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

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

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

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

The Effect of Endotracheal Suctioning Using the Four-handed Care on Physiological Criteria and Behavioral Responses of the Preterm Infants: Randomized Crossover Clinical Trial.

Background: Endotracheal suctioning, despite its necessity, is one of the procedures that can cause pain and stress for infants admitted to neonatal intensive care units. Pain and stress manifest with physiological and behavioral responses in infants. Purpose: This study is a cross-sectional clinical trial that aimed to investigate the effect of endotracheal suctioning using four-handed care on the physiological criteria and behavioral responses of preterm infants. Methods:In this study, 40 infants were randomly divided into two groups of 20, one group was first suctioned by the routine method (two hands) and then with the four-handed method. The other group was first suctioned by the four-handed method and then with the routine one. The ALPS NEO was used to evaluate behavioral criteria. One camera recorded facial expressions and body movements, and physiological data were recorded from the monitor simultaneously. Results:Four-handed suctioning method can prevent an increase in heart rate during and two minutes after suctioning but it did not affect behavioral responses and oxygen saturation of the preterm infants admitted to NICUs. Since one of the symptoms of pain and stress in infants is the change of vital signs, especially the heart rate, stable heart rate during painful procedures can be an indication of the effectiveness of the four-hand method in invasive procedures such as suctioning. Implications for Practice: We recommend four-handed method for suctioning of endotracheal tube. Implications for Research: Evaluate the effect of four-handed care by mother on physiological criteria and behavioral responses of the preterm infants.

The Effect of Facilitated Tucking on the Pain Intensity Induced by Chest Tube Removal in Infants.

BACKGROUND: Removal of a chest tube is a painful procedure for infants. Medications, including narcotics, are used to control pain, but nonpharmacologic interventions are also effective in reducing pain during this procedure and are not associated with adverse effects. PURPOSE: To evaluate the additive effect of facilitated tucking to the use of morphine on infant pain associated at the time of chest tube removal. METHODS: This was a prospective, randomized control study. Sixty infants were randomized into 2 equal groups utilizing a coin flip. All infants received 0.05-mg/kg morphine 20 minutes before chest tube removal. The intervention group received facilitated tucking and the control group received standard care. Infant pain was measured using the Neonatal Infant Pain Scale. Pain was assessed at 3 time points by 2 independent evaluators: 5 minutes before, during, and 5 minutes after removal of the chest tube. Mann-Whitney and Fisher's exact (Chi-square) tests were used to compare the intervention and control groups. RESULTS: Pain scores were increased during chest tube removal for both the intervention and the control groups. Compared with the control group, pain scores for infants in the intervention group were less before, during, and after chest tube removal. IMPLICATIONS FOR PRACTICE: Facilitated tucking combined with morphine administration can be an effective additive intervention for pain control in infants during chest tube removal. IMPLICATIONS FOR RESEARCH: Evaluate the effect of the facilitated tucking on pain induced by chest tube removal in preterm infants. Preterm infants may respond differently to pain.

The Effect of Emotional Disclosure by Writing on the Depression of Hemodialysis Patients in Iran: A Randomized Clinical Trial.

Introduction: Depression is the most common psychological problem in patients with renal failure, and it can lead to mortality in severe cases. Effective interventions are required to promote mental health in patients on hemodialysis with various types of mental disorders. The current study aimed to evaluate the effect of emotional disclosure by writing on depression of patients on hemodialysis in Iran. Methods: This clinical trial study was carried out on 140 patients undergoing hemodialysis in hemodialysis centers of Kerman. Patients were randomly assigned into two groups of intervention and control after signing the written consent forms and completing the Depression Anxiety Stress Scale (DASS 21). The intervention group was requested to write daily the deepest emotions and intrusive thoughts within 15 to 20 minutes in four consecutive days. The control group received routine care. Then, the questionnaire was recompleted two weeks later. Finally, the data were analyzed by SPSS (version 13) using independent t-test and paired t-test. Results: The mean depression score was either moderate or high. While depression scores seemed to decrease in the intervention group after the intervention, the depression scores continued to rise following the intervention in the control group. The difference in depression scores was statistically significant between the two groups before and after the intervention. Conclusion: Emotional disclosure by writing can be effective on the level of depression in patients on hemodialysis.Simus adi omnimodipsa sam fugita dolenistiae inveles est doluptat.

Challenges of paediatric palliative care in the intensive care unit during the COVID-19 pandemic.

