Ethical challenges in caring for healthy older adults: Qualitative perspectives.

BACKGROUND: Healthy aging is one of the essential aspects of a health promotion program in the elderly. AIM: Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context. RESEARCH DESIGN: This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data. ETHICAL CONSIDERATIONS: The ethics committee of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation. FINDINGS: The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers. DISCUSSION: The findings showed that due to nurses' unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients. CONCLUSION: Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly.

From clinical expert nurse to part-time clinical nursing instructor: design and evaluation of a competency-based curriculum with structured mentoring: a mixed methods study.

BACKGROUND: Transition from a clinical expert nurse to a  part time clinical nursing instructor (PTCNI) poses several challenges. Designing a professional development curriculum to facilitate the transition from a clinical expert nurse to a  PTCNI is critical to effective education. A comprehensive competency-based curriculum was developed and implemented with structured mentoring to prepare clinical expert nurses as PTCNIs. METHODS: A mixed-methods study with a sequential-exploratory approach was conducted in Iran in 2019. In the qualitative phase, Saylor et al.'s (1981) seven-step model was used, consisting of (1) collecting evidence from a systematic review, (2) conducting interviews with learners, (3) setting goals and objectives, (4) design, (5) implementation, (6) evaluation, and (7) feedback. In the quantitative phase, curriculum domains were evaluated. Additionally, the effective professional communication skills module was implemented using a quasi-experimental study with a pre-test post-test single-group design for 5 PTCNIs in a pilot study. RESULTS: After integrating the findings of the literature review and field interviews in the analysis stage, a curriculum was developed with a total of 150 h, six modules, and 24 topics. Results of the pilot study showed a significant improvement in the confidence of PTCNIs as a result of the implementation of the effective communication skills module using the mentoring method (t = - 16.554, p = 0.0005). CONCLUSIONS: This competency-based curriculum was based on the evidence and needs of PTCNIs and provides a complete coverage of their clinical education competencies. It is suggested that managers of educational institutes that offer nursing programs use this curriculum to prepare them in continuing education programs. Further studies are needed to thoroughly evaluate the learning outcomes for students.

Nursing instructors' clinical education competencies: An integrated review.

OBJECTIVE: To identify nursing instructors' clinical education competencies. METHODS: The integrative review comprised research articles published between 2008 and 2018 on Medline, Scopus, Web of Science and Education Information Resource Centre databases searched through relevant key words. All the short listed papers were reviewed and quality assessment was done. Data was analysed using content analysis method. Nursing instructors' clinical education competencies were extracted from the original texts in the form of initial codes which were categorised into subcategories and categories based on comparisons of their similarities and differences. Finally, themes were extracted as expression of content hidden in the data to generate new insights. RESULTS: Of the 17 studies selected, 6(35.3%) were quantitative, 4(23.5%) qualitative, 3(17.6%) review studies and 4(23.5%) were mixed-methods studies. Three overarching themes identified were clinical teaching process competencies, students' supervision competencies in clinical settings and nursing instructors' professional ethics. CONCLUSIONS: The review provides insightful information on nursing instructors' clinical education competencies. Nursing educational institutions need to be encouraged to incorporate these concepts into educational curricula to empower nursing instructors and to enhance the quality of clinical education.

Promoting professional and interprofessional relationship among nurses in Iran: a participatory action research.

Communication is the basis of nursing care and can have a significant effect on patient and community health. This study aimed to optimize the professional and interprofessional relationships of nurses. This participatory action research was conducted with 288 patients and 23 staff of one of the Reference Hospitals in Tehran, Iran, from 2019 to 2020. Interviews were simultaneously analyzed using the conventional content analysis method, and in the quantitative section, the communication skills checklist and a researcher-made questionnaire were used. Participants gave oral and written consent, and their confidentiality and anonymity were respected. Participants' experiences showed that the implemented programs changed the work environment. The acquired basic concepts were improving the nurse's responsibility and accountability, improving the quality of care and respecting the patient and the family. Quantitative data obtained before and after the implementation of change programs showed that patient satisfaction increased from 41.57±7.03 to 94.34±4.67 and patient and family training from 113.73±19.77 to 245.99±36.61. The length of hospital stay decreased from 5.52±2.47 to 3.57±2.35 days, nosocomial infections from 32.1±2.8 to 17.4±2.4 and readmission from 4.8±1.2 to 2.3±1.1. The results indicated that patients' quality of care and safety was increased by optimizing the nurse's professional and interprofessional relationship. Patients reported greater respect, and nurses had higher job satisfaction.

