Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study.

Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.

Barriers to the development of community-based nursing in Iran.

Purpose: Today, the care of chronic patients and older adult people in hospitals has moved towards community-based care, and health systems focus on disease prevention, health promotion, and rehabilitation. Community-based nurses play an essential role in early identification and intervention for these conditions. On the other hand, there is an increasing trend in ageing and chronic diseases in the world especially in Iran, which increases the importance of disease prevention and public health promotion. Therefore, the current research aims to identify barriers to the development of community-based nursing in Iran. Methods: In this qualitative study, 12 semi-structured interviews were conducted with nursing experts recruited in the study by purposive sampling in 2021-2022. Interviews were recorded and transcribed and a framework analysis method was used to analyse the data. Results: The results obtained from the analysis of documents and qualitative interviews led to the identification of 4 barriers: not having a specific position, inappropriate image of nursing in society, inadequacy of education with the needs of society, and high cost of home nursing services. Conclusion: Improving the image of nursing in society, locating a special place in the health system, improving education, and adjusting the costs of home care could be the strategies that help the further development of community-based nursing (CBN).

Persistent suffering: Living experiences of patients with rare disease: An interpretative phenomenological study.

BACKGROUND: The low prevalence of rare diseases has caused the need for studies in this field to be neglected. Regardless of the prevalence of rare diseases, many people around the world have to live with the medical, psychological, and social consequences of their condition. Individuals with rare diseases may face challenges that are different from those experienced in more common medical conditions. The life experiences of patients with rare diseases have not been sufficiently investigated. The purpose of this study was to discover the meaning of living as a person with a rare disease. MATERIALS AND METHODS: This interpretative phenomenological study was conducted in 2021-2022 on 10 patients with one of the rare diseases (registered in the Atlas of Rare Diseases of Iran). Based on purposeful sampling, people with rare diseases living in Mazandaran, Golestan, and Tehran provinces were invited to participate in the study. Data collection was done using open and semi-structured interviews. The research question was exploring understanding the experience and meaning of life as a person with a rare disease. Van Manen's interpretive phenomenological approach was used to analyze the data, and the criteria of validity, transferability, and verifiability were used to ensure the trustworthiness of the research. RESULTS: The five main themes "permanent suffering, such as a bird in a cage, rejection, immersion in the whirlpool of thoughts, losing the feeling of life", and 10 sub-themes "nightmare, giving up, deprivation, limitation, worthlessness, being stigmatized, dark vision, confusion, continuous regret, and inferiority feeling" were extracted. CONCLUSION: The results of this study show that the suffering of the disease casts a shadow on all aspects of a patient's life with a rare disease. The effects of illness, disability, limitations, and exclusions had created a human being in a cage, whose right to live like others has been denied.

Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure.

Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.

The Main Features of Resilience in Healthcare Providers: A Scoping Review.

Background: Resilience refers to the capacity for suitable responding to stress in achieving the objectives at the least physical and psychological costs. The present review aims to illustrate the individual and contextual features of resilience improvement in healthcare professions. Methods: A scoping review was conducted according to the PRISMA-ScR guidelines and searching the online databases as PubMed, Embase, Scopus, Web of Science, and Google Scholar from January 2014 to December 2020 using a combination of MESH and EMTREE entry terms and free keywords. The English articles, book chapters, and grey literature were included in the study. The data were recorded to an extraction form designed in Excel. The quality assessment of studies wasn't performed due to scoping review. Thematic analysis was used to synthesize the data. Results: 5434 articles were identified via searching in the databases. 63 articles were reviewed that most of them from the USA (30 articles, 46%) and conducted as a qualitative study (32 articles, 50%). The main aspects of resilience that were extracted from the included studies were personal resilience, resilience in the emergency department, and resilience in healthcare providers. The main feature of resilience among healthcare providers was coping. Conclusion: Studies with more accurate methodology should investigate the situation of the healthcare providers' resilience in difficult healthcare conditions instead of the mere emphasis on providing a fixed concept for all persons without considering the system impacts.

