The effects of a Namaste care program on quality of life: A pilot study in Iranian women with late-stage Alzheimer's disease.

The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings.

Accreditation of nursing clinical services: Development of an appraisal tool.

Aim: This study aimed to determine comprehensive and applicable indicators for assessing the quality of nursing clinical services. Design: Methodological research. Methods: The checklist was designed in three phases (conceptualization, item generation and item reduction). In the first phase, a qualitative study using conventional content analysis was performed to clarify the concept of accreditation of clinical nursing services. In the second phase, using the views of experts was obtained in phase 1 and then by a review of the literature, related items were extracted, and item pool was formed. In the last phase, validity and reliability of the checklist were examined. Result: Based on three phases (Conceptualization, Item Generation and Item Reduction), the accreditation indicators of clinical nursing services were extracted in three dimensions including structure, process and outcome at two levels of organizational (including structural and outcome indicators) and individual performance appraisal (process indicators) in 19 main categories.

Older adults' self-advocacy in patient safety: a cross-sectional study.

BACKGROUND: patient advocacy is a major nursing role, which is linked to supporting, encouraging and reinforcing self-advocacy in patients. Patient safety is an important nursing outcome, especially in older adults. AIMS: older adults' self-advocacy regarding patient safety behaviour and its relationship with some demographic characteristics were assessed. METHODS: a valid older adult patients' self-advocacy questionnaire, which included subscales of behaviour, self-efficacy, attitude and outcome efficacy (range of scores=0-63), was used. In this cross-sectional study, 230 patients aged over 60 years were selected using a stratified sampling method. FINDINGS: an association was found between total self-advocacy score (mean=40.16; SD=9.6) and rural living (ß=-0.168; P=0.016) using multiple linear regression analysis. Similar findings were found between questionnaire subscales and sex, rural living, occupation and age. CONCLUSION: older adults, especially women, those of advanced age and those in rural areas, may benefit from nursing interventions to improve their self-advocacy in patient safety.

Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study.

BACKGROUND: Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services. METHODS: The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire. RESULTS: In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance. CONCLUSION: Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses.

BACKGROUND AND PURPOSE: Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran. METHODS: Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed. RESULTS: Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication." IMPLICATIONS FOR PRACTICE: Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

BACKGROUND: Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. METHODS: Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. RESULTS: We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. CONCLUSIONS: We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

Motherhood challenges and well-being along with the studentship role among Iranian women: A qualitative study.

This study purposed to explore and describe the experiences of Iranian female students with the role of motherhood. This 2015 qualitative study used purposeful sampling to select 20 student mothers aged 24-50 who were studying at a state or non-state university in an urban area in northwest Iran. Data was collected through individual semi-structured interviews and analysed using a qualitative content analysis approach. Three main themes were developed during data analysis: "simultaneous management", "facilities", and "barriers". The management of maternal and family affairs by female students in universities where motherhood is not supported is a challenge. The significance of mother-student roles must be emphasized and support and education provided for women to gain skills useful in playing these roles. Policy makers should devise strategies for bringing change to the traditional perspective that motherhood and educational responsibilities cannot be met at the same time by one person.

The assessment of safe nursing care: development and psychometric evaluation.

AIM: To develop an instrument for the assessment of safe nursing care (ASNC) within the Iranian context and psychometrically evaluate its reliability and validity. BACKGROUND: There is a need for a valid and reliable instrument to assess how nurses employ the components of safe nursing care in clinical practice in non-Western countries. METHOD: This methodological study was conducted in two phases: (1) a qualitative phase of instrument development, and (2) a quantitative phase of psychometric evaluation of the assessment of safe nursing care (ASNC). The instrument's content validity was assessed by experts in the field of safe nursing care. The reliability of this instrument was examined using internal consistency reliability and intra-rater reliability analysis. Exploratory factor analysis was then conducted to establish the instrument's initial construct validity. RESULTS: The instrument developed was a questionnaire with 32 items. The Cronbach's alpha of the scale was 0.92, and Intra-class Correlation Coefficient for intra-rater reliability was 0.78. Exploratory factor analysis resulted in a four-factor solution: (1) evaluation of nursing skills, (2) assessing the patient's psychological needs, (3) assessing the patient's physical need, and (4) Assessing nurses' teamwork. The four factors accounted for 63.54% of the observed variance. CONCLUSION: The ASNC can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of safe care, and its initial reliability and validity. IMPLICATIONS FOR NURSING MANAGEMENT: The ASNC can help nurse managers assess whether clinical nurses are prepared to apply their safe care skills in clinical practice. It can also be used by clinical nurses to assess their own and peers' practice to detect potential areas for improvement in nursing care and help nurse managers with planning appropriate quality improvement programmes.