Islamic and Western Ethical Values in Health Services Management: A Comparative Study.

PURPOSE: This research was performed to compare Islamic and Western ethical values in health services management. APPROACH: Whittemore and Knafl's integrative review was employed. FINDINGS: Eight final categories of Islamic values (i.e., honesty, piety, foresight, dignity, justice, good temperament, widened heart, and certainty to God) and nine final categories of Western values in health services management (i.e., honesty, freedom, forgiveness, altruism, justice, dignity, responsibility, tolerance, and wisdom) were extracted in this study. CONCLUSIONS: The results showed some discrepancy between Islamic and Western ethical values, which are partially due to a different definition of values in Islam and the West. IMPLICATIONS: The comparison of ethical values can facilitate the exchange of intellectual, cultural, and experimental ideas between Islamic and Western healthcare management.

Motivation to Care: A Qualitative Study on Iranian Nurses.

BACKGROUND: The performance of nurses, which is rooted in personal motivation, determines the quality of care. Therefore, it is important that nurses are motivated to provide high-quality care. PURPOSE: The purpose of this study was to explore the factors that affect caring motivation from the perspectives of nurses in Iran. METHODS: This was a qualitative study. Seventeen nurses were interviewed using a semistructured, in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. RESULTS: Data analysis led to the identification of the two themes of (a) self-valuation and (b) providing beneficial care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study increase scholarly understanding of the caring motivations of nurses. These motivations may be used in related programs by senior nursing managers to improve the quality of nursing care.

Learning challenges of nursing students in clinical environments: A qualitative study in Iran.

BACKGROUND: Clinical learning environment is a complex social entity. This environment is effective on the learning process of nursing students in the clinical area. However, learning in clinical environment has several benefits, but it can be challenging, unpredictable, stressful, and constantly changing. In attention to clinical experiences and factors contributing to the learning of these experiences can waste a great deal of time and energy, impose heavy financial burden on educational systems, cause mental, familial and educational problems for students, and compromise the quality of patient care. Therefore, this study was carried out with the goal of determining the learning challenges of nursing students in clinical environments in Iran. MATERIALS AND METHODS: In this qualitative study carried out in 2012-2013, 18 undergraduate nursing students were selected by using purposive sampling method from the Faculty of Nursing and Midwifery of Tehran and Shahid Beheshti Universities. Semi-structured interviews were used to collect data. The content analysis method was used to determine relevant themes. RESULTS: Two themes were derived from the data analysis, which represented the students' clinical learning challenges. These two themes included insufficient qualification of nursing instructors and unsupportive learning environment. CONCLUSIONS: Identification of the students' clinical learning challenges and actions to remove or modify them will create more learning opportunities for the students, improve the achievement of educational goals, provide training to nursing students with the needed competencies to meet the complex demands of caring and for application of theories in practice, and improve the quality of healthcare services.

Life associated with fear and worry: A major concern among the cardiac valve-replaced patients.

