Effect of Home Care Program on Re-hospitalization in Advanced Heart Failure: A Clinical Trial.

Background: Heart failure is the leading cause of readmission in all medical and surgical patients. Home care studies have reduced hospitalization in heart failure. This study aimed to investigate the effect of home care program on readmission in advanced heart failure. Materials and Methods: The study was a randomized clinical trial conducted at the Rajaie Cardiovascular, Medical and Research Center from September 2017 to March 2018. Ninety-eight patients with advanced heart failure were selected using census method and were randomly divided into experimental and control groups. For the experimental group, the home care program was implemented for 6 months. The date and frequency of hospitalization were recorded during 30, 90, and 180 days before and after the home care program. The quantitative data analysis was performed using Mann-Whitney and Wilcoxon's signed-rank tests and qualitative data analysis was performed using the Chi-square test. Results: The number of hospitalization and length of hospital stay 30, 90, and 180 days after implementation of the home care program in the experimental group was significantly less than the control group (p < 0.001). The number of hospitalizations and length of stay in the experimental group decreased significantly after the program (p < 0.001). In the control group, 90 days after the intervention, the number of hospitalizations (p = 0.013) and length of stay increased significantly (p < 0.001), and 180 days after the intervention, increased significantly (p < 0.001). Conclusions: The implementation of a designed home care program reduces readmission and the length of hospital stay in advanced heart failure.

Social participation among Iranian community-dwelling older adults: A grounded theory study.

Background: Iran is among the countries whose older adult population is increasing rapidly. The social dimension of health in older adults affects their other existential dimensions. Social participation is a key determinant of health for older adults. This study aimed to explore the process of social participation among community-dwelling older adults. Methods: This is a qualitative study with the grounded theory approach. The study population consisted of eligible community-dwelling older adults. The participants were initially selected by purposeful sampling. Data were collected through semi-structured interviews. The time and place of the interviews were arranged in discussion with the participants in advance. Lincoln and Guba's criteria were used to assess the scientific accuracy and validity of the study. The university ethics committee issued the ethics code for the study. Data were analyzed using Corbin and Strauss approach. Result: The results of interviews with 15 participants, in this study, led to the emergence of 12 main categories and 32 subcategories with the core concept of "older adults' desire to stay active". Social participation of older adults was a concept clarified with the efforts of older adults to stay active in the community. Categories are fully described in the manuscript. Conclusion: Staying active is one of the main concerns regarding the concept of older adults' social participation. The existence of conducive underlying factors, such as a participation-seeking older adult, family, and society, assists in the development of social participation at various levels and multiple forms among older adults.

Facilitators and barriers for families caring for adults living with Alzheimer's dementia: A qualitative study.

This study investigates the barriers and promoters of caring for older adults living with Alzheimer's Dementia (AD) in families. This was a qualitative study through content analysis (based on the Granheim and Lundman method), and the participants were selected using purposive sampling from the families of older adults living with AD who were receiving care in the community. We used semi-structured interviews to collect data from 32 family members. The validity and reliability of the data were assessed using the Lincoln and Guba criteria. In this study, 70.58% of primary caregivers were women. Caregiving facilitators included "Efficient family," "Capable caregiver," and "Motivated caregiver." Caregiving barriers included "Lacking awareness and knowledge," "Vulnerable family," "Older person with complex/multiple needs," and "Lack of care infrastructures." Training families and caregivers and developing care infrastructures for older adults with AD can help reduce caring barriers in older adults.

The Effectiveness of Emotion Regulation Therapy for Adolescent Females With Nonsuicidal Self-Injury Disorder: A Mixed-Method Study.

ABSTRACT: Given the prevalence and consequences of the nonsuicidal self-injury disorder (NSSID) among adolescents, this study aimed to analyze the effectiveness of emotion regulation therapy (ERT) among adolescents with NSSID. The present study is an after-trial, mixed-method intervention design. Six participants completed questionnaires at baseline, during their treatment, and follow-up. In-depth interviews were made after the intervention. The quantitative findings were consistent with the pattern of the qualitative findings that prominently supported the treatment efficiency concerning the difficulties in emotion regulation. The research findings indicated that ERT had a positive effect on adolescents with NSSID.

Public Intention to Prepare for Earthquakes: Psychometric Properties of Persian Version.

