The Importance of a Holistic Approach During the Perioperative Period

The preparation of children for day surgery from the parent's viewpoint: A mixed methods study

AIM

The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint.

DESIGN

Empirical Research Mixed Method.

METHODS

The research applied a mixed-methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2-6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi-structured interviews were conducted with 15 parents to better understand their experiences.

RESULTS

According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective.

Digital Health for Patients Undergoing Cardiac Surgery: A Systematic Review

Digital health interventions have shown promise in improving patient outcomes and experiences in various healthcare settings. However, their effectiveness in the context of cardiac surgery remains uncertain. This systematic review aims to evaluate the existing evidence on the use of digital health interventions for patients undergoing cardiac surgery. A comprehensive search of PubMed MEDLINE, Elsevier EMBASE, Elsevier Scopus databases, and ClinicalTrials.gov was conducted to identify relevant studies published up to the present. Studies that examined the effects of digital health interventions, including mobile applications and web-based interventions, on perioperative care and patient outcomes in cardiac surgery were included. The data were extracted and synthesized to provide a comprehensive overview of the findings. The search yielded 15 studies composed of 4041 patients, analyzing the feasibility and implementation of mobile or internet applications for patients undergoing cardiac surgery. The studies included the use of mobile applications (ManageMySurgery, SeamlessMD, mHeart, Telediaglog, ExSed, Soulage Tavie, Heart Health application, and Mayo Clinic Health Connection) and web-based interventions (Heartnet and Active Heart). The findings indicated that these digital health interventions were associated with improved patient engagement, satisfaction, and reduced healthcare utilization. Patients reported finding the interventions helpful in their recovery process, and there was evidence of enhanced symptom monitoring and timely intervention. The completion rates of modules varied depending on the phase of care, with higher engagement observed during the acute phase. Interest in using digital health applications was expressed by patients, regardless of age, gender, or complexity of the cardiac defect. The results demonstrated that web-based interventions resulted in improvements in mental health, quality of life, and eHealth literacy. This systematic review highlights the potential benefits of digital health interventions in the context of cardiac surgery. Further research, including randomized controlled trials, is needed to establish the effectiveness, feasibility, and generalizability of digital health interventions in cardiac surgery.

Design and validation of the presenteeism scale in nursing

BACKGROUND

The instruments used to measure presenteeism are all flawed and only incompletely measure the concept of presenteeism in employees of the general population. As a result, the concept of presenteeism is not measured, and in most of these instruments, the population for which the instrument has been developed differs from the nursing population. The present research was conducted to design and validate the instrument for evaluating presenteeism in nursing.

METHODS

The present study was part of an exploratory sequential mixed study. In this study, the instrument for measuring the level of presenteeism among nurses was developed and validated based on the results of the qualitative stage. To this end, the instrument's psychometric properties were investigated using face, content, and construct validity, as well as reliability through internal consistency and stability.

RESULTS

In this study, an instrument containing 17 items and three dimensions (imperfect cognitive presence, imperfect emotional presence, and imperfect movement presence) with favorable validation characteristics was developed. Therefore, the instrument was able to explain 56.375% of the total variance. Furthermore, Cronbach's alpha and McDonald's omega coefficients were 0.881 and 0.815, respectively. The intra-cluster correlation coefficient (ICC) was also reported as 0.972 for the entire instrument, with a 95% confidence interval of 0.941 to 0.987.

CONCLUSION

Based this study, it was possible to measure the level of nurses' presenteeism through an instrument with favorable psychometric properties. This study helps health managers lay the groundwork for designing a system for measuring presenteeism among Iranian nurses using the developed instrument.

Quality of anesthetist communication with surgical patients in the perioperative setting: a survey at an academic tertiary referral hospital in Ethiopia

BACKGROUND

Effective communication is a fundamental step in providing best medical care and recognized as vital component of clinical anesthesia practice. Poor communication adversely affects patients' safety and outcome. The objective of this study was to investigate the quality of anesthetist communication from patients' perspectives at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

METHODOLOGY

A descriptive cross-sectional study was conducted on 423 surgical patients from April 1, - May 30, 2021. Perioperative patient-anesthetist communication (PPAC) was measured by using 15-items Communication Assessment Tool graded by 5-points Likert scale. Data collection was executed during postoperative time as the patients were optimally recovered from anesthesia. The collected data were cleaned and descriptive analysis was performed.