BACKGROUND: The integration of paediatric palliative care into the Iranian health system is essential. AIMS: The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers. METHODS: A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection. FINDINGS: Ten main categories were extracted from data analysis, including 'caring in COVID-19', 'communication and family centre care', 'breaking bad news', palliative care training', 'pain and symptom management', 'support of the child, family and clinical team', 'physical environment', 'guidelines', 'specialised staff' and 'home based palliative care'. CONCLUSION: Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.

Health Care Providers' Experiences of the Non-Pharmacological Pain and Anxiety Management and Its Barriers in the Pediatric Intensive Care Units.

OBJECTIVES: Children in the intensive care unit experience a high level of pain and anxiety. This study aimed to reveal the health care providers experience of non-pharmacological pain and anxiety management and its barriers in the pediatric intensive care unit. METHODS: This qualitative-descriptive study was conducted with thirteen nurses and five physicians in the pediatric intensive care unit in Iran. Individual, in-depth and semi-structured interviews were conducted, which were analyzed by conventional content analysis. RESULTS: Five main categories were identified from data analysis: 1) The importance of parents' presence, 2) Disturbance in the presence of parents and communication during the COVID-19 pandemic, 3) Choosing non-pharmacological approaches according to the child's interests and conditions, 4) Building trust in the child through non-pharmacological interventions 5) Barriers to non-pharmacological pain and anxiety management in the pediatric intensive care unit. CONCLUSION: Health care providers implement some non-pharmacological methods to manage pain and anxiety in the pediatric intensive care unit. Facilitating the open presence of parents, using innovative methods to communicate with children, and training and psychological support for nurses and parents, especially during the COVID-19 pandemic are recommended.

Correction to: The effect of transactional analysis on the self-esteem of imprisoned women: a clinical trial.

Following publication of the original article [1], the authors advised that the name of the 4th author had been submitted incorrectly; the author has the family name 'Pouraboli', however, their article was originally published with the family name (mis) spelled as 'Pouraboili'.

The effect of transactional analysis on the self-esteem of imprisoned women: a clinical trial.

BACKGROUND: The imprisoned women usually have low self-esteem and suffer from various physical and mental complaints; they may suffer from feelings of emptiness, isolation, and depression. Transactional analysis (TA) is part of a comprehensive system attributed to the individual and social psychiatry for personal development of self-esteem among the imprisoned women. Therefore, the present study aimed to investigate the effect of TA group-training on the self-esteem of imprisoned women. METHODS: This clinical trial was conducted among the imprisoned women in a prison in Southeastern Iran using pretest-posttest design. In this regard, 76 women were randomly allocated to the intervention (n = 35) and control (n = 41) groups. The TA group-training program was held for eight 90-min sessions for the intervention group. Data were collected using a demographic questionnaire and the Rosenberg's self-esteem scale (RSES). Later, all participants were evaluated before and 1 month after the intervention. RESULTS: In pre-test, the mean scores of self-esteem were 11.8 ± 4.67 and 7.97 ± 4.52 for the intervention and control groups, respectively. These scores showed low levels of self-esteem and the difference between the two groups was significant (p = 0.001, t = - 3.61). In the post-test, the mean scores of self-esteem improved to the moderate level (22 ± 2.52) in the intervention group compared to the control group (8.92 ± 4.04). This indicates the significant improvement of self-esteem in the intervention group (p = 0.001, t = 17.15). CONCLUSIONS: The results showed that TA group-training had a significant effect on self-esteem. Therefore, the experienced and expert counselors and psychologists are recommended to hold transactional analysis group-training courses to enhance self-esteem among women prisoners. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20170725035289N5 Date registered: 25/08/2018.

Comparison of the Effect of Massage and Music on Fatigue in Mothers With Premature Newborns Admitted to the Neonatal Intensive Care Unit: A Randomized Clinical Trial.

OBJECTIVE: The purpose of this study was to compare the effect of massage and music on fatigue in mothers with preterm newborns in neonatal intensive care units (NICUs). METHODS: This study was a clinical trial with a crossover design which was conducted in Valiye Asr Hospital, Tehran, Iran. A convenience sample of 41 mothers with hospitalized premature neonates in the NICU were randomly assigned to massage-first or music-first groups. Both groups received music and massage, but in different orders. Fatigue was measured using the Multidimensional Fatigue Inventory before and after interventions. Data were analyzed using SPSS version 16 and repeated-measures analysis of variance. RESULTS: The mean ± SD Multidimensional Fatigue Inventory scores after music, massage, and control measurements were, respectively, 66.90 ± 6.23, 55.78 ± 6.65, and 54.71 ± 6.81. Results of the analysis of variance indicated that there was a significant difference in mean fatigue score between the control group and after both music and massage (P < .001). However, there was no significant difference between the music and massage groups (P = .780). CONCLUSION: In this sample of participants, massage and music reduced fatigue in mothers who had preterm newborns in the NICU.

