Exploring the Position of Community-Based Nursing in Iran: A Qualitative Study.

BACKGROUND: Community-based nursing focuses on providing health services to families and communities in the second and third levels of prevention and this can improve the individuals, families and communities' quality of life, and reduce the healthcare costs. The aim of this study was to explore the status of community-based nursing in Iran. METHODS: This qualitative study was conducted from March to November 2015, in Tehran, Iran, using the content analysis approach. The study setting consisted of Iran and Tehran Faculties of Nursing and Midwifery, Tehran, Iran. The purposive sampling method was used. Twenty faculty members and Master's and PhD students were interviewed by using the face-to-face semi-structured interview method. Moreover, two focus groups were conducted for complementing and enriching the study data. The data were analyzed using the Graneheim and Lundman's approach to content analysis. The trustworthiness of the study findings was maintained by employing the Lincoln and Guba's criteria of credibility, dependability, and confirmability. RESULTS: In total, 580 codes were generated and categorized into three main categories of conventional services, the necessity for creating infrastructures, and multidimensional outcomes of community-based nursing. CONCLUSION: Introducing community-based nursing into nursing education curricula and creating ample job opportunities for community-based nurses seem clearly essential.

Exploring Nurse's Communicative Role in Nurse-Patient Relations: A Qualitative Study.

Introduction: Recognition the nurses' communicative roles can influence quality of patient's care. Therefore, this study was aimed to explore nurse's role in nurse-patient relations. Methods: This study was a qualitative research in which collected data was analyzed by content analysis method. The participants were 23 nurses, patients and their families in medical and surgical wards of a referral hospital in Tehran, Iran. Data were collected by semi-structured interview and observation. Results: Data analysis was led to the emergence of a main conceptual category: The patient's need-based communication. This category was derived from two categories: 1) Identifying the patient's needs; and 2) Communicative behavior in the face of the patient's needs. "Identifying the patient's needs" was related to "type of the patient's problem", "patients' inquiring about their health status" and "monitoring the patient's health status". "Communicative behavior in the face of the patient's needs" was composed of four subcategories: "caring attention", "informal education of the patient", "inducing calmness to the patient", and "obtaining the trust of the patient". Conclusion: The nurse's role in relationship with patients is designed according to patients' needs. Therefore, if the patients' needs in clinical settings are defined and clarified appropriately, the nurse-patient relations will be enhanced and thereby the quality of care will be improved.

Effectiveness of training on preventative nutritional behaviors for type-2 diabetes among the female adolescents: Examination of theory of planned behavior.

BACKGROUND: Since type-2 diabetes is the most common chronic disease among Iranian female adolescents, we applied theory of planned behavior to examine the effect of training to intention to preventative nutritional behaviors for type-2 diabetes among female adolescents. METHODS: In this experimental study 200 (11-14 year old) girls from 8 schools of Tehran city (100 in each intervention and control group) were recruited based on cluster sampling method during two stages. For intervention group, an educational program was designed based on the theory of planned behavior and presented in 6 workshop sessions to prevent type-2 diabetes. The data were collected before and two months after the workshops using a valid and reliable (α=0.72 and r=0.80) authormade questionnaire based on Ajzens TPB questionnaire manual. The data were analyzed using t-test, chi-square test and analysis of covariance. RESULTS: Findings indicate that the two groups were homogeneous regarding the demographic characteristics before education, but the mean score of the theory components (attitudes, subjective norms, perceived behavioral control, and intention) was higher in the control group. Also, results showed all of the theory components significantly increased after the education in the intervention group (p=0.000). CONCLUSION: Training based on the theory of planned behavior enhances the intention to adherence preventative nutritional behaviors for type-2 diabetes among the studied female adolescents.

Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study.

BACKGROUND: Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. OBJECTIVES: This study aimed to audit nursing care based on a nursing process model. PATIENTS AND METHODS: This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses' compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests. RESULTS: The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses' age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001). CONCLUSIONS: Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools.

Congestive heart failure: Predictors of health-related quality of life in Iranian women.

UNLABELLED: Abstract Background and Objectives: Identify the factors affecting quality of life (QOL) is one of the major goals for improving the Health-Related Quality of Life (HR-QOL) in patients suffering from Congestive Heart Failure (CHF). Considering the fact that there are few published studies in this regard in Iran, as a developing country, this research was designed to determine the HR-QOL in Iranian CHF patients and its related factors. METHODS AND MATERIALS: In this cross-sectional study, random sampling was used to select 1840 female CHF patients. After obtaining informed consent, patients' demographic and disease-related data (using a researcher-made questionnaire which assessed eight dimensions including role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health), and the HR-QOL data (using the SF-36 questionnaire) were assessed and analyzed with SPSS version 15. RESULTS: A high proportion of the participants had an unfavorable HR-QOL in physical functioning (44.56%), role-physical (49.55%), role-emotional (59.83%), mental health (54.50%), and general health (53.36%) dimensions and a relatively favorable HR-QOL in social functioning (50.57%), vitality (49.26%), and body pain dimensions (52.55%). A significant relationship was found between the HR-QOL and the employment status, level of education, being cared for at home, functional capacity, disease duration, frequency of medical encounter and hospitalization, duration of hypertension and concurrent CHF, presence of edema, presence of disease symptoms and morbidities, intensity of fatigue at the study time and previous months, and the type of medications. CONCLUSION: According to the results, QOL in CHF patients was unfavorable in the scales of general health, role-emotional, and mental health.

