Facilitators and barriers to self-management in Iranian men with chronic obstructive pulmonary disease: a qualitative study.

INTRODUCTION: Self-management, as the most common method of chronic obstructive pulmonary disease (COPD) management, is not an isolated behaviour, but a set of physical, social, cultural, psychological and existential factors affecting it. AIM: This study aimed to explore the facilitators and barriers to self-management in men with COPD in the unique social, cultural, political and economic context of Iran. METHODS: This paper reports part of the findings of a qualitative grounded theory study aimed at exploring the process of self-management in Iranian men with COPD, which was conducted in Iran from January 2019 to July 2023. Participants included men with COPD, their family members and pulmonologists. The selection of participants in this research began with the purposeful sampling method. Data was collected using semistructured interviews. Data collection continued until the data saturation was achieved. A total of 15 interviews were conducted with nine patients, three family members of patients and three pulmonologists. The data was analysed using the constant comparative analysis method. RESULTS: The findings of this study showed that knowledge, education, experience, family involvement and financial support are the factors that facilitate self-management. Factors related to deficits include lack of education, lack of treatment support, family cooperation deficit, financial problems, medication obtaining problems and factors related to disease impacts include specific nature of the disease, residual effect, comorbidity and factors related to negative patients characteristics include false beliefs, poor self-efficacy, feeling shame and non-adherence are barriers to self-management in men with COPD. CONCLUSION: Based on results of this study, healthcare providers and health planners can strengthen the factors that facilitate self-management and weaken or remove the barriers to self-management, so that these patients use self-management strategies with maximum capacity to control the disease.

Contributing factors involved in the safety of elderly people with chronic illness in home healthcare: a qualitative study.

INTRODUCTION: Patients receiving home care are often elderly people with chronic illnesses that increasingly experience patient safety barriers due to special care needs. OBJECTIVE: The present study was conducted to determine the factors involved in the safety of elderly patients with chronic illnesses receiving home care. METHODS: A qualitative study with a conventional content analysis method was conducted in home care agencies of Tehran, Iran from August 2020 to July 2022. For data generation, semistructured interviews were conducted with 11 nurses, 2 nurse assistants, 1 home care inspector (an expert working at the deputy of treatment) and 3 family caregivers. Moreover, four observational sessions were also held. Data analysis was done using the five-step Graneheim and Lundman method. RESULTS: According to the results, the facilitators of the safety of the elderly patients with chronic illnesses included the family's participation, nurse's competence, efficiency of the home care agency management and patient's participation in patient safety. The barriers to patient safety included problems created by the family, nurse's incompetence, inefficiency of the home care agency, patient's prevention of patient safety, home care setting limitations and health system limitations. CONCLUSION: The majority of the factors involved in the safety of elderly patients with chronic diseases receiving home care had dual roles and could serve as a double-edged sword to guarantee or hinder patient safety. Identification of the facilitators and barriers can assist nurses and the healthcare system in planning and implementing patient safety improvement programmes for elderly patients with chronic illnesses.

Development and psychometric evaluation of nurses' health-related procrastination scale.

There is no valid scale to measure health related procrastination, especially in nurses. This study was conducted to design and assess the psychometric properties of the health-related procrastination scale in nurses. This exploratory mixed method study was conducted between April 2017 and May 2019. The design and psychometric assessment of the nurses' health-related procrastination scale (NHRPS) was carried out through quantitative and qualitative phases. In the qualitative phase, nurses were interviewed and a review of literature was carried out to generate the items. In the quantitative phase, the scale validity was evaluated using the face, content and construct validity and its reliability was evaluated through the Cronbach's alpha, McDonald's omega, intra-class correlation coefficient, standard error of measurement, minimal detectable changes. The results of the exploratory factor analysis showed that, with 29 items and five factors, the NHRPS explains 54.81% of the variance in NHRPS. The results of confirmatory factor analysis also confirmed the final fit of model with five factors (RAMSEA: 0.08, CMIN/DF: 2.42, NFI: 0.92, PNFI: 0.83, CFI: 0.95, IFI: 0.95, RFI: 0.91, SRMR: 0.074). The Cronbach's alpha of the scale was 0.947, its intra-class correlation coefficient was 0.944, the Half-fold consistency coefficient was 0.970 and Omega internal consistency coefficient was 0.96. The NHRPS has good psychometric properties. This scale is suitable for research purposes, especially to plan for nurses' health promotion.