The Effect of Relaxation Techniques on Anxiety, Fatigue and Sleep Quality of Parents of Children with Leukemia under Chemotherapy in South East Iran.

INTRODUCTION: Cancer can cause emotional stress in parents, which has a negative impact on the quality of their life. Also, anxiety and psychological stress have a negative effect on the health of parents, and fatigue causes a sense of weakness and reduces the capacity for mental and physical activity, and insomnia, as well as stress and inability to perform their occupational and social functions. This study aimed to determine the effect of relaxation techniques on anxiety, fatigue, and sleep quality of parents of children with leukemia under chemotherapy in South East Iran in 2015. METHODS: This is a randomized controlled trial study. The study population included parents of children with leukemia undergoing chemotherapy who were admitted to a teaching hospital in South East Iran. One hundred twenty parents were randomly assigned to control and intervention groups, and the experimental group was provided with Benson relaxation technique. Data collection tool included a demographic questionnaire, state-trait anxiety inventory, Brief Fatigue Inventory, and sleep quality inventory. Data analysis was done by SPSS 16 and paired t-test, Wilcoxon, Mann- Whitney, regression, One - Way ANOVA and Pearson tests were performed, and p ≤ 0.05 was statistically significant. RESULTS: The mean score of state anxiety in the intervention group was 60.86 ± 8.95 and 35.95 ± 4.61 before and after the intervention, respectively. The mean score of trait anxiety was 56.56 ± 4.75 and 34.45 ± 4.95. The mean score of the fatigue was 73.83 ± 14.63 and 43.71 ± 11. 06, and the mean score of the quality of sleep was 13.5 ± 6.05 and 5.7 ± 3.43 before and after the intervention respectively. There was a statistically significant difference among state-trait anxiety, fatigue, and sleep quality in intervention and control groups after the intervention. There was a statistically significant negative correlation between fatigue and age, but there was no statistically significant relationship among the mean fatigue, weight, the number of sons and daughters, education, occupation, gender, place of residence and income (p> 0.05). There was no statistically significant relationship among the quality of sleep of parents, education, gender, and place of residence, but there was a statistically significant relationship between state anxiety and education (p≤0.05). CONCLUSION: The results can predispose family-centered nursing care to support more the parents of children with cancer in the face of the stress of illness. Developing programs for training muscle relaxation techniques will improve family functioning and mental health.

Relationship Between Lifestyle and Family Functioning Among Family Members of Amphetamine Abusers in Southeast Iran.

INTRODUCTION: Drug abuse is a social event and one of the worse health problems in the current age. Nowadays, the inclination of young people has changed from traditional drugs to more sophisticated and industrial drugs such as ecstasy, glass, and crack. Increasing drug abuse can be sought in families' lifestyles as an effective factor on individuals' health. The disturbance in family functioning can be associated with an individual's antisocial behaviors like addiction. Therefore, the current study is aimed at determining the relationship between lifestyle and family functioning of family members of patients with amphetamine abuse who referred to drug rehabilitation clinics in Southeast Iran. METHOD: This is a correlational descriptive study conducted on 196 family members of patients with amphetamine abuse who referred to drug rehabilitation clinics in Southeast Iran. Data were collected through the use of demographic, family functioning, and lifestyle questionnaires. Data analysis was performed with SPSS 19 using independent t test, one-way analysis of variance, and Pearson correlation coefficient test. RESULTS: The total mean score of lifestyle was observed to be 105.77 ± 24.39. Among the dimensions of lifestyle, the highest mean score was associated with health responsibility (26.28 ± 7.43), whereas the lowest mean score was associated with exercise (12.7 ± 5.1). In addition, the results showed that the total mean score of family functioning was 129.25 ± 20.97. Among the dimensions of family functioning, the highest mean score was associated with general functioning (26.07 ± 4.92), whereas the lowest mean score was associated with affective responsiveness (13.16 ± 2.88). There was a positive and significant relationship between lifestyle and family functioning, such that the increase in the mean score of lifestyle increased the score of family functioning (r = .34, p = .001). CONCLUSION: Because lifestyle is associated with family functioning of patients with amphetamine abuse, basic measures can be taken in families to prevent addiction by increasing information to families, which enhances their lifestyle and functioning.

