Disaster health-related challenges and requirements: a grounded theory study in Iran.

BACKGROUND: Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster. METHODS: This study was conducted using grounded theory. Study participants included members of a multidisciplinary disaster response team as well as residents of the community affected by the earthquake (n = 29). Data collection included semi-structured interviews, field notes, and reviews of narratives. RESULTS: The findings of this study indicate that the lack of planning, inadequate organizational management of resources, insufficient coordination in the provision of health services during the disaster, and the manner of participation of international relief efforts were the most important barriers to adequate disaster healthcare services delivery during the 2003 Bam Iranian earthquake. CONCLUSIONS: This study supports the value of health service managers coordinating the appropriate use of international aid in advance. It is suggested that this can be done by better communication with local and foreign constituents. Further, this study indicates that public education and proper pre-event planning help to bring about an effective response to providing healthcare services during a disaster.

Iranian clinical nurses' coping strategies for job stress.

OBJECTIVES: Since the existence of work-related stressors is inevitable in nurses' workplace, nurses usually use a variety of coping strategies which can be called cognitive, affective, and behavioral techniques. In this study, we aimed to explore the coping strategies employed by the Iranian clinical nurses in depth. METHODS: This work was a qualitative study using Straus and Corbin's grounded theory approach focusing on the process of coping with job stress used by Iranian clinical nurses. RESULTS: The results of the present qualitative study indicate that the core category was "on the route to coping" which contained six categories comprising work management, self-control, emotional, spiritual, cognitive, and interactional strategies. CONCLUSIONS: We conclude that in nursing it is inevitable that different kinds of strategies are used to cope with the many stressors. The conceptual model emerging from the data indicate that nurses are engaged in a dynamic process of struggling to cope with job stressors. In fact, they are "on the route to coping" with the job stressors. Considering the high level of stress in the nursing profession, the findings of this study have implications for both hospital managers and Iranian clinical nurses.

Iranian nurses' preparation for loss: finding a balance in end-of-life care.

AIM: To explore the nurse-patient interaction in terminally ill situations in acute care, focusing on the nurses' preparation for loss. BACKGROUND: Caring for dying patients can be a distressing and sometimes even threatening experience for nurses. Despite the vast body of literature on nurse/patient interaction and the quality of end-of-life care, few studies focus specifically on nurses' experience. DESIGN: A grounded theory approach was used to explore nurses' interaction with dying patients and their families and examine how nurses deal with situations in which the patient's death is inevitable. METHOD: Eighteen nurses were interviewed up to three times each at three teaching hospitals in Isfahan, Iran, during autumn 2006. A shortlist of possible participants was obtained by means of theoretical sampling and those who had experienced the death of patients and were able to express their feelings verbally were selected. RESULTS: The results clarified a core consideration: striking a balance between restorative and palliative care, information and hope, expectations and abilities and intimacy and distance. CONCLUSION: Attaining a balance in caring for dying patients is a major challenge to nurses: it concerns not only their interactions with patients and their families, but also their perceptions of themselves and their actions in end-of-life care. RELEVANCE TO CLINICAL PRACTICE: In end-of-life care, it is important for nurses to be able to change the focus of their care when the patient's condition is diagnosed as irreversible. They also need to be well equipped to maintain a balance, thereby preparing themselves for the patient's forthcoming death.