questionable and the main reasons of this inaccuracy are not well-known. The study aim was to explore inhibitors of and corrective recommendations for HAIs case findings and reporting in some of Iran hospitals. METHODS: Sixteen face-to-face interviews and an expert panel were performed with expertise of infection prevention and control (IPC) programs in hospitals, and Deputies of Health and Treatment in medical university and Ministry of Health from Feb 2018 to May 2019. Using conventional content analysis, code, subcategories and categories were developed. RESULT: Three categories emerged including improper structure preparation, conflict of interest, and inadequate motivation. Allocating distinct budget and adequate staff to IPC programs, developing a user-friendly surveillance system and engaging physicians and nurses for HAIs reporting are the main corrective recommendations accepted by the expert panel. CONCLUSION: Despite the improvement in growing case-findings and reporting of HAIs in Iran, there are many challenges which inhibit accurate case finding and reporting of HAIs. So it is necessary to update the structure, system and rules to reach accurate HAIs data in Iran.

Physical problems of prolonged use of personal protective equipment during the COVID-19 pandemic: A scoping review.

BACKGROUND: It is widely believed that using personal protective equipment (PPE) provides high levels of protection for healthcare workers (HCWs) in the fight against coronavirus disease (COVID-19). However, the long-term use of PPE is inconvenient for HCWs and may cause physical discomfort. These factors could result in poor compliance and disrupt the health and safety of HCWs, which may negatively affect the patient's safety. OBJECTIVE: This study aimed to investigate the literature for the purpose of collecting convincing evidence of HCWs' physical problems associated with PPE use during the COVID-19 pandemic. METHODS: This scoping review was conducted using PubMed, Embase, ProQuest, Science Direct, Springer, Biomed Central, and Google Scholar to identify the related literature. RESULTS: HCWs have experienced various physical disorders including skin, respiratory, musculoskeletal, nervous, urinary, and circulatory system problems that are associated with PPE in various body systems. Among these, skin problems were the most frequent physical problems. CONCLUSIONS: The literature demonstrated the adverse impacts of using PPE on HCWs. Therefore, healthcare policymakers should take the appropriate measures to improve the work environment during the COVID-19 pandemic, which could consequently prevent and mitigate the adverse effects of using PPE.

Using a model to design, implement, and evaluate a training program for improving cultural competence among undergraduate nursing students: a mixed methods study.

BACKGROUND: Due to changing population, culturally diverse clients with different perceptions of illness and health are present in healthcare settings. Therefore, it is increasingly important for nursing students to have high levels of cultural competence in order to meet diverse client needs. A training program is essential to enhance students' cultural competence. This study aimed to design, implement, and evaluate a cultural care-training program to improve cultural competence of undergraduate nursing students. METHODS: This exploratory mixed methods study used six steps proposed in the Talbot and Verrinder model to design a training program. In the first step, a conventional qualitative study was conducted and 18 participants were interviewed using purposive sampling. In the second and third steps, literature review and the classic Delphi technique were used for initiation and finalization of the program. The fourth, fifth, and sixth steps were completed by implementing, monitoring, and evaluating the cultural care program (five two-hour sessions) among 73 nursing students using a quasi-experimental design. Finally, effectiveness of program was evaluated through the cultural care inventory before and 1 month after the program. Data were analyzed via SPSS25, independent samples t- test, paired t- test, chi-square test, analysis of covariance, and multivariate linear regression tests. RESULTS: A systematic model was used to identify key elements of a cultural care program, including main topics, educational objectives and contents, assignments and activities for students, teaching and evaluation methods. The curricular objectives and educational contents were implemented in five sessions to produce measurable results. The quantitative step showed that nursing students' cultural competence in the intervention group (184.37 ± 22.43) improved significantly compared with the control group (153.19 ± 20.14) (t = 6.24, p = 0.001) after intervention. CONCLUSION: A cultural care training program can be designed by the model applied in this study in order to improve cultural competence of nursing students. This training program will be effective if students' learning needs, appropriate assignments, and acceptable teaching methods are addressed. Therefore, nurse educators can design comprehensive training programs to improve nursing students' cultural competence in different cultures and contexts. This training program is highly efficient because it is applicable in many disciplines of nursing education.