Challenges of living with veterans with post-traumatic stress disorder from the perspective of spouses: a qualitative content analysis study

BACKGROUND AND OBJECTIVE

The needs and characteristics of veterans with post-traumatic stress disorder (PTSD) create significant challenges in family life, particularly for spouses. Identifying the nature of these challenges from the perspective of spouses leads to a more comprehensive and profound understanding of their existing problems and can be used for targeted interventions. Therefore, this research was conducted to explore the challenges of living with veterans suffering from PTSD from the perspective of their spouses.

METHODS

This qualitative study used conventional content analysis to explore Challenges of spouses of veterans with post-traumatic stress disorder. Fifteen spouses of veterans with PTSD from the Veterans Affairs Center in Iran between June 2022 and January 2023, were purposively selected to participate in the study. Semi-structured in-depth interviews were conducted to collect data. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using the method proposed by Graneheim and Lundman content analysis method with the support of MAXQDA 2020 software.

RESULTS

The mean age of the participants was 56.74 ± 6.43 years. Through data analysis, seven main categories and sixteen subcategories were identified. These categories included burnout (sleep disturbances, feelings of exhaustion), apathy towards self-care and caring for the veteran (neglecting self-care, lack of interest in continuing care), depression (feelings of hopelessness and being at the end of the line, decreased self-confidence ( Crushed and ignored (being mistreated, having multiple roles), relationship disturbances (Dissatisfaction with marital relationship,isolation and limited social interactions, disconnection from God), financial burden (heavy costs of care, lack of insurance support), and declining social status (negative attitude of the society, suffering from discrimination and inequality).

CONCLUSION

The consequences of PTSD-related injuries in veterans directly and indirectly affect the overall living conditions of their spouses. These spouses experience emotional detachment and constant rejection, leading to a decrease in their resilience against existing stressors and exposing them to disruptive and challenging issues in individual, family, and social dimensions of life that affect their physical and mental well-being. Therefore, these spouses require empowerment and access to social support in dimensions of educational, caregiving, therapeutic, and supportive. It is recommended that health policymakers pay special attention to designing up-to-date interventions to enhance the health of these spouses in physical, mental, spiritual, and social dimensions.

Barriers and facilitators to fulfilling the teaching assistant role from nursing students' perspective: a qualitative study

BACKGROUND

Employing postgraduate students as Teaching Assistants (TA) has become a common practice in many higher education institutions and is part of a growing international trend for professional practice.

OBJECTIVE

This study aimed to determine the barriers and facilitators to fulfilling the teaching assistant role from nursing students' perspective.

METHODOLOGY

This qualitative-descriptive study was conducted in 2022 on teaching assistants in the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences. 13 teaching assistants were selected by targeted sampling method with maximum variation. The inclusion criteria were 2nd-semester postgraduate nursing students and above, having experience as a teaching assistant, and willing to participate in the research. Data were collected through semi-structured individual interviews for 45 to 60 min until saturation was reached. Data analysis was done manually and using the framework analysis method with steps: Familiarization, Identifying a thematic framework, indexing, Charting, data synthesis, mapping, and interpretation. The trustworthiness of the study data was determined with the Lincoln and Guba criteria.

RESULTS

Barriers to fulfilling the TAs' role were divided into three main categories with nine subcategories: (1) Not accepting the teaching assistant as a clinical instructor (2) not being prepared to accept the TA role, and (3) improper planning of the TA plan. Facilitators are divided into two main categories with five subcategories: (1) internal motivation, and (2) empowering TAs.

CONCLUSION

To facilitate management processes in the field of education and to achieve educational goals, including improving the quality of education and better learning, planning and compiling instructions to create written job descriptions for teacher assistants should be done, also, with careful planning, steps should be taken to scientifically employ capable teacher assistants as young and motivated forces in education processes.

Effect of using a mobile drug management application on medication adherence and hospital readmission among elderly patients with polypharmacy: a randomized controlled trial

BACKGROUND

Adherence to complex drug regimens and polypharmacy are among the challenges of old age, which may negatively affect their motivation to continue drug therapy or lead to incorrect drug consumption. The present study was conducted to evaluate the effect of using a mobile drug management application on medication adherence and hospital readmission among polypharmacy older adults.

