Parental barriers to implementing family-centred care in a neonatal intensive care unit in Islamic Republic of Iran.

Background: Studies have shown short-term and long-term positive effects of family-centred care interventions on neonatal and maternal health, and developmental outcomes in neonatal intensive care units. However, some challenges and barriers limit implementation of family-centred care. Aim: To investigate parental barriers to implementing family-centred care in a neonatal intensive care unit in Islamic Republic of Iran. Methods: A conventional content analysis was conducted at a neonatal intensive care unit in Tehran, Islamic Republic of Iran from 2020 to 2021. Twenty semi-structured interviews and 9 field notes were conducted. The interview data were analysed using the Graneheim and Lundman method and the demographic data were analysed using SPSS version 21. Findings: Two themes emerged from the data analysis. The first theme was "inefficiency of playing the parental role", with 2 main categories of "face unpleasant feelings" and "inappropriate presence and participation". The second theme was "ineffective involvement of parents in the care", with 3 main categories of "lack of effective communication with personnel", "interference of parents in the treatment process", and "given insufficient information by parents". Conclusion: Parental barriers to the provision of family-centred care featured prominently in the study. Therefore, to improve neonatal and family health, there is a need for involvement, coordination and effective communication between the medical teams and parents to create a supportive and friendly environment in neonatal intensive care units.

Exploring men's struggles with infertility: A qualitative content analysis.

AIM: To investigate the experiences of men struggling with infertility. DESIGN: This is a qualitative study, and the report follows the COREQ checklist. METHODS: A team of nurse researchers conducted this research in Iran to examine the experiences of 11 men with primary infertility. The participants were selected through targeted sampling and underwent in-depth semi-structured interviews. The data collected was analysed using the conventional content analysis method outlined by Krippendorff. To ensure the study's accuracy, it followed the criteria proposed by Lincoln and Guba. RESULTS: The central theme, "the threat to masculinity," was identified upon analysis. It comprises six categories: psychological pressure of confronting reality, frustration, discomfort with others, holding out against ridicule, tolerating unwanted opinions and advice and concealment of infertility and therapy. CONCLUSION: This study brings attention to the challenge to masculinity that men with primary infertility face as their central struggle. It highlights the importance of culturally sensitive care from healthcare professionals, emotional support, counselling services and public awareness to reduce the stigma surrounding male infertility. It can be valuable to evaluate and enhance infertility care in various settings. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: To provide the best possible care for infertile men, it would be beneficial for nurses to pay more attention to sociocultural factors. Fertility care should be respectful of patients' beliefs and backgrounds. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: Infertility care has been the subject of recent research, focusing on the impact of sociocultural factors. Male-factor infertility is often overlooked in clinical care literature. There is a correlation between cultural background and men's acceptance of reproductive healthcare. WHAT WERE THE MAIN FINDINGS?: Male infertility is often avoided in discussions due to its perceived threat to masculinity. Multiple factors, including societal norms, cultural expectations and personal experiences, influence the nature of men's struggles with infertility. Providing emotional support and counselling services is crucial so that men can openly discuss their fertility challenges and seek treatment without feeling ashamed or judged. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: Raising public awareness and providing education about male infertility is crucial. Nurses must exhibit cultural sensitivity while caring for men experiencing infertility. Policymakers need to implement strategies to reduce the stigma surrounding male infertility. REPORTING METHOD: The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No public or patient involvement.

Ethics education: Nurse educators' main concern and their teaching strategies.

