Culture of discrimination in healthcare: A grounded theory

BACKGROUND

Discrimination in health care is an international challenge and a serious obstacle to justice and equality in health.

RESEARCH OBJECTIVE

The purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients.

RESEARCH DESIGN

This qualitative study was conducted using by the grounded theory method.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse's assistants, and three patients in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach.

ETHICAL CONSIDERATIONS

The study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form.

FINDINGS

The "culture of discrimination" was the study's core category, reflecting the nature of discrimination in health care. The theory of "culture of discrimination in health care" is the result of five main categories: "individual social stimuli," "culture of discrimination," "unintentional discrimination," "conflict with discrimination," and "dissatisfaction with discriminatory behavior." These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care.

DISCUSSION

The results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers.

CONCLUSION

The theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended.

Instability of emotional relationships and suicide among youth: a qualitative study

BACKGROUND

Interpersonal problems are one of the factors for understanding the complex issues that result in suicide attempts and self-injury by poisoning. The quality of familial relationships is a predictor of the occurrence and outcome of suicide attempts. This study aimed to explore motives for self-poisoning suicide attempts amongst young adults.

METHOD

This research was a qualitative study conducted using semi-structured interviews in 2019 in Kermanshah Province, Iran. Eighteen participants who had attempted suicide by self-poisoning were interviewed, and information was collected until data saturation was achieved. The interviews were recorded and transcribed, and the data were analyzed through content analysis.

RESULTS

The results included the category of instability in emotional relationships with the three sub-categories of 1- Emotional failure, 2- Emotional trauma, and 3- Loss of emotional resilience (caused by emotional failure and emotional trauma within the previous few months). Instability in emotional relationships creates feelings of disgrace, humiliation, burdensomeness, worthlessness, and insignificance, which increases the chances of attempting suicide.

CONCLUSION

The study results provided an in-depth understanding of romantic, and unstable familial relationships as a significant factor in suicide attempts, demonstrating the role of emotional stress in attempting suicide. The present study provided information on the risk factors and warning signs for psychiatrists and nurses dealing with suicidal patients to take effective measures to prevent suicide through social support.

Barriers to the Development of Clinical Reasoning Skills among Coronary Care Nurses: A Qualitative Study

Background

Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses.

Materials and Methods

Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi-structured interviews and were analyzed using conventional content analysis.

Results

The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self-efficacy.

Conclusion

There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses' CR skills.

Depression, anxiety, and stress among Iranian nurses in COVID-19 care wards

Background

Nurses are at the frontline of care provision to patients with coronavirus disease 2019 (COVID-19). The high communicability of COVID-19, high levels of stress associated with the disease, and challenges of care provision to afflicted patients faced nurses in Iran with problems such as depression, anxiety, and stress. The aim of the study was to assess depression, anxiety, and stress among Iranian nurses who provided care to patients with COVID-19.

Methods

This cross-sectional descriptive-analytical study was conducted in 2020–2021. Participants were 468 nurses purposively selected from university hospitals in Iran. They completed two online instruments, namely a demographic questionnaire and the 21-item Depression Anxiety Stress Scale. Data were analyzed using the SPSS software (v. 23.0).

Results

Most participants were female (75.9%) and married (73.4%) and held bachelor’s degree (88%). The means of participants’ age and work experience were 33.59 ± 6.40 years and 10.26 ± 6.61 years, respectively. The mean scores and the prevalence rates of depression, anxiety, and stress were 13.56 ± 5.37 and 74.1%, 13.21 ± 4.90 and 89.7%, and 15.13 ± 4.76 and 54.9%, respectively. The prevalence rates of moderate to severe depression, anxiety, and stress were 43.7%, 73%, and 24%, respectively. The mean scores of participants’ depression, anxiety, and stress had significant relationship with their employment status (p < 0.05). Besides, the mean scores of their anxiety had significant relationship with their educational level, employment status, and work shift (p < 0.05).

Conclusion

Most nurses who provide care to patients with COVID-19 suffer from depression, anxiety, and stress. Psychological support services may be needed for nurses in order to protect and promote their mental health.

Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study

INTRODUCTION

Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills.

AIM

The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU.

DESIGN

A qualitative design was used.

METHODS

This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring.

RESULTS

The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively.

CONCLUSION

This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.

Explaining the Concept of Violence Against the Older Adult: A Hybrid Study

Objectives Violence against the elderly is a single, repetitive act or omission of appropriate action that occurs in an interpersonal relationship and causes harm or discomfort to an elderly person. The lack of a clear definition is one of the challenges of this concept. The present study has been conducted to explain the concept, provide ab operational definition and present some empirical references to violence against the elderly with a hybrid approach. Methods & Materials In this study, the hybrid concept analysis method was used, which includes three steps: theoretical, field research, and analytical. In the first step, the texts were reviewed using Walker and Avant’s approach. In the second step, unstructured interviews using purposive sampling were conducted. Finally, in the third step, the perceptual analysis method was used to integrate the results of the previous two steps. Results The results of the final analysis expressed the definition of violence against the disabled elderly and its components, which are violence against the disabled elderly living in the family, including a range of behaviors or actions threatening human dignity and status with or without a purpose that is applied in the living environment or related situations by family members, caregivers or others in the form of exposing the elderly to emotional-mental violence, physical violence, economic violence, sexual violence, social violence, neglect, and abandonment. It is observed as apparent or hidden, intermittent or continuous, and mild to severe. Being neglected, interactive separation, predisposing factors related to the elderly person, and predisposing factors related to the violent perpetrator lead to its occurrence and are associated with destructive personal, family, and social harms. Conclusion The findings of this study can provide a clearer picture of the experiences of this group of elderly people who have all been exposed to violence in some way. Knowledge of the elderly’s experiences and perceptions of the phenomenon of violence leads to an increase in nurses’ awareness of this phenomenon. It reveals essential concepts in nursing, especially in the elderly.