BACKGROUND: Few attempts were made for alleviating the physical/psychological problems among the cardiac valve-replaced patients and no comprehensive study was done based on the experiences of such patients. This study was undertaken to describe the stressful experiences of the heart valve-replaced patients. MATERIALS AND METHODS: In this qualitative study performed during 2012-2013 with a content analysis approach, 13 patients from Tehran and Kashan therapeutic centers participated. The study sampling was accomplished with purposeful sampling using a semi-structured interview that continued until data saturat ion. All interviews were recorded, and were immediately handwritten word by word and finally typewritten. Description and analysis of the data were done by Graneheim and Lundman content analysis. RESULTS: One hundred and seventy-five primary codes were derived among the 680 codes taken from the participants interviewed. Using abstract and deep perception of the categories, 14 subcategories and 5 themes were derived. The themes are as follows: worry of care conditions, worry of life with the ongoing condition of having prosthetic cardiac valve, worry regarding the instability in life, fear of hospital, and fear of unknown factors. Each theme consisted of special subsidiary themes with specific functions. CONCLUSIONS: The main themes of fear and worry about on losing the valve were identified and introduced in the cardiac valve-replaced patients. As the nature and function of these themes are different in different societies, recognition and discrete definition of them are necessary for care planning and promotion.

The experiences of "difficult life" in heart valve replaced patients.

BACKGROUND: Several reports, however, not comprehensive, have been presented about the experiences of patients with replaced heart-valve. OBJECTIVES: This study explores the experiences of the patients with heart valve replacement. PATIENTS AND METHODS: A qualitative research with a content analysis approach was carried out on the patients with cardiac valve replacement during the year 2012 and 2013. A purposeful sampling using a semi-structured interview and open-ended questions (with the main question of "What problems did you have after the valve replacement?" followed by the exploratory questions) were performed until the data saturation. All interviews were recorded, then transcribed and typed. The data analysis was done according to Grancheim and Lundmen content analysis using the MAXQDA software. RESULTS: Of 22 interviews taken from 13 participants, 430 codes were taken. Out of them, after deleting the similar items, 162 initial, 18 subcategory, and 5 subsidiary themes (problematic exposure with valve replacement, continuity of some difficulties, aggravation of life problems, insufficient support, and following a perceived care) were extracted. Based on the abstract and deep perception of the categories, the main theme of "difficult life" was explored. CONCLUSIONS: Aggravation and the continuity of some physical problems, and insufficient support after the valve replacement make the life difficult for the patients. Identification of these problems is necessary for planning and improvement of the patients' care, life quality, and survival through consultations, rehabilitation and education.

The diversity of Iranian nursing students' clinical learning styles: a qualitative study.

BACKGROUND: Numerous factors, including learning styles, affect the learning process of nursing students. Having insights about students' learning styles helps promoting the quality of education. The aim of this study was to explore the Iranian baccalaureate nursing students' learning styles in clinical settings. METHODS: A qualitative design using a content analysis approach was used to collect and analyze data. Semi-structured interviews were conducted with fifteen Iranian baccalaureate nursing students selected using a purposive sample method. FINDINGS: During data analysis, it was found that nursing students employed different clinical learning styles such as 'thoughtful observation,' 'learning by thinking,' and 'learning by doing'. CONCLUSION: Students adopt different learning strategies in clinical practice. Designing teaching strategies based on students' learning styles can promote students' learning and maximize their academic and clinical practice success. Nursing educators, curriculum designers, and students can use the findings of this study to improve the quality of nursing education in both the classroom and clinical settings.

Semantic divergence in clinical education: Student-centered or student democracy.

AIMS: Although several studies have confirmed the validity and the strength of the student-centered approach and most training centeres have put it as the heading of their agenda, there are still problems in the method of implementation, increasing the need for further research to review the mode of implementation. In this regard, the present study has been conducted to investigate students' and educators' perception in terms of interaction manner in clinical education process. SETTINGS AND DESIGN: This study was performed in a qualitative approach and by the conventional content analysis method. MATERIALS AND METHODS: Data were collected until saturation through use of individual semi-structured interviews. Twenty-one subjects including undergraduate nursing students (8 cases), faculty member educators (9 cases), head nurses (3 cases), and educational supervisor (1 case) participated in the study, and the data were analyzed using MAXQDA3 software. RESULTS: "tudent democrac" was extracted through data analysis as the main theme of the study. Participants' experience in terms of the five sub-themes included instructor's loss of dignity, negligence in the evaluation of the students, poor discipline, lack of compliance with the educator, and lack of motivation. CONCLUSIONS: Instructor's weaknesses in planning, guiding, and evaluating the students led to student's interference in these affairs and a challenge in effective student-centered approach. Although excessive emphasis on students' opinion for educational evaluation is apparently a sign of tribute to the students, it ultimately contributes to ignoring the process of learning to attract students' interest, occupational devaluation, and a decrease in students' motivation.

