Improving self-management and diabetes indicators in adolescents with type 1 diabetes through self-care education.

Introduction: The frequency of type 1 diabetes (T1D) as one of the most prevalent endocrine disease in adolescents is increasing globally. This type of diabetes is a progressive degeneration ß cells of the islets of Langerhans, which decreases insulin production and causes permanent dependence on insulin injection. It is essential to control diabetes in adolescents and increase awareness about the effective factors (self-care) on the health of adolescents with diabetes. Therefore, this study aimed to evaluate the effect of self-care training intervention on self-management subscales and some diabetes indicators (glycosylated hemoglobin level and fasting blood sugar) in adolescents with T1D. Materials and Methods: This study was conducted on 50 adolescents with T1D, who were referred to the Diabetes Clinic of Golestan Hospital, aged 12 to 18 and selected for this semi-experimental intervention and case-control study by the census. Six one-hour self-help sessions were held for adolescents and their parents. The data collection tools were the Adolescent Self-Care Questionnaire and the Diabetes Index Form for T1D (SMOD-A), used before and three months after the intervention. Chi-square, t-pair tests, and SPSS software version 23 were utilized for statistical data analysis. Results: There was no significant difference between the case and control group regarding gender, age, race, course of the disease, education level, and family history of diabetes (P = 0.771, 0.551, 0.074, and 0.111, respectively). Three months after the intervention, a significant increase was observed in all subscales of self-management and total self-management (P < 001), and a significant decrease was seen in fasting blood sugar (P = 0.001) and glycosylated hemoglobin changes (P = 0.001). Conclusion: Based on the results, training adolescents through a T1D self-care program effectively improved their overall and subscale self-management and reduced fasting glucose and HbA1c levels.

Needs Assessment and the Identification of Palliative Care Dimensions of the Essential Service Package for the Elderly with Alzheimer's Disease: A Mixed Exploratory Study.

AIM: This study was conducted with the aim of assessing the needs and determining the care dimensions of the essential palliative care service package for the elderly with Alzheimer's disease. METHOD: The mixed exploratory study was conducted in three phases. The first phase of the study was conducted in the form of a qualitative study and a literature review. This qualitative research was done through in-depth and semi-structured interviews with 19 qualified caregivers (11 informal caregivers and 8 formal caregivers) The samples were selected using the purposive sampling method by referring to hospitals, nursing homes, and active branches of the Alzheimer's Association in some provinces. In the second phase, the dimensions of palliative care were codified, and in the third phase, the prioritization and the validation of the dimensions of palliative care were performed in the form of two Delphi rounds. RESULTS: Based on the results of the first phase of the study, the care dimensions of the service package were placed in eight categories based on National Consensus Project. In the second phase, the needs of Alzheimer's patients were arranged in the form of a questionnaire consisting of 8 parts, with 180 indicators. Then, in the third phase, the dimensions of the palliative care essential package were designed with 74 items in the form of 4 dimensions. CONCLUSION: The dimensions of the essential service package of palliative care included a series of interventions as well as physical, psychological, cognitive, and spiritual support.

Challenges in implementation of patient-centred care in cardiac care unit: A qualitative study.

AIM: This study aimed to explore the barriers to the implementation of patient-centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. DESIGN: This study was performed with a descriptive qualitative study approach. METHODS: In this study, the data were collected through face-to-face in-depth semi-structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. RESULTS: After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.

Effective strategies for implementing patient-centered care in cardiac care unit: An opportunity for change.