Childbearing culture: a prominent context in the process of maternal role attainment in Iranian mothers with preterm neonates.

Transition to the role of mothering is one of the most important events in a woman's life. While childbirth is a biological event, pregnancy and the experiences around it are more influenced by social structure, which is shaped by cultural perceptions and practices. The aim of this study was to explore cultural context during maternal role attainment in neonatal intensive care units (NICUs) in Iran. The study was part of a grounded theory study on how the mothers of preterm neonates go through maternal role attainment. Data collection was carried out by purposeful sampling from 20 participants (15 mothers of preterm neonates and 5 NICU nurses). Data were analysed according to Corbin and Strauss's (2015) approach. Four categories of childbearing culture emerged: 'The necessity of childbearing', 'Childbearing rituals', 'Maternal persistent presence' and 'Attitudes and religious beliefs'. The findings showed that the special beliefs and practices in Iranian culture affected all of the participants' reactions to mothering process. Culture is one of the most important factors affecting the development of motherhood in Iran. In order to provide sensitive and culturally appropriate care, nurses should be aware of the general impact of cultural norms and values on the process of maternal role attainment and strive to meet the cultural needs of all mothers.

Development and psychometric evaluation of postgraduate nursing student academic satisfaction scale.

AIM: To develop and evaluate the psychometric properties of postgraduate nursing student academic satisfaction scale (PNSASS). DESIGN: The mixed-method study was carried out in two phases; (a) item generation by hybrid concept analysis and (b) item reduction by psychometric evaluation of the developed scale. METHODS: The initial item pool (N = 209) was prepared based on concept analysis results and similar instruments. A total of 402 postgraduate nursing students willingly participated in online data gathering from August 2019 to May 2020. The validity (face, content and construct) and reliability (stability and internal consistency) of the scale were assessed. RESULTS: Exploratory factor analysis identified that the scale had four factors which explained 64.80% of the total extracted variance. The results of confirmatory factor analysis showed a good model fit. The reliability of scale was strong to excellent. The results showed that the PNSASS has suitable validity and reliability properties, which can be used to measure the academic satisfaction of postgraduate nursing students.

Self-reinforcement: Coping strategies of Iranian mothers with preterm neonate during maternal role attainment in NICU; A qualitative study.

INTRODUCTION: Having a preterm neonate in the neonatal intensive care unit (NICU) is one of the most stressful experience for parents. In facing these stressors, mothers need to find ways to adapt and control resources to maintain stability. The aim of this paper is to report coping strategies of mothers with preterm neonate during maternal role attainment in NICU. METHODS: This paper reports a part of the findings of a grounded theory study that investigated how the mothers of preterm neonates go through maternal role attainment. The data were collected through in-depth semi-structured interviews with 12 mothers with preterm neonate admitted to the NICU and 5 nurses working in NICU. Data were analyzed according to Corbin and Strauss's (2015) approach using constant comparative analysis technique. FINDINGS: Four themes, emerged from experiences of the participants, formed the concept of "Self-reinforcement" as the prominent strategy of mothers: "support seeking", "Spiritual getting in the mood", "Hope creation" and "Getting energy from the baby". CONCLUSION: These findings showed that mothers use strategies to calm and support themselves and their neonates, and recognize that their lives had changed and need to adjust to their new circumstances.

The Process of Managing the Children with Type 1 Diabetes in the Family: A Grounded Theory Study.

