Uncertainty and its related coping strategies in systemic lupus erythematosus. Life in the fog.

BACKGROUND: One of the most prevalent problems of patients with systemic lupus erythematosus (SLE) is the uncertainty over an indefinite future. Uncertainty has significant effects on quality of life. The aim of this study was to explore uncertainty and personal strategies to cope with it among patients with SLE. MATERIALS AND METHODS: This qualitative study was conducted in 2020-2021 using conventional content analysis. Participants were 21 patients with SLE who were purposefully selected from rheumatology clinics in Kashan, Kerman, and Bandar Abbass in Iran. Data collection was performed using face-to-face, in-depth, semi-structured interviews and was continued up to data saturation. Data were analyzed concurrently with data collection through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS: Two main themes, namely, "life in the fog" and "attempt to find peace" emerged from patients' experiences of illness uncertainty of SLE. Life in the fog included three main categories of "perception of threat to health", "challenge of doubt and certainty," and "indefinite future." Attempt to find peace included three main categories of "spirituality," "reflection," and "attempt to acquire SLE-related knowledge. CONCLUSIONS: Uncertainty is a major psychological stress for patients with SLE. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.

Factors Contributing to Grief Experience Among Oncology Nurses: A Qualitative Study.

OBJECTIVES: Care provision to patients with cancer can cause varying levels of grief for oncology nurses. Grief in turn significantly affects nurses' personal and professional life. However, there is limited information about the contributing factors to grief experience among oncology nurses. The aim of this study was to explore the contributing factors to grief experience among oncology nurses. DATA SOURCES: This qualitative study was conducted in Iran from May 2020 to October 2021. Participants were 18 oncology nurses purposively selected from several hospitals in Iran. Data were gathered via in-depth semistructured interviews and analyzed via the conventional content analysis method proposed by Graneheim and Lundman. Lincoln and Guba's criteria were used to ensure trustworthiness. CONCLUSION: The four categories of the contributing factors to oncology nurses' grief experience were exposure to patients' painful death, depressing work atmosphere, knowing the heavy financial burden of cancer for patients, and patients' helplessness in the healthcare system. Oncology nurses experience deep grief due to a wide range of personal, professional, environmental, and sociocultural factors. IMPLICATIONS FOR NURSING PRACTICE: The findings of this study can be used to better understand the contributing factors to grief experience among oncology nurses, determine their needs, and develop strategies to strongly support them.

Intuitive Decision-making by Iranian Nurses of Patients with COVID-19: A Qualitative Study.

Introduction: Clinical decision-making related to coronavirus disease 2019 (COVID-19) is a new experience; thus, there is a lack in knowledge in this area. The aim of this study is to explore critical care nurses' experience of intuitive decision-making in patients diagnosed with COVID-19. Methods: In this qualitative descriptive study, 16 nurses who had the experience of providing care for patients diagnosed with COVID-19 were selected through purposive sampling and participated in semi-structured interviews. The interviews were transcribed and finally analyzed through the conventional content analysis approach. Results: 62.5% of participants were females and the mean (SD) of the participant's age and working experience were 36.56 (6.58) and 12.62 (5.59) years, respectively. Three main themes emerged out of the experiences of the nurses, including (a) inner revolution, (b) holistic awareness and (c) clinical wisdom. Conclusion: Critical care nurses use intuition in novel, complex situations where they often have to make quick and independent decisions. Understanding the phenomenon of intuition in clinical decision making increases the professional practice of nursing and leads to better quality care for patients, especially in acute, critical situations and pandemic diseases.

Corrigendum to "Determining the sexual quality of life and related factors in patients referred to the department of cardiac rehabilitation: A cross-sectional study" [Int J Reprod BioMed 2021; 19: 261-270].

[This corrects the article DOI: 10.18502/ijrm.v19i3.8574.].

Determining the sexual quality of life and related factors in patients referred to the department of cardiac rehabilitation: A cross-sectional study.

