A qualitative content analysis of nurse-patient communication in Iranian nursing

Barriers and outcomes of therapeutic communication between nurses and patients in Africa: a scoping review

BACKGROUND

Therapeutic communication (TC) promotes effective patient care, emotional wellbeing, and improves patient outcomes. The purpose of this review was to synthesise evidence on barriers and outcomes of TC between nurses and patients in Africa and to inform future studies and systematic reviews.

METHODS

Search for the records was done in four major databases including PubMed, Science Direct, PubMed CENTRAL, and JSTOR. Additional searches were done in Google Scholar and Google. Results and findings from published studies and grey literature were included. A total of 16 articles met the eligibility criteria and were included in the review. This scoping review followed the guidelines by Askey and O'Malley.

RESULTS

Barriers associated with TC were grouped under five main themes: sociodemographic factors, patient-related factors, nurse-related factors, environmental and health service-related. Age, and religious beliefs were the main sociodemographic factors that hindered TC while stress and inadequate knowledge and skills were identified among the nurse-related barriers to TC. Extreme weather conditions and mosquito infestation were environmental factors while lack of access to TC educational programmes on TC was a health service-related factor that interfered with TC. Both positive and negative outcomes of TC were also identified.

CONCLUSION

Continuous professional development on TC is necessary to improve nurses' attitudes and update their skills to enable them to render culturally competent nursing care to patients.

Drivers of success in global health outcomes: A content analysis of Exemplar studies

Applying a positive outlier lens is one effective approach for generating evidence to inform global health policy, program, and funding decisions. Exemplars in Global Health (EGH) is a program that studies positive outlier countries that have made extraordinary progress in health outcomes (despite limited resources) and disseminates their successes through multiple types of outputs. To date, EGH has studied, or is studying, 14 global health topics in 28 countries. This paper aims to identify findings, summarized as themes and sub-themes, that appear among all completed EGH studies. We developed a conceptual framework and used a content analysis approach to identify the top thematic areas that appear as drivers for programmatic success across EGH studies that were completed between June 2020-May 2023. The EGH studies (N = 31) spanned six topics including under-five child mortality (n = 6), childhood stunting (n = 5), community health workers (CHW) (n = 4), vaccine delivery (n = 3), COVID-19 response (n = 6), and newborn and maternal mortality reduction (n = 7) across 19 countries in sub-Saharan Africa, Latin America, South and Central Asia, and the Caribbean regions. Top drivers of success were defined as those critical or catalytic in achieving the intended outcome. Eight key drivers were identified: (1) efficient data collection and use for decision-making, (2) strong political commitment and health leadership, (3) effective stakeholder coordination, (4) a local, connected, and capacitated workforce, (5) intentional women's empowerment and engagement, (6) effective adoption and implementation of national policies, (7) effective and sustainable financing, and (8) equitable, efficient outreach and targeting. These cross-cutting drivers span a broad range of development outcomes, sectors, and populations, and indicate a need to effectively integrate people, systems, and sectors to improve global health outcomes. Findings from this study aim to support peer learning among countries and support evidence-based decision-making for funders, policymakers, and other key stakeholders.

Silent Mourning: Infant Death and Caring for Iranian Parents Under the Influence of Religious and Socio-cultural Factors

Despite all the advances in healthcare technology and all the care services in the field of neonates, many infants die in neonatal intensive care units (NICUs). This qualitative study investigated socio-cultural factors influencing the care for bereaved parents in three main NICUs of northwest Iran between March 2018 and April 2019. The purposeful sampling method with the maximum variation was used, and data collection was continued until obtaining rich data to answer the research question. Twenty-eight interviews were conducted with 26 healthcare providers. The thematic analysis method was applied to analyze the data, and two main themes, including "Religious context as a restriction on the parental involvement in the infant's end-of-life care" and the "Socio-cultural challenges of the grieving process among parents", were generated accordingly. The religious and socio-cultural contexts in the NICUs of Iran are a restriction to the presence of parents at their infants' end-of-life phase, and health care providers are less inclined to have parents in the NICU at the time of infant death.