BACKGROUND: Diabetes is a disease that affects all family members. Parents of children with type 1 diabetes are always concerned about all aspects of children's life. The aim of this study was to elucidate the process of managing children with diabetes in the family. MATERIALS AND METHODS: This is a qualitative grounded theory of a doctoral dissertation, which was done on 2016. The 18 participants were selected through purposive and theoretical sampling until data saturation. The main participants in this study included parents, siblings, and children with type 1 diabetes. The data was gathered by semi-structured interviews as well as field notes and memos. Data analysis was done concurrently with data collection in four levels, including data analysis for concept and contex, bringing the process into the analysis, and integration of categories according to Corbin and Struss (2008). Core category appeared at the end of integrated categories. RESULTS: "The family with diabetes in the child's diabetes orbit" as a core category contains the process of managing children with diabetes within the family, which included three main subcategories, including "entering into the diabetes orbit", "movement into the diabetes orbit", and "living into the diabetes orbit". CONCLUSIONS: The family through the concept of "The family with diabetes in the child's diabetes orbit "as a main concern of families with diabetes suffering diabetes attempt to select and practicing appropriate strategies and manage diabetes and children with diabetes.

Emotional disorganization: The prominent experience of Iranian mothers with preterm neonate: A qualitative study.

When a preterm neonate is born and needs to be taken care of in the neonatal intensive care unit (NICU), the mother experiences a different process of mothering. A grounded theory study was conducted to explore the maternal role attainment in mothers of preterm infants. The authors of this paper report the most prominent experience of Iranian mothers with preterm neonates during their stay in the NICU that emerged as part of the process of maternal role attainment. Data were collected through in-depth semi-structured interviews with mothers in the NICU. We found four categories as emerged from experiences that formed the concept of "emotional disorganization". We argue that these findings can help caregivers and nurses to provide sensitive and supportive care to mothers of preterm neonates.

Maternal Role Attainment in Mothers with Term Neonate: A Hybrid Concept Analysis.

BACKGROUND: A review of the literature shows that there is little consensus on the practical definition of maternal role attainment in the field of neonatal nursing care. The initial interaction between mother and neonate most often begins in the hospital and can be influenced by neonatal nurses, so it is necessary to clarify this concept in nursing. The purpose of this study was to show the basic characteristics and practical definition of maternal role attainment in mothers with term neonate in a new context. MATERIALS AND METHODS: This study used a hybrid model three-step concept analysis: theoretical, fieldwork, and final analysis phases. At theoretical phase, articles indexed in credential databases were searched using keywords. Totally, 33 articles were analyzed. At fieldwork phase, 12 participants were interviewed. At final phase, the findings of the two earlier phases were analyzed. The study lasted from August to November 2018. After determining the attributes, antecedents, and consequences, a final definition of maternal role attainment was introduced. RESULTS: The concept of maternal role attainment was defined as "a developmentally, interactive, adaptive, and committed multi-dimensional process based on the discovery of pregnancy, characteristics of the mother, receiving social support, which leads to maternal identity, formation of maternal skills, resiliency, development of newborn, improvement of mother-newborn interactions and increased well-being of the mother". CONCLUSIONS: This study identifies the concept of maternal role attainment in nursing, providng a good basis for evaluating and applying this concept.

Designing and Psychometric Evaluation of Nurses' Social Responsibility Instrument: A Mixed-Method Study.

BACKGROUND: To provide excellent nursing care services, nursing standards should be considered; one of these standards is being socially responsible. Regarding the lack of appropriate instruments in Iran for measuring social responsibility, the design of an instrument in accordance with Iranian culture seems to be necessary. So, the present study aimed to design a valid and reliable tool for measuring the social responsibility of nurses. MATERIALS AND METHODS: In this sequential exploratory mixed-method study, designing and psychometric evaluation of nurses' social responsibility instrument were performed in qualitative and quantitative phases. In the qualitative phase, the concept of nurses' social responsibility was explored and its characteristics and dimensions were identified using a hybrid concept analysis model. In the quantitative phase, validity (face, content, and construct), and reliability (Cronbach's α and interclass correlation) were examined a sample of nurses in Tehran, Iran (n = 280). The construct validity of the scale was determined using exploratory factor analysis. RESULTS: The findings supported 23 items in four factors: dedicated to others, efforts to improve social conditions, holistic vision, and favorable relationship. A total of 44.40% of the variance was explained by these four factors. Scale-Content Validity Index/Average (S-CVI/AVE) was calculated 0.91 and it was found that the Cronbach's alpha was 0.88. CONCLUSIONS: The researchers focused on designing and psychometric evaluation of nursing social responsibility tools based on nurses' opinions and prepared a native, valid, and reliable tool, which seems to be a good tool for measuring the social responsibility of nurses.

