Saturation in qualitative research: An evolutionary concept analysis.

Background and Aim: Qualitative research plays an important role in improving nursing knowledge. Understanding the concept of saturation is essential to conducting rigorous qualitative research that contributes to evidence-based practice. The purpose of this study is to clarify the concept of saturation in qualitative research. Method: Evolutionary concept analysis was performed. A literature search was conducted using a variety of online databases for the years 2005- 2023. In total, 33 articles and books were analyzed using thematic analysis to identify the attributes, antecedents and consequences of saturation. The validity of the data was obtained by examining the analysis process by two independent researchers. Results: Saturation in qualitative research is a context-dependent, subjective process that requires detailed systematic analysis. Saturation is used in four ways in qualitative research: theoretical saturation, data saturation, code or thematic saturation, and meaning saturation. The antecedents of saturation were classified into two categories: study related factors and researcher related factors. The consequences of saturation were identified as: ensuring credibility and quality in qualitative research and time, energy and budget saving. Conclusion: This concept analysis serves to enhance the understanding of the concept of saturation, thereby offering valuable resources for qualitative researchers. By gaining a profound comprehension of saturation and its various types, researchers can ensure the validity of their studies while also optimizing time and resource allocation by avoiding redundant data collection. Future investigation warranted to elucidate how factors associated with reaching saturation impact estimations sample size.

The relationship between stress, anxiety, depression and medication adherence behavior in patients with epilepsy: A cross-sectional study.

OBJECTIVE: To investigate the relationships between stress, anxiety, and depression and medication adherence behavior in patients with epilepsy (PEW). METHODS: A cross-sectional study design was conducted on 235 PEW in the Qazvin's Boo Ali Sian Hospital. Data collection tools included socio demographic and clinical data form, morisky medication adherence scale (MMAS-8), depression anxiety stress scales -21(DASS-21). We used adjusted multivariate logistic regression model for statistical analysis. RESULTS: A considerable proportion of patients reported mild, moderate, severe and extremely severe symptoms of depression (177 [75/3%]), anxiety (169 [71.9 %]), and stress (158 [67.2 %]). However, 61/8% of the participant had proper medication adherence and 38/3% had poor medication adherence. The results of adjusted multivariate logistic regression showed that in patients who had severe and extremely severe depression and anxiety, the probability of poor medication adherence was higher (P < 0.05). The levels of stress were not significant predictors for medication adherence behavior (P > 0.05). CONCLUSION: According to this study, severe and extremely severe depression and anxiety can be considered as an important predicting factor in the lack of adherence to antiepileptic medication. PRACTICE IMPLICATIONS: Healthcare professionals can improve care of patients with PEW by considering patients' mental and psychological health problems in educational, counseling and supportive programs.

Resilience of first-line nurses during adaptation to the COVID-19 pandemic: A grounded theory study.

AIM: Nurses are a vital resource in providing care to COVID-19 patients. During adaptation to the pandemic, the mental health of nurses was disturbed. The present study aimed to explain the resilience development process and adaptive strategies of first-line nurses during the COVID-19 pandemic. METHODS: This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian first-line nurses, who were employed in one teaching hospital in Qazvin city, were included via purposive and theoretical sampling. The data were collected through semi-structured interviews and were analyzed based on the Corbin and Strauss approach 2015. RESULTS: The resilience development process of nurses had three stages including initial confrontation with changes, managing conditions and reorganizing, developing resilience. Professional commitment was identified as a core category that affected all stages of resilience development. Negative emotions, nurses' characteristics, and caring challenges were identified as contextual factors which affected the adaptation of nurses to the COVID-19 pandemic and the development of resilience. CONCLUSION: Regarding the importance of professional commitment in the nurses' resilience development and not leaving the profession in the COVID-19 pandemic, it is important to emphasize the ethical values and principles of the nursing profession in practice and especially in the education of nursing students. It is necessary to monitor mental health and provide professional psychological counseling by the healthcare systems; also, nursing managers should follow a supportive leadership style and consider first-line nurses' worries.

Nurses' professional commitment in COVID-19 crisis: A qualitative study.

