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.

Exploring nursing students' experiences of blindness simulation: A phenomenological study

Aim

The aim of this study was to explore the experiences of blindness simulation among a group of nursing students.

Design

This qualitative study was conducted using an interpretive phenomenological method.

Methods

Using purposeful sampling method, students were informed and invited to participate in the research through the Website of Tehran School of Nursing and Midwifery. We listed the candidates and until data saturation and compilation of the study, 8 students entered the study. They shared their experiences about blindness simulation through individual in‐depth and semi‐structured interviews. We continued the interviews until the data were saturated. The transcribed interviews were analysed by Colaizzi's approach.

Results

The results of data analysis resulted in three major themes and nine sub‐themes, which were conceptually named based on their nature. The major themes included abandoned in the labyrinth puzzle, vision of heart and self‐alienation.

How Do Nurses Apply Personal Knowing to Patient Care? A Grounded Theory Study

Background: Personal Knowing (PK) is an expression of self-knowledge concerning others. Besides, PK is the most difficult as well as the most essential pattern of knowing in nursing. The current study aimed to explore how nurses apply personal knowledge in patient care. Methods: This qualitative study was performed based on the grounded theory method. The study was performed in different hospital wards of Tehran City, Iran. The required data were generated using semi-structured interviews and clinical observations. Finally, 15 interviews and 8 sessions of observation were included in the data analysis. Strauss and Corbin’s constant comparison method (2008) was used to analyze the collected data. Results: The obtained findings suggested that nurses use the PK pattern in 3 forms of the therapeutic use of self, self-centering, and elimination of therapeutic communication. The therapeutic use of self was accompanied by kindness and amiability; efforts to strengthen the patients’ spirit; giving comfort and hope; humor; talking in a friendly manner, and gaining the patient’s trust and cooperation. Self-centering was characterized by establishing silence in the ward, strict enforcement of the rules, setting more rules, and developing rules for the method of care provision. Eliminating the therapeutic communication was accompanied by the referral of patients to others, avoidance, reluctance, and mechanical care. Conclusion: The obtained findings added to the knowledge of the patterns of knowing in nursing. The therapeutic use of self leads to a positive outcome of care as well as the satisfaction of nurses and patients. However, a self-centering and eliminating therapeutic relationship will raise an inappropriate image of nursing.

The effect of drug dosage calculation training program on math anxiety and nursing students’ skills: A non-randomized trial study

Background & Aim: Drug dosage calculation is one of the main skills in the drug administration process that requires sufficient knowledge about mathematical calculations and drug dosage; besides, lack of math anxiety is required for drug dosage calculation. This study aimed to determine the effect of mathematical calculation and drug dosage training programs on math anxiety and nursing students’ drug dosage calculation skills. Background & Aim: Drug dosage calculation is one of the main skills in the drug administration process that requires sufficient knowledge about mathematical calculations and drug dosage; besides, lack of math anxiety is required for drug dosage calculation. This study aimed to determine the effect of mathematical calculation and drug dosage training programs on math anxiety and nursing students’ drug dosage calculation skills. Results: The two groups were homogeneous in terms of demographic variables, math anxiety, and drug calculation scores in the baseline. Two-way analysis of variance with repeated measures indicated the significant effect of the group on math anxiety (P=0.024). Given the interaction between group effect and time for the drug dosage calculations, comparing the differences between the second- and third-time scores of the baseline scores showed a statistically significant difference between the two groups in terms of drug dosage calculations (P <0.001). Conclusion: Implementation of a drug dosage calculation training program for nursing students can lead to the reduction of math anxiety and improvement of the drug dosage calculations; this can ultimately help improve patient safety.

A qualitative study of Ghanaian pediatric oncology nurses' care practice challenges

BACKGROUND

Pediatric cancer is a global problem, and some studies have emphasized that nurses caring for these children experience work-related challenges. This has caused many children diagnosed with cancer to have a prolonged hospital stay and suffer unnecessary pain. However, there is insufficient documentary evidence on this issue. This study aims to explore and understand the challenges faced by pediatric oncology nurses in caring for children in Ghana.

METHODS

An exploratory qualitative research design study was conducted from August 2019 to April 2020. The study was conducted at the pediatric oncology unit which is located at the Tamale Teaching Hospital (TTH), Ghana. The study was conducted among 14 Ghanaian pediatric oncology nurses who were purposively sampled. A semi-structured interview guide was used to collect data. The interviews were recorded, transcribed verbatim, and analyzed inductively using Elo and Kyngas content analysis approach. The criteria proposed by Guba and Lincoln were used to ensure the validity of the study.