RESULTS

A total of 400 (94.6% response rate) patients included and 226 (56.7%) were female. The median (IQR) age was 30 (25 - 40) years. Three-hundreds and sixty-one (90.3%) patients had reported good PPAC and 39 (9.8%) reported poor PPAC. The median (IQR) of PPAC scores was 53.0 (48.0 - 57.0) and range from 27 to 69. Highest mean score was observed for the item "Talked in terms I could understand" (4.3 ± 0.7). Lowest mean scores were observed for the item "Checked to be sure I understood everything" (1.9 ± 0.9). Patients who had underwent emergency surgery, no previous anesthetic exposure, had significant preoperative anxiety, no history of previous hospital admission, and moderate-severe preoperative pain were found to have poor PPAC compared to their counterparts in the proportions of 82.1%, 79.5%, 69.2%, 64.1%, and 59.0% respectively.

CONCLUSIONS

There was good PPAC in our hospital from patients' perspective. However, there should be improvements in checking the degree of understanding of the delivered information, encouraging to question, disclosing next steps and involving in decision-making. Patients who underwent emergency surgery, had no previous anesthetic exposure, had clinically significant level of preoperative anxiety, had no history of previous hospital admission, and had moderate-severe preoperative pain were found to have poor PPAC.

Clinical profile of HIV-infected adults receiving a holistic approach of care model in Nakawa, Kampala District

People Living with HIV (PLHIV) are often dealing with a range of issues that make life more difficult because of the limited emotional, spiritual, psychological, social, physical and clinical support which consequently lead to poor physical health and quality of life. The holistic care of individuals infected with HIV/AIDS involves promoting psychological and physiological well-being as well as fostering socio-cultural relationships and supporting the fulfillment of spiritual aspirations. We conducted a retrospective cross-sectional study among HIV-infected patients receiving a holistic approach of care model from January 2015 to December 2018 in Kampala district, Uganda. The study involved adult individuals aged 18 and above from whom demographics and other information were obtained. All eligible participants were selected using stratified random sampling from the parishes and systematic random sampling to select study participants. We investigated the clinical profile and the factors associated with viral load suppression among HIV-infected patients receiving a holistic approach of care model in Kampala District. The data was analyzed using STATA version 13. 0. Results: A total of 910 patients were enrolled. 676 (74.3%) were female; 453 (49.8%) were between 18 and 39 years. 324 (35.6%) were either overweight or obese. 769 (84.5%) had viral load beyond detectable limits, 904 (99.3%) were adhering to HIV treatment. 867(95.3%) were virally suppressed. The age group 40–59 years (Adjusted Odds Ratio (aOR) = 2.85, 95% Confidence Interval (CI):1.36–5.97, P = 0.005) and good adherence (aOR = 12.9, 95%CI:1.86–81.07, P = 0.009) were significantly associated with viral load suppression. Conclusion: The holistic care model supports patients in all facets of their lives, resulting into improved treatment outcomes. Our findings show that age and adherence are linked to viral load suppression among HIV-infected adults receiving a holistic approach of care model.

Novel Patient-Reported Outcome Measures for the Assessment of Patient Satisfaction and Health-Related Quality of Life Following Postmastectomy Breast Reconstruction

BACKGROUND

Patient-reported outcome measures (PROMs) have become an integral part of the evaluation of reconstruction surgery outcomes. However, there are limitations in current PROMs when it comes to the assessment of well-being during inpatient stay, patient perception of health, relationship with partner, and vitality (i.e., mood and ability to work and pursue hobbies, carry out daily tasks, and sleep) following breast reconstructive surgery. The aim was to develop a novel set of measures to compare patient satisfaction and health-related quality of life following different types of postmastectomy breast reconstruction.

METHODS

A novel questionnaire was created and refined through cognitive interviews with patients and expert feedback. A field test study was conducted, including patients who had undergone delayed postmastectomy breast reconstruction with implant, autologous tissue, or combination of implant and autologous tissue. Based on the results, confirmatory factor analysis and examination of reliability of the questionnaire were conducted. Results of patient responses were analyzed using Chi-square test, Kruskal-Wallis test, and Mann-Whitney U test.

RESULTS

Confirmatory factor analysis showed good model fit, and Cronbach's alpha indicated high internal consistency of the questionnaire. Besides that, patients with combination reconstruction reported significantly lower vitality than patients with implant and autologous reconstruction (p = 0.048).