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.

Iranian nurses perspectives on assessment of safe care: an exploratory study.

AIM: To explore the perspectives and experiences of nurse instructors and clinical nurses regarding the assessment of safe nursing care and its components in clinical practice. BACKGROUND: Safe nursing care is a key aspect of risk management in the healthcare system. The assessment of safe nursing care and identification of its components are primary steps to establish patient safety and risk management and enhance the quality of care in clinical practice. METHODS: This was an interview study, with qualitative content analysis. Semi-structured interviews were conducted with 16 nurse instructors and clinical nurses including nurse managers chosen by purposive sampling based on theoretical saturation. Data collection and analysis were carried out simultaneously until data saturation was reached. RESULTS: Data analysis led to the extraction of four main themes: holistic assessment of safe nursing care; team working and assessment of safe nursing care; ethical issues; and challenges of safe nursing care assessment. CONCLUSION: Identifying these four components in the assessment of safe nursing care offers a contribution to the understanding of the elements of safe care assessment and the potential for improved patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: Safe care management requires the accurate and reliable assessment of safe nursing care and the need for strategies for reporting actual or potential unsafe care and errors to ensure patient safety.

Cardiac patients' perception of patient-centred care: a qualitative study.

AIM: The aim of this study was to explore cardiac patients' perception of patient-centred care. BACKGROUND: Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction. DESIGN: This study is a descriptive qualitative study. METHODS: Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews. FINDINGS: The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions. CONCLUSIONS: Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care. IMPLICATIONS FOR PRACTICE: Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care.

Professionalism in Iranian Nursing: Concept Analysis.

PURPOSE: The present study was conducted with the aim of clarifying and reducing the semantic ambiguities around the concept of professionalism. METHODS: The concept analysis method of Walker and Avant was used. FINDINGS: The analysis demonstrated that professionalism in nursing consists of three main pillars: principles of care, communication, and ethics. CONCLUSIONS: Given that the process of professionalism in nursing may have positive outcomes for the nurse, the nursing profession, and the health system of the community, these items have been attended to. IMPLICATIONS FOR NURSING PRACTICE: The present concept analysis can open the way to conducting more extensive research and devising tools to identify the barriers, facilitators, and administrative arrangements by clarifying the concept.

Iraqi Nurses' Perspectives on Safety Issues in Maternity Services.

BACKGROUND: Studies introduce maternal and neonatal safety phenomena as important challenges to the public health, particularly in low-income countries. However, few researches are conducted on the identification of safety issues in maternity hospitals in Iraq. It was the first study on nurses' perspectives on safety issues in Kurdistan, Iraq. OBJECTIVES: The current study aimed to describe nurses' perspectives on what constitutes a safe maternity service in Kurdistan, Iraq. PATIENTS AND METHODS: A qualitative design, based on a content analysis approach, was used. Ten Kurdish nurses who worked in the delivery room of Kurdistan, Iraq maternity hospital were recruited through purposive sampling. Semi-structured interviews were performed to collect data. All interviews were audiotaped and transcribed verbatim. Sampling continued to the level of data saturation. Data analysis was performed based on the steps suggested by Graneheim and Lundman. RESULTS: Thematic analysis led to the identification of six main categories including stressful job, lack of schedule and job description, providing care with limited resources, professional unaccountability, regional sociopolitical factors, and inadequate training. CONCLUSIONS: Iraqi nurses identified factors such as limited health resources, lack of job description, and professional unaccountability as major safety issues in maternity services. These findings alarm the need to ensure the provision of females and neonates with appropriate care. This, however, would require coordination between Iraqi Kurdistan health authorities to provide midwifery care facilities, high-quality and relevant staff training, and an effective healthcare system in the maternity units.

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.

Nurses' Clinical Judgment Development: A Qualitative Research in Iran.

BACKGROUND: Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion. OBJECTIVES: In this study we explored the process of Iranian nurses' development in clinical judgment. PATIENTS AND METHODS: This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method. RESULTS: The study participants' main concern was 'being non-professional in clinical judgment'. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was 'struggling for becoming professional in clinical judgment development'. When nurses were supported professionally, they were able to develop their professional clinical judgment. CONCLUSIONS: The findings of this study provided critical information about nurses' professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses' clinical judgment ability.