RESULTS

From the analysis of participants transcripts, eight subcategories emerged from two major categories. The subcategories were; time-consuming care, low job motivations, inadequate logistics, work stress, reduced labour force, low knowledge level, lack of teamwork and the perception of contracting cancer.

CONCLUSIONS

The results point to several organizational and personal constraints experienced by the nurses who work at the pediatric oncology ward. It is hoped that by addressing these challenges, it would lead to further improvement in the care that is provided to children with cancer. There is the need for the administrative managers of hospitals, government and other stakeholders to invest in human, material and financial resources for delivering childhood cancer care services.

Striving to reduce suffering: A Phenomenological Study of nurses experience in caring for children with cancer in Ghana

Aim

To provide insights into nurses lived experiences in caring for children with cancer.

Background

Little is known about the paediatric oncology nurses shared practices of caring for children with cancer in Ghana.

Design

A hermeneutic phenomenological qualitative study.

Methods

A semi-structured interview with 14 purposely sampled Ghanaian paediatric oncology nurses. Findings were analysed using Diekelman, Allen and Tanner's approach.

Results

The theme "Striving to reduce suffering" and three relational subthemes: "knowing children's needs," "Rendering a hopeful fight" and "Ensuring continuity and coordination of care" emerged. Increased awareness of this phenomenon for the nurses who care for these children is vital to ensure quality and holistic care that is meaningful and satisfying by nurses for children with cancer. Paediatric oncology nurses can use the result of the study to evaluate their caring practice and as an avenue to develop better caring practice.

Exploring the Lived Experience of Missed Nursing Care in Postgraduate Nursing Students in Iran

BACKGROUND

Missed care is a global phenomenon, which can include many clinical conditions that threaten the patients' safety in all countries and cultures, and also indicates the quality of nursing care. The nursing students' awareness and understanding of missed nursing care is of great importance. The current study aims to explore the lived experience of postgraduate nursing students in missed care.

METHODS

The current qualitative study was performed based on the interpretive phenomenological approach in Tehran, Iran, in February to December 2019. A total of 10 master's degree nursing students were selected through purposive sampling. A total of 10 semi-structured individual interviews were used to collect the data. The trail version of MAXQDA-10 software was used for coding. All interviews were recorded and codified, and the main themes were extracted from them using Dicklemann et al.'s (1989) analytical method.

RESULTS

Two main themes, five sub-themes, and 31 meaning units were obtained. The main themes included: "unfulfilled care" and "living in limbo".

CONCLUSION

Missed care, as unfulfilled care, is accompanied with living in limbo for nursing students, and this condition is influenced by organizational and personal factors. It seems that managers can prevent missed nursing care by supervising nursing care, reducing the nurses' workload, creating a sense of commitment to work, and enforcing ethical issues among nurses.

Designing a truth-based communication model in patient ethical care process

INTRODUCTION

Providing information based on truth is very important in patients' treatment-related decisions and reduces emotional and physical sufferings as well as patient costs. The aim of this study was to design a model that is based on the culture and health-care context of Iran in order to establish a truth-based communication and provide accurate information to patient.

MATERIALS AND METHODS

This qualitative study was conducted in 2019. Data were collected through semi-structured interviews with 18 nurses who had been selected by purposeful sampling method. Data analysis was performed in two steps. In the first step, the participants' experiences were determined using the grounded theory approach. In the next step, using Walker and Evant's (2011) method, the concepts and statements were combined and presented in a central concept.

RESULTS

The central concept in this study was "an attempt to establish a truth-based communication with patient," and then, a truth-based communication model was presented. The components of the model were presented in three parts: improving patient communication skills, managing the situation in which the truth is presented, and the patient's participation in decision-making.

CONCLUSION

To present the truth of the treatment, which can sometimes be unpleasant and bitter, it is very important to improve communication skills and choose an effective communication strategy. To establish a truth-based communication, it is necessary to create a suitable ground for communication, which should be provided in clinical setting and community.