CONCLUSIONS

This novel questionnaire expands the current knowledge base of postmastectomy breast reconstruction PROMs. Results of the field test study showed that combination reconstruction was associated with lower patient vitality than other reconstruction types.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Spiritual well-being, self-transcendence, and spiritual practices among Filipino women with breast cancer

OBJECTIVE

The study was conducted in order to determine the relationship between spiritual well-being and self-transcendence and to identify the spiritual practices utilized by Filipino patients who are recovering from breast cancer.

METHODS

A descriptive correlational study was used, and a purposive sampling technique was utilized to select the participants in the study. Data were collected using self-administered questionnaires and were analyzed using frequency, percentage, mean, standard deviation, and Pearson's r correlation.

RESULTS

The study revealed that the overall mean score of the spiritual index of well-being among the participants was 4.41 (±0.54), while the mean score of self-transcendence was 3.64 (±0.50). The results showed that there was a significant relationship between spirituality and self-transcendence among Filipino women with breast cancer.

SIGNIFICANCE OF RESULTS

Filipino women with breast cancer rely on their spirituality, which enables them to find meaning in their illness. Hence, assessing spirituality among this population group will enable nurses to provide holistic nursing care, as this can help them cope with the challenges associated with their illness.

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

BACKGROUND

Providing holistic and humanistic care to patients requires a variety of factors. A care solely based on objective knowledge might be unsafe and of low quality. Using the patterns of knowing in an integrated manner and relative to the context of caring is one of the necessities for proving a holistic and efficient nursing care. This study aimed to explore the role of patterns of knowing in the formation of uncaring behaviors.

MATERIALS AND METHODS

The researchers used a qualitative research design for this study. Participants included 19 clinical nurses who attended semi-structured and in-depth interviews. In addition, theoretical and purposeful sampling methods were used in this research. Observation of caring processes in different hospital wards was another method used for collecting data. The data analysis was carried out according to conventional content analysis technique.

RESULTS

The study findings revealed five categories for the theme of "omission of some patterns of knowing" including omission of scientific principles, omission of therapeutic relationship, omission of ethics, omission of social justice, and omission of flexibility.

CONCLUSIONS

The omission of some patterns of knowing creates an ugly image of nursing and a negative outcome of caring as well.

The development of Spiritual Nursing Care Theory using deductive axiomatic approach

The concepts of spirituality and spiritual well-being are not novel ideas as they have been subjects of scrutiny in several studies. However, there has yet to be a formalized framework of spiritual nursing in the Philippines despite its importance. Developing such a framework is significant, especially since holistic nursing believes in the relationships among body, mind, and spirit. Thus, the Spiritual Nursing Care theory was conceptualized, which states that every person has holistic needs, including spiritual needs that must be satisfied to attain spiritual well-being. It forwards that for the patient's spiritual needs to be met, what is required is the triumvirate interconnection among the nurse, the external environment, and the spiritual nursing care which may be provided by the nurse as a healthcare provider and the significant others or family as part of the external environment. The theory has two propositions that were subjected to validation studies that either strengthened or repudiated the propositions presented: (1) the meaning of spirituality differs from person to person, and (2) the patient's spiritual well-being is influenced by the nurse's spiritual care competence, as well as the patient's internal and external variables.

Effects of perioperative comprehensive nursing based on risk prevention for patients with intracranial aneurysm

OBJECTIVE

To explore the effect of comprehensive nursing based on risk prevention in perioperative nursing of intracranial aneurysm.

METHODS

A total of 156 patients who suffered from intracranial aneurysm were admitted in neurosurgery department from the hospital between January 2018 and January 2019. Patients were randomly divided into observation group (n = 78, patients were given comprehensive nursing based on risk prevention) and control group (n = 78, patients were given routine nursing). The following parameters, such as postoperative hospital stay, rescue success rate, Glasgow coma scale (GCS) after being awake, anxiety degree and nursing effect (incidence of complications, incidence of infection and patient satisfaction) were compared between the two groups.

RESULTS

The postoperative hospital stay, rescue success rate and GCS after intervention in the observation group were significantly better than those in the control group (P < .05). The degree of anxiety in the observation group after intervention was superior to that in the control group (P < .05), similar results were obtained in terms of the nursing effect in the observation group compared with the control group (P < .05).