Experience of Workplace Violence from the Patients among Mental Health Nurses in Indonesia: A Mixed Method Study

Background: Workplace violence by patients and visitors (PVV) against nurses is regarded a devastating occupational issue around the world. The most frequent perpetrators of violence against nurses were patients, followed by their families and other healthcare professionals. Aim:This study aimed to use a mixed method to analyze violence by patients and visitors against nurses in mental health hospital in Indonesia. Methods: The 250 mental health nurses at two general public hospitals in Bandung were recruited with stratified convenience sampling by years of working experience. Result: All nurses experienced workplace violence from both patients and their families. At least nurses experienced more than 3 types of violence with the most frequent type of violence were verbal and physical violence. The six themes were emerged including variation of violence in nurse, traumatic impact of violence, impacts of violence on profession, violence not only come form patients but also family, reason of violence, and spiritual coping. Conclussion: It is necessary to prioritize more efficient and approachable methods for nurses to deal with patients’ aggresive behavior, and to establish constant training program.

Occupational fatigue, individualized nursing care, and quality of nursing care among hospital nurses

PURPOSE

This study aimed to evaluate the relationships among nurse fatigue, individualized nursing care, and nurse-reported quality of care.

DESIGN

The study used a cross-sectional design. Data from 858 registered nurses providing bedside care in hospitals were collected between March and April 2021 in the United States.

METHODS

Participants completed a self-administered online survey, including the Occupational Fatigue Exhaustion Recovery scale, the Individualized Care Scale-Nurse version, and a single item assessing nursing care quality. Relationships among the study variables were examined using multiple linear and logistic regression models.

FINDINGS

Nurses' higher levels of acute fatigue were significantly associated with decreased perceptions of individualized nursing activities provided to patients on their last shifts, specifically related to personal life condition and decision-making control. Nurses' higher levels of chronic fatigue were significantly associated with decreased perception of individualized nursing activities provided to patients on their last shifts related to clinical condition, personal life condition, and decision-making control. Nurses with higher levels of acute or chronic fatigue, and who perceived their nursing care activities as less individualized were less likely to assess their quality of care as excellent.

CONCLUSION

These findings suggest that addressing hospital nurses' acute and chronic fatigue may contribute to promoting the delivery of individualized nursing care and in improving patients' quality of care.

CLINICAL RELEVANCE

Healthcare institutions are encouraged to regularly monitor and manage nurse fatigue to improve the delivery of individualized and quality nursing care to their patients.

Patient’s Experiences of Violence as Perpetrator: A Qualitative Study from Patients with Schizophrenia in Indonesia

BACKGROUND: Individuals with schizophrenia are at an increased risk for violence – limited study on exploring the experience of violence in patients with schizophrenia as a perpetrator. AIM: This research aimed to investigate the perception of violence as a perpetrator in Indonesia in patients with schizophrenia. METHODS: This study used phenomenology using a purposive sampling technique. A total of 40 patients were from the psychiatric ward of significant mental hospitals in West Java, Indonesia. The inclusion criteria for patients were the following: Age over 18 years old confirmed diagnosis with schizophrenia. Focus group discussion of patients comprised four groups. Each group consisted of tens of patients. RESULTS: The patient’s experiences as a perpetrator were categorized into six subthemes: Committing physical violence to family, quarreling with family, verbal abuse to family, a perpetrator of verbal violence to neighbors, expression of anger to object, and physical violence to nurse. CONCLUSION: The patient’s experiences of violence were not linear, but rather it was a complex experience of being a perpetrator, yet at the same time as of perpetrator violence. A staff training program to reduce patient violence is needed.

Facilitators of Professional Communication Between Nurse and Opposite Gender Patient: A Content Analysis

Introduction: Caring for a patient of the opposite gender is followed by many challenges. Hence, making an appropriate professional communication between the patient and the nurse is of great importance in order to provide a high-quality care to the patient and reduce tensions. Identifying positive factors in the formation of an appropriate professional communication can play an important role in preventing such challenges. Materials and methodology: The current study aimed to identify the facilitators of professional communication between nurse and opposite gender patient in Iran. A qualitative method and a conventional content analysis approach were used. A total of 25 nurses were included in the study by purposive sampling. Data were collected through unstructured and semi-structured interviews in hospitals of three provinces of Northwestern Iran, and were analyzed by Graneheim and Lundman method. Results: The results included seven categories and three main themes: prevention of misunderstanding, non-violation of therapeutic relationship boundaries, and observance of the socio-individual context. Discussion: Despite accepting the difficulties of nursing care for an opposite gender patient, the results of the present study showed that paying more attention to, and carefully watching, the mentioned factors could enhance the chance to establish a proper professional communication between a nurse and an opposite gender patient, which is crucial in providing a high quality care, also improving nurses' comfort in their work environment. Therefore, it is recommended to consider these factors in academic and in-service training of nurses.

Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital: A mixed-methods systematic review

BACKGROUND

The fundamental importance of establishing an interpersonal care relationship for quality nursing care has been highlighted. However specific elements of the interpersonal care relationship of importance to older patients in the hospital have not been identified.

OBJECTIVES

The aim of this review was to explore and synthesise research findings regarding the elements of the interpersonal care relationship concept from the perspectives of older patients.

DESIGN

A systematic mixed-methods review.

DATA SOURCES

An extensive search was conducted up until October 2018 for articles without any publication date time limit in PubMed, Web of Science, Cochrane Database of Systematic Reviews and CINAHL.

REVIEW METHODS

Primary studies were included if they concerned patients aged 65 years or older and their perspectives on the elements of the interpersonal care relationship with nurses. Inclusion was limited to patients without cognitive impairment who were admitted to an acute hospital setting. The methodological quality of each study was assessed using the Critical Appraisal Skills Programme for qualitative studies, the Quality Assessment Tool for Quantitative Studies and the Mixed-Methods Appraisal Tool. Thematic analysis was used to structure the results of the included studies.

RESULTS

Of the 7596 studies found, 24 were included in this review. Twenty articles had a qualitative, three a quantitative and one a mixed methods design. Older patients consider dignity and respect as core values that need to be met in the interpersonal care relationship. Five core elements of the interpersonal care relationship were identified to meet these core values: elements related to caring behaviour and attitude, person-centred care, patient participation, communication and situational aspects. These core elements were structured according to three categories, identified in the literature, that determine the quality of the interpersonal care relationship: nurse-, older-patient-related elements and situational aspects.

CONCLUSIONS

The elements identified in this review can guide efforts to define the interpersonal care relationship between older patients and nurses. Nurses should be supported and motivated by education and practice to adapt their behaviour, attitudes and communication to meet older patients' expectations. Hospital management can also encourage nurses to communicate well. Investment in the current organisation of care is needed to improve nurses' work overload and presence. Further research is needed to clarify the underlying processes influencing the experience of the interpersonal care relationship from the perspectives of older patients, nurses, informal caregivers and hospital management.

Compassionate Care Challenges and Barriers in Clinical Nurses: A Qualitative Study

Background:

Compassion is the heart of nursing care. Barriers to compassion in nursing may be influenced by the prevailing culture and religion of a society. Determining the barriers to providing compassion-based care would help nurses to plan better and more appropriate interventions. This study aimed to explore the challenges and barriers to compassionate care in nurses.

Materials and Methods:

This ethnographic study was performed in 2014–2016. The study participants consisted of 40 nurses, 16 patients, and 8 family members in medical and surgical wards. Data collection was performed through observations and interviews. Data analysis was performed based on Strauss and Corbin's constant comparative method.

Results:

Data analysis defined three themes as the challenges and barriers to compassionate care; challenges and barriers related to the contextual environment of hospitals, sociocultural challenges and barriers, and challenges; and barriers related to staff.

Conclusions:

This study described the challenges and barriers to compassionate care. Therefore, to eliminate these barriers and challenges, corrective action should be taken by managers. Attention to teaching the concept of compassion and patient-centered care and increasing the number of nurses and positive attitude toward the nursing profession in clinical environment can be effective in providing compassionate care.