BACKGROUND: People are still not prepared for earthquakes in vulnerable areas although preparedness considered an effective way of reducing the disastrous consequences. A proper tool was needed to assess the predicting factors of mitigation behaviors in a large vulnerable community who speak Persian. This study aimed to introduce the valid and reliable Persian version of public intention to prepare against earthquakes. METHODS: Translation, validation and reliability checking articulated according to the standard methodology for Forward-Backward translation and psychometric evaluation. Totally, 369 Tehran households were selected through stratified random sampling from Oct 2016 to Jun 2017. Exploratory Factor Analysis used to check the construct validity of all scales. RESULTS: Face, content and construct validity of all scales confirmed (S-CVR: .65) and (S-CVI/Universal: .98). The finalized Persian version (69 items in 8 scales) showed good reliability over time in test-retest (ICC: .92) and high internal consistency both in the pilot (α: .94) and main studies (α: .94). No significant floor and ceiling effects were found in any of scales. CONCLUSION: Persian version of Earthquake Public Intention to Prepare is applicable as a valid and reliable instrument for research regarding disaster preparedness in Persian speaking communities.

Health services coverage: Physical access to rehabilitation facilities in Tehran compare with the country.

OBJECTIVE: According to the World Health Organization, estimates about 1,800,000 people lived with disability in Tehran. Against there is little evidence of physical access to rehabilitation facilities in Tehran. This study is aimed to assess the physical access to physical rehabilitation facilities in Tehran and compare it with the country. METHODS: This is a cross-sectional study conducted since January to April 2017. We used a master facilities list of rehabilitation facility that developed in Iran to collect the information. The samples of this study included all existing physical rehabilitation centers in Tehran province. Data analysis was done using the SPSSr version 21.0 (SPSS Inc., Chicago, IL). RESULTS: The results showed that rehabilitation facilities existed at different levels, including inpatient (10.51), outpatient (224.28), community based (36.72), and long-term care (4.96)/1,000,000 populations. Rehabilitation services are provided by rehabilitation professional including: Physical medicine and rehabilitation specialists (8.7), physiotherapists (132.89), occupational therapists (57.4), speech therapists (42.11), and audiologists (48.84) (in 1,000,000 populations). CONCLUSION: Tehran needs to increase the physical access to rehabilitation facilities and compared with country was disproportionate physical access to facilities in most cases. It is necessary to establish an interdisciplinary referral system between different rehabilitation providers.

Families' Experiences of End-of-Life Care at Home for Iranian Older Adults: A Qualitative Study.

AIM: While the care of dying elderly patients at home is very complex and ambiguous, it has not been studied in Iran so far. Hence, this study aimed to explore the experience of a representative sample of the Iranian family caregivers from the end-of-life (EOL) care for their elderly relatives. METHODS: The present study was conducted using a qualitative content analysis method. Twelve family caregivers caring for the chronically ill dying elderly were selected using purposeful sampling. The purposive sampling method was applied with an extreme variation in sampling, and data gathering was pursued until data saturation was achieved. Semi-structured interviews were utilized for data collection. Interviews were recorded and instantly transcribed verbatim. Inductive content analysis was used to analyze the data. RESULTS: Four core themes and 13 subthemes emerged from the experiences of family's caregiver as fallow: (1) Committed to care: This is related to encounter with the end of stage disease of the relative, accepting the care role and priority of care, (2) challenges of Care: Caregivers, despite their efforts, provided ineffective care, so they sought to empower themselves and at the same time provide compassionate care, (3) the crisis of care including the complexity of care, fear, and wandering, helplessness, devastating tension, and vacuum of supporting, and (4) conditions after death that family members involved with a sense of loss and Tension control. CONCLUSION: When families had to take care of their elderly patients at home, although their wish to give the best care, they are completely powerless to provide care, and in an atmosphere of the vacuum of supporting, they encounter severe challenges and crisis. It is vital that palliative care centers in the society are arranged to care for EOL elderly with comprehensive insurance services.

Pain characteristics of older residents in Iranian nursing homes.