BACKGROUND: Patient-centered care (PCC) is a cornerstone for health-care professionals to improve the quality of care they provide to patients with cardiac disease. However, implementation of PCC programs has always accompanied with unpredictable challenges and obstacles. Therefore, the present study was conducted to determine effective strategies for the implementation of PCC from the perspective of patients and healthcare providers. MATERIALS AND METHODS: The present research was a qualitative study using conventional content analysis method in one of the university hospitals of Abadan University of Medical Sciences during 2019-2020. Purposive sampling was performed until data saturation was achieved. Data were collected through four focused group discussions and 24 in-depth semi-structured interviews with 22 health-care providers and seven cardiac patients. Depending on the interview process and the responses of each individual, the sequencing of questions was different from one participant to another. Data analysis was performed continuously and concurrently with data collection, using a comparative method. RESULTS: After data analysis, seven subcategories and three main categories were extracted. The main categories included structural, process, and outcome strategies. The category of structural strategies included subcategories of nursing care organization, application of appropriate motivational mechanisms, and expansion of team coordination. Process strategies included three subcategories, namely, promoting communication, respectful and compassionate care, and the development of holistic care. Finally, the outcome strategy consisted of the subcategory of patient empowerment. CONCLUSION: The practical strategies for the implementation of PCC in coronary care unit revealed in this study were at structural, process, and outcome levels. Health-care managers and administrators can avail themselves of the findings of the present study to promote the quality care for cardiac care unit patients and improve patient satisfaction.

Explore the Bereavement Needs of Families of Children With Cancer From the Perspective of Health Caregivers: A Qualitative Study.

Introduction: The experience of bereavement is associated with severe physical, psychological, social and spiritual reactions in the parents of children with cancer. Because of that, the families of these children need to receive bereavement services. The aim of this study was to explore the bereavement needs of families of children with cancer from the perspective of health caregiver as people who have a close relationship with the child and the family. Methods: This qualitative descriptive study design in. In total 15 semi-structured interviews were conducted using a purposive sampling in 2018. Interviews were recorded and transcribed and conventional content analysis was used to analysis the data. The Trustworthiness of the data were assessed according to the criteria of Lincoln and Guba. Results: From the data analysis, needs of the bereaved family were categorized in three dimension including "achieving peace," "Abandoned family access to care," and "continuing care." The category of "achieving peace" includes spiritual and existential support, companionship with the family, contact with other bereaved families, support in passing and accepting the bereaved and continuing empathetic communication with the family, the category "Abandoned family access to care" includes the promotion of family self-control, awareness of end-of-life care to the family, and the category of "continuing care," includes formal and informal family care and individualized care. Conclusion: It is necessary for the care team to pay special focus to family considering the needs of the family about the death of the patient and the challenges of the family bereavement period. It is recommended that members of the health care team should be trained in assessing family needs, identifying risks of adverse outcomes, continuing care, and providing resources during bereavement. The needs of the bereaved family should also be addressed in their care plan.

Explain the Experience of Family Caregivers Regarding Care of Alzheimer's Patients: A Qualitative Study.

Introduction: Due to the long-term and progressive nature of Alzheimer's disease, these patients need caregivers who will be responsible for their long-term care and who may then experience an increasing burden related to the progressive disease course, so it is important to understand the experiences of caregivers. The aim of this study was to explain the experience of family caregivers regarding care of Alzheimer's patients. Methods: The present qualitative study employed a conventional content analysis approach and was conducted in Iran in 2020. This research was done through in-depth and semi-structured interviews with 11 qualified caregivers enrolled in a purposive sampling method. Interviews continued until data saturation. Data analysis was performed simultaneously with data collection. Interviews were recorded, transcribed and analyzed through Graneheim and Lundman style content analysis and data management was done with MAXQDA software. In order to achieve the accuracy and validity of the study, the Four-Dimensions Criteria (FDC) by Lincoln and Guba, credibility, dependability, confirmability, and transformability were considered and used. Results: A total of 11 caregivers with mean age and standard deviation 48, ±26.12 participated in the study. The acquired data were put in two main categories of "burnout and exhaustion" with six subcategories and "excellence and personal growth" with three subcategories. Conclusion: In this study, we found that perceptions of caregivers' role were not the same among study participants, who experienced both positive and negative dimensions of care provision to AD patients. The care experience has a spectrum that, in some people, leads to positive outcomes such as growth. A major part of caregiver challenges is related to the burden of caregiving strain and the erosive nature of the disease. Therefore, health planners should identify the challenges, pain and suffering of caregivers and seek to address them through appropriate strategies.

Explaining Caregivers' Perceptions of Palliative Care Unmet Needs in Iranian Alzheimer's Patients: A Qualitative Study.