Family and Rehabilitation of Children with Cochlear Implant: A Qualitative Study

Aim

This study was conducted to explain the role of families in rehabilitating children with cochlear implants based on the participants’ experiences and perceptions.

Method

This research is a qualitative study based on the method of contract content analysis, and it is conducted with semi-structured interviews to collect information in Iran in 2018–2019. The interview was conducted with 12 participants, including caregivers (child caregivers with a cochlear implant), and the process of data collection continued until saturation. Interviews were recorded and transcribed, and the data were analyzed using Gran Haim and Landman content analysis. This study was guided by consolidated criteria for reporting qualitative (COREQ).

Results

The results of the study were formed in the main class titled the family, the effective rehabilitation factor, and two sub-classes titled supportive family and continuing professional and non-professional rehabilitation.

Conclusion

The findings of this study indicated that the rehabilitation process in these children will be incomplete without the presence and support of the family.

Older people's perceptions of intergenerational relationships in nursing homes: A qualitative content analysis

Introduction:

Intergenerational conflict is one of the components which helps to inappropriate communication patterns and ineffective interactions. Intergenerational research aims to promote deeper understanding and respect between generations and helps to create more cohesive communities, suggesting that it can have numerous health and social benefits. Despite the importance of intergenerational relationships in the elderly, the older people’s perceptions of intergenerational relationships in nursing homes are not well understood. The purpose of this study was to explore the older people’s perceptions of intergenerational relationships in nursing homes in relation to nurses.

Methods:

This was a qualitative content analysis in which 12 elderly residents and 6 employees (3 nurses, 1 supervisor, 1 psychologist and 1 nursing home manager) in the nursing home were recruited purposively from three nursing homes located in Tehran, Iran. Semi-structured interviews were used to collect information. Data were analyzed via qualitative content analysis and continuous comparison and were based on self-interactional group theory (SIGT).

Results:

During data analysis, “Struggle for existence” was extracted from three subthemes as the main theme. Subthemes such as “prejudicious tendencies”, “Communication nodes” resulting from intra-group and inter-group analysis, respectively, and the “umbrella of society,” which influences both concepts, formed the intergenerational relationships in the nursing homes.

Conclusion:

Generational differences between nursing home residents and nurses make establishing effective communication between them difficult and lead to lack of quality care. The study findings can help nursing home managers apply strategies to remove barriers to intergenerational relationships, improve these relationships and increase cohesion between generations to lead to better care and subsequent improvement in their quality of life.

Competence in providing spiritual care and its relationship with spiritual well-being among Iranian nurses

BACKGROUND

Competence in providing spiritual care to patients has become an increasingly important aspect of nursing care delivery. However, studies on nurses' competence in spiritual care delivery and the factors affecting it are very limited. The present study was conducted to evaluate Iranian nurses' competence in providing spiritual care and its relationship with their Spiritual Well-Being.

MATERIALS AND METHODS

The present study is descriptive-analytical research conducted in Bam in the south of Iran between 2016 and 2017. All nurses working in the teaching hospitals affiliated with Bam University of Medical Sciences were invited to participate in the study. For data collection, the Spiritual Care Competence Scale (SCCS) and the Spiritual Well-Being Scale (SWBS) were used. Collected data were then analyzed using descriptive statistics (mean and standard deviation), Pearson correlation coefficient, independent t-test, and one-way ANOVA with SPSS software.

RESULTS

In this study, 158 nurses were participated. The result showed that the mean score SCCS and SWBS were 101 ± 12.6, 76.92 ± 13.4, respectively. Pearson correlation test showed a significant and direct relationship between the mean score of SCCS and SWBS (P = 0.001, r = 0.264). The results of this test also showed a significant relationship between all the dimensions of SCCS and SWBS (P < 0.05).

CONCLUSIONS

In this study, the nurses had a relatively appropriate competence in providing spiritual care to patients. There was also a significant relationship between the nurses' spiritual care competency and their spiritual well-being. Given the lack of adequate studies in spiritual care delivery competencies, it is recommended that similar studies are conducted among nurses in other parts of the country and worldwide.

Nurses' experiences of the causes of their lack of interest in working in psychiatric wards: a qualitative study

Background

The shortage of psychiatric nurses is a major healthcare challenge. Lack of interest (LOI) contributes to the shortage of psychiatric nurses. Nonetheless, there are limited studies in this area. The present study was conducted to explore nurses’ experiences of the causes of their LOI in working in psychiatric wards.

Methods

This qualitative study was conducted in 2016–2019 using the content analysis approach. Participants were 27 nurses purposively recruited with maximum variation from the psychiatric wards of three referral hospitals in Iran. Data were collected via unstructured interviews and were concurrently analyzed using the conventional content analysis approach recommended by Graneheim and Lundman.

Results

The causes of participants’ LOI in working in psychiatric wards were grouped into three main categories, namely inadequate professional skills for psychiatric care practice, negative public attitude towards psychiatric nurses, and concerns over patients.

Conclusion

This study suggests that the causes of nurses’ LOI in working in psychiatric wards are not only personal, but also social and organizational. Findings help managers and authorities develop strategies to increase psychiatric nurses’ interest in working in psychiatric wards through improving their work conditions and professional knowledge and skills.

Nursing Care Challenges of Child Violence Victims: A Qualitative Study

BACKGROUND

Violence against children is a serious global phenomenon. The severity of the injuries caused due to violence toward a child is sometimes so great that it sends them to the hospital. Nurses have the first contact with Child Violence Victims (CVVs). These nurses experience different challenges. This study was aimed at exploring nurses' experiences of challenges in care provision to CVVs.

MATERIALS AND METHODS

This conventional content analysis and qualitative study was conducted in 2018-2019. Using a purposive sampling method, 17 nurses with experience in care delivery to CVVs were recruited from among those working in Children's Medical Center, Tehran, Iran, and Bu-Ali Subspecialty Hospital, Ardabil, Iran. In-depth semi-structured interviews were conducted to collect the required data. Data were analyzed through the conventional content analysis method.