Barriers to empathy-based care: oncology nurses' perceptions

Purpose The purpose of this paper is to explore oncology nurses' barriers to empathy-based care perceptions. Design/methodology/approach The authors used a descriptive qualitative method. In total, 18 oncology nurses were selected via purposive sampling. Data were collected through in-depth interviews and qualitative content analysis using an inductive approach. Findings Three main categories emerged from the data analysis: barriers related to nursing including: lacking compassion; disinterest in oncology nursing and self-criticism; psychological distress; barriers related to healthcare: job strain; task-centeredness; no formal training; poor manager support; nurse-patient gender imbalance; and barriers related to cancer care including: difficulty maintaining empathy with cancer patients; and inappropriate cancer patient Practical implications Oncology nurses provided insights into barriers to empathy-based care and the challenges they encountered while caring for cancer patients. Understanding these barriers is the first step to overcoming obstacles and creating an open and caring environment to provide an empathic care culture. Originality/value Given that oncology nurses experience several emotions, positive coping strategies for these distresses should be adopted. Healthcare systems should change cancer-caring culture from task-centered to patient-centered care. Compassion and empathy should become patient care values.

The perceptions of nurses, patients and family members regarding nurses' empathetic behaviours towards patients suffering from cancer: a descriptive qualitative study

Background

Although evidence suggests that empathic behaviour is an essential component in nursing care that affects the psychological distress experienced by cancer patients, it remains a neglected issue in nursing in Iran.

Methods

This study was conducted on 33 participants selected through purposive sampling. Data were collected using in-depth interviews and were then analysed using qualitative content analysis with an inductive approach.

Findings

Three categories of data thus emerged, comprising: (a) empathetic attention; (b) empathetic presence; and (c) the facilitators of empathetic behaviour.

Conclusions

The findings can help oncology nurses provide more empathetic care to patients and their family members.

Blended learning pedagogy designed for communication module among undergraduate nursing students: A quasi-experimental study

BACKGROUND

Effective communication is important for nurse and patient outcomes. Nursing students often feel unprepared to communicate effectively with patients and other healthcare workers within the clinical environment. Blended learning pedagogy-based communication skills training can provide an alternative to traditional methods of teaching to enhance students' satisfaction and self-efficacy levels in communicating with others.

OBJECTIVES

To examine the effectiveness of blended learning pedagogy in a redesigned communication module among nursing undergraduates in enhancing their satisfaction levels and attitudes towards learning communication module as well as self-efficacy in communication.

DESIGN

A single group pre-test and post-test quasi-experimental design was adopted.

SETTINGS AND PARTICIPANTS

Data were collected from August 2016 to November 2016 from 124 nursing undergraduates from a leading nursing school.

METHODS

Blended learning pedagogy was adopted to redesign a communication module that offered a wide array of learning opportunities via face-to-face classroom and online sessions. Validated and reliable instruments were used to measure satisfaction levels with blended learning pedagogy, attitudes towards learning communication, and communication self-efficacy. Descriptive and inferential statistics were used to analyze the data.

RESULTS

Participants had enhanced satisfaction levels with blended learning pedagogy, better attitudes in learning communication skills, and improved communication self-efficacies at posttest (week 13 of the semester) when compared with their pre-test scores (week one of the semester). Participants scored higher in the Blended Learning Satisfaction Scale, the Communication Skills Attitude Scale, and the communication skills subscale of the Nursing Students Self-Efficacy Scale.

CONCLUSIONS

Blended learning pedagogy can be effectively used in facilitating communication modules and enhancing student outcomes among nursing undergraduates. The long-term effectiveness of using blended learning pedagogy in facilitating communication modules should be evaluated from students' and patients' perspectives. Additionally, the technology should be constantly improved by incorporating more interactive functions and should be tested to accommodate the learners' needs.

Factors influencing nurse-to-parent communication in culturally sensitive pediatric care: a qualitative study

BACKGROUND

To deliver quality healthcare to diverse patients, effective commmunication is key. Little evidence exists about what factors influence nurse-to-parent communication in culturally sensitive pediatric care.

OBJECTIVE

The aim of this study was to explore factors that influence nurse-to-parent communication in the provision of culturally sensitive pediatric care.

DESIGN

This study employed a qualitative content analysis.

METHOD

The participants included 25 nurses and 9 parents from pediatric wards of hospitals located in Northwest and Central Iran. Semi-structured interviews were conducted. Data were analyzed using Graneheim and Lundman's method of content analysis.

RESULTS

Factors that influenced the nurse-to-parent communication in pediatric culturally sensitive care were 1-organizational factors (inefficient policies and professional factors) and 2-human factors (nurse-related factors and unique characteristics of the family). Sub-categories included: lack of definitive policies for delivering cultural healthcare, insufficient cultural healthcare education, professional status of nursing in society, time, individual characteristics, cultural knowledge, cultural differences, and family's health literacy.