Nursing students' expectations regarding effective clinical education: a qualitative study.

This study aimed to describe the expectations of Bachelor of Science nursing students regarding what constitutes an effective clinical education. In this study, a semistructured interview process was utilized with 17 nursing students studying in sophomore, junior and senior years in training units of hospitals affiliated with Tehran University of Medical Sciences. Content analysis was employed to analyse the data. Data analysis led to identification of three main themes: (i) appropriate communication and interaction between instructors and students; (ii) incorporation of both theory and practice in clinical education, with two subthemes, one being the presence of the instructor as a factor for reducing the gap between theory and practice and the other being evaluation based on appropriate criteria; and (iii) having specialized instructors, with a specific emphasis on the instructor's knowledge and motivation as important factors in learning. The findings reveal the significant role of mentors in providing effective educational and clinical experiences. Therefore, mentors must strive to develop their knowledge and clinical behaviours according to students' needs in clinical settings.

Futile care; concept analysis based on a hybrid model.

BACKGROUND: Making decision about what kind of caring is entitled as futile care requires the presentation of a clear definition of such caretaking. OBJECTIVE: To report an analysis of the concept of futile care. DESIGN: The analysis in this research was carried out through hybrid model in three stages. At the theoretical stage:  a review of the available literature. At the work-in-field stage: semi-structured interviews. SETTING: Data collection was on cancer unit and palliative care unit. PARTICIPANTS: A total of 7 participants were recruited in the study. The inclusion criteria were: having at least a bachelor's degree in nursing, having at least 5 years of experience in critical care or cancer units, and being willing to participate in the study. RESULTS: Three themes emerged: "low quality of life", "lack physiologic return to life" and "performing non-professional duties". CONCLUSION: Futile care consists giving clinical cares irrelevant to a nurse's job and giving cares through which the return of patient would be impossible both physiologically and qualitatively.

Probing concept of critical thinking in nursing education in Iran: a concept analysis.

PURPOSE: Given the wide disagreement over the definition of critical thinking in different disciplines, defining and standardizing the concept according to the discipline of nursing is essential. Moreover, there is limited scientific evidence regarding critical thinking in the context of nursing in Iran. The aim of this study was to analyze and clarify the concept of critical thinking in nursing education in Iran. METHODS: We employed the hybrid model to define the concept of critical thinking. The hybrid model has three interconnected phases--the theoretical phase, the fieldwork phase, and the final analytic phase. In the theoretical phase, we searched the online scientific databases (such as Elsevier, Wiley, CINAHL, Proquest, Ovid, and Springer as well as Iranian databases such as SID, Magiran, and Iranmedex). In the fieldwork phase, a purposive sample of 17 nursing faculties, PhD students, clinical instructors, and clinical nurses was recruited. Participants were interviewed by using an interview guide. In the analytical phase we compared the data from the theoretical and the fieldwork phases. RESULTS: The concept of critical thinking had many different antecedents, attributes, and consequences. Antecedents, attributes, and consequences of critical thinking concept identified in the theoretical phase were in some ways different and in some way similar to antecedents, attributes, and consequences identified in the fieldwork phase. Finally critical thinking in nursing education in Iran was clarified. CONCLUSION: Critical thinking is a logical, situational, purposive, and outcome-oriented thinking process. It is an acquired and evolving ability which develops individually. Such thinking process could lead to the professional accountability, personal development, God's consent, conscience appeasement, and personality development.

Parents' participation in taking care of hospitalized children: A concept analysis with hybrid model.

BACKGROUND: Although today parents' participation in taking care of hospitalized children is considered as an indispensable principle, it is still among the concepts with no consensus about. The main objective of this study is to define parents' participation in taking care of hospitalized children. MATERIALS AND METHODS: The concept of "parents' participation in taking care of hospitalized children" was analyzed using a hybrid model in three phases: Literature review (theoretical phase), fieldwork, and combination of literature review and fieldwork (analytical phase). RESULTS: Based on the results of theoretical (literature review), fieldwork, and analytical phases, the best definitions for the concept of "parents' participation in taking care of hospitalized children" are mutual relationship and gaining parents' trust toward nurses, giving the required information and education to the parents about care and treatment process, assigning the needed home care to the parents, involving the parents in caregiving process, and finally, defining their participation in decision making (clarifying the parents' role) in order to improve the quality of care given to the children. CONCLUSIONS: The findings of this study showed that the dimensions of parents' participation can be applied in pediatric wards, and nurses can improve the quality of care through application of the obtained findings.