BACKGROUND: Pain is a common complaint among the aging population, particularly among the older residents of nursing homes. AIMS: The main aim of the study was to examine the pain characteristics among older residents of nursing homes in Tehran, Islamic Republic of Iran. METHODS: This was a cross-sectional study. The sample consisted of 394 older adults admitted to Tehran nursing homes. To gather the required data, Brief Pain Inventory and Abbreviated Mental Test score were used. RESULTS: 51% of the female and 26% of the male participants suffered from pain. Lower extremity and lower part of back were the most frequently affected. Pain interfered with general activity (P < 0.001), mood (P = 0.016), walking (P < 0.001), normal work (P < 0.001), relations with others (P = 0.043), sleeping (P = 0.002) and enjoyment of life (P = 0.019) of the older residents and these effects were more prominent in female sex. Factors such as age, gender and schooling were of significant relationships with pain (P < 0.001) and its intensity (P <0.001). CONCLUSIONS: Chronic pain is common among older residents of nursing homes and deteriorates their quality of life. This study reconfirms the previously mentioned importance of using effective pain evaluation and pain management strategies in nursing homes.

Defining loneliness in older adults: protocol for a systematic review.

BACKGROUND: Socialization is an important part of the healthy aging process, but natural changes in the lifestyle and health of older people increased risk of loneliness. However, loneliness is not well defined and might differ in different cultures and settings. The main objective of this systematic review is to summarize literature on the topic and propose a definition that might help aging research and practice in the future. METHODS: Eight databases including PubMed, Scopus, CINAHL, Web of Science, EMBASE, PsycINFO, Proquest, and Age Line bibliographic will be run individually to retrieve relevant literature on loneliness among elderly population using subject headings and appropriate MeSH terms. Inclusion and exclusion criteria will be developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction, and appraisal. We will restrict our search to articles published in the English language biomedical journal between 2000 and 2017. The protocol adheres to the standards recommended by the PRISMA-P. DISCUSSION: The results of this systematic review can present a more accurate definition of loneliness for researchers who aim at conducting new primary and secondary studies on this subject. SYSTEMATIC REVIEW REGISTRATION: CRD42017058729.

The predictors of earthquake preparedness in Tehran households.

BACKGROUND: The high risk of an earthquake happening and the harmful consequences that it leaves, besides the unsuccessful policies for preparing the community for mitigation, suggested that social factors should be considered more in this regard. Social trust is an influencing factor that can have significant impact on people's behavior. OBJECTIVE: To determine the relationship of the influencing factors on the preparedness of Tehran households against earthquake. METHODS: This was a cross-sectional study with 369 participants (February to April 2017) involved through stratified random sampling from selected urban districts of Tehran. The Persian version of an 'Intention to be prepared' measurement tool and a standard checklist of earthquake preparedness behaviors were used. The tool was evaluated for internal consistency and test-retest reliability in a pilot study (Cronbach's α =0.94 and Intra Class Correlation Coefficient =0.92). RESULTS: Multivariate linear regression analysis showed that social trust is the most important predictor for the preparedness mean of changes in Tehran (R2=0.109, p<0.001, ß: 0.187 for the Preparedness behavior; R2=0.117, ß: 0.298, p<0.001 for Intention to be prepared; and R2=0.142, ß: 0.345, p<0.001 for the Perceived preparedness). CONCLUSION: The relationship between social trust and preparedness dimensions suggested that changing a social behavior is not possible through considering only individual characteristics of community members and not their social networks relations. The programs and policies which try to enhance the social trust in general, may be able to increase public preparedness against earthquakes in the future.

Iranian nurses' experience of "being a wrongdoer": A phenomenological study.

BACKGROUND: Patient safety, which is a patient's right, can be threatened by nursing errors. Furthermore, nurses' feeling of "being a wrongdoer" in response to nursing errors can influence the quality of care they deliver. RESEARCH OBJECTIVES: To explore the meaning of Iranian nurses' experience of "being a wrongdoer." RESEARCH DESIGN: A phenomenological approach was used to explore nurses' lived experiences. Nurses were recruited purposively to take part in semistructured interviews, and the data collected from these interviews were analyzed using Van Manen's thematic analysis. Participants and research context: Eight nurses working in three private or governmental hospitals in Tehran, Iran. Ethical consideration: The research design was approved in each participating hospital, and all interviews were carried out at a predetermined time in a private place. FINDINGS: Five themes were extracted from the data: "wandering in unpleasant feelings" (with two subthemes: "unpleasant physical feelings" and "unpleasant emotions"), "wandering in the conscience court" (with three subthemes: "being the accused," "being the victim," and "being the judge"), "being arrested in time," "time for change" (with three subthemes: "promoting accountability," "promoting learning," and "strengthening supportive relationships"), and "spiritual exercise." DISCUSSION: Some of our results are supported by the model of self-reconciliation and the recovery trajectory of "second victims" theory. CONCLUSION: The meaning of "being a wrongdoer" has positive and negative aspects. Feelings of wandering provide nurses the opportunity to reflect on and re-embrace the professional and moral responsibility of nursing. Nursing managers can convert their "defeats" into a prelude to learning, increase their accountability, and improve the quality of nursing care.

