The elderly, COVID-19, and violence: A qualitative content analysis.

Introduction: Violence against the elderly is one of the types of domestic violence that is one of the major social health problems in modern societies and whose incidence has increased sharply in the last two decades, especially during the COVID-19 pandemic. The present study aims at explaining the concept of violence against the elderly during lockdown and the epidemic of COVID-19. Methods: This qualitative study was conducted with a conventional content analysis approach in Izeh (a city in Khuzestan Province) in 2021. The data were collected through conducting unstructured interviews as well as taking field notes with as many as 13 elderly family members. After obtaining informed consent, the collected data were written word for word, and the content analysis method was applied to name the data, create analytical codes, and determine subgroups and categories. The data were analyzed using MAXQDA-10. Results: The results of this study indicated that the elderly who have been subjected to violence have many ambiguities in the process of identifying and dealing with the violence inflicted on them; the fear of being rejected by family members and their escalated violence make the violence remain hidden. Conclusion: Given their failure to seek help and the lack of support provided by the related organizations, the elderly did not report violence inflicted on them, which in turn led to the spread of violence against them. Thus, it is recommended that nurses and health policymakers provide the required planning to address the problems of violence against the elderly during the COVID-19 pandemic and post-pandemic era.

Dynamic fluctuations in ascending heart-to-brain communication under mental stress.

Dynamical information exchange between central and autonomic nervous systems, as referred to functional brain-heart interplay, occurs during emotional and physical arousal. It is well documented that physical and mental stress lead to sympathetic activation. Nevertheless, the role of autonomic inputs in nervous system-wise communication under mental stress is yet unknown. In this study, we estimated the causal and bidirectional neural modulations between electroencephalogram (EEG) oscillations and peripheral sympathetic and parasympathetic activities using a recently proposed computational framework for a functional brain-heart interplay assessment, namely the sympathovagal synthetic data generation model. Mental stress was elicited in 37 healthy volunteers by increasing their cognitive demands throughout three tasks associated with increased stress levels. Stress elicitation induced an increased variability in sympathovagal markers, as well as increased variability in the directional brain-heart interplay. The observed heart-to-brain interplay was primarily from sympathetic activity targeting a wide range of EEG oscillations, whereas variability in the efferent direction seemed mainly related to EEG oscillations in the γ band. These findings extend current knowledge on stress physiology, which mainly referred to top-down neural dynamics. Our results suggest that mental stress may not cause an increase in sympathetic activity exclusively as it initiates a dynamic fluctuation within brain-body networks including bidirectional interactions at a brain-heart level. We conclude that directional brain-heart interplay measurements may provide suitable biomarkers for a quantitative stress assessment and bodily feedback may modulate the perceived stress caused by increased cognitive demand.

Optimizing Fixation Filters for Eye-Tracking on Small Screens.

The study of consumer responses to advertising has recently expanded to include the use of eye-tracking to track the gaze of consumers. The calibration and validation of eye-gaze have typically been measured on large screens in static, controlled settings. However, little is known about how precise gaze localizations and eye fixations are on smaller screens, such as smartphones, and in moving feed-based conditions, such as those found on social media websites. We tested the precision of eye-tracking fixation detection algorithms relative to raw gaze mapping in natural scrolling conditions. Our results demonstrate that default fixation detection algorithms normally employed by hardware providers exhibit suboptimal performance on mobile phones. In this paper, we provide a detailed account of how different parameters in eye-tracking software can affect the validity and reliability of critical metrics, such as Percent Seen and Total Fixation Duration. We provide recommendations for producing improved eye-tracking metrics for content on small screens, such as smartphones, and vertically moving environments, such as a social media feed. The adjustments to the fixation detection algorithm we propose improves the accuracy of Percent Seen by 19% compared to a leading eye-tracking provider's default fixation filter settings. The methodological approach provided in this paper could additionally serve as a framework for assessing the validity of applied neuroscience methods and metrics beyond mobile eye-tracking.

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.

Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature.

BACKGROUND: Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach. METHODS: An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding. RESULTS: Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA. CONCLUSION: There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.

Nurse in limbo: A qualitative study of nursing in disasters in Iranian context.