RESULTS

During data analysis, the 3 main categories of role conflict, lack of continuity of care, and emotional resentment and 9 subcategories were identified. Nurses experience challenges in care provision to CVVs. They do not have enough knowledge about CVVs, are unable to maintain the continuity of care, and experience role conflicts and emotional resentment.

CONCLUSIONS

Nurses experience some difficulties and challenges in the process of care delivery to CVVs. They tried to overcome emotional resentment, different conflicts, and concerns about the lack of continuity of care without adequate support and resources. Thus, planning to support nurses in this regard seems essential.

Rehabilitation of children with cochlear implant in Iran: A scoping review

Background: Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran.

Methods: A scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale.

Results: The results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results.

Conclusion: The process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.

The principles of physical restraint use for hospitalized elderly people: an integrated literature review

BACKGROUND

Physical restraint (PR) is a routine care measure in many hospital wards to ensure patient safety. However, it is associated with many different professional, legal, and ethical challenges. Some guidelines and principles have been developed in some countries for appropriate PR use. The present study aimed to explore the principles of PR use for hospitalized elderly people.

METHODS

This was an integrative review. For data collection, a literature search was conducted in Persian and English databases, namely Magiran, Scientific Information Database (SID), Scopus, Google Scholar, Web of Science, and PubMed as well as the websites of healthcare organizations and associations. Eligibility criteria were publication in English or Persian between January 1, 2010, and January 1, 2021, and description of the principles of PR use for hospitalized elderly people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection, while the critical appraisal tools of the Joanna Briggs Institute (JBI) and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument were used for quality appraisal. The data were analyzed through constant comparison.

RESULTS

Primarily, 772 records were retrieved, while only twenty were eligible for the study. The principles of PR use for hospitalized elderly people were categorized into six main categories, namely principles of education for PR use, principles of decision making for PR use, principles of implementing the PR procedure, principles of monitoring patients with PR, principles of PR use documentation, and principles of PR management.

CONCLUSION

PR should be used only by trained healthcare providers, with the consent of patient or his/her family members, with standard devices and safe techniques, based on clear guidelines, and under close managerial supervision. Moreover, elderly people with PR should continuously be monitored for any PR-related complications. The findings of the present study can be used for developing clear PR-related guidelines.

Exploring the Process of Spiritual Health of the Elderly Living in Nursing Homes: A Grounded Theory Study

BACKGROUND

Spiritual health is one of the important dimensions of the elderly's health, which plays an important role in other dimensions of their health. This study aimed to explain the process of spiritual health of the elderly living in nursing homes.

METHODS

This grounded theory study was conducted in 4 nursing homes in the city of Arak Iran between October 2019 and September 2020. The participants were 24 elderly people living in nursing homes, two health care providers, one nurse and one family member, first selected through purposive sampling and then, through theoretical sampling. The data were collected through semi-structured interviews and field notes. All the interviews were transcribed verbatim and analyzed based on Strauss and Corbin approach (2008).

RESULTS

Six main categories were identified, including helplessness, inefficient supportive environment, spiritual distress, seeking support, relative improvement of spiritual health and factors affecting spiritual health, each of which explains a part of the whole process of spiritual health of the elderly living in nursing homes.

CONCLUSION

Supporting the elderly living in nursing homes is necessary in order to meet their spiritual needs and preserve and promote their spiritual health.

Spiritual Needs of the Muslim Elderly Living in Nursing Homes: A Qualitative Study

Paying attention to and meeting the needs of people who are elderly helps to improve their health. Caring for the elderly includes addressing their spiritual needs which has been less investigated. This study aimed to examine the spiritual needs of the Muslim elderly living in nursing homes. A qualitative study was conducted using conventional content analysis. Seventeen elderly people (nine women and eight men) were selected from four nursing homes in Iran using purposive sampling. The subjects were asked to participate in semi-structured interviews. The interview transcripts were analyzed using content analysis. First, semantic units were identified and then related codes were extracted and classified into categories and subcategories based on their similarities. Finally, themes were extracted from the data. The elderly’s spiritual needs were classified into three main themes: religious needs, existential needs, and communication needs. Religious needs were divided into religious beliefs, individual religious practices, and collective religious practices. Existential needs were categorized as meaning of life, purpose of life, and need for peace. Communication needs were conceptualized to include relationship with God and relationship with others. It is argued that caregivers of the elderly should recognize the elderly’s spiritual needs, including religious, existential, and communication needs, and attempt to maintain and promote the elderly’s spiritual health.

Confusion at the beginning of sexual intercourse, the challenge of patients after coronary artery bypass graft surgery in Iran: A qualitative study

BACKGROUND:

Many patients suffer from sexual dysfunction after coronary artery bypass graft surgery, but they refuse to propose and follow up on the problem due to the cultural structures prevailing in Iranian society. Untreated sexual dysfunction will disturb the quality of life of these patients. This study was performed to explain the experiences of male patients from sexual problems after coronary artery bypass graft surgery.

MATERIALS AND METHODS:

This qualitative study was performed with the approach of conventional content analysis in Tehran in 2020. The data were collected through semi-structured interviews with 12 men after coronary artery bypass graft surgery at the hospital's cardiac surgery clinic, as well as the surgeon's clinic. Participants were selected by the targeted sampling method. After obtaining informed consent, the collected data were written word by word, and the content analysis approach was used to name the data, create analytical codes, and determine subcategories and categories. The data were analyzed by MAXQDA 10 software.

RESULTS:

The findings of this study show that the dimensions of confusion in patients’ sexual intercourse after coronary artery bypass graft surgery in four subcategories of challenges of the first intercourse after surgery, ambiguity in how to obtain information, the ambiguity of sexual issues after surgery, and spouse are concerned about having sexual intercourse.

