Modelling of physicians' clinical information-seeking behaviour in Iran: a grounded theory study

OBJECTIVES

Exploring clinical information-seeking behaviour (CISB) and its associated factors contributes to its theoretical advancement and offers a valuable framework for addressing physicians' information needs. This study delved into the dimensions, interactions, strategies and determinants of CISB among physicians at the point of care.

DESIGN

A grounded theory study was developed based on Strauss and Corbin's approach. Data were collected by semistructured interviews and then analysed through open, axial and selective coding.

SETTING

The study was conducted at academic centres affiliated with Isfahan University of Medical Sciences.

PARTICIPANTS

This investigation involved recruiting 21 specialists and subspecialists from the academic centres.

RESULTS

The findings revealed that physicians' CISB encompassed multiple dimensions when addressing clinical inquiries. Seven principal themes emerged from the analysis: 'clinical information needs', 'clinical question characteristics', 'clinical information resources', 'information usability', 'factors influencing information seeking', 'action/interaction encountering clinical questions' and 'consequences of CISB'. The core category identified in this study was 'focused attention'.

CONCLUSIONS

The theoretical explanation demonstrated that the CISB process was interactive and dynamic. Various stimuli, including causal, contextual and intervening conditions, guide physicians in adopting information-seeking strategies and focusing on resolving clinical challenges. However, insufficient stimuli may hinder physicians' engagement in CISB. Understanding CISB helps managers, policy-makers, clinical librarians and information system designers optimally implement several interventions, such as suitable training methods, reviewing monitoring and evaluating information systems, improving clinical decision support systems, electronic medical records and electronic health records, as well as monitoring and evaluating these systems. Such measures facilitate focused attention on clinical issues and promote CISB among physicians.

Pediatric Ward Nurses' Caring Self-Efficacy Scale: Development and Validation

BACKGROUND

No instrument specifically designed to investigate the caring self-efficacy of nurses in pediatric wards was found. The aim of the present study was therefore to develop a scale to evaluate pediatric wards nurse's caring self-efficacy.

MATERIALS AND METHODS

In this study, an exploratory, sequential, mixed method was used in 2015 in Iran. Data collected from 27 semi-structured interviews with nurses in pediatric wards were analyzed using conventional content analysis. The initial version of the scale was obtained with 65 items. Face validity was determined using impact score and content validity using the Content Validity Index (CVI) and Content Validity Ratio (CVR). The construct validity of the scale was investigated using exploratory factor analysis with 305 nurses in pediatric wards. The concurrent validity of the scale was acquired using the General Self-Efficacy Scale. Internal consistency and test-retest reliability were also examined.

RESULTS

The scale-CVI (S-CVI) (average) was 0.85. The 14 items with a CVR and CVI of less than 0.51 and 0.70, respectively, were deleted and the final 51-item scale was approved. All 51 items had good impact score (>1.50). In the final scale, four subscales were extracted using construct validity. The concurrent validity of the scale was also obtained (r = 0.77, p < 0.001). The total Cronbach's α correlation coefficient of the scale was 0.96 and test-retest reliability was 0.98.

CONCLUSIONS

The Pediatric Ward Nurses' Caring Self-Efficacy (PWNCSE) scale developed in this study is a practical, reliable, and valid scale to evaluate pediatric ward nurses' caring self-efficacy.

Factors related to the international research collaboration in the health area: A qualitative study

BACKGROUND

International research collaboration (IRC) is known as one of the important indicators of productivity, efficiency, and validity of universities in the world. In other words, IRC is necessary for the scientific trade-off between researchers in international scientific societies. The study aimed to address the experiences of an academic researcher about factors related to IRC.

MATERIALS AND METHODS

The present study was conducted using a qualitative approach and conventional content analysis method. The participants consisted of 19 experienced faculty members and researchers from Isfahan University of Medical Sciences, who were selected based on the purposive and snowball sampling techniques. Data were collected through semi-structured interviews and were analyzed using the content analysis technique. Guba and Lincoln's evaluative criteria, including credibility, confirmability, dependability, and transferability, were applied to evaluate the trustworthiness of the study.

RESULTS

According to the research findings, factors of "personal skills," "personality," "professional position," and "scientific activities" under the category of personal factors; "rules and regulations" and "equipment and facilities" under the organizational factors; and "domestic policies" and "foreign policies" were identified under the government factors category.

CONCLUSION

Research collaborations are influenced by individual, intra-academic, and extra-academic factors; thus, research policymakers can help further to enhance the quantity and quality of scientific output and promote the university's placing in international rankings through providing conditions that enable international interactions.

Personal, technical and organisational factors affect whether physicians seek answers to clinical questions during patient care: a literature review

BACKGROUND

Numerous questions are generated for physicians during patient care. Facilitators and barriers affect the physicians' clinical information-seeking behaviour. While most health studies have focused on barriers, few have dealt with facilitators.

OBJECTIVE

This review aimed to identify facilitators in physicians' information-seeking behaviour to help respond to clinical questions raised during patient care.

METHODS

A narrative review was conducted, and 9 databases were searched. Selection criteria included original articles in the context of patient care and full-text articles published in the English language from 2002 to 2019. The articles were selected and analysed by group discussions.

RESULTS

Analysis of studies disclosed personal, technical and organisational facilitators including 26 themes. Internet utilisation and information searching skills, more available time, personal interests and knowing preferred sites or textbooks were among the personal factors. The most common technical factors included providing navigation support, and ease of searching and finding needed information. The most commonly reported factors at the organisational level are closeness to Internet facility and access during the consultation.