Death with Dignity in End-of-Life Nursing Care: Concept Analysis by Rodgers' Evolutionary Method.

Background: The concept of dying with dignity is being discussed in various fields, including psychology, sociology, medicine, and nursing, with different definitions available for this concept. However, few studies investigated the concept of end-of-life nursing care, which plays an important role in the implementation of the concept. This concept can also affect people's perception, attitude, and behavior toward practicing dignified death in health-care centers. The current study aimed to clarify, understand, and further recognize the concept of death with dignity in end-of-life nursing care. Materials and Methods: Rodgers' evolutionary concept analysis was used to clarify the concept of death with dignity in end-of-life nursing care. MEDLINE, BLACKWELL, PROQUEST, Science Direct, and CINAHL databases and national databases of SID and Iran Medex were systematically searched to identify relevant studies using various combinations of the following keywords: "dignity," "dignified death," "dying with dignity," and "dignifying death" in combination with "end-of-life care." All articles with the above-mentioned terms in their title, abstract, or keywords and published in English from 2006 to 2020 were included. A total of 21 articles were finally identified for review. Results: Characteristics of dying with dignity were categorized into two dimensions of human dignity and holistic care. The antecedents included professional and organizational factors, and outcomes included good death and career promotion. Conclusions: This study demonstrated that end-of-life nursing care is an important dimension of clinical nursing that plays a unique role in admission and facilitating the process of dying and, eventually, dying with dignity.

Patient safety in home health care: a grounded theory study.

BACKGROUND: The home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care. DESIGN: The aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015. METHOD: In total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015. RESULTS: The results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care. CONCLUSION: The results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.

Factors Involved in Nurses' Health-Seeking Behaviors: A Qualitative Study.

This study aimed to explore the factors involved in Iranian nurses' health-seeking behavior. In this qualitative exploratory descriptive study, 15 nurses from hospitals affiliated to Iran and Qazvin University of Medical Sciences were interviewed from April to March 2020. Data were collected via purposive sampling by unstructured in-depth interviews and analyzed using thematic analysis. Findings identified 5 main themes, "fear," "trust/distrust," "excuse," "accessibility," and "support" that were involved in nurses' health-seeking behavior. The findings of this study may contribute to a deeper understanding of the factors involved in nurses' health-seeking behavior and pave the way for further research and policy making regarding nursing workforce health.

Concept analysis of patient safety in home care: a hybrid model.

BACKGROUND: Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no clear and uniform definition for this concept. OBJECTIVE: The objective of the present study was to analyse patient safety in home care in Iran. METHODS: The study was done using a hybrid model at three phases, including theoretical, field work and the final analysis. We searched valid databases including MEDLIN and CINHAL; electronic references including Web of Science, Scopus, Ovid, ProQuest, PubMed and Persian databases including Magiran, IranDoc and SID during 2008-2022, using these Persian and English keywords: Patient Safety, Safety, Home Care Service, Domiciliary Care, Home Care and Home Health Care. A total of 16 articles were searched in the theoretical phase and then analysed by content analysis. In field work phase, nine participants were interviewed (nurse, family and patient) and then the interviews were analysed by the content analysis method. In the final analysis phase, a general analysis of the previous two phases was performed and after determining the attributes, antecedents and consequences, a final definition of patient safety in home care in Iran was presented. FINDINGS: Based on different studies, patient safety in home care is a multifaceted concept, which encompasses physical, mental, social and practical dimensions. Evaluation, prevention, participation and commitment to the safety culture are the core features of this concept. The patient care concept depends on the commitment of the involved participants, adequate resources, environmental conditions, support of the involved centres (home care agency, hospital and the insurance), self-efficacy and the ability of the caregivers (nurses). CONCLUSION: Defining the concept of patient safety in home care provides a basis for the development of a safe patient care system at home. This concept analysis for patient safety in home care could be a guide for future studies.

Factors Involved in Praxis in Nursing Practice: A Qualitative Study.