Iranian Pediatric Nurse's Experience: The Facilitators of the Learning of Ethical Practices.

BACKGROUND: Ethical care is a core value in nursing. Pediatric nurses are in direct and continuous contact with children and their parents. They manage their lives and health. As part of the pediatric nurses' daily work, ethical issues play an important role in making decisions, are important to make decisions, and this capability is only achieved by ethical practice. This study aimed to explore the factors facilitating the learning of ethical practice among Iranian pediatric nurses. MATERIALS AND METHODS: This study is a conventional qualitative content analysis based on the Graneheim and Lundman method. It was conducted through semi-structured interviews with two focus groups, incorporating 28 nurses working in pediatric wards. Unstructured observation and field notes were other methods of data collection. Purposive sampling continued until data saturation was ensured. All interviews were tape recorded and transcribed in verbatim. RESULTS: Three main categories and 12 subcategories emerged from this study. The facilitating factors include (1) individual competencies (knowledge, experience, emotional intelligence, and loving children), (2) ethical imprinting (responsibility, reflection, empathy, and ethical beliefs), and (3) an environment that nurtures moral values (organizational, spiritual, family, and cultural environments) as facilitating factors. CONCLUSIONS: The promotion of nurses' competencies, ethical virtues, and imprinting, as well as improvement of the quality of nursing care must be the top priority of the health team. Undoubtedly, the success of the health care system is not possible without ensuring that pediatric nurses learn ethical practices.

National survey of availability of physical rehabilitation services in Iran: A mixed methods study.

BACKGROUND: The prevalence of disability in Iran has increased due to ageing of the population and the presence of chronic diseases. However, little is known about the availability of rehabilitation services in Iran. OBJECTIVE: To study the availability of physical rehabilitation services in Iran. METHODS: This was a mixed method study. In the first phase, a qualitative design was conducted for designing an instrument with focus groups based on Service Availability and Readiness Assessment (SARA) instrument (developed by World Health Organization). Content analysis was used for data analysis. Then, in the second phase, a cross-sectional study was performed to collect the data with census method in Iran. This study was formed from June to October 2015, and samples consisted of all governmental, public non-governmental and private facilities established for rehabilitation centers affiliated with the Ministry of Health and Medical Education, Ministry of Labor, Cooperative and Social Welfare and the Iranian Red Crescent Society. Data analyses were performed using SPSS software (version 16). Descriptive statistical analysis (percentage and frequency) were calculated for quantitative data. RESULTS: In the first phase, the content analysis of qualitative data identified a Master Facilities List (MFL) of rehabilitation services and service providers in Iran. Results of the second phase showed that the rate of inpatient, outpatient, community-based and long-term care centers per 1,000,000 populations in Iran were 1.68, 89.24, 66.21 and 3.6, respectively. Also, that the rate of rehabilitation professionals including physical medicine and rehabilitation specialists, physiotherapists, occupational therapists, speech therapists, and audiologists were 3.90, 64.65, 22.09, 22.83 and 24.18 per 1,000,000 populations, respectively. CONCLUSION: There is a need to increase the availability of rehabilitation services and to promote rehabilitation referrals by using an interdisciplinary team approach.

Nursing error: an integrated review of the literature.

Nursing errors are complex and take place frequently in the care of patients. However, despite their significance, they have not been properly defined or addressed in the literature. This integrative review of the literature explored the concept of nursing error, explained its definitions and described its attributes and measurements. The databases of Medline, CINAHL, Google Scholar and SID were searched using a number of keywords, including malpractice, adverse events and mistake, with and without the word nurse. The aim was to determine the definition of nursing error, regardless of the contextual aspects, in various scientific systems. After reviewing the relevant literature, content analysis (in MAXQDA) was applied to classify the definitions, attributes and measurements obtained on the basis of their similarities and differences. Ultimately, a definition was established for the concept of nursing error.

Translation and psychometric properties of the Persian version of self-management of type 1 diabetes for adolescents.

