Requirements for improving social capital among faculty members of medical universities: A multicenter qualitative study.

Introduction: Social capital is critical to organizational dynamics, particularly in developing countries. This study explored strategies for enhancing social capital among faculty members at seven medical universities in the south of Iran. Methods: This qualitative study was conducted in 2021. We used a purposeful sampling technique to recruit faculty members and conducted individual semi-structured interviews with them. Thematic analysis was used to analyze and describe the collected data. Results: A total of 49 faculty members (34 males; 15 females) participated in this study. The participants expressed satisfaction with their affiliations with medical universities. Social capital was related to the feeling of belonging to the organization, as well as to interpersonal and intra-organizational relations. Social capital was associated with three components: empowerment, organizational policy change, and organizational identification. Additionally, a dynamic relationship between the individual, interpersonal, and macro-organizational levels reinforced the organization's social capital. This means that, just as the macro-organizational level affects the members' identities, the members' activism affects the macro-organizational level. Conclusion: To strengthen the organization's social capital, managers should work on the mentioned components at the individual, interpersonal, and macro-organizational levels.

Representation of a `positive experience' of surrogacy in Yazd, Iran: A qualitative study.

Background: The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate mothers, their expressions and interpretations of their lived experiences, and their feelings of personal and spiritual satisfaction. Objective: This study aims to present the positive experiences of surrogate mothers from a phenomenological perspective. Materials and Methods: Using a phenomenological approach, this study was conducted from September 2020 to January 2021 in the city of Yazd, Iran. Participant observation and semi-structured interviews were used to collect the data among 12 participants with at least 1 experience of surrogate motherhood. Results: Our findings showed that, despite having had harsh physical and socio-cultural experiences such as fear of social labeling and stigma, participants felt a kind of inner satisfaction and a positive view of their actions. A core theme found in the study was mothers' satisfaction. The main categories included feminine self-sacrifice and positive rewards. Feminine self-sacrifice included 2 sub-categories: creating happiness and conveying motherly feelings, while positive rewards included good childbirth, family acceptance, and halal income. Conclusion: This study showed that surrogate mothers experience conflicting feelings of inner satisfaction and social stigma during surrogacy. Some of those interviewed were willing to go through surrogacy again, but they feared social labeling and stigma, being misunderstood by others who are not fully informed about surrogacy, and being subjected to family and social disapproval.

Citizens' Opinion on Governmental Response to COVID-19 Outbreak: A Qualitative Study from Iran.

Studying the people's expectations of government measures to control and manage the coronavirus disease 2019 (COVID-19) can help to prepare for future crises. This study aimed to investigate the opinion of the Iranian people on authorities' management during a crisis, such as the COVID-19 pandemic. This qualitative study was conducted on 70 Iranian citizens in Shiraz to explore their opinion about the government response to the COVID-19 outbreak in February and March 2020. Based on saturation criteria, the data was collected by 1 open-end question: "What is your attitude toward the readiness of the officials and government in this epidemic?" Thematic analysis was conducted to explore themes. At the first step of the outbreak, people had critical opinions on their authorities' management. Four themes were studied, including trust and responsiveness, policymaking during a health crisis, economic management, and epidemic management. Although the citizens' expectation is dynamic, our study showed that there are still high demands from citizens toward the authorities, even in a new crisis that was not perceived before. One of the best ways to respond to these demands is appropriate risk communication.

A Qualitative Study of Nursing Management in Iran.

Background: Nursing managers have a critical role at the hospitals. The current study aims to investigate different experiences of nursing managers. Method: This is a qualitative study that investigates the experiences of 11 nursing managers in Shiraz, Iran. Semistructured interviews and thematic analysis were, respectively, applied for data collection and analysis. Results: It could be found from the current investigation that nursing managers have a critical role at the hospitals, and their creativities have more impacts on procedures compared to organizational orders. There are four major challenges faced by nursing managers including nursing shortage, structural deficiencies, lack of authorities, and burnout. Although shortage is considered as the most important challenge, there are more emphasizes on the improvement of their controlling power in order to prevent their fatigue and burnout. Conclusion: This study showed that creativity of nursing managers is the most important factor of system management; also, shortage and deficiencies are recognized as the most significant challenges faced by them. According to the current study, the shortage of nursing staff is the central issue that has to be considered.

Nurses' perception of disruptive behaviors in emergency department healthcare teams: A qualitative study.