CONCLUSION:

The results of this study show that male patients who have undergone coronary artery bypass graft surgery have many ambiguities in the process of sexual intercourse, which passes the beginning of sexual intercourse with fear and avoidance of intercourse. Postoperative patients do not propose these problems with the medical staff when they suffer from sexual dysfunction or ambiguity due to the taboo of talking about sexual intercourse. Eventually, the patient and his or her partner become confused about sexual intercourse after surgery. Therefore, it is recommended that policymakers in the field of health create the culture and planning for solving the ambiguities created in the path of sexual intercourse of these patients.

Justice and unintentional discrimination in health care: A qualitative content analysis

BACKGROUND:

Discrimination in health care is a common phenomenon whose complete understanding has always been a major concern of health-care systems to control and reduce it. This study aimed to explore the experiences of unintentional discrimination and related factors in health-care providers.

MATERIALS AND METHODS:

This qualitative study was conducted with a content analysis approach in 2019. Data were collected through semi-structured interviews with 13 health-care providers including two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling. The obtained data were analyzed by Graneheim and Lundman method.

RESULTS:

Three main categories and eight subcategories were obtained from the data analysis: (1) forced discrimination (superiors' pressures and executive orders, occupational concerns, and fear of the superiors); (2) guided discrimination (professional challenges, managers' policymaking, and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of medical equipment).

CONCLUSION:

The results of this study suggest that health-care providers such as doctors and nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing the factors that lead to superiors' pressures and occupational forces and improving the medical ethics knowledge should be considered by health-care managers.

Iranian nurses' perceptions about using physical restraint for hospitalized elderly people: a cross-sectional descriptive-correlational study

BACKGROUND

Using physical restraint (PR) for hospitalized elderly people is a major nursing challenge. It is associated with different physical and mental complications and ethical dilemmas, though many nurses still use it to ensure patient safety. Nurses' perceptions are one of the most important factors affecting PR use. This study aimed to evaluate Iranian nurses' perceptions about PR use for hospitalized elderly people.

METHODS

This cross-sectional descriptive-correlational study was conducted from July to December 2019. Participants were 270 hospital nurses who were purposively recruited from intensive care units and medical and surgical wards of three teaching hospitals in Kermanshah, Iran. Data were collected using a demographic questionnaire and the Perceptions of Restraint Use Questionnaire (PRUQ). The SPSS software (v. 23.0) was used for data analysis through the independent-sample t test, the one-way analysis of variance, and the multiple regression analysis.

RESULTS

The total mean score of PRUQ was 4.08 ± 0.12 in the possible range of 1-5. The most important reasons for PR use were to prevent patients from falling out of bed and to prevent them from pulling out catheters. The total mean score of PRUQ had significant relationship with participants' age, work experience, and history of receiving PR-related educations (P < 0.05), but had no significant relationship with their gender, educational degree, and affiliated hospital ward (P > 0.05).

CONCLUSION

This study suggests that nurses attach high importance to PR use for hospitalized elderly people. Healthcare policy-makers at national and hospital levels are recommended to provide nurses with PR-related educations in order to reduce the rate of PR-related complications.

The process of responding to stigma in people with schizophrenia spectrum disorders and families: A grounded theory study

BACKGROUND

The way people with schizophrenia spectrum disorders and families address stigma has a significant role in their vulnerability to this distressing phenomenon. However, there is little knowledge about this issue in Middle Eastern countries.

PURPOSE

Exploring the process of addressing stigma in people with schizophrenia spectrum disorders and families.

DESIGN AND METHODS

In our grounded theory study, we interviewed seven patients and nine family members and used a constant comparative analysis approach for data analysis.

FINDINGS

The participants expressed being socially rejected and oppressed by others. In addressing stigma, the patients and families surrendered passively and reluctantly. This main strategy sometimes led to deprivation and isolation and sometimes resulted in lessening their tension.

PRACTICE IMPLICATIONS

Mental health nurses can empower patients and families with the skills necessary to counter stigma and, in this way, modify the sense of disability as an obstacle to stigma resistance. Also, mental health nurses can modify the contextual factors of stigma by initiating campaigns, educating society members, and involving them in fighting stigma.

Prevalence of HTN in Iran: Meta-analysis of Published Studies in 2004-2018

INTRODUCTION

Prevalence of hypertension (HTN) is increasing in the developing countries like Iran. Various studies have reported different rates of HTN in Iran. The purpose of this study was to estimate an overall prevalence of HTN in Iran.

METHODOLOGY

Using the English and Persian key derived from Mesh, the databases including MagIran, Iran Medex, SID, Web of Sciences, PubMed, Science Direct and Google Scholar as a searching engine were reviewed: from 2004 to 2018. The overall prevalence of MA was estimated using Random effect model. The I2 test was used to assess the heterogeneity of the studies. Additionally, the quality of studies was evaluated using a standard tool. Publication bias was conducted with the Egger test. Meta-regression and analysis of subgroups were analyzed based on variables such as age, marital status, region and tools. Data were analyzed using STATA 12 software.

RESULTS

Analysis of 58 primary articles with a sample size of 902580 showed that the prevalence of HTN in Iran was 25% (with 95% CI of 22-28). The highest prevalence of HTN was related to elderly (42%). The prevalence of HTN was 25% (95% CI: 19-31) in women and 24% (95% CI: 20-28) in men with no significant difference (p = 0.758). The results also indicated that the prevalence of HTN was not related to the year of studies (p = 0.708) or sample size (p = 769).

CONCLUSION

Despite the advancements in science and technology, along with health and prevention of diseases, the overall prevalence of HTN raised in Iran. Since HTN is a silent disease with significant health consequences and economic burden, programs designed to better HTN control seem vital to enhance community health.

Caregiving burden in family caregivers of patients with schizophrenia: A qualitative study

INTRODUCTION:

After the psychiatric revolution and implementation of deinstitutionalization policies, caring for people with a mental health condition shifted from psychiatric hospitals to their families. In this way, family caregivers were forced to take full responsibility for taking care of the patients that lead to the occurrence of challenges for them. Only a few studies have investigated the caregiving challenges of family caregivers in patients with schizophrenia.