CONCLUSION

The Iranian healthcare system requires a paradigm shift regarding the provision of culturally sensitive care.

Exploring Nurse's Communicative Role in Nurse-Patient Relations: A Qualitative Study

Introduction: Recognition the nurses’ communicative roles can influence quality of patient’s care. Therefore, this study was aimed to explore nurse’s role in nurse-patient relations.

Methods: This study was a qualitative research in which collected data was analyzed by content analysis method. The participants were 23 nurses, patients and their families in medical and surgical wards of a referral hospital in Tehran, Iran. Data were collected by semi-structured interview and observation.

Results: Data analysis was led to the emergence of a main conceptual category: The patient's need-based communication. This category was derived from two categories: 1) Identifying the patient’s needs; and 2) Communicative behavior in the face of the patient’s needs. "Identifying the patient’s needs" was related to "type of the patient’s problem", "patients’ inquiring about their health status" and "monitoring the patient’s health status". "Communicative behavior in the face of the patient’s needs" was composed of four subcategories: "caring attention", "informal education of the patient", "inducing calmness to the patient", and "obtaining the trust of the patient".

Conclusion: The nurse’s role in relationship with patients is designed according to patients’ needs. Therefore, if the patients’ needs in clinical settings are defined and clarified appropriately, the nurse-patient relations will be enhanced and thereby the quality of care will be improved.

Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician-patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients' experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships.

Factors Influencing Intraoperative Waiting Time According to the Experience of Iranian Families

PURPOSE

The purpose of this study was to explore factors influencing family members' experience of waiting for patients' surgery.

DESIGN

A qualitative design using content analysis approach was used.

METHODS

The study took place at a university medical center hospital in an urban area of Iran. After using a purposive sampling method for the selection of participants, semistructured interviews and field notes were held for data collection.

FINDINGS

The experience of 16 Iranian family members who were waiting for their patient's surgery to be finished was analyzed. Data analysis led to the development of three main themes: "family member-related factors," "patient-related factors," and "organization-related factors."

CONCLUSIONS

The results revealed some factors in real context that can help health care professionals, especially nurses, to get a better understanding of the situation and improve quality of care. In addition, understanding these factors will contribute to the body of knowledge in nursing.

Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication

INTRODUCTION

The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example.

METHODS

We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). At the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity.

RESULTS

From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items), informational support (seven items), emotional support (five items), problem solving (seven items), patient activation (10 items), intimacy/friendship (six items) and spirituality strengthening (14 items). Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93.

CONCLUSION

This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.

Communication elements supporting patient safety in psychiatric inpatient care

Communication is important for safe and quality health care. The study provides needed insight on the communication elements that support patient safety from the psychiatric care view. Fluent information transfer between the health care professionals and care units is important for care planning and maintaining practices. Information should be documented and implemented accordingly. Communication should happen in an open communication culture that enables discussion, the opportunity to have debriefing discussions and the entire staff can feel they are heard. For effective communication, it is also important that staff are active themselves in information collecting about the essential information needed in patient care. In mental health nursing, it is important to pay attention to all elements of communication and to develop processes concerning communication in multidisciplinary teams and across unit boundaries. The study aims to describe which communication elements support patient safety in psychiatric inpatient care from the viewpoint of the nursing staff. Communication is an essential part of care and one of the core competencies of the psychiatric care. It enables safe and quality patient care. Errors in health care are often connected with poor communication. The study brings needed insight from the psychiatric care view to the topic. The data were gathered from semi-structured interviews in which 26 nurses were asked to describe the elements that constitute patient safety in psychiatric inpatient care. The data were analysed inductively from the viewpoint of communication. The descriptions connected with communication formed a main category of communication elements that support patient safety; this main category was made up of three subcategories: fluent information transfer, open communication culture and being active in information collecting. Fluent information transfer consists of the practical implementation of communication; open communication culture is connected with the cultural issues of communication; and being active in information collecting is related to a nurse's personal working style, which affects communication. It is important to pay attention to all the three areas and use this knowledge in developing patient safety practices and strategies where communication aspect and culture are noted and developed. In mental health nursing, it is important to develop processes concerning communication in multidisciplinary teams and across unit boundaries.