Background: Professional commitment is an important factor in employee performance. COVID-19 outbreak has seriously affected the nurses working conditions. Numerous factors can affect nurses' professional commitment in this situation.Aim: To explore the nurses' lived experiences, attitudes, views and perceptions toward professional commitment and factors affecting it in the Covid-19 crisis.Method, Setting and Participants: This qualitative study was conducted using phenomenological approach and content analysis method. Twenty-five nurses were interviewed using semi structured in-depth interviews. Conventional content analysis was used to analyze collected data.Ethical considerations: Ethical approval was obtained from the Ethics Committee of Qazvin University of Medical Sciences.Results: Five themes were extracted as follows: "Collaborative empathetic commitment", "Loyal commitment", "Sacrificial commitment", "Commitment with doubt and concern" and "humanistic commitment".Discussion and Conclusion: The Covid-19 crisis has caused major changes in nurses' working conditions, which have also affected the concept of professional commitment to the nursing profession and revealed new concepts. Identifying internal and external factors that can enhance nurses' commitment to the profession in critical situations such as the Covid-19 outback is of particular importance.

Stigma in the Context of COVID-19 Crisis: An Evolutionary Concept Analysis.

BACKGROUND: Stigmatizing anyone during a pandemic poses a threat to everyone and can be an obstacle to disease treatment. The stigma around COVID-19 stems from the fact that it is a life-threatening disease and a lot is unknown about it. AIM: This study was conducted with the aim of analyzing and clarifying the concept of stigma in the context of COVID-19; determining its psychological and socio-psychological outcomes; enhancing understanding and recognition of features, antecedents, and consequences of the concept; and proposing an adequate definition for use in clinical practice or research. METHODS: Rodgers' evolutionary concept analysis was used. RESULTS/CONCLUSION: Stigma in the context of COVID-19 has antecedents, which include informational and psychological issues, media performance, and some governments' policies and actions to control COVID-19 pandemic. The attributes of COVID-19 stigma are subjective and variable, perceived, and/or experienced with interrelated intrapersonal, interpersonal, and structural or institutional dimensions that can be summarized as social stigma and self-stigma. The consequences of COVID-19 stigma are social isolation and psychological burden, physical and mental violence and harassment, hiding disease, and reduced care-seeking behavior. These results will extend the body of knowledge on theory and practice and also assists future researchers in many folds. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: These findings will be a major tool for the case manager/health care team, policy makers, and other human resource planning professionals to develop plans for preventing, combating, and stopping the COVID-19-related stigma.

The association between sexual health literacy and sexual function of women in Iran.

BACKGROUND: Considering the importance of sexual health literacy in promoting individual sexual health and ultimately improving family and social health as well as the effect of health literacy on sexual function, this study was designed and conducted to determine the association between sexual health literacy and sexual function among women. MATERIALS AND METHODS: This was a cross-sectional study. A total of 420 women referring to health centers were entered into the study using one-stage cluster sampling method. Data collection tools included a demographic questionnaire, Iranian Adult Sexual Health Literacy Assessment Questionnaire, and the Persian version of the Female Sexual Function Assessment Questionnaire (FSFI). Data were collected and entered into SPSS 22 and logistic regression. RESULTS: The results of the logistic regression test showed that the variable of sexual health literacy was effective on women's sexual function (P = 0.021) so that the chances of having a desirable sexual function in women with excellent were 4.222 times more than women with inadequate health literacy; the variables of employment status, level of education, duration of marital life, and the number of sexual intercourses per recent week were the factors affecting women's sexual function (P < 0.05). CONCLUSION: The results of this study pointed out the existence of an undesirable level of sexual function and a desirable level of sexual health literacy among participating women. Hence, designing and implementing the training plans to promote sexual function among these women is necessary.

Cancer Pain: An Evolutionary Concept Analysis.

BACKGROUND: Cancer pain is among the most severe types of pain and is among the most common types of cancer-related problems. Yet, many ambiguities surround the concept of cancer pain and its attributes. OBJECTIVE: This study aimed to analyze the concept of cancer pain. METHODS: This concept analysis was conducted using the Rodgers' evolutionary method. Nursing, psychology, social sciences, and medicine literature were reviewed through searching online databases. In total, 52 articles were included and analyzed through thematic analysis. RESULTS/CONCLUSION: The attributes of cancer pain are known origin, sharp, burning, piercing, or throbbing quality, varying duration (acute, chronic, or breakthrough), intolerability, and moderate to severe intensity. Its antecedents are cognitive system, pain-related beliefs, coping strategies, family and social support, financial status, and cultural, ethnic, racial, and religious values. Its consequences include physical, psychological, existential and spiritual, and social consequences, and reduced quality of life. This concept analysis concludes that cancer pain is different from other types of acute and chronic pain. Thus, specific interventions are needed for its assessment and management. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The results of this concept analysis can broaden the case manager/health care team and other health care providers' knowledge about cancer pain and help them make better decisions and take more effective interventions for its management. The information in the article can be used to inform the case manager/health care team when it may be time to consider palliative care or even hospice care. Also, the information, itself, is crucial for case managers to understand when a patient has cancer pain.