METHODS

In this randomized controlled trial study conducted in 2022, with Trial Registration Number (IRCT20191231045966N1) (18/07/2021), 192 Iranian older adults with polypharmacy were selected according to the inclusion criteria and allocated to case and control groups using the block randomization method. The data collection tools included a demographic questionnaire, case report form, and Morisky Medication Adherence Scale. The intervention was done using a mobile drug management application. Drug adherence was measured at baseline and both with hospital readmission were measured after 8 weeks. The collected data were entered into the SPSS software version 22 and analyzed using descriptive (frequency, percentage, mean, standard deviation) and inferential (Chi-square, Fisher's exact test, independent t-test) statistics.

RESULTS

The case and control groups were homogeneous in terms of demographic variables and drug adherence level before the intervention. A significant difference was found in the drug adherence level after using the app (p < 0.001). Moreover, a significant difference was found in adverse events, including re-hospitalization due to disease aggravation, re-hospitalization due to error in medication consumption, falling, hypo or hypertension, and hypo or hyperglycemia, and medication use accuracy between the groups after the intervention (p < 0.05).

CONCLUSION

The results showed that using a mobile drug management application that meets the specifications of older adults can improve drug adherence, reduce the adverse events and pave the way for a better disease period management.

The effects of simulated video education about falling on falling rate and fear of falling among hospitalized elderly people: a randomized clinical trial

BACKGROUND AND AIM

Management of falling and its consequences is a major challenge of elderly nursing care. An effective educational strategy is essential to prevent falling among elderly people. The aim of this study was to evaluate the effects of simulated video education (SVE) about falling on falling rate and fear of falling (FOF) among hospitalized elderly people.

METHODS

This randomized controlled clinical trial was conducted from May 2021 to February 2022. Participants were 132 elderly people conveniently selected from a leading hospital in Qom, Iran, and randomly allocated to an intervention and a control group through block randomization. Data collection instruments were a demographic and clinical questionnaire, a researcher-made falling rate questionnaire, and the Falls Efficacy Scale-International. Participants in the intervention group individually watched three simulated videos (fifteen minutes in total) and had access to the videos for frequent watching. Their FOF was assessed on the first day of hospitalization, hospital discharge, and one and three months after hospital discharge. The data were analyzed at a significance level of less than 0.05 using the SPSS software (v. 16.0).

RESULTS

Groups did not significantly differ from each other respecting baseline demographic and clinical characteristics (P > 0.05). After the intervention, falling rate in the intervention group was 46% less than the control group (incidence rate ratio = 0.5454, 95% CI = 0.307-0.968; P = 0.039). Moreover, the posttest mean score of FOF in the intervention group was significantly less than the control group (P < 0.001).

CONCLUSION

SVE is effective in significantly reducing falling rate and FOF. Context-based SVE is recommended to reduce falling rate and FOF among hospitalized elderly people.

CLINICAL TRIAL REGISTRATION

The effects of simulated video education about falling on falling rate and fear of falling among hospitalized elderly people.

CLINICAL TRIAL REGISTRATION

this research was registered (17/09/2021) in the https://www.irct.ir with registration number: IRCT20210910052427N1).

Explaining the perspective of people living with HIV on health-promoting behaviours based on Pender's model: A directed content analysis

AIM

Health-promoting behaviours are an important challenge in people living with HIV (PLHIV). Knowing PLHIV's perspective can be helpful for more effective health-promoting behaviour planning. Therefore, the present study aims to explain PLHIV's perspective on health-promoting behaviours based on Pender's health-promotion model.

DESIGN

A qualitative study with a directed content analysis approach.

METHODS

Altogether, 17 PLHIV referring to the Behavioural Diseases Consultation and Control Center in Tehran, Iran and were selected through purposive sampling. The data were collected through semi-structured individual interviews and the results were analysed through directed content analysis based on Pender's model. Data management was done by MAXQDA V10.

RESULTS

Data analysis led to the extraction of 396 codes in 35 subcategories and 15 main categories in 6 constructs of Pender's model, including the perceived benefits (health assurance and optimal disease control), perceived barriers (insufficient knowledge and awareness, lack of motivation, adverse outcomes of the disease and socioeconomic status), perceived self-efficacy (endeavouring to have a healthy lifestyle, responsibility for one's health and that of others), activity-related affect (positive and negative feelings), the interpersonal influences (family, friends and relatives and social media) and situational influences (the resources available to the community and community's culture).