Introduction: The needs of Alzheimer's patients are very complex and diverse and many of them are considered unmet needs. Understanding and responding to the unmet and complex needs of Alzheimer's patients can affect the quality of care. Therefore, the present study aimed to explain the perception of formal and informal caregivers of the unmet needs of Iranian Alzheimer's patients. Methods: The present qualitative study employed a Directed Content Analysis approach and was conducted in Iran in 2020. This research was done through in-depth and semi-structured interviews with 19 qualified caregivers enrolled (11 informal caregivers and 8 formal caregivers) with the mean age of 46.05 ± 10.98 years in a purposive sampling method. Interviews continued until data saturation. Data analysis was performed simultaneously with data collection. After recording and transcribing, the data were analyzed using the Elo and Kyngas method based on the National Consensus Project framework (NCP). Data management was done with MAXQDA software. In order to achieve the accuracy and validity of the study, the criteria presented by Lincoln and Guba Credibility, Dependability, Confirmability, and Transformability were considered and used. Results: The mean age of participants was 46.05 ± 10.98. Participants in this study acknowledged that Alzheimer's patients need comprehensive needs management with a holistic approach to increase quality of life. This theme based on the NCP framework consists of seven main categories including "Structure and processes of care," "Physical aspects of care," "Psychological and psychiatric aspects of care," "Social aspects of care," "Cultural aspects of care," "Care of the patient nearing the end of life," and "Ethical and legal aspects of care" with 16 subcategories. Conclusion: The findings of this study provide a deep understanding of the unmet needs of Alzheimer's patients in Iran. Identifying the unmet needs of patients can pave the way for the treatment team to provide effective solutions to meet the needs and empower caregivers to provide comprehensive care for patients.

Stressors in open-heart surgery patients: A qualitative study.

BACKGROUND: Open-heart surgery is a stressful experience for the patients and their families. From the moment that patients are told they must undergo surgery until discharge, they experience different degrees of worry and nervousness. This study was conducted with the aim of identifying stress factors in heart surgery patients. METHODS: This study was performed using a qualitative method on 21 participants (14 patients and 7 caregivers). The research environment was open-heart surgery wards of two educational hospitals in Ahwaz (south of Iran) in 2017. The participants were selected through purposive sampling. The data were collected through semi-structured interviews, and then, analyzed using the qualitative approach of content analysis proposed by Graneheim and Lundmnan (2004). RESULTS: The 5 themes of "physical stressors", "self-care stressors", "psychological stressors", "religious stressors", and "hospital stressors" were obtained. These themes were the result of the patients' experiences and dimensions of patients' perceptions regarding stressors in open-heart surgery. CONCLUSION: Stress in patients undergoing open-heart surgery is a contextual and relative concept and a subjective experience, which is experienced as a sense of worry. Identifying and clarifying stressors in open-heart surgery patients for nurses is vital, like a key for improving care quality. Nursing managers in clinical practice can also benefit from these findings regarding heart surgery in improving the care quality and professional performance of nurses.

A Comparison of Symptom Management for Children with Cancer in Iran and in the Selected Countries: A Comparative Study.

AIM: The aim of this study is to describe the experiences of other countries regarding the status of pediatric palliative care in the field of symptom management and to compare it with the current status in Iran to achieve an appropriate level of symptom management for children with cancer. MATERIALS AND METHODS: This is a comparative study. The research population includes the palliative care systems of Jordan, England, Australia, and Canada, which were ultimately compared with Iran's palliative care system. RESULTS: The results showed that in the leading countries in the field of palliative care, such as Australia and Canada, much effort has been made to improve palliative care and to expand its service coverage. In the UK, as a pioneer in the introduction of palliative care, a significant portion of clinical performance, education and research, is dedicated to childhood palliative care. Experts in this field and policymakers are also well aware of this fact. In developing countries, including Jordan, palliative care is considered a nascent specialty, facing many challenges. In Iran, there is still no plan for providing these services coherently even for adults. CONCLUSION: Children with cancer experience irritating symptoms during their lives and while they are hospitalized. Regarding the fact that symptom management in developed countries is carried out based on specific and documented guidelines, using the experiences of these successful countries and applying them as an operational model can be useful for developing countries such as Iran.