Effect of Preterm Infant Massage by the Mother on the Mood of Mothers Having Preterm Infants.

OBJECTIVE: The purpose of this study was to determine the effect of preterm infant massage by the mother on the mood state of mothers of preterm infants. METHODS: This experimental study assessed 52 mothers of preterm infants (born at 30-37 weeks of gestation) hospitalized in the neonatal intensive care unit of Afzalipour Hospital of Kerman University of Medical Sciences, Iran. Recruitment was done using the convenience sampling method, and participants were randomly assigned into intervention and control groups. In the intervention group, massage therapy was done once a day for 5 consecutive days. Infants in the control group received the usual care. Data were collected using a questionnaire of demographic information and the Profile of Mood State questionnaire and analyzed using SPSS version 19 (IBM Corp, Armonk, New York) and Kruskal-Wallis, Mann-Whitney U, Wilcoxon, and χ2 tests. RESULTS: Comparison of the mothers' mean mood scores between the intervention and control groups showed no significant difference before the intervention (P = .51), whereas mean scores differed significantly after the intervention between the groups (P = .005). Mothers' mean mood scores improved significantly in the control group (P = .02) and the intervention group (P < .001), whereas the intervention group showed a greater improvement (-4.155 vs -2.238). CONCLUSION: Those mothers performing massage on their preterm infants showed greater improvement in their mood compared with those in the control group. Teaching massage to the mothers of these infants could be considered as a possible intervention to enhance a mother's mood and the quality of care she provides to her infant.

Communication Behaviors in Nursing Homes in South-East Iran: An Ethnographic Study.

BACKGROUND: Because of the increasing number of the elderly, the need for care in aged nursing homes (NHs) is increasing. As a cultural perspective toward care is new, it is very important to understand the communication behavior of the elderly in various cultures. This study aimed to explore the communication behaviors among the elderly in NHs in Kerman, Iran. MATERIALS AND METHODS: This ethnographic focused study was conducted on 25 staff members and 8 residents in two NHs in 2015. Data were collected through observation of the participants, field notes, and semi-structured deep interviews in Kerman. Cuba and Lincoln method was used to ensure the trustworthiness of the data. The collected data were analyzed through content analysis. RESULTS: By analyzing primary codes, 3 categories and 8 subcategories were extracted through content analysis including fluctuation in communication (task-oriented communication, avoidance of communication, and establishment of effective communication), artificial collaboration (fake friendships, jealousy, and its consequences, and cooperation in concealing error), and lack of collaboration among team members (fragmented teamwork, extreme working conditions, and physical burnout among the elderly). CONCLUSIONS: The results of this study indicate that communication problems between caregivers and the elderly are high. Thus, it is necessary that people who care for elderly indiviuals are trained regarding special communication strategies and skills, and they are not influenced by fatigue and burnout resulting from caring.

An ethnographic study in nursing homes in Iran.

BACKGROUND:: The approach of death is an undeniable part of ageing and death is the most important concern for elderly people who live in nursing homes. This study examines describes how care home residents feel when they recognise that they are close to death. AIMS:: The aim of this study was to explore the experiences of elderly residents who are dying in nursing homes as well as their caregivers toward death in an Iranian context. METHODS:: A focused ethnographic research design was chosen. The research sample consisted of 25 nursing home staff-three nurses, 18 healthcare assistants, two administrators, a social worker and a psychologist-and 10 elderly people in two nursing homes in Iran. Data was collected through field notes, observations and semistructured, in-depth interviews. Data was analysed using thematic analysis. FINDINGS:: There were two main themes of: seeking the embrace of a calm death; and waiting for death. Within these, four subthemes were identified. CONCLUSION:: The perceptions of the participants originated from the nursing home culture and their beliefs in eternal life. Training staff about the cultural needs of dying people and end-of-life care would be the most effective way to improve the experience of dying for nursing home residents.

The relationship between anxiety and social support in male and female students in high schools in the southeast of Iran.