PATIENT OR PUBLIC CONTRIBUTION

In this study, the contribution of PLHIV was used and their perspectives were surveyed. The findings of this study can help policymakers and planners formulate health policies to select the most appropriate strategies and approaches to promoting effective healthy behaviours among PLHIV.

The relationship between mental fatigue and social responsibility among nurses who provided care to patients with coronavirus disease 2019: a cross-sectional study

BACKGROUND AND AIM

Mental fatigue (MF) was a major challenge for nurses during the coronavirus disease 2019 (COVID-19) pandemic. Nurses' sense of responsibility towards their patients and societies may influence their MF. This study aimed to assess the relationship between MF and social responsibility (SR) among nurses who provided care to patients with COVID-19.

METHODS

This cross-sectional descriptive-analytical study was conducted in 2021. Participants were 258 nurses randomly selected from eleven COVID-19 care hospitals in Tehran, Iran. Data were collected using three self-report instruments, namely a demographic questionnaire, the Mental Fatigue Scale, and the Social Responsibility Questionnaire. The SPSS software (v. 16.0) was used to analyze the data at a significance level of less than 0.05.

RESULTS

The mean scores of MF and SR were 31.73 ± 7.35 and 3.45 ± 0.35, respectively. The highest and the lowest scored SR subscales were ethical responsibilities with a mean of 3.67 ± 0.42 and economic responsibilities with a mean of 2.93 ± 0.62. MF had a significant negative correlation with legal responsibilities and a significant positive correlation with economic responsibilities (P < 0.05). The only significant predictor of SR was financial status which significantly predicted 4.3% of the variance of SR (P < 0.05).

CONCLUSION

More than half of the nurses who provided care to patients with COVID-19 suffered from MF and their mental fatigue had a significant correlation with their legal and economic responsibilities. Healthcare authorities and policymakers need to develop programs to reduce nurses' MF and improve their satisfaction.

A cross-cultural concept analysis of healing in nursing: a hybrid model

BACKGROUND

As a familiar yet abstract and vague concept for nurses, healing is affected by the cultural needs of different communities. The concept of healing is nowadays recommended in nursing theories, and its clarification can develop healing-based nursing care. The present study was conducted to objectify and clarify the concept of healing in nursing care.

METHODS

The present research employed a hybrid concept analysis model developed by Schwartz-Barcott and Kim. The conceptual analysis model of Walker & Avant was used in the theoretical phase, i.e., literature review, where relevant articles in PubMed, ISI, Google Scholar, Scopus, SID and Magiran were reviewed irrespective of publication time. Unstructured interviews were conducted with ten participants in the field data collection phase. A final analysis was performed by combining the two phases.

RESULTS

The theoretical phase identified healing characteristics such as balancing and hope-making originated from mental and spiritual states. Analyzing the data in the fieldwork stage extracted five main themes, i.e. "comprehensive psychophysical health", "cure, a small part of healing", "healing, a spiritual recovery", "an individual's own role in healing" and "healing, an unexpected event". During the patient care process, nurses can help patients heal by establishing appropriate communication and comprehensive understanding of the patients by designing and implementing appropriate interventions and integrating healing strategies into their comprehensive care measures.

CONCLUSIONS

The concept of healing in nursing care is a general and complex process, and different people can interpret it differently on their road to health. Properly understanding the concept of healing enables nurses to assist patients in achieving health and healing through proper communication, holistic care, empowering patients to perform self-care and providing spiritual care.

Weight Management Challenges in Nulliparous Women Being Overweight or Obese Due to Pregnancy: A Qualitative Study

Background

Getting overweight after pregnancy is a common phenomenon and getting back to pre-pregnancy weight in the postpartum period is a major concern for mothers. This study aimed to explain the challenges in performing post-pregnancy weight-management behaviors in nulliparous women being overweight and obese due to pregnancy.

