Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure.

Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.

Fatalism, distrust, and breast cancer treatment refusal in Ghana.

Following recent advancements in science and technology, cancer treatment options have increased remarkably alongside improved survival rates. Yet, some individuals diagnosed with breast cancer refuse treatment. This study aimed to explore how breast cancer patients' personal beliefs and ideas influence their decision to refuse medical treatment. Thirteen participant interviews were selected from a larger cohort for a secondary analysis using the grounded theory approach. The decision to forgo medical treatment was influenced mainly by personal beliefs, which were framed as: 1. Triangle of religion, superstition, and ignorance, 2. Ghanaian traditional belief system, 3. My destiny, 4. Frail patient-staff relationships, 5. Futile appointments, and 6. Endless journey. Together, these fit into two overall themes-fatalism and poor communication patterns between healthcare providers and patients. Personal beliefs and managerial gaps within the health system mainly influence the growing trend of refusal of medical treatment among breast cancer patients in Ghana. These findings highlight the need for breast cancer education, professional counselling, and psychological support services.

Barriers to Self-care Among Patients with Heart Failure: A Qualitative Study.

Introduction: Heart failure is the most prevalent cardiovascular disease. It is the end stage of most cardiovascular diseases and is characterized by the reduced ability of the heart to pump enough blood to fulfill the metabolic needs of the body. Self-care is the basis of the management of chronic diseases such as heart failure. The aim of this study was to explore the barriers to self-care among patients with heart failure. Methods: This was a qualitative content analysis. Participants were fourteen patients with heart failure and three healthcare providers who were purposively recruited from cardiac care centers in Zanjan, Iran. Data were collected through in-depth semi-structured interviews and were analyzed through the conventional qualitative content analysis approach proposed by Elo and Kyngäs. Results: Self-care barriers -care among patients with HF were categorized into three main categories, namely personal factors, disease burden, and inefficient support system. Each category had three subcategories which were respectively lack of self-care knowledge, heart failure-related negative emotions, the difficulty of changing habits, progressive physical decline, comorbid conditions, financial strain, inadequate social support, healthcare providers' inattention to self-care, and limited access to healthcare providers. Conclusion: Patients with heart failure face different personal, disease-related, and support-related barriers to self-care. Based on these barriers, healthcare providers can develop interventions for promoting self-care among patients with heart failure.

Limited access to care for persons with breast cancer in Africa: A systematic review.

PURPOSE: To systematically review the available evidence and examine the factors that may limit patients' access to breast cancer care in Africa. METHODS: We searched six databases (Google Scholar, Web of Science, PubMed, EMBASE, CINAHL, and Scopus) for studies conducted among breast cancer patients in Africa, highlighting patient challenges and barriers to care or treatment. The search was limited to studies published in the English language and from January 2000 until August 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. There were no limitations to the methodological design of the included studies. RESULTS: In total, 18,154 articles were retrieved through electronic search; twenty-five were eligible for inclusion after quality appraisal. We analyzed the data using the deductive content analysis approach. Three categories emerged as barriers to breast cancer care: Socio-economic challenges, Institutional shortfalls, and Distinctiveness. CONCLUSIONS: The findings support that economic hardships, fear, and scarcity of cancer treatments/equipment are critical in limiting access to breast cancer care. Sustainable strategies aimed at scaling-up breast cancer care in the region are necessary. The results also highlight the need for reduced treatment cost and aggressive educational campaigns across healthcare facilities and the local communities.

Relationship between health literacy and quality of life among hemodialysis patients, Tehran, Iran, 2019.

BACKGROUND: Chronic kidney disease and dialysis are associated with various complications. OBJECTIVE: This study aimed to determine the relationship between health literacy and quality of life among patients receiving hemodialysis in hospitals affiliated with Tehran University of Medical Sciences. METHODS: In this study, a descriptive - correlational study design with 138 sample size was used. Convenience sampling was used to select the study participants. We collected the data on May-September 2019. Data collection was done using the HELIA and KDQOL SF™. RESULTS: In this study, 133 respondents fully completed the questioners. The mean score of health literacy of the respondents was 49.03 (± 22.37) while the average score of quality of life of the respondents in this study was 53.01 (± 14.86). CONCLUSION: Based on the findings, patients receiving haemodialysis had insufficient health literacy and a better quality of life. In order to address the health literacy needs of the patients, consideration of continuous health education and assessment in this patient subpopulation could gradually improve their health literacy and quality of life. Health care providers such as nurses could improve Health Literacy and substantially Quality of Life through interventions aimed at determining existing literacy needs in the long and short term treatment course for individual dialysis patients.

The Effectiveness of Workshop and Multimedia Training Methods on the Nurses' Decision-Making Skills Regarding Weaning From Mechanical Ventilation.

BACKGROUND: Nurses can safely and effectively wean patients from mechanical ventilation (MV) by the use of proper instruments and planning. OBJECTIVE: The aim of this study was to compare the effectiveness of 2 training methods on the decision-making skill of intensive critical care (ICU) nurses with regard to weaning from MV. METHODS: In this quasi-experimental study, 80 nurses working in ICUs participated in 1 of 2 educational groups in 2016. The interventions were workshop and multimedia training for decision-making skill regarding weaning from MV. The data were gathered from a questionnaire based on the Burns Weaning Assessment Program tool before and 1 month after the intervention. Data were analyzed by independent t test, the χ test, and the Fisher exact test using the software SPSS v. 17. RESULTS: The decision-making skill with regard to awareness of weaning factors (physiological and respiratory) increased in both groups after the intervention (P ≤ .001), but the difference between the 2 groups was not statistically meaningful. Considering the mean scores before and after the intervention, the general skill of decision-making regarding weaning from MV was higher in the multimedia training group compared with the workshop training group (P ≤ .001). CONCLUSION: The multimedia training method, which has been more successful, is recommended owing to its characteristics of virtual education, such as accessibility, flexibility, learner centeredness, and expansibility, as well as nurses' lack of time.