Introduction: Praxis is a process of applying knowledge in nursing practice to advance emancipatory goals in society and in the world and to eliminate any injustice and discrimination in care. Praxis requires the coherent application of patterns of knowing in nursing practice; however, understanding nursing knowledge is complex and using experiential knowledge alone cannot help us achieve it. The aim of this study was to determine the factors involved in praxis in nursing practice. Methods: The method adopted was qualitative. The researcher interviewed 19 nurses and attended eight observation sessions in different hospital departments. The findings were analyzed using conventional content analysis. Results: Findings from analyzing interviews and observations indicated that desirable and humanistic attributes and effective nurse-patient communication are facilitators of praxis. In contrast, prejudice, occupational barriers, negative thoughts, and discriminatory beliefs are barriers of praxis in nursing practice. Conclusion: If we consider praxis as the simultaneous application of all patterns of knowing alongside efforts to create social justice, factors that drive nurse performance toward social justice, facilitate praxis, and factors that contribute to varied degrees of discrimination and injustice, inhibit praxis. By identifying these factors, nurses may identify and eliminate social justice barriers to care.

Organ Donation Decision in Families With Brain-Dead Patients: An Evolutionary Concept Analysis.

BACKGROUND AND AIM: Organ donation decision is a complicated process for bereaved families; however, its attributes and associated factors are not clear. Accordingly, the purpose of this study was to analyze the concept of organ donation decision in families with brain-dead patients. METHODS: Concept analysis was performed using Rodgers' evolutionary method. For this purpose, PubMed, OVID, Scopus, and ProQuest databases were searched in English from 1985 to 2019. In total, 54 articles were analyzed using the thematic analysis to identify the attributes, antecedents, and consequences of the concept. The validity of the data was provided by examining the analysis process by 2 independent researchers. FINDINGS/CONCLUSIONS: Organ donation decision in these families is a complicated and conflicting process of vicarious decision-making that begins with an organ donation request: a difficult, painful, and critical experience that requires extensive interpersonal interactions and is ultimately influenced by various factors, leading to the acceptance or refusal. The antecedents include deceased-related factors, family-related factors, the quality of organ donation request, and the quality of health care professionals' interactions. The consequences include the positive outcomes (grief solace, gift of life, and promoting human values) and negative outcomes (ambiguity, doubt and regret, and psychological inconsistency). The results of this concept analysis led to a better understanding of the complexity of an organ donation decision in these families. In this way, in addition to knowledge development, it assists the health care staff to support families in making the organ donation decision. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Although case managers rarely participate in organ donation, they definitely need to understand the concepts related to organ donation decision while advocating for the patients or families. The results of this concept analysis can broaden the case managers' and other health care professionals' knowledge about families' organ donation decision and help them take more effective interventions for management of this process. Case managers and the health care team can use the information of this article for informing families about brain death, negotiating with families for organ donation, preparing information, and caring and facilitating the families in making the clear and unconflicted decision.

Symptom Disclosure Process Among Iranian Women With Self-discovered Breast Cancer.

BACKGROUND: Breast cancer is the most common malignancy among Iranian women. Symptom disclosure plays an important role in help-seeking behavior among women with self-discovered breast cancer. OBJECTIVE: The aim of this study was to explain how symptoms are disclosed by Iranian women. METHODS: This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian women with breast cancer, who discovered the symptoms themselves and were referred to 2 teaching hospitals in Tehran and Qazvin, were included via purposive and theoretical sampling. The data were collected through semistructured interviews and were analyzed based on the Corbin and Strauss approach. RESULTS: The process of symptom disclosure had 5 stages including identifying the symptoms, evaluating and interpreting the symptoms, weighing the disclosure conditions, selecting the disclosure audience, and disclosing. The perceived threat was identified as the core category. On the basis of the level of threat perception and the seriousness of the symptoms, the 3 patterns of immediate disclosure, delayed disclosure, and nondisclosure were recognized. CONCLUSION: Perceived threat is the main motivator for rapid disclosure in Iranian women with potential breast cancer symptoms and leads to a better follow-up of the symptoms. Therefore, increasing women's awareness about breast cancer symptoms, treatments, and non-follow-up consequences leads to a better perception of the threat level. IMPLICATIONS FOR PRACTICE: According to these findings, it is very important to increase Iranian women's awareness about the symptoms of breast cancer (especially the nonspecific ones). For this purpose, it is necessary to design educational interventions.

The omission of some patterns of knowing in clinical care: A qualitative study.