Methods

The present qualitative study was conducted with the conventional qualitative content analysis method based on Granheim and Landman's approach from October to December in 2021. In this study, participants were 15 women who referred to comprehensive health service centers in Tehran, Iran; they were purposefully selected according to the inclusion criteria. Data were collected through individual, in-depth, and semi-structured face-to-face interviews and simultaneously analyzed using the MAXQ Data version 10 software.

Results

The mean age of the participants was 25.93±3.21 years. Data analysis resulted in three main categories: 1) failure to adhere to calorie-restricted diets, 2) inability to engage in physical activity, and 3) lack of adequate social support.

Conclusion

Women with obesity due to pregnancy face many challenges to improve their weight-control behaviors. As such, improving healthy behaviors not only requires relevant stakeholders' commitment, but also demands women, their families and communities' intention to engage in healthy behaviors.

The effects of virtual logotherapy on health-promoting lifestyle among single-parent adolescent girls during the coronavirus disease 2019 pandemic: a randomized clinical trial

Single-parent adolescents are vulnerable individuals and it is necessary to improve their health, particularly during epidemics. This study aimed to investigate the effects of virtual logotherapy (VL) on health-promoting lifestyle (HPL) among single-parent adolescent girls during the COVID-19 pandemic. This single-blind randomized clinical trial was conducted on 88 single-parent adolescent girls recruited from the support organization for vulnerable individuals in Tehran, Iran. They were randomly allocated to a control and an intervention group through block randomization. Participants in the intervention group received VL in three-five person groups in 90 min biweekly sessions. The Adolescent Health Promotion Short-Form was used to assess HPL. Data were analyzed using the SPSS software (v. 26.0) and through the independent-sample t, Chi-square, Fisher's exact, and Mann-Whitney U tests. There was no significant difference between the intervention and the control groups respecting the pretest mean score of HPL (73.58±16.74 vs. 72.80±9.30; P=0.085). However, the posttest mean score of HPL in the intervention group (82 with an interquartile range of 78-90) was significantly more than the control group (71.50 with an interquartile range of 63.25-84.50) (P=0.001). Moreover, after adjusting the effects of the significant between-group differences respecting pretest mean scores, the pretest-posttest differences of the mean scores of HPL and all its dimensions in the intervention group were significantly more than the control group (P<0.05). VL is effective in significantly improving HPL among single-parent adolescent girls. Healthcare authorities are recommended to use VL for health promotion among single-parent adolescents.Trial registrationThis research was registered (17/05/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200517001.

Validity and reliability of the Persian version of the Short-Form Adolescent Health Promotion scale: Methodological study

Background and Aim

Assessing health promotion among adolescents is vital to identify healthy and unhealthy behaviors and to evaluate health promotion interventions. This study aimed to determine the validity and reliability of the Persian version of the Short-Form Adolescent Health Promotion scale.

Methods

Three hundred and twenty-seven adolescents were recruited through a multistage sampling method in this methodological study. The original version of the Adolescent Health Promotion scale was translated from English to Persian using the Backward-Forward translation protocol. Then, the scale's validity and reliability, including the face, content, construct validity, and reliability indices, were evaluated. The statistical analysis was performed using SPSS software version 24.

Results

The mean CVI and CVR were 0.99. The exploratory factor analysis revealed four factors covering 42.57% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the English version of the scale's validity and reliability analysis. The obtained factors called included: life appreciation, stress management, nutrition, and health responsibility. In the current study, both Cronbach's ɑ and the intraclass correlation coefficient were calculated at 0.84 and 0.99.

Conclusion

The Persian version of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity of the content, face, and reliability. However, the construct validity of this scale should be checked in other samples.

The barriers and facilitators to health-promoting lifestyle behaviors among people with multiple sclerosis during the coronavirus disease 2019 pandemic: a content analysis study

BACKGROUND AND AIM

Health-promoting lifestyle behaviors (HPLBs) have a significant impact on disease management among people with multiple sclerosis (MS). However, the coronavirus disease 2019 (COVID-19) pandemic has significantly affected lifestyle of all individuals, particularly patients with chronic diseases. The present study aimed to explore the barriers and facilitators to HPLBs among people with MS during the COVID-19 pandemic.