Congestive Heart Failure: Predictors of Health Related Quality of Life in Iranian Women.

Abstract Background and Objectives: Identify the factors affecting quality of life (QOL) is one of the major goals for improving the Health Related Quality Of Life (HR-QOL) in patients suffering from Congestive Heart Failure (CHF). Considering the fact that there are few published studies in this regard in Iran, as a developing country, this research was designed to determine the HR-QOL in Iranian CHF patients and its related factors. Methods and Materials: In this cross-sectional study, random sampling was used to select 1840 female CHF patients. After obtaining informed consent, patients' demographic and disease-related data (using a researcher-made questionnaire which assessed eight dimensions including role-physical, physical functioning, bodily pain, general health, vitality, role-emotional, social functioning and mental health), and the HR-QOL data (using the SF-36 questionnaire) were assessed and analyzed with SPSS version 15. Results: A high proportion of the participants had an unfavorable HR-QOL in physical functioning (44.56%), role-physical (49.55%), role-emotional (59.83%), mental health (54.50%), and general health (53.36%) dimensions and a relatively favorable HR-QOL in social functioning (50.57%), vitality (49.26%), and body pain dimensions (52.55%). A significant relationship was found between the HR-QOL and the employment status, level of education, being cared for at home, functional capacity, disease duration, frequency of medical encounter and hospitalization, duration of hypertension and concurrent CHF, presence of edema, presence of disease symptoms and morbidities, intensity of fatigue at the study time and previous months, and the type of medications. Conclusion: According to the results, QOL in CHF patients was unfavorable in the scales of general health, role-emotional, and mental health.

Perception of Iranian middle-aged women regarding moral health concept: a content analysis.

INTRODUCTION: The present study aimed at exploring and describing the perception of moral health from middle-aged women standpoints. Women's decisive role in family is undeniable. In the family which is built upon tradition, faith and ethics, this is women's principle which is represented in the moral health of the individual and the society, deals with the nature of the vice and virtue. This study attempted to identify the perception of Iranian middle-aged women about the concept of moral health. METHOD: The present study completed through a content analysis method. Twenty two middle-aged women were recruited through purposive sampling. Data were granted by face to face, semi-structured interview. RESULT: Our major categories are devotion, preserving moral values and moral challenges. Devotion category includes subcategories such as prioritizing the health of family members and trying to save marriage. Preserving moral values category includes subcategories such as respecting values and consolidating beliefs over time. Moral challenges category consists of individual and familial challenges subcategories. CONCLUSION: Moral health is of high importance which affects various dimensions of individual, social and familial life. The findings of the present study presented new dimensions of middle-aged women's health regarding moral health which can finally have different consequences on familial and social moral health.

Compliance with treatment regimen in women with gestational diabetes: Living with fear.

BACKGROUND: Gestational diabetes mellitus is a prevalent pregnancy complication that seriously endangers mothers' and babies' health. The aim of this study was to explore factors affecting treatment compliance among women with gestational diabetes mellitus. MATERIALS AND METHODS: A qualitative content analysis approach was employed. Twenty-five semi-structured interviews were conducted with hospitalized pregnant women with gestational diabetes mellitus. The research was conducted in four teaching hospitals in Tehran, Iran; purposive sampling was used. RESULTS: Participants' experiences regarding factors that influence treatment compliance fell into six categories: Unexpected diagnosis, the need for urgent change, temptation to consume inappropriate foods, life in the shadow of the illness, risk avoidance, and seeking adjustment. CONCLUSIONS: Holistic education of families on gestational diabetes, training specialist diabetes nurses, and referral to public health centers and diabetes clinics could increase treatment compliance. These findings could serve patients and the healthcare system in general, if considered by healthcare officials and policy makers. Furthermore, providing outpatient services, considering cultural dietary conventions when recommending diets, and alleviating the stigma associated with diabetes through mass media could also promote treatment compliance.

Women's Health Concept: A Meta-Synthesis Study.

BACKGROUND: It is necessary to identify unidentified or less- concentrated issues in women's health dimension through an extended study. This study is done to identify different dimensions of women's health among qualitative research. METHOD: The present meta-synthesis study is done through a systematic review. The main criteria were to use qualitative studies issued in the same language and researches in which their participants were women. All the published and indexed articles related to women's health in Iran at SID, Magiran and Iranmedex databases from 2001 to 2013 were scrutinized. Search in these databases was done using key words "health" and "women". Finally, 29 qualitative articles were chosen. Data analysis was performed using qualitative content analysis. RESULTS: Generally, concepts extracted from women's health dimension are classified in three main categories including personal, familial and social dimensions. Each category includes some subcategories, too. Personal factors consist of physical, psychological -emotional and spiritual; familial factors consist of fertility, husband's support and women's fundamental roles, and social factors consist of cultural, socioeconomically support, and women's management issues. CONCLUSION: In this meta-synthesis study, there was an effort to present a new interpretation of the previous studies. This study helped attain a more comprehensive and deeper knowledge about women's health concept and reveal its different aspects, which are not assessed in the country.