BACKGROUND: One of the neglected issues among cardiovascular participants is sexual activity, which can affect their general quality of life. OBJECTIVE: To evaluate the sexual quality of life and its related factors. MATERIALS AND METHODS: This cross-sectional study was conducted on 200 cardiovascular participants, referred to the department of rehabilitation of the Shahid Beheshti Hospital of Kashan, Iran in May 2017. Individuals who met the inclusion criteria filled the demographic characteristics questionnaires, including sexual quality of life questionnaire (SQOL)-female and SQOL-male, sexual knowledge post-myocardial infarction scale (SKS-MI), sexual knowledge after coronary artery bypass grafting surgery scale (SKS-CABG), and couple communication scale (CCS). RESULTS: In this research, the mean score of SQOL of the participants was 50.02 ± 22.57. According to the results, there was a significant and positive association between the scores of SQOL and CCS (r = 0.540, p ≤ 0.0001), SKS-MI (r = 0.322, p = 0.006), and SKS-CABG (r = 0.178, p = 0.046). The maximum association was observed between SQOL and CCS and the minimum association between SQOL and SKS-CABG. Moreover, there was a relationship between the SQOL and participant's age and level of education. CONCLUSION: According to the results of the study, the sexual quality of life scores among participants with MI and CABG was not favorable and this participant suffered from a lack of sexual knowledge.

Nursing faculty's point of view regarding noncompliance with ethics in academic environments: a qualitative study.

BACKGROUND: An academic environment is the first place that nursing students are introduced to ethics related to nursing and healthcare. In this study, we explored the nursing faculty members' point of view regarding noncompliance with these academic ethics. METHODS: This study was a qualitative descriptive study conducted in 2018. Faculty members at a nursing school were selected through purposeful sampling. Data was collected using semi-structured interviews. The interviews were digitally recorded and transcribed verbatim. Data collection and data analysis were conducted simultaneously. Data saturation was ensured with 11 interviews. The interview transcripts were analyzed using a qualitative content analysis method introduced by Elo and Kyngäs. RESULTS: The participants were six women and five men with 12.72 ± 6.64 years of experience as nursing instructors. After data analysis, seven categories were identified: discrimination, violence, misuse, out-of-date instruction and knowledge, conflicts of evaluation, hypocrisy, and disorganization. CONCLUSION: The findings of this study indicated the existence of noncompliance regarding academic ethics. It is recommended that faculty members be informed about possible instances of ethical noncompliance in academia. There is a need to develop strategies to promote a faculty's compliance with academic ethics. Academic administrators need to emphasize the importance of ethics in academia and use further methods to enhance academic ethics.

The effect of sexual counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men who have undergone invasive coronary interventions: An RCT.

BACKGROUND: Sexual dysfunctions are common in men with ischemic heart disease, especially in men undergoing therapeutic interventions. OBJECTIVE: This study intended to assess the effect of counseling on depression, anxiety, stress, sexual knowledge and sexual quality of life in men after invasive coronary interventions in the post catheterization department of Kashan Shahid Beheshti Hospital during 2018. MATERIALS AND METHODS: The study population consisted of 54 male participants who had undergone an invasive coronary intervention. The intervention group received counseling and the control group underwent the standard ward routine. Data were collected using the depression anxiety stress scales, Abraham's sexual quality of life, and the Yi-Hung Sexual Knowledge questionnaires before discharge and also two months later. RESULTS: Within two months, the intervention group's mean score of sexual knowledge significantly increased, compared with the control group, from 12.37 to 14.81 (p ≤ 0.001). The intervention group's mean score of sexual quality of life also significantly increased, compared with the control group, from 48.2 to 60.7 (p ≤ 0.001). Moreover, the mean anxiety score changed in the intervention group from 11.18 to 5.25, again a significant difference compared with the control group (p = 0.01). But, the differences in the depression and stress scores were not significant. CONCLUSION: Our findings suggest that sexual counseling may improve sexual knowledge, sexual quality of life and anxiety in men following invasive coronary intervention, but might not reduce their stress or depression. Further studies are needed to confirm these findings.

The effectiveness of mobile phone text massaging support for mothers with postpartum depression: A clinical before and after study.

