The Association between Caring Behavior and Death Anxiety among Iranian Nurses Working in Covid-19 Wards.

Introduction: Nurses who are at the forefront of the fight against Covid-19 have faced problems such as anxiety and stress due to the high contagiousness of this disease and the challenges of providing services to infected patients. Death anxiety and the resulting fear following the Covid-19 pandemic can affect caring behaviors and the quality of nursing care services. Objective: The present study was conducted with the aim of determining the association between caring behaviors and death anxiety among Iranian nurses working in COVID-19 wards. Methods: This cross-sectional study was conducted in 2021 in Tehran. The participants consisted of 233 nurses who were purposively selected from university hospitals in Iran. Data collection tools included Demographic Information Form, Death Anxiety Scale, and Caring Dimension Inventory (CDI-25). Data analysis was done using SPSS (version 16). Results: Most of the participants were female (79.4%), had less than 5 years of work experience (50.6%), and had bachelor's degree (88.8%). Based on the results, the level of death anxiety among nurses was moderate (7.05 ± 3.85) and their caring behavior was at optimal level (103.03 ± 13.15). Among the subscales of caring behavior, physical-technical behaviors with mean of 46.43 ± 6.20 got the highest score, and unnecessary behaviors with mean of 4.39 ± 0.73 got the lowest score compared to other subscales. Based on data analysis findings, caring behavior and its dimensions had no significant correlation with nurses' death anxiety (p = 0.111). Conclusions: Our results showed that despite having a moderate level of anxiety, nurses try to provide good care behaviors to patients with covid-19. However, reducing nurses' anxiety can improve caring behaviors.

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

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

Barriers to Self-Care Planning for Family Caregivers of Patients with Severe Mental Illness.

The chronic nature of severe mental illnesses is necessary for constant care provided by the family caregivers. Considering the significance of family caregivers in providing care, it is imperative to ensure their self-care if they are to play the role of caregiving effectively and efficiently well. The present study was conducted using the purposive sampling method and in-depth semi-structured interviews among 13 family caregivers and five health team members. The data were analyzed via a conventional content analysis approach. In the data analysis, seven main categories and 18 subcategories emerged: "A troublesome patient and me," including "Care-induced distress," "Caring dilemma," "Emotional fluctuations," and "Self-forgetfulness"; "Passive-destructive individuality," including: "Mental stereotypes" and "Unhealthy lifestyle"; "Family turbulence," including: "Family malfunction" and "Break in family ties"; "The conjoined influencing social factor," including "Lack of awareness at the family and community level" and "Social stigmatization"; "lack of well-organized health care system," including "Biomedical-oriented health system," "Disruption in continuity of care," and "Problems associated with the support provided by the health system"; "Disturbed economic conditions," including "Difficulty in life with disrupted financial capability," "Problems related to education and promoting awareness," and "Family health care problems"; "Dysfunctional Public mental health," including "Macro-dysfunction of mental health education," and "Disruptive advocacy activities to support families of patients with mental disorders." There are several barriers to family caregiver self-care planning that require health professionals to develop appropriate interventions.

Nurses' Knowledge, Attitudes, and Practice in Relation to Pharmacovigilance and Adverse Drug Reaction Reporting: A Systematic Review.

AIM: To describe and synthesize aspects of knowledge, attitudes, and practice regarding pharmacovigilance and adverse drug reaction (ADR) reporting and to explore associated barriers from a nurse perspective. METHODS: A systematic review was conducted. Electronic databases including MEDLINE, Embase, Scopus, and Web of Knowledge from January 2010 to October 2020 were searched. Original observational studies that were written in English and which focused on nurses' knowledge, attitudes, practice, and perceived barriers regarding pharmacovigilance and ADR reporting in various healthcare settings were included. RESULTS: Twenty-three studies published in English from 2010 to 2020 were retrieved during the search process. Overall, in the knowledge domain, the median percentages of nurses who were aware of the definitions of ADRs were 74.1%, while only 26.3% were aware of the adverse drug reaction reporting form. In the attitude domain, 84.6% of nurses believed ADR reporting to be important for patient/medicine safety and 37.1% had a fear of legal liability following ADR reporting. Although 67.1% of nurses encountered ADRs during their professional life, only 21.2% had a history of ADR reporting. In addition, lack of knowledge/training (median: 47.1%) was identified as the most common barrier in ADR reporting from a nursing viewpoint. CONCLUSION: Despite positive nurse attitudes, knowledge and practice in relation to pharmacovigilance activities and ADR reporting did not occur regularly or often. Improving nurses' knowledge through in-service training and degree-level education and addressing the main barriers of ADR reporting may help to achieve an improved level of reporting.