INTRODUCTION: In an emergency setting, the occurrence of disruptive behaviors hinders team participation and cooperation. Exploring nurses' perception of disruptive behaviors can lead to a better identification of these behaviors in emergency departments and the provision of better recommendations. This study aimed to explore nurses' perception of disruptive behaviors among emergency healthcare teams in hospitals affiliated to the Hamadan University of Medical Sciences, Hamadan, Iran. METHOD: The study was carried out using qualitative content analysis in 2018-2019. Twenty participants from emergency departments of five hospitals in Hamadan, Iran, were enrolled using purposive sampling. Data were collected using semi-structured interviews that continued until data saturation. Data analysis was performed using Erlingsson and Brysiewicz's qualitative content analysis approach. RESULTS: Three main themes emerged including observable disruptive behaviors, hidden disruptive behaviors, and trigger factors. Observable disruptive behaviors consisted of two main categories: violence and incivility. Hidden disruptive behaviors included troubling behaviors, poor communication, and irresponsibility. Finally, the trigger factors of disruptive behaviors involved two categories: professional incompetency and workplace discrimination. CONCLUSION: Exploring nurses' perception showed that trigger factors such as professional incompetency and workplace discrimination could cause the occurrence of observable and hidden disruptive behaviors in emergency healthcare teams.

Nursing experiences of COVID-19 outbreak in Iran: A qualitative study.

AIM: The global outbreak of coronavirus in 2020 was considered as a serious risk for healthcare providers, especially nurses. This study aimed to investigate nurses' perceptions and experiences of COVID-19 outbreak in Iran. DESIGN: This thematic analysis study was conducted in March 2020. METHOD: Semi-structured interviews were conducted with 24 nurses in Qazvin, Arak, Shiraz and Kashan cities of Iran. RESULTS: It was found out that all the participants had faced a mysterious world created by the virus. No one had clear understanding of the new virus and knew how to tackle with such a virus. In this case, the main experiences were related to defected preparedness, the worst perceived risk, family protection, social stigma and sacrificial commitment. Urgent preparedness of facilities in such outbreaks is inevitable. Accordingly, psycho-social support of nurses and their families and strengthening their sacrificial commitments are proposed in these conditions.

Burnout among Nurses during Coronavirus Disease 2019 Outbreak in Shiraz.

BACKGROUND: The function of healthcare workers, particularly nursing staff, in taking care of coronavirus disease 2019 (COVID-19) patients, cannot be overemphasized. As the pandemic lasts, burnout among the nursing staff needs to be considered as an important challenge. This was aimed to assess the nurses' burnout and factors affecting this variable. MATERIALS AND METHODS: In this cross-sectional study, Maslach Burnout Inventory was completed by 261 nurses in Shiraz hospitals (Iran) in April 2020. This questionnaire addresses different aspects, including emotional exhaustion, personal achievement, and depersonalization, to determine the intensity of perceived burnout among nurses during the outbreak. RESULTS: Our data demonstrated that the nurses' burnout in Shiraz hospitals during the COVID-19 pandemic was high (64.6%). Emotional exhaustion and depersonalization were observed in 63.6 and 53.3 percent of the participants, respectively. Moreover, the rate of successful personal achievement among these nurses was >97%. Work experience <10 years (P=0.016), hospital ward (P=0.044), the number of deaths observed by nurses during the COVID-19 pandemic (P<0.001), and the total number of shifts during the COVID-19 pandemic (P=0.006) had a positive correlation with emotional exhaustion. CONCLUSION: Workload and stress resulting from the COVID-19 outbreak seem to be one of the major causes of emotional exhaustion in nurses. The emotional exhaustion among nurses must be considered in epidemics, such as COVID-19.

Experience of violence among street prostitutes: a qualitative study in Shiraz, Iran.

BACKGROUND: Female Sex workers (FSWs) are a marginalized group. Although some studies have shown various types of violence against sex workers, it is a subject which needs more in-depth knowledge. METHODS: This is a conventional content study conducted on 18 street sex workers in Shiraz, Iran. RESULTS: The present study observed that sex workers had extensive experience in five forms of violence: physical, barbaric, psychological, sexual, deception and robbery. Moreover, violence was deep-rooted in their previous experiences prior to becoming a prostitute, leading to the formation of yet another type of violence, called hidden slavery with male or female pimps. CONCLUSIONS: To improve the general health of this group, it is recommended that they be supported by social institutions and be provided with psychological consultations.