CONCLUSION

Information systems designers, health service managers and librarians may need to work together to provide systems and settings that encourage doctors to seek information to answer their clinical questions during patient care.

Thematic Analysis of Management Behaviors of Civilian Nurses in Iran-Iraq War 1980-1988: A Historical Research

BACKGROUND

One of the most important roles of nurses in the war was the application of management interventions, which led to provide better services for the wounded soldiers. The purpose of this study was to explore the Management behaviors of civilian nurses in the Iran-Iraq war.

MATERIALS AND METHODS

The historical research methodology and thematic analysis using in-depth interviews were applied to gather data. This study was conducted in 2010-2012 in five big cities of Iran, and involved 18 male nurses who were selected by purposeful sampling method.

RESULTS

The interviews of the nurses revealed a main category as the management behaviors of the nurses in the war. Six subcategories were obtained, namely call up for the war, establishing emergency teams, managing the therapeutic units, managerial innovation during war operations, teamwork and variety of roles of nurses in the war.

CONCLUSIONS

This study demonstrated how the nurses adapted to the harsh a situation without any previous experience on management in crises such as wars and increased medical treatment facilities outcome using management principles.

Experiences of civilian nurses in triage during the Iran-Iraq War: An oral history

PURPOSE

Nurses played a critical role in performing triage during the Iran-Iraq War. However, their experiences in triage have not been discussed. Therefore, the current study aimed to investigate the triage experiences of civilian nurses during the Iran-Iraq War.

METHODS

Oral history method and in-depth interviews were used to collect data to gain the nurses' experiences in triage.

RESULTS

Four themes were extracted from the data, which were the development of triage, challenging environment to perform triage, development of mobile triage teams, and challenges of triage chemical victims for nurses.

CONCLUSION

Triage is an important skill for nurses to manage critical situations such as disasters and wars. Nurses have to be competent in performing triage. Involvement in critical situations helps the nurses learn and gain more experience on how to manage unexpected events.

Patient's dignity in intensive care unit: A critical ethnography

BACKGROUND

Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units.

OBJECTIVES

The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit.

RESEARCH DESIGN

The study was conducted using a critical ethnographic method proposed by Carspecken.

PARTICIPANTS AND RESEARCH CONTEXT

Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace.

ETHICAL CONSIDERATION

Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained.

FINDINGS

The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity".

DISCUSSION

The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches.

CONCLUSION

Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

The Effects of Massage and Breastfeeding on Response to Venipuncture Pain among Hospitalized Neonates

Background:

Untreated procedural pain leads to long-term and short-term complications in neonates. Preventing pain in sick infants and neonates, whose conditions are getting worse, not only is a professional and legal duty but also a prevention measure to decrease future psychological and even neurological complications. Therefore, nurses should prevent newborns' pain. The aim of this study was to compare the effects of massage and breastfeeding on the pain of the neonates.

Materials and Methods:

This was a clinical trial conducted among 75 full-term and near-term infants who underwent venipuncture. The newborns were randomly allocated to the following groups (n = 25 for each): group 1, breastfeeding; group 2, massage; and group 3, control. In the first group, venipuncture was done 2 minutes after breastfeeding. In the second group, massage was done with effleurage technique for 3 minutes and venipuncture was done 2 minutes after massage. The Neonatal Infant Pain Scale (NIPS) was used for pain measurement in the first 30 seconds of venipuncture. Data were analyzed by t-test and one-way analysis of variance (ANOVA).

Results:

The lowest mean pain score recorded in the massage group (0.92) whereas it was 4.84 in the breastfeeding group and 6.16 in the control group. ANOVA test and post-hoc statistics revealed that both interventions resulted in a significant reduction of the pain scores.

Conclusions:

According to the findings of this study, the lowest pain score was in massage group, then in breastfeeding group and control group accordingly. Considering the fact that massage and breastfeeding are natural, useful, and cost free interventions and do not need any special facility, these methods are suggested in pain management and pain control during painful procedures administrated for infants.

Altruism, the values dimension of caring self-efficacy concept in Iranian pediatric nurses

BACKGROUND

Self-efficacy is the most influential among factors affecting nurses' performance. Yet, understanding of the constituent elements of the caring self-efficacy concept was not considered. This study was to introduce altruism as one of the main aspects of caring self-efficacy in pediatric nurses.

MATERIALS AND METHODS

This is part of a larger study on the concept of caring self-efficacy conducted with qualitative content analysis approach in Iran. Participants included 27 clinical pediatric nurses and instructors, selected purposively. Data were collected using semi-structured interviews and analyzed using conventional content analysis method.

RESULTS

Theme "altruism" as one of the main themes extracted from the analysis of the interviews in this study. This theme includes two main categories of "humanistic care" and "caring attitude."

CONCLUSIONS

This paper introduces altruism as one of the values aspects of caring self-efficacy in pediatric nurses. Efficient nurse with features Humanistic care, through the provision of maternal care and family-centered care and caring attitudes resulting from religious beliefs and loving children to care for the children.

The relationship between nurses' clinical competence and burnout in neonatal intensive care units

Background:

Nurses’ clinical competency plays an important role in the care of preterm infants. On the other hand, burnout is one of the most important factors in reducing the nurses’ efficiency. With regard to the importance of the role of nurses, and the vulnerability of the infants, the purpose of this study was to investigate the relationship between nurses’ burnout and clinical competency in NICUs.