BACKGROUND: Providing holistic and humanistic care to patients requires a variety of factors. A care solely based on objective knowledge might be unsafe and of low quality. Using the patterns of knowing in an integrated manner and relative to the context of caring is one of the necessities for proving a holistic and efficient nursing care. This study aimed to explore the role of patterns of knowing in the formation of uncaring behaviors. MATERIALS AND METHODS: The researchers used a qualitative research design for this study. Participants included 19 clinical nurses who attended semi-structured and in-depth interviews. In addition, theoretical and purposeful sampling methods were used in this research. Observation of caring processes in different hospital wards was another method used for collecting data. The data analysis was carried out according to conventional content analysis technique. RESULTS: The study findings revealed five categories for the theme of "omission of some patterns of knowing" including omission of scientific principles, omission of therapeutic relationship, omission of ethics, omission of social justice, and omission of flexibility. CONCLUSIONS: The omission of some patterns of knowing creates an ugly image of nursing and a negative outcome of caring as well.

How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study.

BACKGROUND: Nurses require a great deal of knowledge to provide a comprehensive and effective nursing care. A number of patterns have been put into place to help nurses acquire this knowledge. The aim of this study was to describe the core variable in the process of using patterns of knowing by nurses in clinical practice. METHODS: The study was conducted in qualitative and grounded theory approach, between April 2018 and January 2020. Semi-structured interviews were used for data collection. All the interviews were transcribed verbatim. Nineteen clinical nurses were interviewed, and eight observation sessions were conducted in different hospital departments. Participants were first selected through purposeful and then theoretical sampling. Data were analyzed and interpreted using constant comparison analysis approach. RESULTS: The findings of the study indicated that nurses apply the patterns of knowing in three ways in their clinical practice: "cohesion of patterns of knowing", "domination of some patterns of knowing" and "elimination of some patterns of knowing". The core variable of this process is cohesion of patterns of knowing in the domain of flexibility. CONCLUSION: The findings of the present study indicate that application of patterns of knowing is practiced in a range of nurse flexibility in clinical settings.

The Relationship between Experienced Respiratory Symptoms and Health-Related Quality of Life in the Elderly with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the diseases that usually present at an advanced age. Respiratory symptoms in patients with COPD are the most important for making treatment decisions and understanding the adverse effects on health-related quality of life (HRQoL). This study aimed to investigate HRQoL in elderly patients with COPD and examine the relationship between this in relation to respiratory symptoms experienced by them and their demographic characteristics. METHODS: This is a descriptive, correlational study of elderly patients with COPD who were hospitalized in five different hospitals in an urban area of Iran. A consecutive sampling method was used. Demographic data form, the respiratory symptoms component of St. George's Respiratory Questionnaire (SGRQ), and the Short Form 36 Health Survey Questionnaire (SF-36) were applied for data collection. RESULTS: The patients (n = 217) reported low HRQoL, and this impairment was more observed in the physical component. There was a significant inverse relationship between the experienced respiratory symptoms and physical (p=0.03) and mental (p < 0.001) components of HRQoL. Moreover, the female gender, the low level of education, the increased duration of the disease, the increased number of hospitalizations during the past year, and the use of two classes of drugs simultaneously were associated with the impaired HRQoL. CONCLUSION: Our findings inform healthcare providers about the negative impacts of respiratory symptoms and other related factors on the HRQoL of elderly patients with COPD. Nurses and other healthcare providers should proactively identify respiratory symptoms and design appropriate caring strategies to improve HRQoL among this group.

Barriers to Effective Cancer Pain Management in Home Setting: A Qualitative Study.

BACKGROUND: Pain is one of the most disturbing and distressing symptoms experienced by cancer patients, and it is the most stressful factor affecting all aspects of patients and their families' lives. Understanding the barriers to effective cancer pain management in home setting is essential for designing programs to improve the quality of the patients and their families' lives. AIM: Exploring family caregivers' and cancer patients' experiences of barriers to pain management at home. DESIGN: Qualitative exploratory descriptive study. SETTING/PARTICIPANTS: Twenty patients and 32 family caregivers were recruited from oncology wards and palliative medicine clinics in hospitals affiliated to Iran University of Medical Sciences. METHOD: In-depth interviews were conducted with each participant, and audio-recorded and transcribed interviews were analyzed using thematic analysis. RESULTS: Ten major themes emerged regarding barriers to cancer pain management in home setting: "Drug dependence and addiction," "Malingering," "Negative attitudes towards opioid analgesia," "Concealing pain," "Painful comorbidities," "Conflict in family members' perspectives," "Inaccessibility of pain relief facilities," "Poor skill and knowledge," "Patients' feelings of depression and hopelessness," and "Caregiver burden." CONCLUSION: The study documented the need for supportive and educational programs for cancer patients and their family caregivers in an attempt to improve the effectiveness of pain managment and cancer patients' quality of life.