Struggle Turning Back to Professional Nursing Practice in Iran: A Qualitative Study.

BACKGROUND: Current nursing shortage is becoming more complicated because of turnover intention among nurses. Most of the inactive nurses in Iran after a long time for various rations Returned To Professional Nursing Practice (RTPNP). Because the RTPNP program does not exist in Iran to prepare inactive nurses returning to practice, this study aimed to explore the strategies that contribute to preparing nurses for RTPNP. MATERIALS AND METHODS: The present study was a part of the findings of a larger grounded theory study that lasted about 9 months from April 2019 to December 2019. The data were collected through semi-structured interviews with participants after signing an informed consent form. The average interview duration was 40 minutes. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Participants included eight nurses, two education supervisors, two matrons, and two head nurses. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method. RESULTS: Struggle turning back to PNP was the main category that emerged from four categories of "seeking learning resources," "return to practice support," "getting used to a practice," and "building a new family life" from the data analysis process. CONCLUSIONS: Returners struggle to get prepared for providing PNP to clients if there is no definite process of RTPNP. Organizational support and RTPNP programs are efficient strategies and could help these returners get prepared for PNP.

The effect of the virtual social network-based psycho-education on the hope of family caregivers of clients with severe mental disorders.

Psycho-education may have a positive effect on family caregivers of clients with mental disorders, and promote positive psychological states such as hope. The present study aims to investigate the effect of virtual social network-based psycho-education on the hope of family caregivers of clients with severe mental disorders. This study is a quasi-experimental research with a control and experimental groups. The participants of the study were 72 family caregivers of clients with severe mental disorders (36 in each group). Data were collected using demographic questionnaire and Adult Hope Scale before the study, immediately after the end of the training (first post-test), and 4 weeks afterwards (second post-test). The experimental group received psycho-education through Telegram App for four weeks. The results of the demographic questionnaire showed that both groups were homogeneous. The results of the Adult Hope Scale indicated that the mean score of both control and experimental groups were statistically significant and increased in the experimental group (P < 0.001). In addition, the changes of hope score in the experimental group were statistically significant in the first post-test than the pre-test, and in the second post-test than the first post-test and pre-test (P < 0.001). The findings of this study suggested that virtual social network-based psycho-education promotes the hopes of the family caregivers of clients with severe mental disorders. Due to the low cost and fast access of people to virtual networks, the content of this educational program can be widely used for family caregivers.

A path analysis model of spiritual well-being and quality of life in Iranian cancer patients: a mediating role of hope.

PURPOSE: Maintenance of quality of life (QOL) is vital for adaptation to life-threatening and chronic illnesses such as cancer. Therefore, the evaluation and strengthening of personal psychological resources that support QOL for patients with cancer is paramount. This study investigated the potential mediating role of hope in the relationship between spiritual well-being and QOL in Iranian cancer patients. METHODS: A correlational predictive design was used with 200 patients with varying types and stage of cancer. Demographic and health characteristic surveys, spiritual well-being (SWB), adult hope, and EORTC QLQ-c30 scales were used for measuring the study constructs. Path analysis modeling was used to determine mediation relationships. RESULTS: Patients' QOL was affected by SWB and hope. Religious (ß = 0.205, p = 0.002) and existential (ß = 0.286, p < 0.001) SWB dimensions and hope (ß = 0.263, p < 0.001) improved QOL scores. The presence of hope partially mediated the relationship between SWB and QOL. CONCLUSION: Quality of life was directly affected by SWB and was further improved by the presence of hope. The study suggests that maintenance of hope is essential to QOL in Iranian patients with cancer.

Exploring the process of turning back to professional nursing practice in Iran: A grounded theory.

BACKGROUND: The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost-effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice. MATERIALS AND METHODS: This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi-structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method. RESULTS: In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The "transformed competence" as the core concept and the four main concepts of "feeling alienated with the new environment," "getting prepared for restart," "gradual maturity in clinical practice," and "components of organizational culture" were extracted from the data analysis process. CONCLUSION: The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

Promoting patients health in intensive care units by family members and nurses: A literature review.