METHODS

This qualitative study was conducted in Iran. Participants were sixteen people with MS purposively selected from the central MS clinic of a referral specialty neuroscience hospital in Tehran, Iran. Data were collected via in-depth semi-structured face-to-face interviews and concurrently analyzed through conventional content analysis.

FINDINGS

The mean of participants' age was 37.93 years and most participants were female (81.25%). The major barriers to HPLBs were lack of knowledge, limited access to resources, and poor health status, while the major facilitators were attention to inner abilities and social support.

CONCLUSION

Many different factors such as lack of knowledge, limited access to resources, poor health status, awareness, and social support can influence engagement in HPLBs among people with MS. Healthcare authorities and policymakers need to use quality educational and supportive interventions to improve knowledge, health literacy, perceived support, self-efficacy, and self-care ability among people with MS during the COVID-19 pandemic.

The effects of self-care education based on the health literacy index on self-care and quality of life among menopausal women: a randomized clinical trial

Purpose

Aging is associated with many different health-related challenges for women such as menopause and its associated problems. Self-care (SC) is a factor with potential effects on menopause and its consequences. SC education based on health literacy has the potential to improve menopausal women’s SC. The aim of this study was to evaluate the effects of SC education based on the health literacy index (HLI) on SC and quality of life (QOL) among menopausal women.

Methods

This randomized clinical trial was conducted in Iran. Participants were 100 menopausal women purposively recruited from five comprehensive healthcare centers in the south of Tehran. They were randomly allocated to a control and an intervention group through block randomization. Intervention was an HLI-based SC education program implemented in four 1.5–hour weekly sessions through the lecture, group discussion, and question and answer methods. Data were collected before and eight weeks after the intervention using a demographic questionnaire, the Health Literacy for Iranian Adults scale, the Menopause-Specific Quality of Life Questionnaire, and the Menopausal Self-Care Questionnaire. The SPSS software (v. 22.0) was used to analyze the data through the Chi-square, Fisher’s exact, paired-sample t, and the independent-sample t tests as well as the analysis of covariance at a significance level of less than 0.05.

Findings

There were no significant differences between the intervention and the control groups respecting the pretest mean scores of QOL (88.15 ± 32.36 vs. 79.6 ± 36.99) and SC (104.75 ± 12.31 vs. 103.32 ± 13.8) (P > 0.05). However, the posttest mean scores of QOL and SC in the intervention group significantly differed from the control group (66.44 ± 28.41vs. 81.3 ± 38.04 and 125.6 ± 11.23 vs. 102.6 ± 14.34) (P < 0.05).

Conclusion

HLI-based SC education is effective in significantly improving menopausal women’s QOL and SC and can be used to improve health-related outcomes among menopausal women.

Clinical trial registration This research was registered (24/03/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200324002.

Effect of Educational Program Based on Health Literacy Index on Self-Care Ability Among Older Adults: A Randomized Clinical Trial

Background

Health literacy index (HLI) was developed to provide a proper framework for educational material in all levels. So, the aim of this study was to determine the effect of education based on (HLI) on the self-care ability among older adults.

Methods

This randomized clinical trial was conducted with 68 older adults during the period of May-August 2019. The research setting was health centers in the south of Tehran, Iran. Samples were selected with considering the inclusion criteria. Then Block randomization was used to assign the participants into two groups. The intervention group for 4 weeks in groups of 8-10 in the intervention group. Self-care ability was measured using a self-care questionnaire in two stages, before and two months after the implementation of intervention. The control group received no education and only used the routine community house services. Statistical analyses were performed using the SPSS software (version 16.0). Data were analyzed using the Chi-square, Fisher's exact test and independent t-test. P < 0.05 was considered statistically significant.

Results

The mean total self-care ability scores in the intervention group were 165.38 ± 10.69 and 184.28 ± 10.07 before and after intervention, respectively. These scores in the control group were 163.65 ± 13.27 and 167.52 ± 13.58, respectively (P < 0.001). The results showed significant differences between the two groups regarding self-care ability after the intervention (P < 0.001).

Conclusions

The implementation of education based on HLI significantly improve the self-care behaviors in older adults. It is suggested that this approach should be established to fit of educational content appropriate to the age of the elderly in order to health promotion. Trial Registration: The trial was registered in the Iranian Registry of Clinical Trials on May 23, 2018, identifier: IRCT20170912036150N1.