Self-rated health and general procrastination in nurses: a cross-sectional study.

INTRODUCTION: nurses are responsible for taking care of the health of the general public. Nurses´ own health is among the important factors affecting the quality of patient care. Self-Rated Health (SRH) is one of the indicators used extensively in health research for the assessment of the health status of individuals. The present study was conducted to evaluate self-rated health and its relationship with general procrastination in nurses. METHODS: the present cross-sectional study was conducted in 2019 on 305 Iranian nurses selected by stratified random sampling. The relationship of self-rated health with procrastination was determined using an ordinal logistic regression analysis after adjustments for personal and occupational factors. RESULTS: self-rated health was poor/bad in 11.3% of the nurses, fair in 23.7%, good in 34.3% and excellent in 30.7%. After adjustments for personal and occupational factors, a significant relationship was observed between procrastination and self-rated health (OR=0.95; 95%CI 0.92, 0.98). CONCLUSION: the results showed an unfavorable health status in nurses. Given the significant relationship between procrastination and poor self-rated health in nurses, it is essential to consider this relationship for improving nurses´ health.

Maternal Role Attainment in Mothers with Term Neonate: A Hybrid Concept Analysis.

BACKGROUND: A review of the literature shows that there is little consensus on the practical definition of maternal role attainment in the field of neonatal nursing care. The initial interaction between mother and neonate most often begins in the hospital and can be influenced by neonatal nurses, so it is necessary to clarify this concept in nursing. The purpose of this study was to show the basic characteristics and practical definition of maternal role attainment in mothers with term neonate in a new context. MATERIALS AND METHODS: This study used a hybrid model three-step concept analysis: theoretical, fieldwork, and final analysis phases. At theoretical phase, articles indexed in credential databases were searched using keywords. Totally, 33 articles were analyzed. At fieldwork phase, 12 participants were interviewed. At final phase, the findings of the two earlier phases were analyzed. The study lasted from August to November 2018. After determining the attributes, antecedents, and consequences, a final definition of maternal role attainment was introduced. RESULTS: The concept of maternal role attainment was defined as "a developmentally, interactive, adaptive, and committed multi-dimensional process based on the discovery of pregnancy, characteristics of the mother, receiving social support, which leads to maternal identity, formation of maternal skills, resiliency, development of newborn, improvement of mother-newborn interactions and increased well-being of the mother". CONCLUSIONS: This study identifies the concept of maternal role attainment in nursing, providng a good basis for evaluating and applying this concept.

A Concept Analysis of Neonatal Palliative Care in Nursing: Introducing a Dimensional Analysis.

Despite the increasing need for neonatal palliative care, it is not adequately implemented in practice. This analysis aimed to clarify the dimension of the neonatal palliative care concept to increase understanding of the concept to give more insight into clinical practice. Using dimensional analysis methodology, 46 English language papers from 2001-2018 were analyzed. The coding of the literature for the perspective, context, conditions, process, and consequences of the concept was completed. Five dimensions informed the conceptualization of this concept and interrelationships among their themes/sub-themes were presented in the matrix named, "improving quality of life and death". Within the family-centered care perspective and under different conditions/contexts through the processes of neonate's comfort and providing holistic care, the consequences of this care were improving quality of life/a good death. Family-centered care was the fundamental dimension and essential to achieving the consequences. The other dimensions of context, conditions, and processes were also affected by the family's needs, preferences, culture, and expectations. This analysis reinforces that neonatal palliative care is a multidimensional concept. To provide the standard of neonatal palliative care an integrated plan to get together many stakeholders including community, parents, clinical staff, policymakers, insurance authorities, health care systems, and education system is required. All NICUs should have neonatal palliative care-trained nurses and protocols with a family-centered care approach to focus on the quality of life of neonates with life-threatening conditions from diagnosis of disease to death. Regular training and educational courses on neonatal palliative care and family-centered care principles can make nurses more sensitive to their advocacy role.