BACKGROUND: It is estimated that postpartum depression (PPD) occurs in 10-15% of women in the year after childbirth. The highest number of women with PPD has limited access to psychosocial and pharmacological interventions. Long-distance counseling via mobile phone might be useful for the treatment of women with PPD, specifically in regions with low socioeconomical status and rural areas. OBJECTIVE: Due to the high prevalence of PPD and its effects on health status of mothers and babies, we aimed to determine whether long-distance counseling via mobile phone text messaging is efficacious for the treatment of mothers at PPD risk. MATERIALS AND METHODS: This pre-test and post-test clinical study was conducted in 2014 on 54 women referred to hospital affiliated to Hormozgan University of Medical Sciences in the south of Iran. Data were collected twice (baseline and follow-up) through telephone interviews for assessing PPD risk of participants via the Edinburgh Postnatal Depression Scale (EPDS). The participants were recontacted by phone within 14 days after their childbirth. Women at PPD risk (EPDS ≥12) were included in the study to receive daily text messages and others were excluded. Each mother received two daily text messages via mobile phones for 35 days. The data were analyzed using SPSS 16. RESULTS: The average age of participants was 27.27 (range 17-35). Findings revealed that sending text messages to women with PPD would decline PPD. At pre-test, the average score for PPD was 14.44 (SD = 2.66) and it was declined to 11.94 (SD = 2.49) at the post-test phase. There was a significant difference between pre-test and post-test evaluations (P-value < 001). CONCLUSIONS: Long-distance counseling through sending text messages to patients with PPD can be an effective treatment along with other current treatments. This can improve mothers' health literacy about maternal postpartum psychological disorders.

The effect of hand reflexology on anxiety in patients undergoing coronary angiography: A single-blind randomized controlled trial.

BACKGROUND: This study aimed to evaluate effects of hand reflexology on anxiety level in coronary angiography patients. MATERIALS AND METHODS: This clinical trial recruited 80 eligible patients >6 months. The patients were randomly assigned to receive routine care plus either hand reflexology or a simple hand massage. Data were collected using the Spielberger State-Trait Anxiety Inventory. Both groups' anxiety levels were measured before (T0) and 30 min (T1) and 1 h after the intervention (T2). FINDINGS: The mean anxiety level in the intervention group decreased from 57.54 at baseline to 55.47 after the intervention (P = 0.0001). The values in the control group were 54.27 and 51.4, respectively. The two groups had statistically significant differences in the mean scores of anxiety at T0 and T1 (P = 0.003), T1 and T2, and T0 and T2 (P = 0.0001). CONCLUSION: Hand reflexology could effectively decrease anxiety in coronary angiography patients.

The effect of sukha pranayama on anxiety in patients undergoing coronary angiography: a single -blind randomized controlled trial.

Introduction: Anxiety is among the most common problems experienced by coronary angiography (CA) candidates. Different modalities are used to manage anxiety. This study sought to examine the effects of a pranayama exercise on CA candidates' anxiety. Methods: This double-blind randomized controlled trial was undertaken in 2015 on 80 eligible patients. The patients were randomly allocated to a control and an experimental group. Before undergoing angiography, patients in the experimental group performed sukha pranayama exercises. They were trained to breathe slowly and rhythmically at a rate of ten breathing per minute for five consecutive minutes. Patients in the control group only received routine preangiography care. Data collection tools were a demographic questionnaire and the Spielberger State Anxiety Inventory. The level of patients' anxiety in both groups was measured before, half an hour after, and one hour after the intervention. The data were analyzed through doing the independent-sample t and the chi-square tests. Results: Before the intervention, the mean of anxiety score in the experimental group was 53.37, which significantly decreased to 40.75 after the intervention (P = 0.0001). In the control group, the mean of anxiety score decreased from 54.27 to 51.4. This decrease was not statistically significant. Moreover, between-group comparisons revealed significant differences between the groups regarding between-measurement mean differences of anxiety score (P < 0.01). Conclusion: Sukha pranayama is effective in alleviating CA candidates' anxiety.

Relationship Between Ischemic Heart Disease and Sexual Satisfaction.

AIM: Ischemic heart disease is a life-threatening condition. Considerable doubts exist over the effects of this disease on patients' sexual activity and satisfaction. The aim of this study was to evaluate the relationship between ischemic heart disease and sexual satisfaction. METHODS: In a retrospective cohort study, the convenience sample of 150 patients exposure with ischemic heart disease and 150 people without exposure it was drawn from Shahid Beheshti hospital, Kashan, Iran. Sampling was performed from March to September 2014. We employed the Larson's Sexual Satisfaction Questionnaire for gathering the data. Data were analyzed using descriptive statistics and Chi-square, t-test and linear regression analysis. RESULTS: The means of sexual satisfaction in patients exposure with ischemic heart disease and among the subjects without exposure it were 101.47±13.42 and 100.91±16.52, respectively. There was no significant difference between the two groups regarding sexual satisfaction. However, sexual satisfaction was significantly correlated with gender and the use of cardiac medications (P value<0.05). CONCLUSION: The level of sexual satisfaction in patients with exposure ischemic heart disease is similar to the people without exposure it. Moreover, the men and the patients who do not receive cardiac medications have higher levels of sexual satisfaction. Nurses who are providing care to patients with ischemic heart disease need to pay closer attention to patient education about sexual issues.