Creativity in Nursing Care: A Concept Analysis

The aim of this study was to present the concept analysis of creativity in nursing care using the Walker and Avant (2019) approach. In this regard, the keywords "creativity" and "nursing care" were searched through PubMed, Ovid, Scopus, EMBASE, Google Scholar, SID, and Web of Science between the years 2000 and 2018 along with hand searching of reference lists extracted from more than 342 articles. Finally, 37 articles that had inclusion criteria were examined based on the eight stages mentioned in Walker and Avant's concept analysis approach. Results revealed that creativity in nursing care includes fluidity of mind and the creation and acceptance of new ideas for patient care in such a way that the new methods are simple, useful, efficient, affordable, and safe. This requires a creative vision, creative sensitivity, and creative thinking. If there is a supportive environment, motivation, sensitivity, and divergent thinking skills, individuals can demonstrate their creativity. This may result in successful decision-making in the clinical setting and therefore contribute to increasing the organization's effectiveness and the quality of care. All nurses can act as agents encouraging change by the use of creativity to improve the quality of care. It is an educational guide for future nurses to implement creativity in practice. Also, this finding can be used for future research and the development of specific tools. Finally, it is suggested to consider creativity in the other aspects of clinical practice as well.

The Effects of Home-Based Self-Care Education on Blood Pressure and Self-Care Behaviors among Middle-Aged Patients with Primary Hypertension in Iran: A Randomized Clinical Controlled Trial

Self-care education (SCE) through home visit is one of the methods with potential effects on self-care. This study aimed to evaluate the effects of home-based SCE on blood pressure and self-care behaviors among middle-aged patients with primary hypertension in Iran. This randomized controlled trial was conducted on 110 middle-aged patients with hypertension recruited from public healthcare centers in the south of Tehran, Iran in September 2019. After convenience sampling, Participants were simple randomly allocated to control and intervention groups. Intervention group received a 2-month home-based SCE while control group received routine care services. Before and 2 months after the intervention, self-care behaviors were assessed using the Hypertension Self-Care Activity Level Effects (H-SCALE). Data were analyzed using the SPSS software (v. 16.0) at a significance level of less than .05. After 2 months, the posttest mean scores of self-care behaviors in medication adherence (17.42 ± 1.03 vs 14.49 ± 1.01, p = .04), physical activity (8.16 ± 0.39 vs 6.47 ± 0.52, p = .01), low-salt diet (52.51 ± 3.8 vs 35.36 ± 3.47, p = .001), and blood pressure control (3.47 ± 0.22 vs 2.42 ± 1.89, p = .001), in the intervention group were significantly greater than the control group. However, there were no significant between-group differences respecting the posttest mean scores of the weight management ( p = .06) and smoking cessation ( p = .2). Also, the mean blood pressure between the 2 groups changed after the intervention, but this difference was not statistically significant. This study suggests the effectiveness of home-based SCE in significantly improving self-care behaviors among patients with hypertension. But more studies are needed to measure the effectiveness of intervention on blood pressure.

IRCT code: IRCT20190623043985N1. Registered 06/30/2019, https://fa.irct.ir/trial/40351 .

Clarifying the concept of conscience in nurses' ethical performance in Iran: a concept analysis study

Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses’ ethical performance.

This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study’s conclusions.

In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase’ results were categorized into three themes: “perception of conscience”, “commands of conscience”, and “obedience to conscience. The final definition was reached by merging the theoretical and field stages.

This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.

Ethical advocacy in the end-of-life nursing care: A concept analysis

AIM

This concept analysis was conducted to identify and define the features and functions of ethical advocacy in the end-of-life nursing care.

BACKGROUND

Ethical advocacy is key to the role of the nurse in delivering quality and competent care. Despite this, the dimensions of this concept are poorly understood.

DESIGN/DATA SOURCE

Databases such as Google Scholar, Scopus, Web of Science, Science Direct, and PubMed were searched systematically. To search these databases, the following keywords were used: "patient advocacy," "nursing," "ethics," "end-of-life care," and their combinations.

REVIEW METHODS

Walker and Avant's method was utilized as a comprehensive review of the literature to explore how ethical advocacy in nursing can be used to improve the quality of care.