Development and Psychometric Evaluation of Coronary Artery Disease Treatment Adherence Scale.

INTRODUCTION: Poor treatment adherence reduces treatment effectiveness and increases healthcare costs. The promotion of treatment adherence necessitates valid and reliable tools to assess the effectiveness of adherence promotion strategies. This study was undertaken to develop and evaluate the psychometric properties of the Coronary Artery Disease Treatment Adherence Scale. METHODS: This methodological study was conducted in two phases. In the first phase, a literature review was done and a 62-item scale was developed. In the second phase, different methods were used to assess the psychometric properties of the scale, namely its face validity, content validity, construct validity, internal consistency, and test-retest stability. RESULTS: During face and content validity assessments, the number of items was reduced from 62 to 53. Moreover, in construct validity assessment via exploratory factor analysis, 18 items were deleted because their factor loading values were less than 0.3. The remaining 35 items were loaded on four factors, namely medication adherence, dietary adherence, exercise adherence, and healthy lifestyle adherence. The Cronbach's alpha values of the scale before and after factor analysis were 0.850 and 0.862, respectively. Its test-retest intraclass correlation coefficient was also 0.85. CONCLUSIONS: The Coronary Artery Disease Treatment Adherence Scale is a valid and reliable tool and can be used in different healthcare settings for the assessment of treatment adherence among patients' with coronary artery disease. TRIAL REGISTRATION: Tehran University of Medical Sciences, identifier, 35456.

Glasgow Coma Scale and FOUR Score in Predicting the Mortality of Trauma Patients; a Diagnostic Accuracy Study.

INTRODUCTION: Many scoring models have been proposed for evaluating level of consciousness in trauma patients. The aim of this study is to compare Glasgow coma scale (GCS) and Full Outline of UnResponsiveness (FOUR) score in predicting the mortality of trauma patients. METHODS: In this diagnostic accuracy study trauma patients hospitalized in intensive care unit (ICU) of 2 educational hospitals were evaluated. GCS and FOUR score of each patient were simultaneously calculated on admission as well as 6, 12 and 24 hours after that. The predictive values of the two scores and their area under the receiver operating characteristics (ROC) curve were compared. RESULTS: 90 patients were included in the present study (mean age 39.4±17.3; 74.4% male). Comparing the area under the ROC curve of GCS and FOUR score showed that these values were not different at any of the evaluated times: on admission (p=0.68), and 6 hours (p=0.13), 12 hours (p=0.18), and 24 hours (p=0.20) after that. CONCLUSION: The results of our study showed that, GCS and FOUR score have the same value in predicting the mortality of trauma patients. Both tools had high predictive power in predicting the outcome at the time of discharge.

Evaluation of the Master's curriculum for elderly nursing: a qualitative study.

BACKGROUND: Improving the quality of health care and rehabilitation for the elderly is one of the most important priorities of the health care system. Given the importance of evaluating the strengths and weaknesses of any program after its implementation, this study was conducted to identify the advantages and weaknesses of a geriatric nursing program at Tehran University of Medical Sciences. METHODS: This was a qualitative study, and the study population comprised students, graduates, and professors of geriatric nursing at the Master of Science level. Data were collected through face-to-face interviews and focus groups. Sixteen interviews were conducted. The interview guide was used as a research tool. Interviews continued until data saturation was reached. Conventional content analysis was used to analyze the data. RESULTS: Three main themes including "motivation to enter geriatric nursing", "lack of employment groundwork", and "lack of practical implementation of the curriculum" were the main findings of the study. CONCLUSION: Efforts to restructure the administrative system and employment can deter geriatric nursing students from simply earning a degree and actually encourage them to learn the required content. Appraisal and improvement of education facilities for student recruitment can guarantee the practical implementation of the curriculum. Drafting policies to attract graduates in clinical environments, opening up employment opportunities, providing organizational positions for the recruitment of this group, as well as dedicating some wards for elderly special care and providing nursing care to elderly people only can increase students' motivation to learn and their hopes of good job prospects.

Iranian undergraduate nursing student perceptions of informal learning: A qualitative research.

BACKGROUND: Nursing education is both formal and informal. Formal education represents only a small part of all the learning involved; and many students learn more effectively through informal processes. There is little information about nursing student informal education and how it affects their character and practice. MATERIALS AND METHODS: This qualitative study explores undergraduate nursing student perceptions of informal learning during nursing studies. Data were gathered through semi-structured interviews with a sample of undergraduate nursing students (n = 14). Strauss and Corbin's constant comparison analysis approach was used for data analysis. RESULTS: The categories that emerged included personal maturity and emotional development, social development, closeness to God, alterations in value systems, and ethical and professional commitment. CONCLUSION: Findings reveal that nursing education could take advantage of informal learning opportunities to develop students' nontechnical skills and produce more competent students. Implications for nursing education are discussed.