Materials and Methods:

The descriptive cross-sectional study was conducted with the participation of 86 nurses working in the NICUs of hospitals in Isfahan, Iran. Census sampling method was used in the NICUs of educational hospitals in 2014. Data were collected by a questionnaire including demographic characteristics, Patricia clinical competency, and Maslach burnout scales. Data were analyzed by the statistical tests of independent t-test and Pearson correlations test with the significance level of α < 0.05.

Results:

Six dimensions of clinical competency and three dimensions of nurses’ burnout were assessed at three levels (weak, moderate, and strong levels). Statistical tests showed that clinical competency was at a moderate level in all fields. Of the dimensions of nurses’ burnout, emotional exhaustion was moderate, depersonalization was weak, and personal performance was strong. The results showed that nurses’ burnout and clinical competency in the NICUs were at a moderate level and had a significant negative relationship (r = −0.322, P = 0.003).

Conclusions:

Results showed that burnout had a negative relationship with competency. Therefore, managers are suggested to improve nurses’ competency and diminish their job burnout through better and more applicable planning.

Experience of Behvarzes (Iranian primary healthcare providers) from giving primary health services in health houses

BACKGROUND

Primary healthcare (PHC) providers play a major role in provision of public health in rural areas in Iran. They are considered as the key elements of health development in rural population. There is limited research on clarification of their experiences from provision of health services in their working conditions. This study aimed to clarify the experience of PHC providers from working conditions in giving primary health services in health houses (district branches of rural health care centers).

MATERIALS AND METHODS

This is a content analysis qualitative study, conducted through personal and group interviews with 12 health workers working in health care centers in rural areas in Isfahan province, 2010. Sampling continued until data saturation. Data were analyzed through conventional content analysis and constant comparative method.

RESULTS

Data analysis led to extraction of 11 categories, and finally, four themes of "ignoring the rights," "causing tension in working climate," "pressure or overload of expectations beyond the power," and "occupational worn out" were yielded from the categories. These themes reveal the concepts and nature of PHC providers' experiences from giving health care at health houses as the first level of PHC centers.

CONCLUSION

The results of the present study showed that the PHC providers work in a tense condition in health houses. Although they devote themselves to the health of society members, their own health is neglected. Policy makers and authorities should amend working conditions of PHC providers through modification of resources and making supportive and collaborative strategies to improve the quality of services and promote the health level of the service receivers.

Relationship between parent-infant attachment and parental satisfaction with supportive nursing care

Background:

Parent–infant attachment is an important factor in accepting parenting role, accelerating infant survival, and adjusting to the environment outside the uterus. Since family supportive interventions can strengthen the parent–infant caring relationship, this study sought to investigate the relationship between mother–infant attachment and satisfaction of the mothers with the supportive nursing care received in the neonatal intensive care unit (NICU).

Materials and Methods:

In this descriptive–correlational study, 210 mothers with premature infants who were hospitalized in the NICUs affiliated to Isfahan Medical University hospitals took part. The data were collected via Maternal Postnatal Attachment Scale and researcher's self-tailored questionnaire based on Nurse Parent Support Tool. Pearson correlation coefficient and multiple linear regressions were used to analyze the collected data.

Results:

The results showed that the overall score of mother–infant attachment and the overall score of maternal satisfaction correlated with a correlation coefficient of r = 0.195. Also, the overall score of mother–infant attachment and mothers’ satisfaction scores in the emotional, communicative-informative, and self-confidence domains correlated with correlation coefficients of r = 0.182, r = 0.0.189, and r = 0.0.304, respectively. The results of multiple regression analysis revealed that about 15% of changes in the dependent variable (mother–infant attachment) could be explained by different dimensions of mothers’ satisfaction.

Conclusions:

The results of the study showed that mother–infant attachment improved by increasing mothers’ satisfaction of supportive nursing care. Therefore, it seems necessary to increase maternal satisfaction through given nursing care support, in order to promote mother–infant attachment.

Challenges in conducting qualitative research in health: A conceptual paper

BACKGROUND

Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices.

MATERIALS AND METHODS

This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature.

RESULTS

One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real-life experiences in conducting qualitative research in health reveal these issues.

CONCLUSIONS

The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Exploration of the counseling needs of infertile couples: A qualitative study

BACKGROUND

Identification of the main needs of infertile patients is essential to provision of appropriate supportive services and care based on their needs. Thus, the present study aims to explore infertile couples' counseling needs.

MATERIALS AND METHODS

This study was carried out with an inductive qualitative content analysis approach during 2012-2013. The participants of this study included 26 Iranian infertile couples and 7 medical personnel (3 gynecologists and 4 midwives). The infertile couples were selected through purposive sampling and considering maximal variation from patients attending state-run and private infertility treatment centers as well as infertility specialists, offices in Isfahan and Rasht, Iran. Unstructured in-depth interviews and field notes were utilized for data gathering and replying to this research main question, "What are the counseling needs of infertile couples?" The data from medical personnel was collected through semi-structured interviews. Data analysis was carried out through conventional content analysis.

RESULTS

Data analysis revealed two main themes. The first theme was "a need for psychological counseling," which included four subthemes: Emotional distress management, sexual counseling, marital counseling, and family counseling. The second theme was "a need for guidance and information throughout treatment process," which included three subthemes: Treatment counseling, financial counseling, and legal counseling.