Professional ethics: beyond the clinical competency.

Assessment of clinical competency in professional roles especially in crucial situations can improve the nursing profession. This qualitative research was conducted to determine the process of acquiring clinical competency by nurses in its cultural context and within the health care delivery system in Iran. This study, using grounded theory methodology, took place in universities and hospitals in Tehran. Nurses (36) included nurse managers, tutors, practitioners, and members of the Iranian Nursing Organization. Simultaneous data collection and analysis took place using participant semistructured interviews. Three categories emerged: (a) personal characteristics such as philanthropy, strong conscience, being attentive, accepting responsibility, being committed to and respecting self and others; (b) care environment including appropriate management systems, in-service training provision, employment laws, and control mechanisms, suitable and adequate equipment; and (c) provision of productive work practices including love of the profession, critical thinking, nursing knowledge, and professional expertise. Professional ethics has emerged as the core variable that embodies concepts such as commitment, responsibility, and accountability. Professional ethics guarantees clinical competency and leads to the application of specialized knowledge and skill by nurses. The results can be used to form the basis of guiding the process of acquiring clinical competency by nurses using a systematic process.

Professional ethics as an important factor in clinical competency in nursing.

It is imperative to understand the factors that influence clinical competency. Consequently, it is essential to study those that have an impact on the process of attaining clinical competency. A grounded theory approach was adopted for this study. Professional competency empowers nurses and enables them to fulfill their duties effectively. Internal and external factors were identified as affecting clinical competency. A total of 36 clinical nurses, nurse educators, hospital managers and members of the Nursing Council in Tehran participated in this research. Data were obtained by semistructured interviews. Personal factors and useful work experience were considered to be significant, based on knowledge and skills, ethical conduct, professional commitment, self-respect and respect for others, as well as from effective relationships, interest, responsibility and accountability. Effective management, education systems and technology were named as influential environmental factors. Personal and environmental factors affect clinical competency. Ethical persons are responsible and committed to their work, acquiring relevant work experience. A suitable work environment that is structured and ordered also encourages an ethical approach by nurses.

Effects of a self-care program on quality of life of cirrhotic patients referring to Tehran Hepatitis Center.

BACKGROUND: Chronic liver disease especially liver cirrhosis is one of the medical problems that substantially reduces the quality of life of its victims. Because of the chronic and irreversible nature of the disease, it needs self-care programs to be developed according to client's needs and to maintain their independence and sense of well-being. The purpose of this study was to determine the effects of a self-care educational program on Quality of Life (QoL) of a sample of Iranian cirrhotic patients. METHODS: A quasi-experimental study was conducted on 44 cirrhotic patients in Tehran Hepatitis Center. Longitudinal case registry and random allocation technique were used to divide the sample into experimental (n = 21) and control (n = 23) groups. Chronic liver disease questionnaire (CLDQ) was used for measuring the quality of life. The experimental group was given a questionnaire to assess their educational needs. A self-care educational program was conducted and the patients were followed for 3 months. Then the quality of life of both groups was compared using descriptive and analytical statistics. RESULTS: The experimental and control groups were the same concerning the effective factors on the quality of life, such as age, sex, etc (P > 0.05). There was no significant difference between QOL mean score of both groups before the intervention, however the QoL significantly improved in the experimental group after the intervention (P = 0.001), while the QoL decreased in control group. CONCLUSION: The result of the present study confirmed the positive effects of the educational and self care programs on the QoL of cirrhotic patients. Extensive educational and self-care programs along with long-term follow up such as the program conducted in this study are suggested.