Effectiveness of clinical teaching associate model in nursing education: results from a developing country.

BACKGROUND AND OBJECTIVES: The credit of the practice nurses in developing countries, due to a gap between theory and practice in nursing education and healthcare delivery, has been questioned by nursing professionals. Therefore, the aims of this study were to investigate the effectiveness of the application of the clinical teaching associate (CTA) model in nursing students' clinical skills and to assess the participants' (faculty members, staff nurses, and nursing students) level of satisfaction with the CTA model and with achieving the educational goals in Iran, as a developing country. METHODS AND MATERIALS: In this experimental study, random sampling was used to assess 104 nursing students' clinical skills, and assess six faculty members and six staff nurses. After obtaining informed consent, the level of satisfaction was evaluated by a questionnaire and clinical skills were evaluated by standard checklists. Data were assessed and analyzed with SPSS version 15. RESULTS: The results showed that the mean scores of all clinical skills of the students were significantly higher after intervention (P < 0.01). Moreover, the mean scores of instructors' satisfaction with applying the CTA model was significantly higher (P = 0.004), but their satisfaction with achieving clinical education outcomes did not show a significant difference (P = 0.109). Similarly, students' satisfaction with achieving educational outcomes did not show any significant differences between the two groups (P = 0.058). CONCLUSION: According to this study, the CTA model is an effective method for developing clinical skills in nursing students in Iran as a developing country. Therefore, application of the method is recommended in clinical nursing education systems of such countries.

Effect of Clinical Teaching Associate Model on Nursing Students' Clinical Skills and Nurses' Satisfaction.

Abstract Background and Objectives: The credit of the practice nurses in developing countries, due to gap between theory and practice in nursing education and health care delivery has been questioned by nursing professionals. Therefore, the aims of this study were to investigate the effectiveness of the application of the CTA model in nursing students' clinical skills and to assess the participants' (faculty members, staff nurses, and nursing students) level of satisfaction with the CTA model and with achieving the educational goals in Iran, as a developing country. Methods and Materials: In this experimental study, random sampling was used to assess 104 nursing students' clinical skills, and assess 6 faculty members and 6 staff nurses. After obtaining informed consent, the level of satisfaction was evaluated by a questionnaire and clinical skills were evaluated by standard checklists. Data were assessed and analyzed with SPSS version 15. Results: The results showed that the mean scores of all clinical skills of the students were significantly higher after intervention (p<0.01). Moreover, the mean scores of instructors' satisfaction with applying the CTA model was significantly higher (p = 0.004), but their satisfaction with achieving clinical education outcomes did not show a significant difference (p = 0.109). Similarly, students' satisfaction with achieving educational outcomes did not show any significant differences between the two groups (P = 0.058). Conclusion: According to this study, the CTA model is an effective method for developing clinical skills in nursing students in Iran as a developing country. Therefore, application of the method is recommended in clinical nursing education systems of such counties.

Knowledge, attitude, and practice of Iranian adolescent girls towards 3-4-methylenedioxymethamphetamine.

OBJECTIVE: To investigate knowledge, attitude, and practice (KAP) of Iranian adolescent girls towards 3-4-methylenedioxymethamphetamine (MDMA [Ecstasy]). METHODS: A cross-sectional design study was conducted on female adolescents in Tehran high schools. The study took place in Tehran University of Medical Sciences, Tehran, Iran in October to December 2008. A randomized cluster sample of adolescent girls from 14-18 years old, and enrolled in 57 public high schools of Tehran were selected. A written informed consent was obtained from all study participants. In order to assess the participants' demographic characteristics, and KAP towards Ecstasy, a 61-item, researcher-made, valid, and reliable questionnaire was completed anonymously by all participants at schools. The questionnaire included 4 main domains assessing adolescents': 1. Demographic characteristics (14 items), 2. Knowledge (10 items) 3. Attitude (24 items), and 4. Practice (13 items) toward Ecstasy. Results were considered significant at p ≤ 05. RESULTS: A total of 4116 adolescents participated in the study. A high proportion of respondents had little knowledge (70%), positive attitude (80%), and moderate practice (60.4%) towards Ecstasy. In addition, findings revealed a significant relationship between knowledge-attitude and attitude-practice with respect to Ecstasy use (Spearman correlation coefficient, rs=0.760, p=0.003). CONCLUSION: Considering adolescents' improper KAP toward Ecstasy, it is obvious that there is a need for appropriate educational interventions to inform adolescent girls regarding the harmful effects of Ecstasy.