Self-perception in Iranian adolescents with diabetes: a qualitative study.

BACKGROUND: It is obvious that self-perception can play an important role in the development of self-management behaviours among adolescents with diabetes to promote their health and quality of life. This study seeks to explain self-perception in adolescents with diabetes. METHOD: This qualitative study, which is of "grounded theory" type, was performed in 2013 in Ahvaz, Iran, through semi-structured interviews with ten adolescents with type 1 diabetes, two parents and a nurse, who were chosen objectively. Data analysis was performed using Strauss and Corbin 1998 method. RESULTS: Four main theme was obtained from the analysis of data, and the consequence theme was inferred as follows: getting insight (knowledge acquisition and belief management), perceiving similarities with others (not hiding the disease, showing the illness is normal, and accepting an active role in the family), and self-care management (independent control of food and treatment regimen and understanding of capabilities to manage the future of life and manage the daily activities of life), and life satisfaction (perception of being healthy and having a normal life). CONCLUSION: Getting insight into the disease is the most important part of perceiving similarities with others and offering self-care, which can provide a person's positive perception of himself/herself and the illness, as well as life satisfaction for their adolescent over time. These results are an operational guide for personnel providing health care services, especially diabetes specialist nurses.

Supporting adolescents with type 1 diabetes mellitus: a qualitative study.

Without sufficient support, type 1 diabetes mellitus often disturbs patients' normal lives. This study describes and explores the support that Iranian adolescents with type 1 diabetes mellitus experienced. Semistructured interviews were conducted with ten adolescents, seven family members, one dietitian, one nurse, and one school nurse. Participants were chosen using purposive sampling from two teaching hospitals and one high school in two urban areas of Iran. Using standard procedures for content analysis, three main themes were identified: maintaining a normal life; receiving tangible, informational, and emotional support from the family and society; and advancement of life toward normalization. The cornerstone of maintaining a normal life for adolescents with type 1 diabetes mellitus is to adopt an active role in taking care of themselves within their systems of support.

Effect of local refrigeration prior to venipuncture on pain related responses in school age children.

INTRODUCTION: Painful medical procedures are the major sources of distress among children; and for those with chronic diseases, the procedure-related pain can be worse than that of the illness itself. OBJECTIVE: The purpose of the study was to determine the effect of local refrigeration prior to venipuncture on pain-related responses in school-age children. DESIGN: Quasi-experimental study. SETTING: This study was undertaken in a paediatric emergency ward of a paediatric centre. SUBJECTS: The subjects were 80 children 6 to 12 years of age selected by purposive sampling after being referred to the paediatric emergency ward. INTERVENTIONS: Two groups were chosen for the study: the test and control groups, in order to test the effect of local coldness in reducing the pain of venipuncture. In the test group, the injection site was refrigerated for three minutes using an ice bag. In the control group, the procedure was performed according to usual routine. Physiological responses (ie. blood pressure, pulse, and respiration), behavioural responses (using the Children's Hospital of Eastern Ontario Pain Scale: CHEOPS), and subjective responses (or intensity of pain using the Oucher scale) were measured in the two groups. A non-invasive (electronic) sphygmomanometer was used before and 5 minutes after the procedure to measure the physiological responses. The measurement of behavioral responses by CHEOPS was done at two time points (during the procedure and 5 minutes after the procedure), measuring six areas of behavior: cry, facial expressions, child verbal, torso, touch and leg movement in reaction to painful stimulation. Finally, the subjective responses were measured at 5 minutes after the procedure. MAIN OUTCOME MEASURES: In this study the main outcome measures were: range of physiologic responses, and scores of behavioral and subjective responses. The study hypothesised there would be a lower score in the test group than the control group in behavioural and subjective responses and a lower range in physiologic responses. RESULTS: Results showed no significant difference between the two groups for physiological responses (before and after procedure). However behavioural responses during and after the procedure (p = 0.0011), and subjective responses after the procedure (p = 0.0097) were significantly lower (ie. the test group had lower scores in behavioural and subjective responses compared to the control group. CONCLUSION: The results of this study suggest that the use of local refrigeration prior to venipuncture can be considered an easy and effective intervention of reducing venipuncture-related pain.