Life associated with fear and worry: A major concern among the cardiac valve-replaced patients.

BACKGROUND: Few attempts were made for alleviating the physical/psychological problems among the cardiac valve-replaced patients and no comprehensive study was done based on the experiences of such patients. This study was undertaken to describe the stressful experiences of the heart valve-replaced patients. MATERIALS AND METHODS: In this qualitative study performed during 2012-2013 with a content analysis approach, 13 patients from Tehran and Kashan therapeutic centers participated. The study sampling was accomplished with purposeful sampling using a semi-structured interview that continued until data saturat ion. All interviews were recorded, and were immediately handwritten word by word and finally typewritten. Description and analysis of the data were done by Graneheim and Lundman content analysis. RESULTS: One hundred and seventy-five primary codes were derived among the 680 codes taken from the participants interviewed. Using abstract and deep perception of the categories, 14 subcategories and 5 themes were derived. The themes are as follows: worry of care conditions, worry of life with the ongoing condition of having prosthetic cardiac valve, worry regarding the instability in life, fear of hospital, and fear of unknown factors. Each theme consisted of special subsidiary themes with specific functions. CONCLUSIONS: The main themes of fear and worry about on losing the valve were identified and introduced in the cardiac valve-replaced patients. As the nature and function of these themes are different in different societies, recognition and discrete definition of them are necessary for care planning and promotion.

The effects of inhalation aromatherapy on anxiety in patients with myocardial infarction: a randomized clinical trial.

BACKGROUND: Anxiety is an important mental health problem in patients with cardiac disease. Anxiety reduces patients' quality of life and increases the risk of different cardiac complications. OBJECTIVES: The aim of this study was to investigate the effects of inhalation aromatherapy on anxiety in patients with myocardial infarction. PATIENTS AND METHODS: This was a randomized clinical trial conduced on 68 patients with myocardial infarction hospitalized in coronary care units of a large-scale teaching hospital affiliated to Kashan University of Medical Sciences, Kashan, Iran in 2013. By using the block randomization technique, patients were randomly assigned to experimental (33 patients receiving inhalation aromatherapy with lavender aroma twice a day for two subsequent days) and control (35 patients receiving routine care of study setting including no aromatherapy) groups. At the beginning of study and twenty minutes after each aromatherapy session, anxiety state of patients was assessed using the Spielberger's State Anxiety Inventory. Data was analyzed using SPSS v. 16.0. We used Chi-square, Fisher's exact, independent-samples T-test and repeated measures analysis of variance to analyze the study data. RESULTS: The study groups did not differ significantly regarding baseline anxiety mean and demographic characteristics. However, after the administration of aromatherapy, anxiety mean in the experimental group was significantly lower than the control group. CONCLUSIONS: Inhalation aromatherapy with lavender aroma can reduce anxiety in patients with myocardial infarction. Consequently, healthcare providers, particularly nurses, can use this strategy to improve postmyocardial infarction anxiety management.

The experiences of "difficult life" in heart valve replaced patients.

BACKGROUND: Several reports, however, not comprehensive, have been presented about the experiences of patients with replaced heart-valve. OBJECTIVES: This study explores the experiences of the patients with heart valve replacement. PATIENTS AND METHODS: A qualitative research with a content analysis approach was carried out on the patients with cardiac valve replacement during the year 2012 and 2013. A purposeful sampling using a semi-structured interview and open-ended questions (with the main question of "What problems did you have after the valve replacement?" followed by the exploratory questions) were performed until the data saturation. All interviews were recorded, then transcribed and typed. The data analysis was done according to Grancheim and Lundmen content analysis using the MAXQDA software. RESULTS: Of 22 interviews taken from 13 participants, 430 codes were taken. Out of them, after deleting the similar items, 162 initial, 18 subcategory, and 5 subsidiary themes (problematic exposure with valve replacement, continuity of some difficulties, aggravation of life problems, insufficient support, and following a perceived care) were extracted. Based on the abstract and deep perception of the categories, the main theme of "difficult life" was explored. CONCLUSIONS: Aggravation and the continuity of some physical problems, and insufficient support after the valve replacement make the life difficult for the patients. Identification of these problems is necessary for planning and improvement of the patients' care, life quality, and survival through consultations, rehabilitation and education.