CONCLUSIONS

The counseling needs of infertile couples are varied, and they require various psychosocial support and counseling interventions. The participants of this study identified clearly the significance of psychological counseling and information throughout the long and onerous journey of infertility and its treatment.

Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden

Background:

Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts.

Research objective:

The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia.

Research design:

A phenomenological hermeneutical method guided the study.

Participants and research context:

A total of 10 enrolled nurses with Iranian background, aged 33–46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden.

Ethical considerations:

The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential.

Findings:

Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day.

Conclusion:

Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.

The existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review

BACKGROUND

In recent years, a growing number of interventions for treatment of female orgasmic problems (FODs) have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context.

OBJECTIVE

In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models.

MATERIALS AND METHODS

For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, "pearl-growing" techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:" orgasm" OR "orgasmic "," female orgasmic dysfunction" OR Female anorgasmia OR Female Orgasmic Disorder ", orgasmic dysfunction AND treatment, "orgasm AND intervention". Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD.

RESULTS

The majority of interventions (90%) related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings.

CONCLUSION

Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women' sexual problems such as FOD in the Iranian settings.

Characteristics of caring self-efficacy in pediatric nurses: a qualitative study

PURPOSE

The present study was conducted to clarify pediatric nurses' characteristics of caring self-efficacy.

DESIGN AND METHODS

This study was conducted using a qualitative content analysis approach. The participants included 27 pediatric nurses and clinical instructors, selected purposively. Data were collected using semi-structured interviews and were analyzed using the content analysis method.

RESULTS

Data analysis generated four main themes as attributes of a self-efficient pediatric nurse including: (a) professional communications; (b) management of care; (c) altruism; and (d) proficiency.

PRACTICE IMPLICATIONS

Nursing managers and instructors can use these results to help develop nurses' empowerment and self-efficacy, especially in pediatric care.

Comparison of anxiety prevalence among based and offshore National Iranian Drilling Company staff's children in Ahvaz, 2013

BACKGROUND

Anxiety is one of the most common psychological issues among all age groups including children. The main role of parents has been known to support their children. Being far away from a source of support has been shown to be a potential trigger for childhood anxiety. Periodical jobs, including offshore work, are among the main reasons for absence of one of the parents. Therefore, this study aims to assess anxiety in children of National Iranian Drilling Company offshore staff.

MATERIALS AND METHODS

In this historical cohort study, 160 students including 80 boys and 80 girls were selected through convenient random sampling from the schools of National Iranian Drilling Company. Data were collected using Revised Children's Manifest Anxiety Inventory (by Reynolds and Richmond), consisting 37 items and a demographic questionnaire. The collected data were statistically analyzed by t-test and logistic regression tests through SPSS software.

RESULTS

The mean anxiety score was 12.80 among offshore staff's children and 11.67 among the children of the based staff. The ratio of manifest anxiety among the offshore workers' children was significantly more than the based ones'.

CONCLUSIONS

Based on the findings, offshore fathers' job affects the anxiety of the children.

Compilation of the neonatal palliative care clinical guideline in neonatal intensive care unit

BACKGROUND

Clinical guidelines are important instruments for increasing the quality of clinical practice in the treatment team. Compilation of clinical guidelines is important due to special condition of the neonates and the nurses facing critical conditions in the neonatal intensive care unit (NICU). With 98% of neonatal deaths occurring in NICUs in the hospitals, it is important to pay attention to this issue. This study aimed at compilation of the neonatal palliative care clinical guidelines in NICU.

MATERIALS AND METHODS

This study was conducted with multistage comparative strategies with localization in Isfahan in 2013. In the first step, the components of the neonatal palliative care clinical guidelines were determined by searching in different databases. In the second stage, the level of expert group's consensus with each component of neonatal palliative care in the nominal group and focus group was investigated, and the clinical guideline was written based on that. In the third stage, the quality and applicability were determined with the positive viewpoints of medical experts, nurses, and members of the science board of five cities in Iran. Data were analyzed by descriptive statistics through SPSS.

RESULTS

In the first stage, the draft of neonatal palliative care was designed based on neonates', their parents', and the related staff's requirements. In the second stage, its rank and applicability were determined and after analyzing the responses, with agreement of the focus group, the clinical guideline was written. In the third stage, the means of indication scores obtained were 75%, 69%, 72%, 72%, and 68% by Appraisal of Guidelines for Research and Evaluation (AGREE) instrument.

CONCLUSIONS

The compilation of the guideline can play an effective role in provision of neonatal care in nursing.

Exploration of infertile couples' support requirements: a qualitative study

Background

Due to high prevalence of infertility, increasing demand for infertility treatment, and provision of high quality of fertility care, it is necessary for healthcare professionals to explore infertile couples’ expectations and needs. Identification of these needs can be a prerequisite to plan the effective supportive interventions. The current study was, therefore, conducted in an attempt to explore and to understand infertile couples’ experiences and needs.

Materials and Methods

This is a qualitative study based on a content analysis ap- proach. The participants included 26 infertile couples (17 men and 26 women) and 7 members of medical personnel (3 gynecologists and 4 midwives) as the key informants. The infertile couples were selected from patients attending public and private infertility treatment centers and private offices of infertility specialists in Isfahan and Rasht, Iran, during 2012-2013. They were selected through purposive sampling method with maximum variation. In-depth unstructured interviews and field notes were used for data gathering among infertile couples. The data from medical personnel was collected through semi-structured interviews. The interview data were analyzed using conventional content analysis method.