Experience Lived by Iranian Patients with Irritable Bowel Syndrome: Transitory Crisis and Liberation.

OBJECTIVES: Research on the nature of living with Irritable Bowel Syndrome. METHODS: Qualitative study of the hermeneutical phenomenology, which conducted in-depth semi-structured interviews with people trained on the irritable bowel syndrome. The sampling was intentional type and open questions were used to collect data. The Thematic Analysis Method by Van Manen was used. RESULTS: Two principal themes and five subthemes emerged in this research to determine the meaning of living with the irritable bowel syndrome: Storm in corporality (body with pain and affliction, tension and sequence of symptoms, and: distress during moments of life) and Relief (sense of liberation of the body symptoms, and moments with pleasure). CONCLUSIONS: The experience lived by patients with irritable bowel syndrome is of a transitory crisis and liberation.

Exploring Iranian obese women's perceptions of barriers to and facilitators of self-management of obesity: A qualitative study.

BACKGROUND: Despite the clinical importance of self-management for obesity, poor compliance or noncompliance with the treatment regimen is a prevalent and persistent problem concerning people with obesity. AIMS: The aim of this study was to explore Iranian obese women's perceptions regarding the barriers to and facilitators of self-management of obesity. MATERIALS AND METHODS: In this qualitative study, the participants were selected through purposeful sampling and the data were collected using semistructured interviews and focus groups between July 2017 and September 2018. Nineteen participants between the age range of 28-50 years and mean age of 38.56 years were interviewed. A focus group with seven participants was conducted to reach data saturation. All the interviews and the focus group were transcribed verbatim and the data were analyzed using constant comparative method. RESULTS: The perceived barriers to obese women's self-management for obesity were identified and classified into four main categories: (I) restrictions, (II) the pressures of being in the group, (III (temptation, (IV) resonators. In addition, seven main categories emerged as facilitators of obese women's self-management for obesity: (I) achieving self-awareness, (II) positive consequences for weight loss success, (III) positive outcomes of exercise and physical activity, (IV) peers experience, (V) correct and logical program, (VI) autonomy and empowerment, and (VII) having supporting umbrella. CONCLUSION: This qualitative research provided a range of facilitators and barriers to self-management of obesity perceived by an obese woman to improve our understanding of the complex nature of self-management of obesity. Healthcare providers may consider this issue while designing and implementing appropriate interventions to upgrades woman's ability for self-management of obesity.

Exploring the Experiences of Iranian Women Regarding Obesity Self-Management: A Qualitative Study.

BACKGROUND: Despite the high and growing prevalence of obesity in Iran and a variety of interventions by the healthcare providers control the problem, and it is still a prevalent health problem among Iranian women. AIM: The aim of this study is to explore the perspective of obese Iranian women in the process of self-management regarding the facilitating factor in self-management of obesity. METHODS: In a qualitative study, the participants were selected through purposeful sampling, and the data were collected using semi-structured interviews and focus group (n = 25) between July 2017 and September 2018. All the interviews were transcribed verbatim and the data were analysed using constant comparative method. RESULTS: Supporting the umbrella was the main category found in the present study. The participating obese individuals found "support" as the main factor with an outstanding effect on motivating, incentivising and keeping diet in long-term. This category contains subcategories: self-help; family, friends, and peers' support; and medical team's support. CONCLUSION: The findings suggested the critical role of support in obesity self-management process. This critical factor improves our perception of the multi-aspect and complicated nature of obesity self-management. Moreover, policymakers and providers of health services can utilise this finding in the design of care plans with higher chance of success.