AIM:

This study aimed to gain a better understanding of caregiving burden in family caregivers of patients with schizophrenia and its related factors.

MATERIALS AND METHODS:

This qualitative study was performed based on 12 family caregivers of schizophrenia patients visiting a psychiatric hospital in Tehran in 2018. Sampling was carried out based on the purposive sampling method and was continued until data saturation. All interviews were recorded, transcript, and imported into the MAXQDA software. Then, qualitative content analysis was conducted based on Graneheim and Lundman's five-step method.

RESULTS:

One theme, two main categories, and five subcategories were identified from the continuous analysis and data comparison. The “Perceived objective burden” as theme included two main categories: “Heavy involvement of caregivers” and “Challenges of the healthcare system”.

CONCLUSION:

The results of this study indicate that the family caregivers of the patients with schizophrenia encounter many problems related to multiple responsibilities in the caring process and challenges in the provision of mental health-care services. This finding could improve psychiatric and mental health nurses’ knowledge and awareness about caregiving challenges in family caregiver of patients with schizophrenia and related factors.

The role of organizational factors in nurse burnout: Experiences from Iranian nurses working in psychiatric wards

Introduction:

The optimal performance of a healthcare organization is one of the effective factors in increasing the efficiency and productivity of nurses and thus reducing their burnout. The aim of this study was to investigate the role of organizational management on nurse burnout based on experiences from Iranian nurses working in psychiatric wards.

Materials and Methods:

This qualitative study was conducted on 15 nurses working in psychiatric wards selected through purposive sampling. Data collection was done through in-depth semi-structured interviews in psychiatric wards in Ahvaz (southwest of Iran) and Tehran. Data analysis was done through conventional content analysis.

Results:

The findings included one main category and three subcategories. The main category was “Providing care at an inadequate organization,” and the three sub-classes namely “Shortages of human resources,” “Shortage of physical resources,” and “Impact of management approaches to care provision” were extracted.

Conclusion:

The results of this study showed that inadequate supply of equipment and human resources along with ineffective managerial approaches in the organization could lead to mental and emotional exhaustion, negative attitudes toward the profession, decreased and poor service quality, employee turnover, and early retirement of nurses in psychiatric wards. Therefore, by adopting appropriate policies in their programs, paying special attention to the physical and mental health of nurses, and addressing their problems, managers of healthcare organizations can motivate and sustain the human resources within the organization.

Defining the concept of family caregiver burden in patients with schizophrenia: a systematic review protocol

BACKGROUND

Since the deinstitutionalization policy, in psychiatric hospitals, the care of patients with schizophrenia was left to their families which has been imposing a heavy burden on them. Family caregiver burden could have consequences for caregivers, patients, and the society. There is very little consensus on the definition and dimensions of the caregiver burden, which leads to a lack of consistency in the results of research. Thus, the present study was aimed to redefine the family caregiver burden of patients with schizophrenia.

METHODS

The databases PubMed, Scopus, Web of Science, MEDLINE (Via Ovid), ProQuest, SCI, Magiran, SID, and IranDoc will be searched from 1940 to 2018 using subject headings and appropriate terms in both Farsi and English languages. Also, gray literature and the reference list of included articles will be used to offer an appropriate definition of the family caregiver burden in patients with schizophrenia. Two independent reviewers will participate in study selection, data collection, and quality assessment steps. The result will be presented in tabular form, and meta-synthesis will be performed.

DISCUSSION

The result of this systematic review will help present the comprehensive definition of the family caregiver burden in patients with schizophrenia according to its evolutionary trend.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018099372.

The Effect of Orientation Program based on Activities of Daily Living on Depression, Anxiety, and Stress in the Elderly

Background:

This study aimed to analyze the effect of the Orientation Program based on Activities of Daily Living on depression, anxiety, and stress in the elderly.

Methods:

This is an experimental study on 65 elderly individuals living in 5 nursing homes in Tehran in 2017 for 6 months (May to October). Samples were selected using non-random available sampling methods and randomly assigned to intervention and control groups. Demographic information questionnaire and 21-item version of the Depression Anxiety Stress Scale (DASS- 21) were used. The elderly in the intervention group were subjected to the Orientation Program based on Activities of Daily Living for 6 one-hour sessions for 1 month. DASS- 21 was measured before the intervention, one month and two months after the intervention. Data were analyzed using SPSS V. 24 and Independent T-test, Mann-Whitney, Chi-Square and repeated measure ANOVA tests with a significance level of P<0.05.

Results:

The results showed differences between the two groups regarding depression, anxiety, and stress one month after the intervention (P=0.003, P=0.005 and P<001, respectively). One month after the intervention, the mean scores of depression, anxiety, and stress in the intervention group decreased to 8±4.54, 4.5±3.09 and 7.53±5.42, respectively, and two months after the intervention, they decreased to 8.25±4.44, 4.71±3.05 and 8.21±5.71, respectively.

Conclusion:

According to the results, the Orientation Program based on Activities of Daily Living is effective on depression, anxiety, and stress in the elderly. Considering the instability of the intervention on the depression variable, further studies and long-term interventions are recommended.

Trial Registration Number: IRCT20180504039528N1

The Iranian Psychiatric Nurses' Perception of Transition in Psychiatric Wards: A Qualitative Study

BACKGROUND

Transition means moving from one period to another and it is usually associated with significant changes in objectives, roles, and responsibilities. Considering the challenges of the psychiatric ward, psychiatric nurses experience numerous problems, especially at the early stages of their job engagement. This study aimed to examine the perception of the Iranian psychiatric nurses in psychiatric wards and their transition period.

MATERIALS AND METHODS

The study was designed as a qualitative content analysis study in three referral hospitals in Mazandaran and Tehran, Iran 2016. Participants included 18 nurses who had experienced transition at the psychiatric ward and had at least 3 months job experience in three referral hospitals of Iran and were selected purposefully. Data were collected using unstructured interviews and analyzed using the inductive approach and conventional content analysis. To ensure the trustworthiness of the data, Guba and Lincoln's criteria were used.