BACKGROUND: Hospitalization in intensive care units (ICUs) can cause physiological and psychological challenges for patients and their family members. Using a family-centered approach in provision of visiting hours promotes the health of patients. The purpose of this study is to review the perception of nurses and family members of patients in ICUs about visiting their patients. METHODOLOGY: The published articles in the last 10 years from 2008 to 2018 on the perception of nurses and family members of patients in critical care units about visiting their patients searched for in databases including ScienceDirect, PubMed, Cochrane, Google Scholar, SID, Scopus, CINAHL, OVID, IRANDOC, and Magiran using keywords "family members perception," "nurses' perception," "intensive care units," and "visiting" in English and Farsi, and finally, 15 articles were selected. RESULTS: Results showed that nurses do not have appropriate viewpoint about visiting patients in ICUs, and they discussed and outlined the barriers of visiting patients given the benefits of family members' presence. CONCLUSION: There are several limitations on the process of family members visiting their patients in the ICUs. It is essential to modify the nurses' attitudes and remove the organizational limitations in this area.

Happiness Strategies for Older Adults: A Qualitative Study.

Ensuring happiness in older adults is critical for their mental health. The purpose of the current study was to identify strategies for creating happiness in Iranian older adults. A qualitative study was performed through content analysis and deep semi-structured interviews with 18 adults age 60 and older and one family member. Participants were selected through purposeful sampling, and data were encoded using MAXQDA. Data analyses revealed 187 codes, 23 subcategories, and four main categories: (a) self-centered strategies, (b) inductive strategies, (c) passive strategies, and (d) unselfish strategies. Following the four categories of strategies may lead to happiness in Iranian older adults. Self-centered strategies seemed to achieve better results given that such strategies can be learned and require involvement of older adults themselves. [Research in Gerontological Nursing, 13(5), 254-263.].

Effect of oral contraceptive pills on rheumatoid arthritis disease activity in women: A randomized clinical trial.

Background: Rheumatoid arthritis is one of the most common autoimmune diseases. Because immunological changes can be induced by steroid hormones, it seems that oral contraceptive pills can affect the severity of the disease. In this study, we examined the effect of oral contraceptive pills on rheumatoid arthritis activity in women. Methods: This blinded randomized clinical control trial was performed in the selected rheumatology centers in Tehran, Iran, in 2011. A total of 100 women with rheumatoid arthritis were included (50 in the intervention and 50 in the control groups), and those in the intervention group took oral contraceptive pills intermittently for 8 weeks. Disease activity was measured at 1 and 9 weeks based on DAS-28, which includes the number of tender joints, number of swollen joints, ESR, and GH. Data were analyzed using SPSS-16, and significance level was set at p≤0.05. This study was registered in IRCT (number: 138904224364N1) and all interventions were done after receiving confirmation from the Ethical Committee of Tehran University of Medical Sciences (Code: 250/ 6441). Results: After administering oral contraceptive pills to the intervention group, we found significant differences between the 2 groups in disease activity and severity scores (p=0.04). Intervention group showed lower swollen joints score (p=0.02), lower joint tenderness score (p=0.02), and lower general health score (p=0.001) than the control group. Conclusion: According to the results of this study, oral contraceptive pills can improve rheumatoid arthritis activity and severity. As these pills are used for contraception, women with rheumatoid arthritis can benefit from both effects of these pills.

Effectiveness of an internet-based education on maternal satisfaction in NICUs.

OBJECTIVE: This study was conducted to evaluate the effect of internet-based education on the satisfaction of the mothers of the preterm neonates in the NICUs. METHODS: This quasi-experimental study was conducted on 80 mothers of preterm neonates hospitalized in the NICUs of two hospitals in Iran during 9 months. The mothers were assigned in two groups as cases and controls. The satisfaction level of the mothers was evaluated by using WBPL-Revised1 in both groups on the first and tenth day of the study. Mothers in the case group received the educational program available at www.iranlms.ir/myinfant for 10days. After 10days, the satisfaction level of the mothers in both groups was measured by questionnaire again. RESULT: the satisfaction of the mothers increased in both groups after this intervention. However, comparison of the mean scores revealed that the satisfaction of the mothers in the case group increased significantly following the intervention (P<0.001). CONCLUSION: Considering the benefits of internet-based education, its utilization in mothers education programs in NICUs is recommended. PRACTICE IMPLICATIONS: The results of this study show nurses in the NICU is a way to improve communication and education to parents of infants hospitalized in NICU.

The effect of narrative writing of mothers on their satisfaction with care in the neonatal intensive care unit.