Spiritual healing from Iranian cancer patients' viewpoints: A hybrid concept analysis.

BACKGROUND: Spiritual healing is a complementary and alternative treatment with different meanings in different cultures and religions. However, the concept has not been defined from the cancer patients' points of view. The present study was done with the aim of concept analyses of spiritual healing from Iranian cancer patients' viewpoints. METHODOLOGY: The study was done using a hybrid method at three phases including of theoretical study, field study, and final analysis. In the theoretical study phase and using the keyword "spiritual healing," pertinent articles were searched in main databases. In the field study phase, ten cancer patients were interviewed, and in the final phase, the two other phases were analyzed. After determining features, antecedents, and consequences, a conclusive definition of spiritual healing from Iranian cancer patients' viewpoints was proposed. FINDINGS: Spiritual healing from Iranian cancer patients' viewpoints was featured with four themes, including connection with paranormal forces; effective, noninvasive, inexpensive, and efficient therapeutic method; a way to achieve piece, adaptation, and health and influenced by cultural and religious beliefs. Spiritual healing is a complementary and alternative treatment that helps careseekers to achieve health through paranormal forces and energies. As the findings showed and according to the participants' viewpoints, the source of such forces and energies was divine force and the healers were mediums to transfer the energy. CONCLUSION: The findings supported that religion and faith were the key elements of spiritual healing in the Iranian Islamic context.

Explaining the Process of Spiritual healing of Critically-ill Patients: A Grounded Theory Study.

BACKGROUND: Spiritual healing is one of the most intriguing category of alternative and complementary medicine. The aim of this study was to explain the process of spiritual healing in patients with refractory diseases in Iran. METHODS: This grounded theory study was conducted in Iran from 2018 to 2019. The participants were 14 patients with refractory diseases and 4 healers whom were first selected through purposeful and then theoretical sampling. Semi-structured interviews were used to collect data on patients and healers. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories and analyzed using the Strauss and Corbin's approach (2008). RESULTS: Four main categories emerged from data analysis including: I) frustration to initial acceptance II) disbelief to trust III) evaluation to action and IV) doubt to certainty. CONCLUSION: The results of our study provide context-specific factors affecting the complex and multifactorial nature of spiritual healing process in patients with refractory diseases. Health care professional can use these findings in designing and implementing appropriate interventions to integrate spiritual healing into their holistic practices of care.

The Process of Pain Management in Cancer Patients at Home: Causing the Least Harm - A Grounded Theory Study.

BACKGROUND: Cancer pain management at home is a complicated and multidimensional experience that affects the foundational aspects of patients and their families' lives. Understanding the pain relief process and the outcomes of palliative care at home is essential for designing programs to improve the quality of life of patients and their families. OBJECTIVE: To explore family caregivers and patients' experiences of pain management at home and develop a substantive theory. DESIGN: The study was carried out using a grounded theory methodology. SETTING/PARTICIPANTS: Twenty patients and 32 family caregivers were recruited from Oncology wards and palliative medicine clinics in the hospitals affiliated to Iran University of Medical Sciences using Purposeful and theoretical sampling. RESULTS: The core category in this study was "pain relief with the least harm." Other categories were formed around the core category including "pain assessment, determining the severity of pain, using hierarchical approaches to pain relief, assessing the results of applied approaches, determining the range of effectiveness, and barriers and facilitators of pain relief." The substantive theory emerged from these categories was "Pain management process in cancer patients at home: Causing the least harm" that explains the stages of applying hierarchical approaches to pain relief, family care givers try to make decisions in a way that maximize pain relief and minimize damage to the patient. Along with using a hierarchical pattern, the process is featured with a circular pattern at broader perspective, which reflects dynamism of the process. CONCLUSION: The inferred categories and theory can expand knowledge and awareness about the stages of pain relief process, the pattern of using pain relief approaches, and the barriers and facilitators of pain relief process at home. Health-care professionals may use these findings to assess the knowledge, skill, capability, problems, and needs of family caregivers and patients and develop supportive and educational programs to improve the efficiency of pain relief process at home and improve the patients' quality of life.