RESULTS

The major themes of transition among the nurses of psychiatric wards included "inadequate preparation," "mental stress," "self-awareness and capabilities," and "the effective role of nurses' full support in adjustment."

CONCLUSIONS

The findings revealed that nurses did not have a decent transition. In this regard, educational systems must provide training courses to prepare nurses to support them in their arrival stage and to facilitate their transition. The findings of this study can help mentally prepare nurses for their preparation to perform their role and improve the quality of care.

Nurses' families' experiences of involvement in nursing errors: A qualitative study

Background

The most important and irreversible consequence of medical errors is the human impact caused by unintended actions. In a few studies, the significant impact of this error on the private life of healthcare staff have been mentioned, but the problems of the involved nurses' families had been ignored, as of now.

Aims

This study aimed to explain the nurses' families' experiences of involvement in nursing errors.

Methods

This is a qualitative study using conventional content analysis with 20 semi-structured interviews conducted with nurses and family members of nurses involved in medical errors, done through purposeful sampling and willingness to participate in the study.

Results

The results of the data analysis consisted of five main categories including disruption in family functioning, the crisis of fear, oppression, damage, and neglect, along with 15 subcategories.

Conclusion

Considering the effects of nursing errors on the families of nurses involved in the error, such as disruption of family functioning, the family of nurses involved in the error should also be considered and paid attention to. These families are abandoned and the need to promote the culture of supporting the family is tangible.

Effects of Empowerment Program on the Burden of Care in Mothers of Children with Phenylketonuria

OBJECTIVES

Phenylketonuria (PKU) is a genetic disease of children that need a lifelong diet for its treatment. Because of the high burden of care, parents and particularly mothers are prone to mental disorders or psychiatric adverse reactions. We aimed to investigate the effect of empowerment of mothers on the burden of caring for children with PKU.

MATERIALS & METHODS

This was a semi-experimental (before-after with control group) study. Overall, 50 mothers of children with PKU that were referred to Endocrine Clinic in Qods Hospital of Qazvin City, northwestern Iran in 2016, were selected and randomly divided into intervention and control groups. Data collection was made by using demographic characteristics of mothers and children and also the Zarit burden interview questionnaires. Empowerment program was delivered during nine sessions of holistic and family oriented empowerment model in the intervention group. The control group received routine services. Data were analyzed using descriptive and inferential statistics through SPSS software.

RESULTS

In intervention group, the mean score of overall care burden and its dimensions in the mothers of children with PKU in post-test was significantly lower than the pre-test (41.20 ± 5.04 vs. 58.24 ± 3.96; P<0.001); but pre-test and post-test scores in the control group had no significant difference (58.4 ± 5.22 vs. 58.96 ± 4; P=0.327). In other words empowerment program was able to reduce the burden of caring in mothers.

CONCLUSION

Empowerment program can reduce the burden of care in mothers of children with PKU. Thus empowerment training is necessary for this group of mothers in the form of workshops and educational pamphlets.

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.

The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: A qualitative study

Background:

To respond to the growing and emerging needs of the people in the health sector, the nurses need to develop their working domain from the hospitals to the community and be prepared to provide entrepreneurial roles at different care levels. Thus, to discover how to identify entrepreneurial opportunities in the field of nursing entrepreneurship, a study was conducted with the aim of describing the experiences of Iranian entrepreneurs on the identification of proper opportunities in entrepreneurship.

Materials and Methods:

This study was a qualitative research in which the Graneheim and Lundman's content analysis was used to collect and analyze the data. Thirteen entrepreneurial nurses were purposefully selected, and the data were collected by unstructured interviews.

Results:

As a result of data analysis, three main themes were obtained including the resources for opportunity identification and opportunity assessment and identification of proper opportunities.

Conclusion:

The findings indicate how to identify entrepreneurial opportunities in the field of health by entrepreneurial nurses which is the first step in the entrepreneurial process. Therefore, the findings of this study can be used to educate nurses who are interested in entering the field of nursing entrepreneurship.

Experience and the meaning of stigma in patients with schizophrenia spectrum disorders and their families: A qualitative study

AIM

This study aimed to explore the experiences of stigma in patients with schizophrenia spectrum disorders and their families.

METHODS

This qualitative content analysis study was carried out in 2016-2017 in a psychiatric hospital in Tehran, Iran. A total of 16 patients with schizophrenia spectrum disorders and their families were chosen purposefully. In order to collect the data, unstructured interviews were conducted. For the data analysis, an inductive content analysis approach was used.

RESULTS

The data analysis led to the formation of two categories, "being socially rejected" and "being oppressed by others," and nine subcategories. In being socially rejected, others do not have a desire to communicate and start or continue cohabitation with the patients and their families and stay at a distance from them with fear. In being oppressed by others, persons behave aggressively with the patients and their families, violate their rights, and humiliate and ridicule them with their incorrect judgment.

CONCLUSIONS

Patients with schizophrenia spectrum disorders and their families have the unpleasant and upsetting experiences of stigma. This problem imposes pressures and extreme difficulties on them, besides the difficulties related to the nature and the symptoms of the disorder. The findings reveals the need to develop strategies to help patients and their families effectively encounter stigma.

Knowledge, attitude, and clinical skill of emergency medical technicians from Tehran emergency center in trauma exposure

Introduction:

Prehospital care is the first part of the trauma treatment and care system. Diagnostic and therapeutic measures taken before these patients arrive at the hospital plays significantly reduce mortality and improve their outcomes. Therefore, the present study aimed to determine the knowledge, attitude, and clinical skill of emergency medical technicians in Tehran Emergency Center in trauma exposure.