BACKGROUND: To practice nursing ethics, students must first understand the ethical concepts and principles of their profession, but despite this knowledge, students face challenges in implementing ethical principles in clinical settings. The educational performance of nurse educators is critical in resolving these challenges. This study focused on the lived experiences of nurse educators. OBJECTIVE: To address the main concern of educators when teaching ethics to undergraduate nursing students and how they deal with it. RESEARCH DESIGN: We conducted this qualitative content analysis in Iran in 2020. We used individual semi-structured interviews to collect, record, and transcribe data, as well as Graneheim and Lundman method to analyze them. PARTICIPANTS: and research context: We used purposive sampling to select 11 nurse educators who either were currently in the position of ethics educators or had taught ethics from Iranian universities of medical sciences. ETHICAL CONSIDERATIONS: The present study received the code of ethics No. IR.MODARES.REC.1399.036. Participants were aware of the study's purpose and signed a consent form to participate in the study. We considered data confidentiality and the voluntary principle in data collection. FINDINGS: Nurse educators' main concern was how to sensitize students to ethical principles in clinical settings, so they tried to involve students in the teaching process, to repeat and practice ethical principles and concepts, simplify and simulate ethical principles and concepts, and provide opportunities for students to gain clinical experiences. DISCUSSION: To sensitize students to ethical nursing care, nurse educators try to institutionalize ethical principles using different teaching methods, including students' involvement in teaching, experiential learning through simulated situations, practice, repetition, and provision of opportunities for practice and experience. CONCLUSION: Improving students' cognitive ability and objectifying moral concepts and principles for students will institutionalize moral values in them that are fundamental for their moral sensitization.

Prevalence of Pressure Injury among Stroke Patients In and Out of Healthcare Settings: A Systematic Review and Meta-Analysis.

Pressure injury is a recognized problem for patients with stroke. Knowing the prevalence of pressure injury post stroke can guide clinical professionals and researchers to take appropriate actions for patient care and education. The aim of this study was to systematically review the literature regarding prevalence of pressure injury among patients with stroke in the hospital, and in the home with no home healthcare services and nursing homes. Original articles available in Scopus, Web of Science, PubMed, ProQuest, and Google Scholar databases were searched separately by two researchers using the following keywords: stroke, cerebrovascular attack, pressure injury, pressure ulcer, bedsore, decubitus ulcer, and prevalence. The search was performed according to the PRISMA flow diagram from 2000 to 2020. After the initial review, 14 articles conducted between 2008 and 2019 were included in the final analysis. Eight studies were conducted in healthcare settings, and six studies were conducted out of hospitals. The estimated pooled prevalence for pressure injury in all studies was 3.9%. The estimated pooled prevalence for pressure injury in studies conducted in hospitals and in patients' homes with no home healthcare services and nursing homes were 3.06 and 17.25, respectively. The prevalence of pressure injury among stroke patients after hospital discharge was significantly higher than when they were hospitalized. This could indicate that this group of patients do not receive adequate care and attention for pressure injury after hospital discharge. Given the limitations of the available studies, it is recommended that further studies be conducted on pressure injury among stroke patients both at the time of hospitalization and after hospital discharge.

Ethical challenges in caring for healthy older adults: Qualitative perspectives.

BACKGROUND: Healthy aging is one of the essential aspects of a health promotion program in the elderly. AIM: Exploring ethical challenges in healthy elderly care from the perspective of nurses, older adults, and families in the Iranian context. RESEARCH DESIGN: This qualitative study was conducted using a content analysis approach in 4 health centers in northeastern Iran from 2017 to 2019. Semi-structured interviews, observation, review of elderly files, and focus groups were used to collect data. ETHICAL CONSIDERATIONS: The ethics committee of the university approved this study in Iran. This study adhered to the principles of the Helsinki Declaration. Ethical principles autonomy, confidentiality, and anonymity were considered for the participants. Participants were informed about the purpose of the study and submitted written informed consent regarding their participation. FINDINGS: The central theme was: An unfair approach to caring for healthy older adults. The three categories were as follows: Forgotten human care, disrespect, and lack of a meaningful and trustworthy relationship. The 14 subcategories highlighted the ethical challenges of healthy aging care in health centers. DISCUSSION: The findings showed that due to nurses' unfamiliarity with the concept of healthy aging, older adults are discriminated against in care centers. Creating a standard care program for healthy older adults ensures that ethical principles are followed for these clients. CONCLUSION: Various individual and organizational factors lead to an unfair approach to caring for healthy elderly in health centers. The following factors can help improve the care of healthy aging and reduce ethical challenges in this area: Introducing nurses to the concept of healthy old age and its dimensions, creating a community-based approach in health centers, prioritizing health issues over health issues, Involvement of families and older adults in needs assessment-goal setting-implementation and evaluation of health services, and design of home visit programs to provide services to healthy elderly.