AIM: This study was conducted to evaluate the effect of narrative writing on the satisfaction of the mothers with care in the neonatal intensive care unit (NICU) during their neonates' hospitalization. MATERIALS AND METHODS: This quasi-experimental study with pretest and posttest were administered to a sample size of 70 mothers with preterm neonates. The Neonatal Index of Parental Satisfaction questionnaire was used. Descriptive and analytical statistics were used for data analysis. RESULTS: The satisfaction level of the mothers was 113.1 ± 17.5 on the 3rd day and 102.3 ± 25.6 on the 10th day of the study in the control group. Paired t-test (p values < 0.011) in the control group showed a significant difference in the satisfaction level of the mothers. In the intervention group, the satisfaction level of the mothers was 107.5 ± 21.5 on the 3rd day and 137 ± 15.2 on the 10th day of the study. Paired t-test (p values < 0.001) showed a significant difference in the satisfaction level of the mothers between the 3rd and 10th day of the study. The results of independent t-test showed a significant difference in satisfaction between the intervention and control groups on the 10th day of the study (p < 0.001). CONCLUSION: We suggest that narrative writing may be considered as an efficient supportive intervention to increase the mothers' satisfaction in the NICUs.

Evaluation of the effect of narrative writing on the stress sources of the parents of preterm neonates admitted to the NICU.

OBJECTIVE: Identification of the nurses' and families' understanding of the stresses in the facilitates nursing interventions and increases parental satisfaction. MATERIAL AND METHODS: The quasiexperimental study with pretest and posttest was administered to a sample size of 70 mothers with preterm neonates hospitalized in the NICUs of two teaching hospitals of Tehran University of Medical during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. RESULTS: Evaluation of the differences in the domains of the questionnaire between the 3rd and 10th day of admission using a multivariate analysis showed that narrative writing had significant effects on all three domains (Roys' largest root = 2.141, F = 47.11, p values < 0.001). The results showed that the highest stress reduction was observed in Infant Behavior and Appearance (-11.847) followed by Sights and Sounds of the Unit (-11.352) while the lowest stress reduction was observed in the Parental Role Alterations (-6.149) in the intervention group, while the control mothers experienced a stress increase in all domains. CONCLUSION: According to the findings, narrative writing may be considered an efficient supportive intervention to reduce the maternal stress Infant behavior and appearance in the NICUs. However, more research is needed to justify its implementation.

Health Related Quality of Life in Family Caregivers of Patients Suffering from Mental Disorders.

INTRODUCTION: In the light of the advances in treatment measures and early discharge of patients with mental disorders from psychiatric hospitals, families play important role in caring for such patients. AIM: The aim of this study is to determine the Quality of Life (QoL) of the family caregivers of patients with mental disorders. MATERIALS AND METHODS: This cross-sectional study was conducted in teaching health care centers affiliated with medical universities in Tehran, Iran. Sampling was conducted by convenience random technique. Participants were 238 family caregivers of mental disorder patients and the Short-Form Health Survey Questionnaire was used to gather data. The data were analyzed by Spearman's correlation, t-test and ANOVA in SPSS 18.0. RESULTS: The women's mean QoL was lower than the men's. Regarding family relationship with the patients, the lowest QoL was observed among the mothers. There was a significant relationship between the caregivers QoL and economic status, the caregivers gender, family relationship with the patients and the patients' gender (p<0.05). CONCLUSION: The caregivers of mental disorder patients have lower QoL compared with general population. Appropriately developed plans should be implemented to improve QoL among the family caregivers of these patients.

The Role of Family Atmosphere in the Relapse Behavior of Iranian Opiate Users: a Qualitative Study.

UNLABELLED: Introduction Many Iranian opiate users live with family members and family atmosphere can be influential on reducing such social behaviors of opiate users as substance use and relapses. This paper reports the impact of family atmosphere on relapse behavior as a part of the findings of a larger study that explored the relapse process among Iranian opiate users. METHODS: In this qualitative research, we selected 17 participants (5 women and 12 men). The questions were been asked through semi-structured interviews. The researchers analyzed the verbatim transcripts using content analysis method. RESULTS: "Family atmosphere" with three sub-themes (family and tribes' interaction, family challenges and family structure) was been found as determinants of relapse behavior. The quality of the family atmosphere could be in harmony with or against the willingness or motivation of the opiate user towards the relapse. Conclusion Health care providers should reinforce involvement of the family members in the treatment and rehabilitation of opiate users. The opiate user's family and even relatives may benefit from learning how to manage their own feelings and attitude towards the client and being supportive during interactions.