Methods:

In this descriptive study, 213 participants were selected through stratified random sampling. Data were collected using a four-part questionnaire including demographic information, trauma knowledge questionnaire, trauma attitude questionnaire, and a clinical skill checklist. To compare the level of knowledge, attitude, and clinical skills on the one hand and demographic variables, on the other hand, independent samples t-test and one-way ANOVA were utilized. Then, to examine the normality of data distribution, Kolmogorov–Smirnov test with Bonferroni post hoc test was used to compare mean scores on different levels of the variables in questionnaires. Data were analyzed in SPSS/17 using descriptive and inferential statistics.

Results:

Results showed that the majority of participants (81.1%) had an average knowledge of trauma. Examining their attitude regarding trauma revealed that the majority (88.3%) had a positive attitude toward trauma and taking care of trauma patients. Moreover, the skill of 62.4% of technicians regarding trauma was good. Based on Pearson's correlation, significant positive correlations existed between scores of knowledge and scores of attitude (r = 0.186, P < 0.05), scores of knowledge and scores of clinical skill (r = 0.333, P < 0.05), and scores of attitude and scores of clinical skill (r = 0.258, P < 0.05).

Conclusion:

According to the results, emergency medical technicians in Tehran had a good level of knowledge, attitude, and clinical skills in trauma exposure. However, to maintain and enhance the level of knowledge and skills, in-service training should be continued more vigorously and periodically evaluated in the clinical practice.

Respecting the privacy of hospitalized patients: An integrative review

BACKGROUND

Privacy is a complicated and obscure concept, which has special meanings in the healthcare environment; therefore, it is essential for healthcare providers to fully understand this concept. However, there is no universally accepted definition for this concept in the texts, and it has been interpreted differently, based on its application.

AIM

To analyze and provide a clear and scientific definition for respect of privacy of hospitalized patients and identify the common aspects of this concept.

RESEARCH DESIGN

This study was conducted using the Whittemore and Knafl's modified framework as a conceptual analysis method. Ethical consideration: This study was approved by the Research Council of the University of Social Welfare and Rehabilitation Sciences. We have respected the ethical requirements required regarding the sources and authorship. Research context and data sources: Using integrative review, a search was performed using national and international databases, including CINAHL, Scopus, Medline, Web of Science, and ISI (with no date restriction). The keywords employed during the search process were "privacy of patients," "confidentiality," "and patients' rights." In total, 1345 articles were retrieved from the databases. After the elimination of repetitive studies and with regard to the study objectives, 124 articles, 3 books, and 4 theses were entered into the study. The data were analyzed using the conventional content analysis approach.

FINDINGS

The results were extracted in the form of four, seven, and two themes related to attributes such as physical, informational, social, and psychological and the antecedents and consequences of respecting patient privacy, respectively.

CONCLUSION

Respect for hospitalized patient privacy contains multiple dimensions. Factors affecting the achievement of this concept include individual backgrounds, nature of the disease, and rule of paternalism. The fulfillment of patient privacy leads to such consequences as protection and improvement of human dignity as well as improved communication between the patient and the health team.

Effect of Telenursing on Levels of Depression and Anxiety in Caregivers of Patients with Stroke: A Randomized Clinical Trial

Background:

Telenursing is a low-cost, highly accessible method that can lead to increased awareness on the principles of care, and may eventually help reduce the stress experienced by caregivers of patients with stroke. The present study aimed to investigate the effect of telenursing through phone consultation on the levels of depression and anxiety in family caregivers of patients with stroke.

Materials and Methods:

This was a randomized clinical trial including 152 caregivers of stroke patients discharged from Mohammad Vase'ee Hospital in Sabzevar in 2016. Participants were recruited through purposive sampling method and were randomly assigned to control (n = 76) and intervention (n = 76) groups. The intervention consisted of 32 sessions of phone consultation. Research tools included demographic characteristics form, needs assessment questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory. Data were analyzed with independent t test using SPSS, version 23.

Results:

Mean (SD) post-intervention anxiety scores for the intervention and the control group were statistically significant (t = 3.51, p = 0.001). However, the difference in mean depression scores after intervention was not significant (p = 0.70).

Conclusions:

Telenursing can be employed to facilitate the care of chronic patients as well as increase the psychological well-being of the caregivers through providing practical and specialized information.

How Do the Nurses Cope with Job Stress? A Study with Grounded Theory Approach

Introduction: Due to the adverse effects of job stress on health of nurses and the importance of coping process of nurses in management of job stress, the present study was carried out with the aim of exploring the experiences of the nurses in order to reveal the original coping process of the nurses in the case of encountering occupational stress.

Methods: This qualitative study was conducted with grounded theory approach. Research participants were 15 clinical nurses and four directors of nursing. Sampling method of study were purposive and theoretical sampling. Data collection done with unstructured interviews and field notes and continued until data saturation. Data analysis was performed using the Strauss and Corbin 1998 constant comparative method.

Results: The results of the analysis led to four axial concepts: "feeling stress at nursing work", "situational coping", "and the effect of personal and environmental factors in coping with job stress" and "Grey outcome of coping". The core variable in the nurse’s process of coping with job stress was "comprehensive effort to calm stressed condition".

Conclusion: Explaining the basic and original psychosocial process of nurses to cope with job stress, revealed context-based nature of the coping processes that nurses adopt, which that can help in taking appropriate measures to lighten up the grey consequences of coping of nurses.

Experiences of substance abusers from methadone maintenance therapy

Background: Substance abusers are not able to withdraw drugs eternally despite the abundance of different treatments; therefore, withdrawal programs are not quite successful and notwithstanding all the successes of methadone maintenance therapy, there are some defects found in the manner this treatment is applied. Thus, this study was conducted to explore the experience of drug abusers regarding methadone maintenance therapy. Methods: This is a qualitative study using content analysis methodology. The research community includes drug abusers admitted to the treatment centers of the western cities of Mazandaran Province, Iran in 2016. The sampling was purposive and the data were collected by face-to-face single interviews with 20 patients. The interviews were continued up to data saturation. Finally, the Lundman and Grenheim method was used to analyze the interviews and the four criteria of Guba and Lincoln were applied to check data integrity. Results: "Buying time," "methadone dependence," and "looking from a narrow view to the patient" were the main three categories that fit the results. Conclusion: Governmental free services for drug abusers; paying attention to different aspects of treatment such as mental, emotional, and social recovery; lifelong support of the family and society members; and balance in prescribing and following the treatment process prescribed by health care providers can enhance both the quality and safety of the treatment process. Psychological consultation alongside social services can facilitate the recovery process in methadone maintenance therapy.