Challenges in implementation of patient-centred care in cardiac care unit: A qualitative study.

AIM: This study aimed to explore the barriers to the implementation of patient-centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. DESIGN: This study was performed with a descriptive qualitative study approach. METHODS: In this study, the data were collected through face-to-face in-depth semi-structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. RESULTS: After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.

Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study.

AIM: Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon. DESIGN: This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis. METHODS: Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach. RESULTS: Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho-emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.

The spousal role of middle-aged Iranian women: A qualitative content-analysis study.

This study aimed to explain the spousal role in the lives of Iranian middle-aged women. This qualitative study was conducted in Iran from July 2018 to November 2019. The participants included 25 middle-aged women selected through purposive sampling. The data were collected using semi-structured interviews and analyzed through conventional content analysis. The theme of reviving the spousal role was explained by three main categories of paying more attention to the spouse's needs, enhancing feminine charms, and maintaining married life. A deeper understanding of the middle-aged women's spousal role may help health-care personnel to develop indigenous marriage-enrichment programs for middle-aged individuals.

Nurses' perception of work and life under COVID-19 pandemic conditions: a qualitative study.

Objectives: Although nurses work and live in special and stressful conditions due to the nature of their profession, in periods of crises and pandemics, when the work pressure on nurses and the public's need for professional services increases to extraordinary and incomparable levels compared to customary conditions, their work and life situation becomes entirely different. Therefore, what nurses experienced in the COVID-19 pandemic went beyond the typical challenges of their work environment. This study was conducted to discover nurses' perceptions of work and life during the COVID-19 pandemic. Methods: This qualitative study was conducted with a conventional content analysis approach on 16 nurses working in the inpatient wards during the COVID-19 pandemic in Iran. Data were collected through unstructured, individual, and in-depth interviews between August 2020 and June 2023 and were analyzed using content analysis with the conventional (inductive) approach of Granheim and Lundman. Results: Data analysis led to the extraction of 11 subcategories, namely, "feeling a lack of support and understanding from managers," "team cooperation and communication challenges in difficult work conditions," "shadow of burnout," "shortage inequity," "dissatisfaction with unfair wages and benefits," "not having their work and sacrifices appreciated," "suffering and fatigue of using personal protective equipment (PPE)," "deprivation of entertainment and rest," "fear of illness and imminent death," "low resilience," and "deteriorating life conditions" These 11 subcategories led to the following themes: "unsafe work environment" and "the shadow of suffering and death." Conclusion: Nurses working in COVID-19 wards in Iran worked in an unsafe work environment during the COVID-19 pandemic and had to deal with suffering and fear of death. It is necessary to pay attention to the needs and problems of nurses, and healthcare organizations must provide the required support to maintain the physical and mental health of nurses during epidemics.

Raising Adolescent Children as a Developmental Task of Iranian Middle-aged Mothers: A Qualitative Study.