The Evaluation of Urban Community Health Centers in Relation to Family Physician and Primary Health Care in Southern Iran.

BACKGROUND: Shiraz University of Medical Sciences, Iran has developed a new version of health urban posts called Urban Community Health Center (UCHC) with primary aim of improving primary health care (PHC) in urban areas. The aim of present study was to evaluate this newly developed model of UCHC in Ghaleno, a suburban region of Shiraz, Iran in 2014. METHODS: Besides descriptive analysis of foregoing model and considering its goal, plan, and dimensions, a qualitative study was carried out using in-depth interview with four managers of this model in Ghaleo region as well as the family physicians (FPs) of the model. Data were analyzed using conventional content analysis. RESULTS: Evaluation of this model in 7-month period after implementation, showed that population coverage was raised from 23% to 84%, a remarkable and increasing achievement of 61%. The universal package is a protocol for providing healthcare services based on PHC.The descriptive study of the model based on physicians view, explored real FP, population's satisfaction, importance of physician's assistant, and payment system reform in the model. CONCLUSION: Ghaleno model has unique objectives in providing healthcare services in urban areas. The findings of this study call for further evaluation, specifically in quality care services. The success and continuation of this model demand the support of policy makers.

Associated Factors and Standard Percentiles of Blood Pressure among the Adolescents of Jahrom City of Iran, 2014.

Background. High blood pressure in adults is directly correlated with increased risk of cardiovascular diseases. Hypertension in childhood and adolescence could be considered among the major causes of this problem in adults. This study aimed to investigate the factors associated with hypertension among the adolescents of Jahrom city in Iran and also standard percentiles of blood pressure were estimated for this group. Methods. In this community-based cross-sectional study 983 high school students from different areas of the city were included using a multistage random cluster sampling method in 2014. Blood pressure, weight, and height of each student measured using standard methods. Data were analyzed by statistical software SPSS 16. Results. In total, 498 male and 454 female students were included in this study. Average systolic blood pressure of students was 110.27 mmHg with a variation range of 80.6-151.3. Average diastolic blood pressure was 71.76 mmHg with the variation range of 49.3-105. Results of this study indicated that there was a significant relationship between gender, body mass index, and parental education level with systolic and diastolic blood pressure of the students (P < 0.05). Conclusions. Body mass index was one of the most important changeable factors associated with blood pressure in adolescents. Paying attention to this factor in adolescence could be effective in prevention of cardiovascular diseases in adulthood.

The pattern of educator voice in clinical counseling in an educational hospital in Shiraz, Iran: a conversation analysis.

Doctor-patient interaction (DPI) includes different voices, of which the educator voice is of considerable importance. Physicians employ this voice to educate patients and their caregivers by providing them with information in order to change the patients' behavior and improve their health status. The subject has not yet been fully understood, and therefore the present study was conducted to explore the pattern of educator voice. For this purpose, conversation analysis (CA) of 33 recorded clinical consultations was performed in outpatient educational clinics in Shiraz, Iran between April 2014 and September 2014. In this qualitative study, all utterances, repetitions, lexical forms, chuckles and speech particles were considered and interpreted as social actions. Interpretations were based on inductive data-driven analysis with the aim to find recurring patterns of educator voice. The results showed educator voice to have two general features: descriptive and prescriptive. However, the pattern of educator voice comprised characteristics such as superficiality, marginalization of patients, one-dimensional approach, ignoring a healthy lifestyle, and robotic nature. The findings of this study clearly demonstrated a deficiency in the educator voice and inadequacy in patient-centered dialogue. In this setting, the educator voice was related to a distortion of DPI through the physicians' dominance, leading them to ignore their professional obligation to educate patients. Therefore, policies in this regard should take more account of enriching the educator voice through training medical students and faculty members in communication skills.

The paradigm model of distorted doctor-patient relationship in Southern Iran: a grounded theory study.