Experience Lived by Iranian Patients with Irritable Bowel Syndrome: Transitory Crisis and Liberation

Objective. Research on the nature of living with Irritable Bowel Syndrome. Methods. Qualitative study of the hermeneutical phenomenology, which conducted in-depth semi-structured interviews with people trained on the irritable bowel syndrome. The sampling was intentional type and open questions were used to collect data. The Thematic Analysis Method by Van Manen was used. Results. Two principal themes and five subthemes emerged in this research to determine the meaning of living with the irritable bowel syndrome: Storm in corporality (body with pain and affliction, tension and sequence of symptoms, and: distress during moments of life) and Relief (sense of liberation of the body symptoms, and moments with pleasure). Conclusion. The experience lived by patients with irritable bowel syndrome is of a transitory crisis and liberation.

Objetivo. Conocer la experiencia de vivir con el Síndrome del Intestino Irritable. Métodos. Estudio cualitativo de la fenomenología hermenéutica en el que se realizaron entrevistas semiestructuradas en profundidad a personas con diagnóstico de síndrome del intestino irritable. El muestreo fue de tipo intencional y se utilizaron preguntas abiertas para recopilar los datos. Se empleó el método de análisis temático de Van Mennen. Resultados. Dos temas principales y cinco subtemas emergieron en la presente investigación para determinar el significado de vivir con este síndrome: Tormenta en la corporalidad (cuerpo con dolor y aflicción, tensión y secuencia de síntomas, y: angustia en los momentos de la vida) y Alivio (sensación de liberación de los síntomas corporales, y momentos con placer). Conclusión. La experiencia vivida de pacientes con síndrome del intestino irritable es de una crisis transitoria y de liberación.

Objetivo. Investigar a natureza de viver com a Síndrome do Intestino Irritável. Métodos. Estudo qualitativo da fenomenologia hermenêutica na qual se realizaram entrevistas semiestruturadas em profundidade a pessoas com diagnóstico de síndrome do intestino irritável. A amostragem foi de tipo intencional e se utilizaram perguntas abertas para recopilar os dados. Se empregou o método de análises temático de Van Mennen. Resultados. Dois temas principais e cinco subtemas emergiram na presente investigação para determinar o significado de viver com a Síndrome do Intestino Irritável: Tormenta na corporalidade (corpo com dor e aflição, tensão e sequência de sintomas, e: angustia nos momentos da vida) e Alívio (sensação de liberação dos sintomas corporais, e momentos com prazer). Conclusão. A experiência vivida de pacientes com síndrome do intestino irritável é de uma crises transitórias e liberação.

Nurse's social responsibility: A hybrid concept analysis in Iran.

Background: Social responsibility in nursing is a complex concept that is completely associated with the context and healthcare system of every society. This study was conducted to analyze the concept of nurse's social responsibility in Iran. Methods: This analysis was done using a hybrid model, which consists of three phases: a literature review in the theoretical phase, semi-structured interviews in the fieldwork phase, and combination of the results of the two previous phases in a final analytical phase. Results: The four main themes extracted in the theoretical phase included: "Multi-dimensional and comprehensive approach", spirituality-based, learner-based and an evolutionary-process. In the fieldwork phase, all the themes obtained in the previous phase were confirmed, and one more theme emerged as "being relative". In the final phase, with the combination of the results of two previous phases, the final definition of the concept was presented. Conclusion: Clarifying the social responsibility of nurses and highlighting it in nursing will definitely lead to satisfaction in patients and clients, professional development and reduction of health care costs. Also, by identifying facilitators, inhibitors and social responsibility concepts, nursing managers and nursing educators will be able to design and implement their management and training activities based on scientific findings based on the findings that are necessary for the correct learning and implementation.

The Effect of Early Passive Range of Motion Exercise on Motor Function of People with Stroke: a Randomized Controlled Trial.