Background: Most parents consider adolescence to be the most difficult stage of parenting. Parental practice is a determining factor in adolescents' outcomes. Mothers play the main role of parenting in Iran. Coinciding the transition of adolescence with the transition of middle-aged mothers can affect the mothers' parenting practice. The present study aimed at explaining the Iranian mothers' practice in parenting an adolescent child. Methods: This qualitative conventional content analysis was conducted from July 2018 to November 2019 in Kashan. 21 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. The data were analyzed through conventional content analysis. Data collection and analysis were performed simultaneously using MAXQDAv10 software. Results: Regarding the study objectives, two themes and six main categories were identified. The theme of 'laying the groundwork for upbringing' was detected by two main categories: 'meeting the needs and 'effective interaction with the adolescent'; also, the theme of 'individual-social capacity building' was explained by four main categories: 'helping to gain independence', 'modeling individual-social behavior', 'socializing the adolescent', and 'preparing to accept future roles'. Conclusion: Mothers' practice was mainly focused on adolescents' independence, college education, career prospects, and marriage preparation and respect for older adults. Consistent with this transition to modernity, and contrary to the collectivist values of Iranian society, mothers' practice was in line with developing adolescents' independence and building their self-confidence, which is close to the authoritative parenting style.

Identifying Important Challenges of Coping with Female Breast Cancer among Iranian Spouses: A Qualitative Study.

Objective: Breast cancer is a multidimensional crisis for women and their spouses that affects every aspect of their life. Coping with this disease requires investigating and resolving the challenges faced by all those affected by it. The present study was conducted to clarify these challenges on the basis of lived experiences of the spouses of women with breast cancer. Method : The present qualitative research performed an interpretive phenomenological analysis in Iran.Purposive sampling was employed to select twenty spouses of women with breast cancer. The data collected through unstructured face-to-face interviews were analyzed using van Manen's method. To ensure the rigor of the study, Lincoln and Guba's criteria were evaluated in the qualitative process. Results: Lived experiences of the spouses of the women with breast cancer in coping with challenges included the four themes of emotional confusion, shouldering the burden of care, psychophysical suffering caused by the disease and life without cohesion. Conclusion: Spouses of the women with breast cancer in the Iranian community faced several challenges and issues. The socioeconomic support provided by supporting organizations and medical personnel appear to help moderate these challenges and improve coping in this group.

Effective strategies for implementing patient-centered care in cardiac care unit: An opportunity for change.

BACKGROUND: Patient-centered care (PCC) is a cornerstone for health-care professionals to improve the quality of care they provide to patients with cardiac disease. However, implementation of PCC programs has always accompanied with unpredictable challenges and obstacles. Therefore, the present study was conducted to determine effective strategies for the implementation of PCC from the perspective of patients and healthcare providers. MATERIALS AND METHODS: The present research was a qualitative study using conventional content analysis method in one of the university hospitals of Abadan University of Medical Sciences during 2019-2020. Purposive sampling was performed until data saturation was achieved. Data were collected through four focused group discussions and 24 in-depth semi-structured interviews with 22 health-care providers and seven cardiac patients. Depending on the interview process and the responses of each individual, the sequencing of questions was different from one participant to another. Data analysis was performed continuously and concurrently with data collection, using a comparative method. RESULTS: After data analysis, seven subcategories and three main categories were extracted. The main categories included structural, process, and outcome strategies. The category of structural strategies included subcategories of nursing care organization, application of appropriate motivational mechanisms, and expansion of team coordination. Process strategies included three subcategories, namely, promoting communication, respectful and compassionate care, and the development of holistic care. Finally, the outcome strategy consisted of the subcategory of patient empowerment. CONCLUSION: The practical strategies for the implementation of PCC in coronary care unit revealed in this study were at structural, process, and outcome levels. Health-care managers and administrators can avail themselves of the findings of the present study to promote the quality care for cardiac care unit patients and improve patient satisfaction.

The Role of Family Caregivers in Pressure Injury Prevention Guidelines: A Scoping Review.