Results

Data analysis revealed four main categories of infertile couples’ needs, including: i. Infertility and social support, ii. Infertility and financial support, iii. Infertility and spiritual support and iv. Infertility and informational support. The main theme of all these categories was assistance and support.

Conclusion

The study showed that in addition to treatment and medical needs, infertile couples encounter various challenges in different emotional, psychosocial, communicative, cognitive, spiritual, and economic aspects that can affect various areas of their life and lead to new concerns, problems, and demands. Thus, addressing infertile couples’ needs and expectations alongside their medical treatments as well as provision of psychosocial services by development of patient-centered approaches and couple-based interventions can improve their quality of life and treatment results and also relieve their negative psychosocial consequences.

Quality of life and related factors among the women undergoing mastectomy

BACKGROUND

Breast cancer is the most common cancer among women and 81% of therapeutic surgery performed for breast cancer in Iran is mastectomy. Following mastectomy, the patients suffer from many problems which lead to several disorders and decrease in their quality of life (QOL).

MATERIALS AND METHODS

This cross-sectional descriptive study was conducted on 105 breast cancer patients who underwent mastectomy, selected with a convenient sampling method. A questionnaire containing three parts was used to collect data. The data were analyzed by SPSS version 14 using descriptive and analytical statistical methods.

RESULTS

Spearman test showed that there was a statistically significant relationship between QOL and education level and also fatigue. Moreover, Spearman test indicated a statistically significant correlation between age and the mental dimension of QOL. There was no significant relationship between QOL with marital and employment status.

CONCLUSIONS

Based on the findings, we can suggest that nurses should be educated about the factors affecting QOL. They can receive the necessary knowledge in various areas such as meeting the patients, optimum management of patients' problems, improvement of their health, and finally help to increase the cancer patients' QOL.

Threats to Pediatric Nurses' Perception of Caring Self-efficacy: A Qualitative Study

Background:

Nurses are considered the largest and most important human resource for healthcare organizations. Self-efficacy as the main predictor of nurses’ behavior plays an important role in nurses’ professional behavior. However, the various dimensions and threats of caring self- efficacy concept have not been taken into consideration.

Objectives:

The present paper attempts to identify threats to self-efficacy as an important aspect of the concept of pediatric nurses’ caring self-efficacy.

Materials and Methods:

This study is part of a larger study on the caring self-efficacy concept that was conducted through content analysis and from a qualitative approach in 2014 in Iran. Twenty-seven nurses and pediatric clinical instructors participated in this research according to the purposive sampling method employed in the study. Data were collected through semi-structured interviews. The collected data were analyzed using the conventional content analysis method.

Results:

“Threats to self-efficacy” was one of the main themes extracted from the interview analysis results in the present study. The theme consists of two main categories “individual barriers,” including not having a caring attitude and not being interested in children, and “organizational barriers,” including an inefficient educational system, not developing professional capabilities, non-valuation of the organization in a caring context, a poor rewards system, and inappropriate managerial policies.

Conclusions:

Nursing management and custodians of nursing trainings can break through the barriers to self-efficacy by knowing these factors and making changes in the educational programs and providing supporting policies. This can be an important step toward improving nurses’ inefficacy and ultimately improving the provision of quality healthcare services.

Focusing on psychiatric patients' strengths: A new vision on mental health care in Iran

BACKGROUND

Identifying and using the strengths of patients, in practice, is a new territory. Today, the need to educate nurses and psychiatric patients about positive psychology in practice and the importance of understanding and focusing on strengths is clear. However, little is known about the strengths the psychiatric patients use and experience. Thus, this study has been designed and conducted in order to understand how people with psychiatric disorders demonstrate their strengths.

MATERIALS AND METHODS

In the present study, 13 semi-structured, qualitative interviews with patients and 2 focus groups with nurses were carried out. In addition, a qualitative content analysis was used to identify significant strengths.

RESULTS

Based on the results, the four main strengths consisted of: Finding a meaning in daily living, work as enduring strength, entertaining activities, and positive relationship. Patients also reported that health care providers rarely focused on patients' strengths, and experts confirmed these findings. Our findings indicate that patients' own strengths are a pivotal factor in getting through their illness from their perspective.

CONCLUSIONS

Despite the enduring legacy of pessimism regarding psychiatric patients, these people have a repertoire of strengths. Nurses should, therefore, have a greater focus on eliciting and nourishing psychiatric patients' strengths in their care. It is suggested that the theoretical and practical aspects of patients' strengths be incorporated in nursing school curricula.

Data analysis in oral history: A new approach in historical research

BACKGROUND

Historical research has limitations in applying proper and credit-worthy chronology to clarify the data. In this methodology, the application of oral history is one of the ways in which answers to questions addressed by the research theme are elicited. Oral history, as a clear and transparent tool, needs to be applied with guidelines for qualitative researchers regarding data analysis limitations from oral evidence and face-to-face contact. Therefore, the development of a systematic method for data analysis is needed to obtain accurate answers, based on which a credit-worthy narration can be produced. The aim of this study was to introduce an ethical and objective approach for the analysis of data obtained from oral history.

MATERIALS AND METHODS

This is a methodological article that suggests an analysis method based on qualitative approach and experiences of the authors.