Antecedents and consequences of workplace violence against nurses: A qualitative study

AIMS AND OBJECTIVES

To explore Iranian nurses' perceptions of and experiences with the antecedents and consequences of workplace violence perpetrated by patients, patients' relatives, colleagues and superiors.

BACKGROUND

Workplace violence against nurses is a common problem worldwide, including in Iran. Although many studies have reviewed the antecedents and consequences of workplace violence, limited information is available on this topic. An understanding of the predisposing factors for violence and the consequences of violence is essential to developing programs to prevent and manage workplace violence.

DESIGN

Qualitative descriptive design.

METHODS

In this qualitative study, 22 unstructured, in-depth interviews were conducted with registered nurses who had experienced workplace violence and who were selecting using purposive sampling in nine hospitals. Inductive content analysis was used to analyse the data.

RESULTS

Five categories emerged as predisposing factors: unmet expectations of patients/relatives, inefficient organisational management, inappropriate professional communication, factors related to nurses and factors related to patients, patients' relatives and colleagues. Individual, familial and professional consequences were identified as outcomes of workplace violence against nurses.

CONCLUSIONS

Workplace violence by patients/their relatives and colleagues/superiors is affected by various complicated factors at the individual and organisational levels. In addition to negatively affecting nurses' individual and family lives, workplace violence may lead to a lower quality of patient care and negative attitudes towards the nursing profession.

RELEVANCE TO CLINICAL PRACTICE

Identifying factors, which lead to workplace violence, could help facilitate documenting and reporting such incidents as well as developing the necessary interventions to reduce them. Furthermore, native instruments must be developed to predict and monitor violence.

Effects of Spiritual Group Therapy on Caregiver Strain in Home Caregivers of the Elderly with Alzheimer's Disease

INTRODUCTION

Care of patients with Alzheimer's disease is one of the most difficult types of care that exposes the caregiver to a high level of care strain. The present research aimed at determining the effect of spiritual care on caregiver strain of the elderly with Alzheimer's disease.

METHODS

An experimental study was carried out on 100 caregivers who were selected by convenience sampling and randomly divided into intervention, control one and control two groups. Group spiritual therapy was performed on the intervention group for five weeks, Control one participate in the group sessions without any particular interventions, and control two received no interventions. Data was collected through a demographic questionnaire and Robinson's (1983) Caregiver Strain Index, and analyzed using the Chi-square, Fisher's Exact test, one-way analysis of variance and paired t-test. Statistical significance level was considered as 0.05.

RESULTS

In the intervention group mean of the posttest care strain score 32.43±2.73 was significantly lower than pretest 37.16±1.26 (P<0.001). The mean posttest score of care strain was significantly lower in the intervention group compared to the two other groups (P<0.001).

CONCLUSION

Spiritual care can reduce care strain in home caregivers of the elderly with Alzheimer's disease.

The empowerment of elderly patients with chronic obstructive pulmonary disease: Managing life with the disease

Chronic obstructive pulmonary disease (COPD) is a serious health problem that has significant effects on the life status of elderly persons. Use of the empowerment approach is necessary for health promotion in older people with COPD, but little attention has so far been paid to all the dimensions of empowerment in the management of COPD, which would provide useful knowledge regarding elders with COPD. This article reports on a study exploring people's experiences of the empowerment of older people with COPD. This study adopted an exploratory qualitative design and was carried out using grounded theory methodology. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems that they encounter. We collected data by conducting in-depth semi-structured interviews and taking field notes. Twenty-four participants were selected through purposive sampling. The results showed that in encountering the complexity of disease and in response to difficulties induced by COPD, three strategies were applied. Elderly persons with COPD, their family caregivers, and professional team members engaged in "managing life with COPD," "striving to keep abreast of life," "preparing for battle with disease," and "helping to stabilize the elder's life." The outcome of these strategies was "co-existence with disease." The potential of "managing life with COPD" was influenced by the following factors: "co-existence with ageing," "personal potential," "a challenged health system," and "weak social support." "Managing life with COPD" enables the elder to feel in control and live optimally. This is a fragile balance, however, and the unpredictability of COPD can tip the elder into "self-efficacy." Understanding the experiences of the empowerment process of older people with COPD can help health professionals provide more focused elderly care.

Family caregivers' experience of activities of daily living handling in older adult with stroke: a qualitative research in the Iranian context

BACKGROUND

Patients with stroke require additional support from family to live independently in the area of activities of daily living. Family members are usually the main caregivers of stroke patients. Comprehensive explanation of ADL handling from family caregivers' view is lacking.

AIM

This study explores and describes family caregivers' experiences about the strategies to handle activities of daily living (ADL) dependency of elderly patient with stroke in the Iranian context.

METHOD

A qualitative content analysis approach was conducted to analyse data. Nineteen family caregivers participated in the study from multiple physiotherapy clinics of physiotherapy in Sari (Iran) between September 2013 and May 2014. Data were generated through in-depth interviews, and content analysis method was used to analyse the data and determine themes.

FINDINGS

The findings show that family caregivers manage the ADL dependency of their elderly stroke patients through seven strategies including encouraging physical movements, providing personal hygiene, nutritional consideration, facilitating religious activities, filling leisure time, and facilitating transfer and assisting in financial issues.

CONCLUSION

Family has an important role in handling of elderly stroke patients' ADL dependency. Health practitioners can take benefit from the findings to help the stroke families play more active role in the handling ADL dependency of their patients after stroke.