Considering the importance of family caregivers in pressure injury prevention, it is necessary to clearly define their role in pressure injury prevention guidelines. We reviewed the contents of pressure injury prevention guidelines with the aim of defining the role of family caregivers. PubMed, Web of Science, Scopus, and Proquest were searched, as well as the internet, as some pressure injury guidelines may not be published in professional journals. Literature published between 2000 and 2020 was searched using the keywords "pressure injury," "pressure ulcer," "bed sore," and "prevention guideline." Ten guidelines related to pressure injury prevention were found. Of these, five guidelines mentioned the role of family caregivers in relation to pressure injury, referring only to the training and empowerment of family caregivers. Of the five guidelines that mentioned caregiver training, only three determined the training content in detail. According to these guidelines, family caregivers should be trained on the risk factors of pressure injuries, characteristics of pressure injuries, intervention to prevent pressure injuries, nutrition, sign and symptoms of pressure injuries, complication such as infection and using protective equipment and devices. In the guidelines that focused on family caregivers, the attention is sometimes limited and vague. Limited attention to the role of family caregivers can lead to lack of awareness and reduced ability of family caregivers to prevent pressure injury and ultimately increase the patient's risk of developing pressure injury.

The concept of coping in male spouses of Iranian women with breast cancer: A qualitative study using a phenomenological approach.

INTRODUCTION: Breast cancer is a multidimensional crisis that affects not just the patient, but the spouse and other family members. Coping with this phenomenon, as one of the important challenges for the families and spouses, requires investigation. Understanding more about how spouses of women with breast cancer cope with this crisis could lead to better performance of spouses in front of their wives and raise their wives' quality of life. PURPOSE: The study was conducted to explore the concept of coping based on the lived experiences of spouses of women with breast cancer. METHODS: This qualitative study was conducted with a phenomenological approach in Hamedan and Rasht cities in Iran in 2019. Participants included 20 spouses of women with breast cancer selected by a purposive sampling method. Data were collected through unstructured face-to-face interviews and analyzed using van Manen's six-stage phenomenological method. RESULTS: The lived experiences of participants showed that the phenomenon of coping in spouses of women with breast cancer included five themes: Emotional pain, Shouldering the burden of care, Striving for family life cohesion, Future in ambiguity, and Sense of loss of self concept. Understanding the concept of coping in the spouses of women with breast cancer in health strategies can help wives achieve effective adaptation and also help professionals take effective measures in the field of medical care for patients and their spouses.

Concept d'adaptation chez les conjoints de femmes iraniennes atteintes du cancer du sein: étude qualitative basée sur une approche phénoménologique.

INTRODUCTION: Le cancer du sein provoque une crise multidimensionnelle qui ébranle non seulement la patiente, mais aussi le conjoint et les autres membres de sa famille. Il convient donc d'étudier l'adaptation à ce phénomène, qui constitue l'une des principales difficultés pour les proches. En comprenant mieux comment les conjoints de femmes atteintes d'un cancer du sein font face à cette crise, ces derniers pourraient mieux prendre soin de leurs épouses et améliorer leur qualité de vie. BUT DE L'ÉTUDE: L'étude visait à explorer le concept d'adaptation à partir d'expériences vécues par les conjoints de femmes souffrant d'un cancer du sein. MÉTHODOLOGIE: Cette étude qualitative a été réalisée en 2019 selon une approche phénoménologique dans les villes de Hamadan et Rasht, en Iran. Le groupe de participants comptait 20 conjoints de femmes atteintes du cancer du sein, recrutés grâce à une méthode d'échantillonnage par choix raisonné. Les données ont été recueillies au moyen d'entretiens non structurés en personne; elles ont été analysées à l'aide de la méthode phénoménologique en six étapes de van Manen. RÉSULTATS: Les expériences vécues par les participants ont montré que le phénomène d'adaptation des conjoints au cancer du sein de leur femme se décline en cinq thèmes: souffrance émotionnelle, fardeau des soins, maintien de la cohésion familial, incertitude de l'avenir et sentiment de perte du concept de soi. La compréhension du concept d'adaptation chez les conjoints de femmes atteintes du cancer du sein dans les stratégies de santé peut aider les femmes à bien s'adapter, tout en aidant les professionnels à adopter des mesures efficaces dans le domaine des soins médicaux, pour les patientes et leurs conjoints.