RESULTS

A systematic method of data analysis for oral history research, based on common qualitative data analysis methods, has been suggested as the result of this article.

CONCLUSIONS

This new technique is equipped with measures that would assist qualitative researchers in the nursing field and other disciplines regarding analysis of qualitative data resulting from oral history studies.

Challenges of children with cancer and their mothers: A qualitative research

BACKGROUND

Cancer is one of the major causes of death in children and adolescents. About 4% of deaths in children of age less than 5 years and 13% of deaths in children of age 5-15 years are due to cancer in Iranian population. The disease can cause many problems, which are usually detected by a psychologist, for the children and their mothers. Therefore, this study aimed to identify the psychological challenges of the children with cancer and their mothers' experience.

MATERIALS AND METHODS

This is a qualitative research conducted through thematic analysis approach. Semi-structured interviews were used to collect the data. Purposive sampling was conducted. The numbers of the children and their mothers participating in this study were 34 and 32, respectively.

RESULTS

Data analysis showed that the problems faced by children with cancer and their mothers fell into five main categories. These categories included spiritual, psychological (such as aggression, anxiety, depression), communicational problems, inadequate knowledge (about the disease, its treatment, and treatment complications), and care-related problems.

CONCLUSIONS

The results showed that lack of awareness and spiritual problems were the most important problems of the patients and their mothers. If necessary knowledge about the disease and its treatment and complications is given to the children and their mothers at the time of diagnosis, and also, spiritual care interventions are administered during treatment, their psychological problems can be notably reduced.

Comparison of the effects of povidone-iodine and chlorhexidine solutions on skin bacterial flora among hospitalized infants

BACKGROUND

Infection control is an essential part of caring for hospitalized infants. With regard to the change of bacterial resistance over time and places, as well as the need for periodic studies on the effectiveness of antiseptics, this study aims to compare the effects of both solutions of povidone-iodine and chlorhexidine on skin bacterial flora among hospitalized infants.

MATERIALS AND METHODS

This clinical trial recruited 98 hospitalized infants and each of the above-mentioned solutions has been applied to a small area in the left or right side of the infants' bodies. Skin cultures were taken before, immediately after and 2 h after the randomly chosen infants' skin areas that were disinfected by each solution (588 skin cultures in total). Colony count and determination of microorganism types were done by only one person in a single laboratory. The study has been conducted in two teaching hospitals in Isfahan, Iran.

RESULTS

Staphylococcus epidermidis was the most common microorganism prior to skin disinfection by either solution. Two hours after disinfection, "Staphylococcus epidermidis" and "Staphylococcus epidermidis and kelebsila" had the highest frequencies of 3.1% and 3.1%, respectively. Before and 2 h after disinfection, distribution of different types of microorganisms had no significant difference between the two groups (P = 0.84 and 0.13, respectively); however, the difference was significant immediately after disinfection, P < 0.01.

CONCLUSION

The present study demonstrated that 10% povidone-iodine solution has more significant effect on reduction of skin pathogens promptly after application compared to 2% chlorhexidine. Therefore, prior to any catheterization procedures, it is imperative to use 10% povidone-iodine solutions for skin disinfection.

An epidemiologic study of burns: Standards of care and patients' outcomes

BACKGROUND

Many people suffer from burn injuries every year, and burns make the patients undergo surgeries and years of rehabilitation. Burns lead to more years of disability, compared to cancer or heart diseases. Epidemiologic studies are needed to reveal the span, impact, and related factors of burns to help take appropriate efforts to reduce its mortality and morbidity.

MATERIALS AND METHODS

This study was conducted in two phases. The first phase was a descriptive retrospective study conducted on 836 burn patients who were admitted to the main special burn hospital of Isfahan, Iran. Data were collected from archived patients' files using a checklist approved by the faculties of epidemiology and nursing. In the second phase, a survey was done based on the professional task checklist of burn ward nurses to assess the fulfillment of each task by the nurses.

RESULTS

Burns were found to occur more among those in the age groups of 20-30 (26.2%) and 0-10 years (22.9%). The most common causes of burns were flammables and gas explosions due to imprudence at home and workplaces, or self-infliction. Mortality rate was 21.7% due to sepsis, shock, and inhalation injuries, respectively. Nurses gave 19.78 out of 50 points (39.56%) to their performance in the prevention of sepsis.

CONCLUSIONS

Based on the findings of this study, it can be concluded that there is still an increasing need for safety education and using environmental safety measures, as well as developing high-quality methods to transport burn patients and administer care to decrease the mortality and morbidity associated with burns.

Erratum: An investigation on the association between students' knowledge and their tendency to take care of HIV patients among the students in nursing and midwifery school: Erratum

[This corrects the article on p. 404 in vol. 19, PMID: 25183983.].

Efficacy of group meaning centered hope therapy of cancer patients and their families on patients' quality of life

BACKGROUND

Quality of life (QOL) is a multidimensional concept which has nowadays turned to a supportive interventional goal in chronic diseases like cancer. Numerous interventions have been carried out to improve the QOL in patients with cancer, but the effect of indirect interventions on the patients' QOL has not been investigated yet. This study aimed to compare the efficacy of group meaning centered hope therapy of cancer patients and their families on the patients' QOL.