CONCLUSION

Comprehensive nursing was associated with the shortness of hospitalisation time of patients, improved rescue rate, reduced occurrence of complications and infection, and improved satisfaction of patients. Thus, comprehensive nursing was regarded to exert protective effect with a promising future for clinical practice.

Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia

BACKGROUND

Holistic practices have been found beneficial for patients as well as nurses. They increase both the nurses and the patients' health-promoting behaviors, spirituality, and interpersonal relationships.

OBJECTIVE

This study aimed to determine holistic nursing care and compare its differences based on individual characteristics.

METHODS

This study employed a quantitative-cross sectional approach. It was conducted at the hospitals of Hail region, Kingdom of Saudi Arabia, from February 2020 to March 2020. Selected through convenience sampling, 154 operating room nurses participated in the study. Frequency and percentages were used to analyze the demographic information, and t-tests and analysis of variance were used to test for differences.

RESULTS

Holistic nursing dimensions such as physiological (4.72 ± 0.40), socio-cultural (4.53 ± 0.45), psychological (4.66 ± 0.32), and spiritual aspects (4.22 ± 0.73) were consistently carried out in the operating room. On the physiological dimension, no significant differences were found in years of experience [(t) -0.073; p > 0.942], gender [(t) -1.113; p > 0.27], or age [(F) 0.558; p > 0.57), but there was a significant difference with nationality [(t) -3.328; p < 0.001]. On the socio-cultural dimension, the length of experience [(t) 0.599; p > 0.550], gender, [(t) -1.420; p > 0.158], and age [(F) 0.148; p > 0.862] were not significant, but a significant difference was found with nationality [(t) -7.516; p < 0.001]. Regarding the psychological dimension, the length of experience [(t) -1.101; p > 0.276], gender [(t) -1.545; p > 0.129], and age [(F) 1.259; p > 0.287] were not significant, but there was a significant difference with nationality [(t) -5.492; p < 0.001]. Finally, with the spiritual dimension, no significant difference was found on length of experience [(t) -1.101; p > 0.276] or age [(F) 0.584; p > 0.559], but there were significant differences on gender [(t) -3.890; p < 0.001] and nationality [(t) -3.653; p < 0.001].

CONCLUSION

Nationality is a causal factor to physiological, socio-cultural, psychological, and spiritual dimensions, while gender is significant to spiritual aspect. Regardless of nationality or gender, nurses must be knowledgeable regarding the significance of adopting holistic care to improve the quality of their care to their patients.

Patients' Experiences of Informed Consent and Preoperative Education

The aim of this descriptive cross-sectional study was to determine adult surgery patients' experiences of informed consent and preoperative education. Research was conducted between September 2018 and February 2019. The sample consisted of 201 adult patients of a university hospital in Turkey. Data were collected using a 48-item questionnaire developed by the researchers based on literature. More than half of the participants (54.2%) were fully informed while 36.8% were partially informed about their surgery process and 61.2% were informed by physicians. Overall, 33.3% had unanswered questions about surgery, with questions relating mostly to the type of surgery (26.8%) and its effect on their body (25.4%). Participants were least informed about preoperative deep breathing and cough exercises (47.8%). More than half (58.4%) of participants expected healthcare professionals to avoid using medical terminology when informing them. Physicians and nurses perform invasive interventions on patients and, therefore, should be sensitive about informing patients.

A Qualitative Study of Perioperative Depression and Anxiety in Older Adults

OBJECTIVE

We had three aims 1) understand barriers to perioperative management of anxiety and depression in older surgical patients; 2) identify preferences and requirements for interventions to manage their anxiety and depression; and 3) explore the feasibility of implementing such interventions in perioperative care.

DESIGN

A qualitative study using semistructured interviews was conducted.

SETTING

Participants were recruited at a large academic medical center.

PARTICIPANTS

We interviewed older surgical patients and clinicians to characterize their perspectives on management of anxiety and depression symptoms, with emphasis on patient needs, barriers, and potential interventions to address these needs.

MEASUREMENTS

We used the Consolidated Framework for Intervention Research to guide the development of interview questions related to intervention implementation feasibility. Thematic analysis was used to analyze interview responses.

RESULTS

Forty semistructured interviews were conducted. Key barriers for perioperative management of depression and anxiety included fear of surgery, acute pain, postoperative neurocognitive disorders, limited understanding of what to expect regarding surgery and recovery, and overwhelmingly complex medication management. Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention.