The doctor-patient relationship (DPR) is one of the most important subjects in medical sociology and health policy. Due to mutual understanding, undistorted DPRs not only result in satisfaction of both doctors and patients, but also help to reduce financial burdens for patients and the health care system. The purpose of this research was to identify a DPR based on the qualitative paradigm model which is called the grounded theory (GT) methodology. The data were collected from 3 focus groups, the participants of which consisted of 21 faculty members of Shiraz University of Medical Sciences, Shiraz, Iran. The content of the interviews, following the transcription stage, was organized based on open, axial, and selective coding. Results showed that DPR was distorted which was the consequence of an inefficient structure in the healthcare system which is related to several cultural barriers. In this situation, agency is determinant so the doctor's personality determines the direction of DPR. Consequences of such scenarios are the patient's distrust, patient's dissatisfaction, lack of mutual understanding, patient suppression, and patient deception. Therefore, the health care system should emphasize on reforming its inefficient infrastructures, so that, besides being controlled and surveyed, physicians are socialized ethically.

From good to great physician: a critical ethnography based on patients' views.

The doctor-patient interaction (DPI) plays an important role in the way patients view physicians. Thus, response to the question of ''Who is a great physician?'' is related to DPI experiences of patients. The aim of this qualitative study was to explore patients' views regarding this subject. Based on critical ethnography in one educational hospital in Shiraz, Iran, the study was performed based on 156 clinical consultations, 920 hours of participant observations, and 6 focus groups with patients and their relatives. The results revealed that asymmetrical power relationships exist in this context. Based on the general views of participants and their recent DPI experiences, a great physician should be kind, empathetic, friendly, and a good listener. Considering the presence of an asymmetrical power relationships in this context, results showed that doctors do not participate in an active interaction. Based on sociological theories, it can be concluded that the concept of a great physician is not only limited to obligations as in the Parsonian view, but is also related to active communication between both sides which is presented in the critical view. Through active communication , asymmetrical power relationships can be reduced. Thus, if a physician wants to become a great physician, he/she must strengthen his/her humanistic dimensions and communicative skills alongside his/her medical skills.

The Relationship between Neutralization Techniques and Induced Abortion.

BACKGROUND: Induced abortion is not only a serious threat for women's health, but also a controversial topic for its ethical and moral problems. We aimed to evaluate the relationship between neutralization techniques and attempting to commit abortion in married women with unintended pregnancy. METHODS: After in-depth interviews with some women who had attempted abortion, neutralization themes were gathered. Next, to analyze the data quantitatively, a questionnaire was created including demographic and psychosocial variables specifically related to neutralization. The participants were divided into two groups (abortion and control) of unintended pregnancy and were then compared. RESULTS: Analysis of psychosocial variables revealed a significant difference in the two groups at neutralization, showing that neutralization in the control group (56.97±10.24) was higher than that in the abortion group (44.19±12.44). To evaluate the findings more accurately, we examined the causal factors behind the behaviors of the abortion group. Binary logistic regression showed that among psychosocial factors, neutralization significantly affected abortion (95% CI=1.07-1.35). CONCLUSION: Despite the network of many factors affecting induced abortion, neutralization plays an important role in reinforcing the tendency to attempt abortion. Furthermore, the decline of religious beliefs, as a result of the secular context of the modern world, seems to have an important role in neutralizing induced abortion.

Medical paraclinical standards, political economy of clinic, and patients' clinical dependency; a critical conversation analysis of clinical counseling in South of iran.

BACKGROUND: Despite its benefits and importance, clinical counseling affects the patient both psychosocially and socially. Illness labeling not only leads to many problems for patient and his/her family but also it imposes high costs to health care system. Among various factors, doctor-patient relationship has an important role in the clinical counseling and its medical approach. The goal of this study is to evaluate the nature of clinical counseling based on critical approach. METHODS: The context of research is the second major medical training center in Shiraz, Iran. In this study, Critical Conversation Analysis was used based on the methodologies of critical theories. Among about 50 consultation meetings digitally recorded, 33 were selected for this study. RESULTS: RESULTS show that the nature of doctor-patient relationship in these cases is based on paternalistic model. On the other hand, in all consultations, the important values that were legitimated with physicians were medical paraclinical standards. Paternalism in one hand and standardization on the other leads to dependency of patients to the clinic. CONCLUSION: Although we can't condone the paraclinical standards, clinical counseling and doctor-patient relationship need to reduce its dominance over counseling based on interpretation of human relations, paying attention to social and economical differences of peoples and biosocial and biocultural differences, and focusing on clinical examinations. Also, we need to accept that medicine is an art of interaction that can't reduce it to instrumental and linear methods of body treatment.