Inducing a sense of worthiness in patients: the basis of patient-centered palliative care for cancer patients in Iran.

BACKGROUND: Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. METHOD: For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman's method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. RESULTS: From content analysis, 3 main categories; considering patient's spirituality, maintaining patient's dignity during care, and reducing patient's suffering, were found. The essence of these categories reflect on the care-providers' consideration and effort in "inducing a sense of worthiness" in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. CONCLUSION: For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.

Trend in the role of licensed practical nurses in health care system: A situational analysis.

BACKGROUND: Over the past hundred years, licensed practical nurses (LPN) have faced several challenges because of the changing situations in health care system. The current study addresses the role changing of LPNs in accordance with the context and new needs. AIMS: This aim of situation analysis is to access what changes have occurred in the role of LPNs in the wake of changes in role of RNs over the past century and What factors and variables have influenced this process? METHODS: This study used a Grounded Theory methodology called Situational Analysis. Data were collected through semistructured and in-depth interviews with 33 nurse. FINDINGS: Researchers identify six themes that focus on how the role of LPNs has been changing and variables have influenced this process. CONCLUSIONS: In Iran, as in other countries of the world, the role of LPNs comes to fore when there are pressing needs and nursing shortage. Iranian policymakers have decided to eliminate LPNs, Although LPNs in other countries are working in community-based settings. Treatment-oriented and self-monitoring structure of the Iranian health care system, new nursing organizations and lack of clear role classification at the caring levels have made the nursing roles ambiguous.

Promoting professional and interprofessional relationship among nurses in Iran: a participatory action research.

Communication is the basis of nursing care and can have a significant effect on patient and community health. This study aimed to optimize the professional and interprofessional relationships of nurses. This participatory action research was conducted with 288 patients and 23 staff of one of the Reference Hospitals in Tehran, Iran, from 2019 to 2020. Interviews were simultaneously analyzed using the conventional content analysis method, and in the quantitative section, the communication skills checklist and a researcher-made questionnaire were used. Participants gave oral and written consent, and their confidentiality and anonymity were respected. Participants' experiences showed that the implemented programs changed the work environment. The acquired basic concepts were improving the nurse's responsibility and accountability, improving the quality of care and respecting the patient and the family. Quantitative data obtained before and after the implementation of change programs showed that patient satisfaction increased from 41.57±7.03 to 94.34±4.67 and patient and family training from 113.73±19.77 to 245.99±36.61. The length of hospital stay decreased from 5.52±2.47 to 3.57±2.35 days, nosocomial infections from 32.1±2.8 to 17.4±2.4 and readmission from 4.8±1.2 to 2.3±1.1. The results indicated that patients' quality of care and safety was increased by optimizing the nurse's professional and interprofessional relationship. Patients reported greater respect, and nurses had higher job satisfaction.

Competencies of charge nurses: a systematic review and thematic synthesis.

OBJECTIVE: To determine the competencies of charge nurses. METHODS: The systematic review and thematic synthesis study was done at Iran from1 Apr 2018 to 31 Jul 2018. Five electronic bibliographic database (Science Direct, Pro Quest, Scopus, Pub-Med, Scientific Information Database) were systematically searched for relevant literature published from 1980 to 2018. Content analysis was done to categorise competency of charge nurses. RESULTS: Of the 1285 articles, 24(1.86%) were reviewed. Through thematic synthesis, six themes identified were self-management, others' management, clinical competency, conceptual-cognitive competency, professional-legal competency and competency in communication. There is need to improve knowledge and skills in the domains of management, leadership, communication and perceptual/cognitive competency. CONCLUSIONS: The findings may help nurse administrators and nurse directors in designing training programmes for charge nurses who could improve their competencies.

Emotional Bond: The Nature of Relationship in Palliative Care for Cancer Patients.

AIM: Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients. METHODS: In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted. RESULTS: Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach. CONCLUSION: Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.