Health Sector Reform, Emotional Exhaustion, and Nursing Burnout: A Retrospective Panel Study in Iran.

BACKGROUND: Nursing burnout is affected by various factors, including work overload. Since the inauguration of the Health Sector Evolution Plan (HSEP) in Iran in 2014, government hospitals have been required to provide health services to the public at all levels. This decision, however, has increased the volume of patients admitted to government hospitals. Because nurses are on the front line of health services, they are faced with a greater load of care provision. PURPOSE: This study aimed to evaluate nursing burnout before and after HSEP in Iran, with an emphasis on the differences between government and private hospitals. METHOD: This retrospective panel study used Maslach's burnout inventory to evaluate nursing burnout in 371 nurses working in government and private hospitals in Shiraz, Iran, before and 7 months after the health sector reform. Chi-square test and paired t test were used to compare burnout scores. RESULTS: The results showed that nursing burnout had changed significantly after HSEP was launched (p = .030). A more detailed assessment found that burnout and emotional exhaustion had both increased significantly in the government-hospital group (ps = .014 and .001, respectively). However, no significant change in burnout was found in the private-hospital group over the same period. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings of this study indicate an increase in nursing burnout in government hospitals. An important issue in every health sector reform is nursing resource management, with a focus on burnout. Accordingly, policymakers should consider the work overload situation of nurses and work to prevent increased burnout, especially emotional exhaustion.

From good to great physician: a critical ethnography based on patients' views.

The doctor-patient interaction (DPI) plays an important role in the way patients view physicians. Thus, response to the question of ''Who is a great physician?'' is related to DPI experiences of patients. The aim of this qualitative study was to explore patients' views regarding this subject. Based on critical ethnography in one educational hospital in Shiraz, Iran, the study was performed based on 156 clinical consultations, 920 hours of participant observations, and 6 focus groups with patients and their relatives. The results revealed that asymmetrical power relationships exist in this context. Based on the general views of participants and their recent DPI experiences, a great physician should be kind, empathetic, friendly, and a good listener. Considering the presence of an asymmetrical power relationships in this context, results showed that doctors do not participate in an active interaction. Based on sociological theories, it can be concluded that the concept of a great physician is not only limited to obligations as in the Parsonian view, but is also related to active communication between both sides which is presented in the critical view. Through active communication , asymmetrical power relationships can be reduced. Thus, if a physician wants to become a great physician, he/she must strengthen his/her humanistic dimensions and communicative skills alongside his/her medical skills.

Religion as an empowerment context in the narrative of women with breast cancer.

This paper aims at exploring women's meaningful perception, semantic understanding, and their experiences of breast cancer in a religion context. Accordingly, eight women who had one of their breasts completely removed by surgery (mastectomy) were studied by narrative interviews. In this narrative interview, participants told their life stories since the beginning of disease. Findings showed that religious concepts have a heightened role in the interpretation and understanding of disease, coping strategies, and gaining new concepts for life and death. Two main themes discovered in this research were fatalism on the one hand, and the hope and empowerment on the other. Despite the intrinsic conflict between these two concepts, religion, as a specific cultural and epistemological context, reconciles them; in a way, these polar concepts form a unitary structure of meaning and activity. In this structure, semantic coherence and concrete experience leads women with breast cancer to a new meaningful system, which shapes a new path for living well.