Challenges with healthcare workers' protection during the COVID-19 pandemic in Iran

During the COVID-19 pandemic, healthcare workers stand in the frontline of the fight against the disease. This study aimed to assess the challenges with personal protection during the pandemic in Tehran, Iran. Seven-hundred healthcare workers were surveyed between April and May 2020, and the study was performed in surgical care wards. Questionnaires, which were sent to 1000 workers via online platforms, social networks, and emails to different associations, were used to assess the use of personal protective equipment (PPE) and the reasons for not using it. A total of 700 replied. Face masks and face shields had the highest and lowest use, respectively. Equipment shortage, time constraint, low supervision, and lack of information were the reasons for personnel not using PPE. To reduce the burden of COVID-19 and accelerate the process of patient care, it is important to protect and maintain the well-being of staff. Organised national and international arrangements to protect them are critical.

White lies in pediatric care: a qualitative study from nurses' perspective

Communication and sharing information with ill children are challenging. To protect a child from the bitter reality, sometimes use of well-intended untruths, or white lies is necessary. This research aimed at studying the experiences of nurses about the use of white lies in in pediatric clinical setting.

In this qualitative, content-analysis study, 24 on-duty pediatric nurses were interviewed in 2019. Data were collected through purposeful sampling using semi-structured interviews, and the collected data were analyzed according to Granheim and Landman’s method using MAXQDA-10 software.

Eighteen female and six male nurses with the mean age of 42 ± 3/7 years and mean work experience of 16 ± 4/1 years were selected to participate in this study. Data analysis showed that use of white lies depends on both situation and several other factors classified into five general categories: nature of data, childhood characteristics, family norms, treatment team’s capabilities and organization policies.

Treatment team members need to improve their communication skills to convey therapeutic information to the ill child’s family appropriately. To do so, special guidelines should be prepared for healthcare staff in pediatric clinical setting.

Exploring the process of turning back to professional nursing practice in Iran: A grounded theory

BACKGROUND

The current nursing shortage is complicated because of turnover intention among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to professional nursing practice program was low attrition rates and a more cost-effective strategy that prepared inactive nurses returning to practice. This study aimed to explain the process of returned to professional nursing practice.

MATERIALS AND METHODS

This study was a grounded theory study, which lasted from about 2018 to 2020. Data were collected through semi-structured interviews and observations with participants after signing an informed consent form. The average interview duration was 45 min. The study participants were selected through purposeful sampling from both public and private hospitals affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed using a constant comparative analysis method.

RESULTS

In this study, 16 participants were selected, including ten nurses, two educational supervisors, two head nurses, and two matrons. The "transformed competence" as the core concept and the four main concepts of "feeling alienated with the new environment," "getting prepared for restart," "gradual maturity in clinical practice," and "components of organizational culture" were extracted from the data analysis process.

CONCLUSION

The process of returned to professional nursing practice in the context of the organizational culture of incentive learning leading to a high level of competence, and in the context of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

Psychometric properties of the mini peer assessment tools (Mini-PAT) in emergency medicine residents

Background: A few studies have been done regarding the validity and reliability of the Mini-Peer Assessment Tool across various specialties. This study was conducted to determine the reliability, content and construct validity of Mini-Peer Assessment Tool to assess the competency of emergency medicine residents. Methods: This study was carried out to investigate the psychometric properties of the mini-PAT tool to evaluate the professional competencies of emergency medicine residents in educational hospitals affiliated to Tehran University of Medical Sciences. The initial Mini-Peer Assessment Tool was translated into Persian. After that, the content validity index and content validity ratio determined by consulting 12 professors of emergency medicine. The construct validity was determined with exploratory factor analysis and investigation of the correlation coefficient on 31 self and 248 peer assessment cases. The reliability of the mini peer assessment tool was determined by internal consistency and item deletion by using Cronbach's alpha coefficient. Reliability was also assessed by determining the agreement between the two tools of self-assessment and peer assessment by using the diagram Bland and Altman. Results: The results showed content validity ratio (CVR) of the items ranged from 0.56 to 0.83, and the content validity index (CVI) of the items ranged from 0.72 to 0.90. The reliability of the self-assessment and peer-assessment tools were 0.83 and 0.95 respectively and there was a relative agreement between the self-assessment method and the peer assessment method. Finally, the tool underwent exploratory factor analysis resulting extraction into two factors namely 'clinical competencies' and 'human interactions' in the peer assessment tool. In the self-assessment tool, the factors of 'good practice' and 'technical competence' were extracted. Conclusion: The results of the present study provided evidence of the adequacy of content validity, reliability of the contextually customized mini-peer assessment tool in assessing the competencies of emergency medicine residents.