BACKGROUND: An understanding of nurses' experiences in disasters can help to identify their problems in this area. These can be overcome with better planning and preparation. The aim of this study was to explore the experiences and perceptions of disaster nurses regarding their provision of disaster health care services. METHODS: This was a qualitative study using an inductive qualitative content analysis. Participants included 15 Iranian nurses who had experiences of health care delivery in disasters. A purposeful sampling was applied until data saturation was reached. Data were collected using semi-structured interviews and then analyzed based on the principle of inductive content analysis. RESULTS: Five main categories emerged from the experiences and perceptions of nurses who were involved in providing health care services in disasters: afraid of probability of recurrence, necessity of providing healthcare services for an unknown period of time, challenge of what to prioritize, nurses' own conflicting emotions, and their concern for their own families. DISCUSSION: There are several factors affecting the delivery of healthcare in disasters. Nurses, who feel better prepared and have some understanding of the ethical implications of working under different standards of care, may be more comfortable with care giving in disasters. Appropriately, training and preparing nurses for disasters is important for optimizing the safe functioning and minimizing emotional and psychological damage.

Nursing in disasters: A review of existing models.

BACKGROUND: Since nurses play an important role in responding to disasters, evaluating their knowledge on common patterns of disasters is a necessity. This study examined researches conducted using disaster nursing as well as the models adopted. It provides a critical analysis of the models available for disaster nursing. METHODS: International electronic databases including Scopus, PubMed, ISI Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar were investigated with no limitation on type of articles, between 1st January 1980 and 31st January 2016. The search terms and strategy were as follows: (Disaster∗ OR Emergenc∗) AND (Model OR Theory OR Package OR Pattern) AND (Nursing OR Nurse∗). They were applied for titles, abstracts and key words. This resulted in the generation of disaster nursing models. RESULTS: Out of the 1983 publications initially identified, the final analysis was conducted on 8 full text articles. These studies presented seven models. These evinced a diverse set of models with regard to the domains and the target population. CONCLUSIONS: Although, disaster nursing models will inform disaster risk reduction strategies, attempts to systematically do so are in preliminary phases. Further investigation is needed to develop a domestic nursing model in the event of disasters.

Resiliency Improvements in Medical Emergency Staff in Burn Missions: A Qualitative Study in an Iranian Context.

BACKGROUND: Medical emergency staff complete understanding of the nature of resiliency in burn events is a prerequisite for improving the quality of clinical service delivery in pre-hospital burn events. OBJECTIVES: The present study aimed to describe resiliency in view of medical emergency staff in burn events. MATERIALS AND METHODS: The present qualitative study was performed using a content analysis method. In total, 18 Iranian emergency care personnel participated in the study. A purposeful sampling method was applied until reaching data saturation. Data was collected using semi-structured interviews and field observations. Afterwards, data was analyzed by face content analysis. RESULTS: By analyzing 456 primary codes, four main concepts including: 1) scene safety/security, 2) effective clinical decision making, 3) self-efficacy and 4) religious support were extracted through content analysis from experiences of pre-hospital emergency personnel during burn care. CONCLUSIONS: Different factors affect resiliency improvements in medical emergency staff and consequently the quality of pre-hospital burn care. This study showed that various factors such as scene security/safety, effective decision making, self-efficacy and religious support are effective in the improvement of resiliency and the quality of pre-hospital emergency care.

Spousal support as experienced by people with multiple sclerosis: a qualitative study.

About 30% of people with multiple sclerosis require some form of supportive assistance at home, and 80% of that assistance is usually provided by spouses or partners. So, the explanation and understanding of patients' experiences of support received from their spouses enable spouses and healthcare professionals to reform their actions toward positive support. This study aimed to explore the experiences of people with multiple sclerosis regarding support from their spouses. A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis who were chosen through purposeful sampling from multiple sclerosis associations of Isfahan and Tehran (Iran). Data were collected through nonstructured interviews from September 2011 to August 2012. Four themes and nine subthemes emerged through data analysis. The main themes were play a supportive role, establish a friendly and comfortable relationship, help patient to fight the disease, and help to maintain and to improve patients' functional ability. The results could help in improving the quality of spouses' support in people with multiple sclerosis. Moreover, it could aid in determining the educational needs of patients as supported persons and spouses as supporters. The results could lead to increased knowledge of healthcare experts about the issue of how Iranian people with multiple sclerosis are being supported by their wives/husbands. Furthermore, it would help them to design caring models to promote successful supporting strategies for patients.