MATERIALS AND METHODS

This is a clinical trial conducted in three groups with a pre-test post-test design in which the effect of independent variable of meaning centered hope therapy on the dependent variable of QOL was investigated. The subjects were selected from the cancer patients who were aware of their diagnosis, were in primary stages of the disease, and had passed one period of chemotherapy. In this study, 42 patients (16 in control group, 14 in patients' group therapy, and 12 in patients' families' group therapy) were studied, and WHOQOL was adopted to investigate their QOL. Data were analyzed in two forms of descriptive and inferential statistical tests.

RESULTS

The results obtained showed that group meaning centered hope therapy of cancer patients and their families had a positive effect on patients' QOL compared to the control group. The notable finding of the present study was that holding group sessions either for the patients or for their families equally improved patients' QOL.

CONCLUSION

QOL of the cancer patients can be improved by either group meaning centered hope therapy for patients or group meaning centered hope therapy for their families. This finding is important for therapists, as when the patients cannot attend group therapy sessions due to complications of chemotherapy, these sessions can be held for their families to improve patients' QOL. This conclusion is very helpful in nurses' interaction with the patients and their families.

Chlorhexidine or povidone-iodine: Which solution is more effective on skin colonization in neonates?

BACKGROUND

Infection control should be an integrated part of patient care, especially to ensure safety and survival in hospitalized neonates. Although povidone-iodine (PVP-I) solution has been used as the most common antiseptic in hospitals of Iran, chlorhexidine is currently used in some wards for skin disinfection. However, there is no evidence about the superiority of either antiseptic solution over the other one. This clinical trial carried out in two university hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, aimed to compare the effects of chlorhexidine and PVP-I solutions on skin bacterial colonization in hospitalized neonates.

MATERIALS AND METHODS

The participants were 98 hospitalized infants. In each infant, one area on the skin was disinfected by chlorhexidine while the contralateral site was disinfected by PVP-I. Skin cultures were taken before and after disinfection. Microorganisms were determined and colony count was performed based on a standard method. The collected data were analyzed using descriptive and inferential statistical methods in SPSS v. 14.

RESULTS

The mean of microorganism colony count before and after disinfection by either solution was statistically different (P < 0.001). There was no significant difference between the two groups in terms of mean microorganism colony count before disinfection. However, a significant difference was observed after disinfection.

CONCLUSIONS

PVP-I is more efficacious than chlorhexidine for skin disinfection. Consequently, it seems better to use PVP-I for skin preparation before invasive procedures.

Discovering the barriers to spread the usage of peripherally inserted central venous catheters in the neonatal intensive care units: A qualitative research

BACKGROUND

By increasing the survival of immature newborns, intravenous access methods, used to provide intravenous therapy, became more important. More attention has been recently paid on peripherally inserted central venous catheters in newborns, although it is yet unknown in Iran. In this study, we tried to discover the barriers to spread the usage of peripherally inserted central venous catheters (PICC) in the neonatal intensive care units of hospitals affiliated to Isfahan University of Medical Sciences.

MATERIALS AND METHODS

In this descriptive explorative qualitative research, conducted from December 2011 to April 2012 with purposeful sampling and snowball method, participants were selected from nurses and residents of neonatology and neonatal specialists working in Alzahra, Shahid Beheshty, and Amin hospitals, until data saturation occurred. Data were analyzed with thematic analysis proposed by Broun and Clarke in 2006.

RESULTS

Data analysis yielded 175 initial codes, 12 sub-themes, and 3 main themes. The main themes included barriers related to procedure and maintenance, barriers related to persons providing care, and barriers related to management and planning.

CONCLUSIONS

One of the major problems in premature newborns during hospitalization is long-term and safe intravascular access; therefore, more use of PICC is needed. A complete planning is also needed to eliminate barriers and to provide required catheters. Educating the personnel is also necessary.

Nurses experiences in chemical emergency departments: Iran-Iraq war, 1980-1988

BACKGROUND

Nurses have played a major role in taking care of the wounded across the centuries. One of the most important roles of Iranian nurses in wartime has been working in chemical emergency departments. This study investigated the nature of nursing practice in chemical emergency departments created in the context of the Iran-Iraq War fought during 1980-1988.

METHOD

This is a history methodology design with oral history and in-depth interview to detect nurses 'actual experiences in chemical emergency departments while taking care of the chemically injured military forces.

FINDINGS

Today's nurses emphasize finding new ways to fulfill the present nursing needs and to combine theory and practice in an appropriate framework. Having a retrospective approach to utilize nurses' experience can well clarify the future way to achieve this goal.

CONCLUSION

This study revealed the way the nurses prepared to take care of the chemically injured in miserable situations and their practice in chemical emergency departments. It highlighted their awareness of wartime nursing and the challenging experiences it brings.

Lived experiences of women with ischemic heart disease

BACKGROUND

Ischemic heart disease (IHD) is one of the leading causes of death and disability among young and older women, respectively. Researches in this area mostly focused on manifestations, risk factors, and treatment of the patients with IHD. Therefore, there is a lack of information on the aspects of affects and feelings of such patients. This study aimed to describe lived experience of women with IHD to provide a suitable guide for nursing practice.

MATERIALS AND METHODS

This was a descriptive phenomenological study. Participants were 8 women with IHD who were hospitalized in critical care units (CCUs) and ambulatory cardiac care centers of Isfahan University of Medical Sciences in Iran. They voluntarily responded to open-ended questions of semi-structured interviews. Data was analyzed using Colaizzi's method to extract meanings and concepts.