BACKGROUND: The present study was conducted to translate and assess the validation of the measure of self-management of type 1 diabetes for adolescents that developed by Schilling et al [Schilling LS, Knafl KA, Grey M. Changing patterns of self-management in youth with type I diabetes. J Pediatr Nurs 2006;21:412-24]. METHODS: The first stage of the study involved the translation of the measure of self-management of type 1 diabetes for adolescents into Persian based on the model proposed by Wild et al. in two versions [Wild D, Grove A, Martin M, Eremenco S, McElroy S, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 2005;8:94-104; Wild D, Eremenco S, Mear I, Martin M, Houchin C, et al. Multinational trials - recommendations on the translations required, approaches to using the same language in different countries, and the approaches to support pooling the data: the ISPOR patient-reported outcomes translation and linguistic validation good research practices task force report. Value Health 2009;12:430-40]. The translated versions were reviewed in consultation sessions with experts and the more appropriate items were selected and the final version was translated back into English in two versions and was then sent to the measure's designer for confirmation. The content validity of the measure was then evaluated by a group of experts and found to be acceptable. The next stage evaluated the measure's construct validity. This measure contains 52 items classified under five subscales. The confirmatory factor analysis was performed to assess the measure's construct validity and was found to be acceptable. For evaluating the reliability of the measure, its internal consistency was assessed through calculating its Cronbach's alpha and intra-class correlation. The measure's consistency was measured through calculating its test-retest reliability. RESULTS: The assessment of the measure's content validity revealed a content validity index of 0.98. For the construct validity of the measure using the confirmatory factor analysis, the following figures were obtained: NFI=0.97, RMSA=0.001, AGFI=0.81, IFI=0.833, GFI=0.83. In the assessment of the measure's reliability, the intra-class correlation showed an overall Cronbach's alpha of 0.88. The test-retest showed a consistency of 0.73 for the measure. CONCLUSIONS: The validation of the 48-item measure revealed that it can be used in the population of Iranian adolescents with type 1 diabetes (8 items changed their subscales and 4 items were removed).

Exploring the Nature of the Intention, Meaning and Perception Process of the Neuro-occupation Model to Understand Adaptation to Change.

The theoretical model of neuro-occupation, intention, meaning and perception, sought to describe the symbiotic relationship between occupation and the brain, as a chaotic, self-organized, complex system. Lack of evidence has limited its applicability to practice. The aim of this study was to track the postulates of the model within the daily experiences of subjects. Structured matrices were created for content analysis, using a qualitative multiple-case-study design, typically used for testing models. An underpinning principle of the model, defined a circular causality feedback process, which was confirmed as described through tracing the repetitive processes within the lived experience of two Iranian men. The process suggested that continual adaptation occurred in lives interrupted by cerebrovascular accident, which enabled the subjects to return to expression of meaning through purposeful occupation and continually re-shaped their perceptions. The primary limitation of this study was that it was the earliest attempt to test the model and to substantiate the process by comparing the similarities and differences between too few subjects. Future research should identify the same process in more subjects and validate a practical assessment tool for clients. These findings may inform practitioners about intentional use of occupational challenges to elicit adaptive behaviours in clients.

Concept analysis of empowerment in old people with chronic diseases using a hybrid model.

PURPOSE: The purpose of this study was to clarify the meaning and the nature of empowerment concept in some Iranian old people suffering from chronic diseases. METHODS: Concept analysis was undertaken according to the hybrid model, which consists of three phases: an initial theoretical phase, a fieldwork phase and a final analytical phase. After an extensive review of the literature in order to describe the characteristics and definition of the concept, a fieldwork phase followed in order to empirically elucidate the empowerment concept in the Iranian old people with chronic diseases. In the third phase, attributes of empowerment were extracted from the first and second phases. Purposive sampling was done for 13 participants consisted of 7 old people with chronic diseases, 3 family caregivers of elderly adult with chronic disease and 3 health care providers with experience of care with elderly patients with chronic disease. RESULTS: The review of literature in theoretical phase determined the attributes of the concept, including "active participation", "informed change", "knowledge to problem solve", "self-care responsibility", "presence of client competency", and "control of health or life". Fieldwork phase determined attributes such as "awareness promotion", "sense of control", "the development of personal abilities", "autonomy", and "coping". In the final analytical phase, the critical attributes of old people with chronic diseases were investigated. They included "social participation", "informed change", "awareness promotion to problem solve", "presence of client competency", and "control of health or life", "autonomy", "coping" and "the development of personal abilities". CONCLUSION: The concept analysis of empowerment showed some of the required conditions for the empowerment of older people with chronic diseases in nursing care, which have not been mentioned in the literature.