Behavioural changes in medication safety: Consequent to an action research intervention

AIM

To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff.

BACKGROUND

Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes.

METHOD

Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles.

RESULTS

The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate.

CONCLUSIONS

Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours.

IMPLICATION FOR NURSING MANAGEMENT

This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety.

Marriage, a way to achieve relaxing evolution: A grounded theory investigation

BACKGROUND

Marital satisfaction is a complex of feelings, which includes pleasure, satisfaction, and pleasure experienced by the husband or wife in all aspects of marriage, and it is an important part of individual health, especially mental health. This qualitative study was conducted to understand marital satisfaction using grounded theory on couples.

MATERIALS AND METHODS

This qualitative study was implemented using grounded theory based on Corbin and Strauss, 2008, to investigate the process of marital satisfaction formation among couples from 2014 to 2016. The sampling was started as purposeful and continued as theoretical. The data were obtained using semi-structured interviews. 28 interviews were taken from 25 participants; MAXQDA software was used to facilitate the organization of classes and subclasses.

RESULTS

The central variable of this study was called "toward a relaxing evolution." On that account, the main classes included "supportive companionship" and "responsible love," and variables of "personality traits," "interactive relationships," "economic status," "passage of time," and "present resources in society" provided the basis for the formation of marital satisfaction.

CONCLUSION

To achieve marital satisfaction, couples should set their family's ultimate goal toward achieving a relaxing evolution for the entire family, and they should accompany each other in order to achieve that goal. This sometimes requires sacrifice and forgiveness to achieve the ultimate goal of the family.

Factors Moderating the Influence of Intergenerational Contact on Ageism: A Systematic Review

The authors conducted a systematic review of factors that moderate the influence of intergenerational contact on ageism. MEDLINE (using PubMed), EMBASE, Scopus, Web of Science, and Proquest databases were searched, using terms and keywords including intergenerational conflict, intergenerational relation, intergeneration gap, and ageism, and no date restrictions. The search yielded a total of 247 articles, of which 23 met eligibility criteria for the review. Findings revealed that the experience of ageism for older adults is widespread and highly prevalent in Western and Eastern countries. In addition, culture, age, and gender played important roles in young people's decisions to contact older adults. These factors were important moderators of intergenerational relationships and ageism. Robust, trans-disciplinary research is needed to examine factors related to intergenerational relations, particularly with older adults in clinical populations. [Journal of Psychosocial Nursing and Mental Health Services, 58(8), 48-55.].

Registered Nurses' Knowledge of and Experience with Health Literacy

Background

Limited skill in health literacy is a global issue. Variation in health literacy skills within societies is a source of health inequality unless health care providers apply health literacy practices to effectively communicate with all clients.

Objective

This study examined Iranian registered nurses' knowledge of and experience with health literacy practices. Methods: This cross-sectional study provides a quantitative description of knowledge of and experience with health literacy practices. Using a rigorous process, we adapted the Health Literacy Knowledge and Experience Survey to collect data from the participants, who were 190 registered nurses working in Tehran, Iran.

Key Results

Findings identify gaps in participants' knowledge and experience with health literacy practices. Knowledge deficits are most noticeable in standards to create written materials, screening tools to identify limited health literacy, and the Teach-Back strategies to determine people's understanding. Limited experience is prominent in using health literacy screening tools, evaluating written health information, and applying technologies to provide health information. Our multivariate analysis suggests participants who reported more interaction with health care professionals for personal reasons scored higher in knowledge of health literacy practices.

Conclusions

This study indicated that registered nurses in Iran do not have adequate knowledge and experience regarding health literacy practices. Addressing this issue is fundamental to promoting health equity. Future investigations should identify both barriers and facilitators for nurses to apply health literacy practices. [HLRP: Health Literacy Research and Practice. 2019;3(4):e268-e279.].

Plain Language Summary

Health literacy practices enable health care professionals to offer understandable health information to all people and contribute to health equity. We surveyed 190 registered nurses in Iran to assess their knowledge of and experience with health literacy practices. The findings will be a guide to create interventions to improve registered nurses' knowledge of these practices and to use them to communicate clearly with clients.