Introduction: Frequent and regular exercises in the first six months of stroke may cause return of a significant portion of sensory and motor function of patients. This study aimed to examine the effects of passive range of motion exercise in the acute phase after stroke on motor function of the patients. Methods: A randomized controlled trial study was conducted. The patients with first ischemic stroke were randomly allocated to either experimental (n=33) or control (n=19) group. Passive range of motion exercises was performed in the experimental group during the first 48 hours of admission as 6 to 8 times of 30 minute exercise. Before intervention, and one and three months after intervention, motor function were measured by muscle strength grading scale (Oxford scale) and compared. SPSS version 13.0 for Windows was used for statistical analysis. Frequency distribution was used to describe the data. For comparisons, paired t-test, independent t-test was used, and repeated measures test was used. Results: In acute phase, the intervention in the experimental group led to significant improvement of motor function between the first and third month in both the upper and lower extremities. In control group, improvement was observed only in the muscle strength of upper extremity in the first and third month compared to pre-intervention measurement. The greatest improvement was observed in the interval from base to one month in the upper extremity, and base to the first month and the first to the third month in the lower extremity. Conclusion: It is recommended to use early passive range of motion exercise as part of care for people with stroke during the acute phase of the disease.

New visiting policy: A step toward nursing ethics.

BACKGROUND:: Patients' rights arise from their expectations of the healthcare system, which are rooted in their needs. Visitation is seen as a necessary need for patients and families in intensive care units. OBJECTIVES:: The authors attempted to design, implement, and evaluate a new visiting policy in the intensive care units. RESEARCH DESIGN:: This study was an action research, including two qualitative and quantitative approaches. PARTICIPANTS AND RESEARCH CONTEXT:: The viewpoints of 51 participants (patients, families, doctors, nurses, and guards) on how to change the limited visiting policy were explained through semi-structured interviews and focus groups. The new visiting policy (contractual visitation) was designed, implemented, and evaluated with the involvement of participants. ETHICAL CONSIDERATIONS:: The hospital ethics committee approval was gained and the informed consent was obtained from all the participants. FINDINGS:: The content of interviews was analyzed and classified into four categories: advantages and disadvantages of visiting policies, and barriers and facilitators of changing the limited visiting policy. After implementation of the new policy (contractual visitation), a significant difference observed in satisfaction status before and after the changes (p value < 0.001). DISCUSSION:: Nowadays, many countries' clinical guidelines recommend flexible visiting policy, which is consistent with the results of this study. CONCLUSION:: Changing the limited visiting policy was a necessary need for patients and families that established with the involvement of them and staff.

Evaluation of psychometric properties of scales measuring student academic satisfaction: A Systematic review.

BACKGROUND: Student satisfaction has an impact on student motivation, recruitment of new students, and retention of existing students. Hence, it is important for researchers and academic institutes to assess student academic satisfaction by valid and reliable scales. The aim of this study was to rigorously assess methodological quality and psychometric properties of scales measuring student academic satisfaction. METHODS: In this systematic review, databases including Scopus, PubMed, ProQuest, ScienceDirect, and Web of Science, and two Persian databases were searched using relevant keywords such as academic satisfaction, student satisfaction, university satisfaction, campus satisfaction, academic life experience, validation, and psychometric and factor analysis from 1970 to December 2018. Considering eligibility criteria, studies were selected after titles and abstracts screening. The methodological quality assessment was performed by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and the Terwee quality criteria. RESULTS: Of 814 retrieved articles, 13 studies were included in the study. Based on the COSMIN checklist, structural validity (84%), content validity (53%), and hypothesis testing (53%) were the most reported properties. One study reported cross-cultural validity, one for criterion validity, and none reported measurement error. CONCLUSION: The results of our study showed that in spite of ≥48 years of development in student satisfaction scales; however, each scale has at least one "poor" psychometric property based on the COSMIN checklist. Quality appraisal of scales is necessary after developing and performing psychometric process.