INTRODUCTION: Adolescence is associated with physical, social and personality changes. Adolescents usually face some fears during this period, the removal and adjustment of which requires family and teachers' support and the lack of attention to the issues of maturity will have negative effects on their health, awareness and self-esteem. The aim of this study was to investigate the relationship between anxiety and social support among male and femaille students in high schools in the southeast of Iran. MATERIALS AND METHODS: In this cross-sectional study that was conducted as a descriptive comparison, 452 students who were studying in the first period of high school in Kerman (junior high schools) were selected as the entire population by the cluster sampling method and the data collection instruments were: a demographic questionnaire, Philips Social Support Scale and the Cattle Anxiety Scale. As well as descriptive statistics, to test the hypothesis of this study by SPSS software, and in the case of abnormal distribution of each variable, non-parametric tests were used. RESULTS: The results showed that anxiety in girls is great than in boys, also data analysis through Pearson's test showed that there is a negative and significant relationship between anxiety and social support in girls (r = -0.428, n = 226, p < 0.001) and boys (r = -0.378, n = 226, p < 0.001). CONCLUSION: The results of research showed that by increasing perceptions of social support in students, their anxiety decreases. Therefore, paying attention to the social determinants of health such as social support is important and necessary to reduce the anxiety of students.

The effectiveness of group hope therapy on the mental health of type II diabetic patients referred to the diabetes clinic in South East Iran.

Introduction Diabetes is a common disease that, besides affecting the physical health, also affects the mental health of patients. Therefore, promoting mental health along with drug therapy seems essential. The purpose of this study was to find the effectiveness of group hope therapy on the mental health of type II diabetic patients who were referred to the diabetes clinic of Imam Reza Hospital in Sirjan City. Materials and methods This was a semi-experimental study. The statistical population consisted of type II diabetic patients referred to a diabetes clinic in southeastern Iran. Forty subjects were selected according to the goals of study and inclusion criteria and were assigned into intervention and control groups. The intervention group received group hope therapy in eight sessions. The instrument was General Health Questionnaire (GHQ) and was completed by both groups before and after intervention. Data were analyzed using independent t-tests and paired t-tests. Results The results showed that the mental health after the group hope therapy significantly increased in the study group compared to the control group (p = 0.02). Conclusion The results showed that the mental health of diabetic patients is more favorable using group hope therapy. This method can be used in diabetic patients.

Self-care in Patient with Major Thalassemia: A Grounded Theory.

Introduction: Self-care is the core concept of health care and may be considered as one's stabilization, and restoration as well as the improvement of his/her health and well-being. Looking at the process of Self-care from patients' perspective who suffer from thalassemia may assist the nurses and health care providers to facilitate the health process. Thus this study was conducted to discover the process of self-care in patients with major thalassemia. Methods: This qualitative study was conducted with grounded theory approach. 21 patients with major thalassemia from a Medical Research Center, supervised by Kerman Medical University, were selected through purposeful and theoretical sampling. Data were collected by unstructured interviews which lasted 30-60 minutes. These data were analyzed using the method of Corbin and Strauss. Results: The main theme of "struggling to improve life quality" that included the sub-themes of "focus on needs of illness, "activating resources" and "restoring a new identity with thalassemia" were extracted from the data. This theme implies that participants endeavor to strengthen their self- efficacy via thalassemia. "Looking for strengthening self-efficacy in light of thalassemia" was the core theme in this study. Conclusion: Facilitating the process of self-care in patients with major thalassemia requires that they be helped so that their self-efficacy, influenced by real life conditions, might be strengthened in light of thalassemia. Increasing public awareness and social support may affect the recognition of individual, family and society.

Living in a misty marsh: A qualitative study on the experiences of self-care suffering of patients with thalassemia.

BACKGROUND: Thalassemia major is the most common hereditary anemia in Iran. Thalassemia major patients require lifelong care and suffer much pain during self-care. Knowledge of the nature, meaning, and impact of suffering from the perspective of patients is needed to determine which interventions are helpful. This study was designed to understand the experience of suffering in patients with thalassemia. MATERIALS AND METHODS: This was a qualitative study conducted with content analysis method. In the present study, 21 patients with thalassemia were selected by purposive sampling. The research was performed at Kerman Samen Alhojaj Medical Center, Iran, in 2013. Data collection method was conducting unstructured interviews using open-ended questions and field notes. In addition, data were analyzed using qualitative content analysis and conventional approach. RESULTS: Data analysis resulted in the emergence of the four central categories of physical exhaustion, mental and spiritual restlessness, society's behaviors and beliefs, and surviving a hard life, which were the suffering themes of the patients. CONCLUSIONS: Results showed that thalassemia in the physical, psychological, social, and spiritual aspects is very stressful for patients. Moreover, culture plays an important role in the patients' experience of suffering. Results of this study can help nurses improve nursing care to alleviate suffering based on these experiences.