Resiliency, the Lived Experience of Patients Undergoing Hematopoietic Stem Cell Transplantation

Background: Hematopoetic stem cell transplantation is considered as a standard treatment for cancer patients to stay hopeful toward treatment outcome. However, these patients experience many complications which might affect different aspects of their life. The aim of this study was to investigate the lived experience of patients after hematopoetic stem cell transplantation and introduce supportive care strategies. Materials and Methods: In this study, Van Manen’s Hermeneutic phenomenological approach was used. Eleven patients (7 males and 4 females) were chosen by targeted sampling from visitors of Shariati Hospital’s outpatient clinic. Semi-structured interviews were conducted and the final data were analyzed by MAXQDA 10 software. Results: Data analysis revealed that the main theme was resiliency with two sub-themes of “not surrendering to disease” and “feeling closer to God”. Conclusion: Participants declared that transplantation was like a second chance for life and considered this opportunity as a gift from God to overcome their disease. According to our findings, spirituality aids can help patients control the disturbances following HSCT and health professionals can use constructive strategies to support patients with spiritual needs.

Designing a Process Model of Home Care Service Delivery in Iran: A Mixed Methods Study

Background:

Considering the position of home health care in the current world, the objective of this study was to design an applied model of providing home care services in Iran.

Methods:

The mixed methods approach was employed in three stages in Iran from Feb 2015 to Sep 2016. During the first phase, the qualitative method of content analysis was used. Data were collected by conducting 26 individual interviews and holding one focus group session involving 7 people. Data analysis was based on Graneheim and Lundman’s approach to content analysis.

In the second phase of the study, a literature review was carried out and at the end of this stage, a preliminary model was designed. The model was standardized in the third phase using the Delphi method with 23 participants in two rounds.

Results:

In the first and second stages of the study, various categories emerged including patient referral, agreement, determination of the needed level of care, care plans designing, provision of comprehensive services, documentation, service monitoring, inter-professional cooperation, issuance of death certificates at home, ethical considerations, and the evaluation of services. Then, in the Delphi phase, 20 (95.2%) of the experts confirmed the structure and content of the model and its applicability.

Conclusion:

The designed model can be helpful in organizing the provision of integrated and comprehensive health services to clients at home, which can be effective in improving the clients’ health and enhancing their self-care and autonomy.

Resiliency, the Lived Experience of Patients Undergoing Hematopoietic Stem Cell Transplantation

Background: Hematopoetic stem cell transplantation is considered as a standard treatment for cancer patients to stay hopeful toward treatment outcome. However, these patients experience many complications which might affect different aspects of their life. The aim of this study was to investigate the lived experience of patients after hematopoetic stem cell transplantation and introduce supportive care strategies. Materials and Methods: In this study, Van Manen's Hermeneutic phenomenological approach was used. Eleven patients (7 males and 4 females) were chosen by targeted sampling from visitors of Shariati Hospital's outpatient clinic. Semi-structured interviews were conducted and the final data were analyzed by MAXQDA 10 software. Results: Data analysis revealed that the main theme was resiliency with two sub-themes of "not surrendering to disease" and "feeling closer to God". Conclusion: Participants declared that transplantation was like a second chance for life and considered this opportunity as a gift from God to overcome their disease. According to our findings, spirituality aids can help patients control the disturbances following HSCT and health professionals can use constructive strategies to support patients with spiritual needs.

Health Professionals' Experience of Barriers in Empowering People with Spinal Cord Injury: a Qualitative Inquiry

Introduction: Empowering an individual with spinal cord injury as far as possible is an experience with various social and cultural aspects. This study investigated health professionals' experiences of barriers in empowering individuals with spinal cord injuries.

Methods: This was a qualitative inquiry with a conventional content analysis approach. A number of 11 healthcare professionals who were members of Iran Spinal Cord Injuries Research National Network or had been working in a related research center for at least three years participated in the study. A purposive sampling method was applied until reaching data saturation. The data were collected by semi-structured interviews. The collected data were managed with MAXQDA software version 13.

Results: Three main themes as barriers in empowering people with spinal cord injury emerged: 1) Lack of patient-and-family-centered education, 2) Failure in providing sufficient healthcare services and 3) Inappropriate setting for using rehabilitation services.

Conclusion: These finding can help policymakers to provide better social facilities and more support services for people with spinal cord injuries and their families. Further research is needed to investigate barriers to empowerment from the perspective of individuals with SCI and their families.

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.