CONCLUSION

New care models need to be developed to integrate mental health care into the current perioperative care practice.

Queering nursing curricula: Understanding and increasing attention to LGBTQIA+ health needs

BACKGROUND

The LGBTQIA+ community has a long history of marginalization, disenfranchisement, and structural violence within the healthcare sector. Sexual and gender minority individuals may be wary of disclosing sexuality-related information to providers, and providers may not have received education on creating therapeutic relationships with these individuals.

PURPOSE

This paper explores factors that shape LGBTQIA+ individuals' daily lives and how these may influence care encounters. We argue for broadening nursing education to incorporate more specific and efficacious LGBTQIA+ education.

DISCUSSION

We propose that consideration of LGBTQIA+ care in nursing education is an important means of meeting the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing. We further suggest specific strategies for so doing.

CONCLUSION

Attending to the inclusion of LGBTQIA+ populations when developing and planning nursing education activities assures that newly-graduated nurses can be safe, effective, and nonjudgmental providers of care to a variety of populations.

Cancer patients’ perspectives on dignity in care

Background:

Since “dignity” is one of the fundamental rights of every patient, consideration for patients’ dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran.

Research objective:

This study aimed to evaluate the perception of Iranian cancer patients on human dignity.

Research design:

A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method.

Participants and research context:

 This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018.

Ethical considerations:

The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study.

Findings:

Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the “personal space and privacy,” “respect for human values,” and “moral support.”

Discussion:

The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity.

Conclusion:

Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.

Assessing the Effect of Spiritual Intelligence Training on Spiritual Care Competency in Critical Care Nurses

Aim & Objective: Due to the importance of spiritual care as a part of holistic care, this study aimed to investigate the effect of spiritual intelligence training on the nurses’ competence in spiritual care in critical care units.

Methods: The study was performed on 82 nurses (40 in the experimental group and 42 in the control group). Participants were selected from critical care units of teaching hospitals affiliated to Lorestan University of Medical Sciences1. The experimental group took part in eight sessions of spiritual intelligence training, held in the form of workshops. In the control group, no intervention was made. The scale for assessing nurses’ competencies in spiritual care was completed before, immediately and one month after the sessions in two groups. Data analysis was performed using SPSS software version 15.

Results: The results showed that spiritual intelligence training had a positive effect on nurses’ competence in spiritual care. Also, 89% of the nurses who participated in the study had not been given any prior education regarding spiritual care. Nurses considered barriers to spiritual care including inadequate staff, cultural differences, high workload and lack of education on this subject.

Conclusions: The present results showed that the training of spiritual intelligence could develop the nurses’ competence in spiritual care. The development of spiritual care provided by nurses can result in various outcomes such as increased satisfaction with care in patients, reduced anxiety and symptoms of depression during hospitalization, reduced length of hospitalization and, in general, improved quality of life.

Holistic nursing competence scale: Turkish translation and psychometric testing

AIM

This study aimed to culturally adapt and evaluate the reliability and validity of the Holistic Nursing Competence Scale for application in the Turkish context.

BACKGROUND

Nurses are expected to assess well-being of individuals by considering physical, social, psychological, cultural and spiritual dimensions to enhance adaptation to diseases. In Turkey, no tools have been developed to date for the evaluation of competencies in holistic nursing in the country.

METHODS

The study was conducted with 288 nurses working in two hospitals in Ankara equipped with over 500 beds. A confirmatory factor analysis was performed in order to identify whether the items and the sub-dimensions of the adapted scale complied with the original structure comprising 36 items and five sub-scales, namely 'general aptitude', 'staff education and management', 'ethically oriented practice', 'nursing care in a team' and 'professional development'. Cronbach's alpha value was used as an estimate for reliability analysis.

RESULTS

Opinions of 11 experts were obtained for content validation of the scale, and the content validity index was 0.90. The adaptation was observed to be acceptable on the basis of structural equation model fit indices in confirmatory factor analysis. Cronbach's alpha value was estimated to be 0.97 and 0.90, respectively, for the complete scale.

CONCLUSION

The study identified the Turkish version of Holistic Nursing Competence Scale as a valid and reliable tool for the evaluation of competence in holistic nursing among nurses.