Pre-hospital burn mission as a unique experience: a qualitative study.

INTRODUCTION: A thorough understanding of experiences related to pre-hospital emergency care of burns is a prerequisite of skill promotion for medical personnel. The aim of the present study was to evaluate the experiences of pre-hospital emergency personnel during burn accidents. METHODS: The present qualitative study was performed using a content analysis method. In total, 18 Iranian emergency care personnel participated in the study. A purposeful sampling method was applied until reaching data saturation. Data were collected using semi-structured interviews and field observations. Afterwards, the gathered data were analyzed through face content analysis. RESULTS: By analyzing 498 primary codes, four main categories; the nature of burn care, tension at the accident scene, gradual job 'burnout', and insufficient information, were extracted from the experiences of pre-hospital emergency personnel during burn care. These categories each included several sub-categories, which were classified according to their significant characteristics. CONCLUSION: This study showed that different factors affect the quality of pre-hospital clinical services for burns. Authorities and health system administrators should consider the physical and psychological health of their staff, and assign policies to improve the quality of pre-hospital medical care. According to the present results, it is recommended that the process of pre-hospital emergency care for burns be investigated further.

Experiences of hospitalization in patients with multiple sclerosis: A qualitative study.

BACKGROUND: Patients with multiple sclerosis experience hospitalization several times in their lives. Certainly, providing efficient and high-quality care by healthcare professionals is not possible unless the experiences of patients' hospitalization are taken into consideration. This qualitative study was aimed to identify experiences of patients with multiple sclerosis in their hospitalization. MATERIALS AND METHODS: A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis, who were chosen by purposeful sampling. Data were collected through non-structured interviews. RESULTS: The analysis resulted in the emergence of 4 themes and 11 subthemes. The main themes were: Religiosity, emotional reactions, seeking support, and feeling of being in a cage. CONCLUSIONS: Awareness of families and healthcare providers of the reactions of patients with multiple sclerosis to hospitalization will help them to deal effectively with patients and to improve relationships with them. However, by understanding the patients' experiences, the practitioners gain expertise and can join in the patients' health journey in a therapeutic way during the hospitalization period. In addition, the findings can serve to create a framework for developing nursing care processes including informational and supporting programs for multiple sclerosis patients during hospitalization while taking into consideration patients' needs and cultural backgrounds.

What is missed in self-immolated patients' care? A grounded theory study.

AIMS AND OBJECTIVES: To explore rehabilitation care process in patients who commit self-immolation. BACKGROUND: Self-immolation is not only a type of burn injury, but it is also a suicidal method. It is placed in burn injury category that requires long-term rehabilitation and treatment measures. As a suicidal method, among all forms of suicidal attempts, it is the most dramatic, violent and often difficult one to understand. Unfortunately, there are few reported studies investigating experiences and perceptions of nurses about burn care and with qualitative study about the patients' experiences and perceptions. DESIGN: On the basis of the research question, the grounded theory method was used. METHODS: Considering ethical codes of Belmont and Helsinki statements, purposive sampling was used to select the participants. The patients were deliberately selected, based on the research needs. They were self-immolated patients being referred to Talaghani hospital of Ilam (western Iran) or discharged previously (time of interview and observation ranged from immediately later the burn till 5 years after), in Ilam, where self-immolation rate is very high. The main methods for data collection were deep, open ended, semi-structured interviews, dairies and observations. The interviews were audio taped in Persian, and verbatim transcriptions were made. By doing so, semantic meaning is preserved, and misinterpretation of data due to translation into English is minimised. Data analysis was conducted using the Strauss and Corbin method. RESULTS: Five main categories were emerged: situation of crisis unprofessional care, prolongation and formidability of the journey, self-immolation as paralyse, and attempt for self-management. Finally, by constant, comparison of collected data and emerged categories, central variable entitled unintegrated care emerged as the main problem of self-immolated patients' care. CONCLUSION: The study comes to the conclusion that we need to focus on specific considerations to provide integrated care for the burned patients as it is a decisive component of care that is missed. RELEVANCE TO CLINICAL PRACTICE: Although self-immolation requires long-term treatment and social, emotional rehabilitation, such a rehabilitation care process is not clear.