Patients' perception of comfort facilitators during hemodialysis procedure: a qualitative study

Background:

The patients receiving hemodialysis spend a lot of their lifetime in the hemodialysis departments, which is an unpleasant experience. Therefore, some interventions are necessary to relieve this experience.

Objectives:

The current study aimed to explore the hemodialysis patients' perceptions of comfort facilitators during the hemodialysis procedure.

Patients and Methods:

This study was conducted by a qualitative content analysis approach. Twenty four patients receiving hemodialysis participated in this study by purposive sampling. The sampling was over when the data saturation occurred. The semi-structured interviews were applied as the main data gathering tool. The data analysis was conducted by conventional qualitative content analysis in eight phases.

Results:

Three themes emerged: The presence of competent nurses, the delightful presence of the others, and coping with comfort obstacles. Each theme consisted of some categories.

Conclusions:

It seems that to achieve the patients' comfort during the hemodialysis procedure, the health care teams, hospitals in charge and the patients themselves have to do their best to provide the patients' comfort.

Evaluation of barriers contributing in the demonstration of an effective nurse-patient communication in educational hospitals of Jahrom, 2014

INTRODUCTION

Establishing an effective communication with patients is an essential aspect of nursing care. Nurse-patient communication has a key role in improving nursing care and increasing patient's satisfaction of health care system. The study aimed at evaluation of barriers contributing in the demonstration of an effective nurse-patient communication from their viewpoint.

METHODS

This was cross-sectional study, carried out in 2014, with a sample of 200 nurses and patients drawn from two educational hospitals in jahrom city. Data were collected by using two questionnaire structured by the researchers. Data were analyzed using SPSS software (version 16).

RESULTS

The results of this study showed that the greatest barriers of nurse-patient communication were characteristics of nursing job with an average score of 71.05 ± 10.18. The most communication barriers from patients viewpoint including: heavy work load of the nurses, age , sex and language difference between patient and nurse and the spicy morality of nurses.

CONCLUSION

It is concluded that overcome barriers to communication and support are needed to enable nurses to communicate therapeutically with patients in order to achieve care that is effective and responsive to their needs.

Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards

Aims:

The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran.

Materials and Methods:

This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control.

Results:

The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication.

Conclusions:

In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach.

Family participation in the nursing care of the hospitalized patients

Background:

Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients.

Objectives:

This study was conducted to assess why family members partake in caregiving of their patients in hospitals, the type of care that family provide, and the outcomes of the participation in the opinions of nurses and family members.

Patients and Methods:

In this comparative-descriptive study, data was collected by a two- version researcher-developed questionnaire, from 253 family members of patients by quota sampling method and 83 nurses by census sampling method from wards which had licensed for entering the families. Each questionnaire has three sections: the care needs of the patients which family participated to provide, the reasons to take part, and the outcomes of this collaborative care. The data was analyzed using descriptive statistics and also chi-squared test through SPSS software version 11.5.

Results:

The patients received more unskilled and non- professional nursing care from their family members. Most of the nurses and families believed that family participation is both voluntary and compulsory. The shortage of personnel in different categories of nursing and speeding up the patient-related affairs were the most important outcome of the participation, from the nurses’ viewpoint was speeding up the patient-related affairs and from the side of the family members, it was the patients’ feeling of satisfaction from the presence of one of their relatives beside them.

Conclusions:

Co understanding, skillfulness and competence of families and nurses in collaboration with each other were not good enough.Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients.

Socio-linguistic analysis of the Charter of Citizens' Rights and Obligations in Health Services

The aim of this study is to carry out a socio-linguistic analysis of the dissemination of the Charter of Citizens' Rights and Obligations in Public Health Services. We designed a qualitative investigation using observation and content analysis. A deductive analysis technique was followed, based on the "SPEAKING" model categories. The data analysis suggests a clear framework of rights and obligations has been established, but is not very familiar to patients and relatives. We can conclude that despite the widespread dissemination and publicity of the Citizens' Charter of Rights and Obligations, we still need the involvement of professionals. Nurses can develop a fundamental role in this process.