Relapse Model among Iranian Drug Users: A Qualitative Study.

BACKGROUND: Relapse is a common problem in drug user's rehabilitation program and reported in all over the country. An in-depth study on patients' experiences can be used for exploring the relapse process among drug users. Therefore, this study suggests a model for relapse process among Iranian drug users. METHODS: In this qualitative study with grounded theory approach, 22 participants with rich information about the phenomenon under the study were selected using purposive, snowball and theoretical sampling methods. After obtaining the informed consent, data were collected based on face-to-face, in-depth, semi-structured interviews. All interviews were analyzed in three stages of axial, selective and open coding methods. RESULTS: Nine main categories emerged, including avoiding of drugs, concerns about being accepted, family atmosphere, social conditions, mental challenge, self-management, self-deception, use and remorse and a main category, feeling of loss as the core variable. Mental challenge has two subcategories, evoking pleasure and craving. Relapse model is a dynamic and systematic process including from cycles of drug avoidance to remorse with a core variable as feeling of loss. CONCLUSION:  Relapse process is a dynamic and systematic process that needs an effective control. Determining a relapse model as a clear process could be helpful in clinical sessions. RESULTS of this research have depicted relapse process among Iranian drugs user by conceptual model.

The effect of narrative writing on maternal stress in neonatal intensive care settings.

OBJECTIVE: This study was conducted to examine the effect of narrative writing on maternal stress in the Neonatal Intensive Care Units (NICUs) during infants' hospitalization. METHODS: A quasi-experimental study was conducted among 2 groups of mothers with preterm infants in the NICUs of two teaching hospitals of Tehran University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. RESULTS: The mean stress level in the control group was 73.9 ± 16.7 at the beginning of the study, and 82.5 ± 19.5 at the end of the study (on the 10th day). Paired t-test results in the control group showed that there was a statistically significant difference between the 3rd and the 10th day of the hospitalization (p < 0.001). In the intervention group, the mean stress level at the beginning of the study and on the 10th day of the hospitalization was 78.9 ± 16 and 48.8 ± 14.1, respectively (p < 0.001). The results revealed statistically significant difference between the 2 groups on the 10th day of the study (p < 0.001). CONCLUSION: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the maternal stress in the NICUs. However, more research is needed to justify its implementation.

Relapse experience in Iranian opiate users: a qualitative study.

BACKGROUND: To understand the relapse process, it is required to notice the clients learned behaviors and environmental contexts. We aimed to explore and describe relapse experiences of Iranian drug users. METHODS: This is a grounded theory study and twenty two participants were selected using purposive sampling, snowball and theoretical sampling. After obtaining written informed consent, data gathering was done by means of in-depth semi-structured interviews. According to Strauss and Corbin three phases of open coding, axial coding and selection coding were done for qualitative analysis and continuous comparison. During the research period Guba and Lincoln criteria were used to be reassured of the accuracy and rigor of the study findings. RESULTS: The main categories of this study were craving and conflict, family stress and psychological indicators of relapse that emerged in three phases including recovery, tension and pre-relapse. High anxiety, withdrawal, rationalization and lying were the most common symptoms. CONCLUSION: Family reactions and social conditions play a key role in relapse. Relapse process is an active and multidimensional event in which the clients experience a psychosocial status continuum from recovery to relapse. Most psychological problems are seen in the tension phase.

Novice nurses' experiences of unpreparedness at the beginning of the work.

INTRODUCTION: Unpreparedness of novice nurses during the process of transition to their professional role can has broad consequences for the nurse and health care system and leads to reduction of the quality of patient care. This study has been carried out with the aim of investigating the experiences of the unpreparedness of novice nurses. METHOD: This study was conducted qualitatively by using conventional content analysis. Participants were 21 persons including 17 novice nurses, 2 supervisors, and 2 experienced nurses who were selected through purposeful sampling from four hospitals dependent on Tehran University of Medical Sciences. FINDINGS: Participants' experiences were reflected in three main themes of "functional disability", "communicative problems", and "managerial challenges". Each of these dimensions consisted of several sub-categories. These areas had represented the inability to apply the learned knowledge in practice. DISCUSSION: The sensitivity of health system, especially, educational mentors and nursing managers to create preparation in novice nurses by providing appropriate orientation programs at the beginning of work and the revision and amendment of nursing curriculum can solve this problem to some extent.