IMPLICATIONS FOR NURSING AND NURSING POLICY

The instrument may now be utilized as a tool of measurement in nursing practice, as well as in education and research, for identifying the level of competence in the holistic nursing practices among the nurses in Turkey.

A Concept Analysis of Holistic Care by Hybrid Model

Purpose:

Even though holistic care has been widely discussed in the health care and professional nursing literature, there is no comprehensive definition of it. Therefore, the aim of this article is to present a concept analysis of holistic care which was developed using the hybrid model.

Methods:

The hybrid model comprises three phases. In the theoretical phase, characteristics of holistic care were identified through a review of the literature from CINAHL, MEDLINE, PubMed, OVID, and Google Scholar databases. During the fieldwork phase, in-depth interviews were conducted with eight nurses who were purposely selected. Finally, following an analysis of the literature and the qualitative interviews, a theoretical description of the concept of holistic care was extracted.

Results:

Two main themes were extracted of analytical phase: “Holistic care for offering a comprehensive model for caring” and “holistic care for improving patients' and nurses' conditions.”

Conclusion:

By undertaking a conceptual analysis of holistic care, its meaning can be clarified which will encourage nursing educators to include holistic care in nursing syllabi, and consequently facilitate its provision in practice.

Holistic Care for Patients During Weaning from Mechanical Ventilation: A Qualitative Study

BACKGROUND

Weaning patients from mechanical ventilation is a complex and highly challenging process. It requires continuity of care, the overall assessment of patients, and a focus on all aspects of patients' needs by critical care nurses.

OBJECTIVES

The aim of the present study was to explore holistic care while patients are being weaned from mechanical ventilation from the perspective of the critical care nurses.

METHODS

The study was carried out in the intensive care units (ICUs) of six hospitals in Ahvaz, Iran, from 2014 to 2015. In this qualitative study, 25 ICU staff including nurses, nurse managers, and nurse educators were selected by means of purposive sampling. Semi-structured interviews were used for data collection. The interview transcripts were then analyzed using qualitative content analysis.

RESULTS

The four main themes that emerged to explain nurses' experiences of holistic care when weaning patients from mechanical ventilation include continuous care, a holistic overview of the patient, promoting human dignity, and the overall development of well-being.

CONCLUSIONS

It was found that avoiding routine pivotal expertise, increasing consciousness of the nonphysical aspects of patients while providing treatment and presenting exclusive care, utilizing experienced ICU nurses, and placing more emphasis on effective communication with patients in order to honor them as human beings can all enhance the holistic quality of care.

Simple mastectomy under hypnosis: A case study approach

There is a clear inverse relationship between preoperative anxiety and effective anaesthesia and recovery. Studies have shown that perioperative anxiety can be detrimental to the efficacy of recovery. In order to mitigate the perioperative anaesthetic risk to the patient, perioperative care must be inclusive of psychological as well as physiological elements. Therefore, when planning and implementing care for the surgical patient alternative interventions, such as hypnosis, should be considered when presented with difficult patient factors, such as crippling anxiety. This article takes on a case study approach to critically analyse and appraise the holistic care of a patient undergoing a simple mastectomy with hypnosis as the primary anaesthesia.

Effective factors in providing holistic care: a qualitative study

BACKGROUND

Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring.

MATERIALS AND METHODS

A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software.

RESULTS

Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits.

CONCLUSION

Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

Going beyond-the-routines view in nursing: a qualitative study

INTRODUCTION

Nurses' practice of beyond-the-routine view leads to a better treatment process and higher professional status for nurses. However, most studies show that such care is ignored in nursing. The objective of the present study is to analyze nurses' experiences with regard to beyond-the-routine care in order to know this type of better care and encourage nurses to practice it.

METHODS

This is a qualitative study based on conventional content analysis. Eighteen nurses participated in the study. Data collection was based on purposive, snowball and theoretical sampling. The data was collected through comprehensive interviews conducted in various wards at the university hospitals of Urmia and Tabriz, Iran. The collected data was analyzed according to qualitative content analysis and by using the software MAXQDA.

RESULTS

The results showed that the categories of attempting to identify the patients' problems and listening to one's inner voice are effective factors in going beyond the routines in providing care which can in turn lead to more satisfactory care plans.

CONCLUSION

Effective communicative skills, sufficient nursing knowledge, strong religious and professional principles will encourage nurses to provide beyond-the-routine care. Accordingly, it is necessary to emphasize these factors during education in order for nurses to practice this type of caring.