FINDINGS

After analyzing the statements of the participants, 14 subthemes forming 5 main concepts of pain and relief, resistance, introversion, loss of control, and mutual communication were emerged.

CONCLUSIONS

Ischemic heart event is an experience with multidimensional impact on various aspects of the patient's life. This study demonstrated this experience as having 5 fundamental elements. Women with IHD expressed their suffering from frequent cycles of pain that drove their feelings and thoughts toward themselves and provoked their sense of resistance. They also faced loss of control on various aspects of their lives and changes in their relationships with others, too. This image would help nurses design their care plan based on a better understanding of these patients.

Stressors in clinical nursing education in Iran: A systematic review

BACKGROUND

Clinical education is a critical and complex component of nursing education that is influenced by many variables. One of them is stress, which may disturb students' learning, too. Stressors may differ according to the learning situation and environment, and recognizing them, seems to be essential for corrective interventions. The present work was performed to identify stressors in clinical nursing education in Iran, according to the published research reports.

MATERIALS AND METHODS

In this systematic review, all published research reports available in Iranian and International web-based data bases and search engines were searched. Also, the archives of peer reviewed Iranian nursing and medical education journals (published between 1989 and 2009) were hand searched. Out of 1104 retrieved records (by a more general terms of clinical education AND Nursing), after stepwise screening, 15 original research articles were selected for content analysis. Coded data were classified and their frequency was represented in Tables.

RESULTS

THE FOLLOWING THEMES WERE OBTAINED TO CLASSIFY MAIN AREAS OF IMPORTANCE FOR FACTORS RELATED TO STRESS IN CLINICAL NURSING EDUCATION: a) clinical competence and ability to play one's roles, b) care load, or stress due to care, c) main area of education, d) interpersonal relationships and interactions, e) clinical environment (facilities and equipments, space, learning opportunities, etc,…). Subthemes were also identified in each theme.

CONCLUSION

Published studies in Iran provide appropriate background evidences for planning and evaluating interventional programs to reduce stress among nursing students and instructors. Each identified theme in this study could be considered as a subject for planned interventions. Among them, it seems that interpersonal relationships and interactions is of the highest priority.

The process of major depressive disorder (MDD) in women referred to the health centers

BACKGROUND

Major depressive disorder is one of the most widespread psychological problems in the world. The feelings of a person who is affected by this condition is boring. This article aimed to shed light on the experiences of women with major depressive disorder.

METHODS

A qualitative approach with thematic analysis design has been used to describe the studied phenomenon as experienced by the participants.

RESULTS

Analysis of 92 codes from 12 interviewed participants brought about 4 main themes including loss, inappropriate marital life, cognitive errors, and economic condition.

CONCLUSIONS

This study revealed main concerns of the participants through their life and suggested that psychotherapists should be more sensitive to these aspects of their depress patients' experiences.

Experiences of patients with multiple sclerosis from group counseling

BACKGROUND

Group counseling is one of the most important methods in somatic and psychological rehabilitation of the multiple sclerosis (M.S.) patients. Knowing these patients' experiences, feelings, believes and emotion based on learning in group is necessary to indicate the importance of group discussion on quality of life of the patients. This study was done to achieve experiences of M.S. patients from group training.

METHODS

This was a qualitative study using phenomenological method. The samples were selected using purposeful sampling. Ten patients from M.S. society who had passed group training were included in the study. The group training was done through seven sessions weekly and voluntarily. The participants were interviewed using in-depth interview. The average time of each interview was between 30-50 minutes which has been recorded digitally and moved to a compact disc to transcribe and analysis.

RESULTS

The data analyzed using 7-step Colaizzi method. The data were transformed into 158 codes, 12 sub-concepts and 4 main concepts including emotional consequences, communication, quality of life and needs.

CONCLUSIONS

M.S can lead to multiple problems in patients such as somatic, behavioral, emotional and social disorders. Group psychotherapy is one of the methods which can decrease these problems and improve rehabilitation of the patients. Group discussion helps patients to overcome adverse feelings, behaviors and thoughts and guides them to move in a meaningful life. It also can improve quality of life and mental health of the patients.

Effect of end-of-life care education on the attitudes of nurses in infants' and children's wards

BACKGROUND

Infants palliative care becomes an important aspect of nursing when providing welfare and promoting children's life quality are the objectives of care. The number of children with life threatening diseases has increased alongside the developments in technology and medical treatment in medicine. It is a pure fact that our attitudes are related to our behaviors and performances. This research was conducted with the aim of assessing the effect of intensive course of children's palliative care on the attitudes of children and infants' nurses in Isfahan University of Medical Sciences.

METHODS

This was a quasi-experimental, two-group and two-stage study in which 56 nurses working at Infants' and children's wards who met inclusion criteria were divided into experiment and control groups. The participants of experiment group attended in the infants' palliative care training course which lasted for 3 weeks. A reliable and already validated questionnaire of Infants and Children Wards Nurses' Attitudes Regarding the Dying Children was used before and after training.

RESULTS

There was no significant difference between the two groups regarding demographic characteristics, except for marital status which was found the study findings were not confounded by it. There was a significant difference between mean test and re-test scores in the experiment group and also between the mean scores of control and experiment groups after training. There was no significant difference between mean scores before and after training in the control group.

CONCLUSIONS

End-of-life children care is one of the issues in modern medicine which has not gained a definite status in Iran. It is hoped that nurses would be the forerunners of this modern science in Iran.