Barriers to Effective Cancer Pain Management in Home Setting: A Qualitative Study.

BACKGROUND: Pain is one of the most disturbing and distressing symptoms experienced by cancer patients, and it is the most stressful factor affecting all aspects of patients and their families' lives. Understanding the barriers to effective cancer pain management in home setting is essential for designing programs to improve the quality of the patients and their families' lives. AIM: Exploring family caregivers' and cancer patients' experiences of barriers to pain management at home. DESIGN: Qualitative exploratory descriptive study. SETTING/PARTICIPANTS: Twenty patients and 32 family caregivers were recruited from oncology wards and palliative medicine clinics in hospitals affiliated to Iran University of Medical Sciences. METHOD: In-depth interviews were conducted with each participant, and audio-recorded and transcribed interviews were analyzed using thematic analysis. RESULTS: Ten major themes emerged regarding barriers to cancer pain management in home setting: "Drug dependence and addiction," "Malingering," "Negative attitudes towards opioid analgesia," "Concealing pain," "Painful comorbidities," "Conflict in family members' perspectives," "Inaccessibility of pain relief facilities," "Poor skill and knowledge," "Patients' feelings of depression and hopelessness," and "Caregiver burden." CONCLUSION: The study documented the need for supportive and educational programs for cancer patients and their family caregivers in an attempt to improve the effectiveness of pain managment and cancer patients' quality of life.

The Process of Pain Management in Cancer Patients at Home: Causing the Least Harm - A Grounded Theory Study.

BACKGROUND: Cancer pain management at home is a complicated and multidimensional experience that affects the foundational aspects of patients and their families' lives. Understanding the pain relief process and the outcomes of palliative care at home is essential for designing programs to improve the quality of life of patients and their families. OBJECTIVE: To explore family caregivers and patients' experiences of pain management at home and develop a substantive theory. DESIGN: The study was carried out using a grounded theory methodology. SETTING/PARTICIPANTS: Twenty patients and 32 family caregivers were recruited from Oncology wards and palliative medicine clinics in the hospitals affiliated to Iran University of Medical Sciences using Purposeful and theoretical sampling. RESULTS: The core category in this study was "pain relief with the least harm." Other categories were formed around the core category including "pain assessment, determining the severity of pain, using hierarchical approaches to pain relief, assessing the results of applied approaches, determining the range of effectiveness, and barriers and facilitators of pain relief." The substantive theory emerged from these categories was "Pain management process in cancer patients at home: Causing the least harm" that explains the stages of applying hierarchical approaches to pain relief, family care givers try to make decisions in a way that maximize pain relief and minimize damage to the patient. Along with using a hierarchical pattern, the process is featured with a circular pattern at broader perspective, which reflects dynamism of the process. CONCLUSION: The inferred categories and theory can expand knowledge and awareness about the stages of pain relief process, the pattern of using pain relief approaches, and the barriers and facilitators of pain relief process at home. Health-care professionals may use these findings to assess the knowledge, skill, capability, problems, and needs of family caregivers and patients and develop supportive and educational programs to improve the efficiency of pain relief process at home and improve the patients' quality of life.

Quality of Life in Different Chronic Diseases and Its Related Factors.

BACKGROUND: Quality of life (QoL) is an important tool for evaluating the effect of a disease as well as effects of treatment interventions. The present study is aimed to investigate QoL of the patients with various prevalent chronic diseases in Iran. METHODS: In a cross-sectional study, 625 patients with one of the prevalent chronic diseases were assessed. Participants were recruited via convenient sampling method in special clinics of chronic diseases in three educational hospitals in Qazvin, Iran, from May to December 2016. Data were collected using WHOQOL-BREF and demographic questionnaire through interview. Data were analyzed using independent t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression method. RESULTS: Significant difference in QoL scores was found in different chronic disease; patients with diabetes and hypertension had higher scores and patients with asthma and chronic obstructive pulmonary disease (COPD) had the lowest scores. Multivariate analysis showed that age, economic status, and type of disease were among the significant variables in predicting the QoL of the patients with chronic diseases. CONCLUSIONS: Some patients, such as those with asthma and COPD, had less QoL than other patients and should be prioritized while planning for the promotion of healthcare services. Due to the negative effects of economic status on QoL, the financial support programs should be among the major priorities of the patients' QoL improvement programs.