RESULTS

The defining attributes of the concept of ethical advocacy included adhering to ethical principles of nursing, championing social justice in the provision of healthcare, safeguarding and defending patient's rights by applying collective wisdom, and involving hospital ethics committees. Antecedents are organizational and personal power and ethical leadership. The optimal consequence of ethical advocacy can be getting the best ethical governance.

CONCLUSION

Based on this analysis, the concept of ethical advocacy is one of the most important roles for nurses which requires their awareness of this concept.

Effect of educational program based on theory of planned behavior on osteoporosis preventive behaviors: a randomized clinical trial

Background

The prevalence of chronic diseases is increasing worldwide. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. This study was conducted to assess the effect of educational program based on the Theory of Planned Behavior (TPB) on the osteoporosis preventive behaviors in middle-aged individuals.

Methods

A randomized clinical trial was conducted on 64 middle-aged individuals presenting to primary care centers. A researcher-made questionnaire developed according to “a guide for compiling and analyzing the questionnaire based on TPB” was used for data collection. Random block sampling was applied to assign participants to control and intervention groups after ensuring the validity and reliability. An educational program on osteoporosis prevention was conducted in six educational sessions based on the TPB constructs for the intervention group in primary care centers. Control group received routine education about lifestyle changes including osteoporosis by primary care centers. Eight weeks after the intervention, the questionnaires were completed again and the data were analyzed using the SPSS V16 software.

Results

Independent t-test found no significant difference in the mean score of knowledge, osteoporosis preventive behavior, attitude, subjective norms, perceived behavioral control and behavioral intention between intervention and control groups before intervention (p > 0.05). After the intervention, however, a significant difference was found in the mean score of knowledge, attitude, subjective norms, perceived behavioral control and behavioral intention between the cases in intervention and control groups (P < 0.05). In addition, based on repeated measurement ANOVA, the intervention had a significant effect on knowledge, preventive behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention (P < 0.05).

Conclusions

The results of the present study showed that implementation of an educational intervention based on the Theory of Planned Behavior significantly increased the knowledge along with all constructs of TPB in osteoporosis preventive behaviors.

Trial registration

This study was registered in the Iranian Registry of Clinical Trials IRCT2017081735647N2 (11/10/2017).

Stakeholders’ Perceptions of Challenges in the Public Health Nursing Practicum: A Qualitative Study

Background: Community health nurses have an important role to play in promoting public health. This study attempted to explore the stakeholders’ perceptions of challenges in the public health nursing practicum in Iran. Methods: This qualitative study was carried out in some schools of nursing and health centers in Iran from October 2015 to September 2017. Twenty-three participants, including faculty members of public health nursing, nursing students, home nurses, experts in health centers, and nursing education policymakers were selected by purposeful sampling. Data were collected using individual interviews and were analyzed by Lundman and Graneheim’s method of content analysis. Results: Three themes resulted from the data analysis, including organizational challenges (with sub-categories of “inappropriate implementation of the curriculum due to lack of authority”, “the treatment-centeredness of health care system”, and “limited fields for nursing practicum”), educational challenges (with sub-categories of “shortcomings of educational curricula” and “the duration and time of practicums”), and workforce challenges (with sub-categories of “the financial burden of public health nursing practicum”, “lack of job position for public health nurses”, and “factors related to the role of instructors”). Conclusion: Senior managers, community health center administrators, and educational planners can use the challenges and barriers raised in this study to make more appropriate planning for the training of nursing students in public health nursing practicum.

The Effect of an Empowerment Program on the Health-promoting Behaviors of Iranian Women Workers: A Randomized Controlled Trial

Objectives

The workplace is an ideal place for encouraging health-promoting behaviors. Therefore, the aim of the present study was to determine the effect of an empowerment program on the health-promoting behaviors of women workers.

Methods

This randomized clinical trial was conducted with 80 women workers employed at a food packaging facility in 2020. The subjects were selected using convenience sampling and were classified into intervention and control groups using block randomization. An empowerment program for women workers was conducted across 6 sessions based on an empowerment model. Data collection tools included a demographic questionnaire and the Health Promoting Lifestyle Profile-II, which participants completed both before the program and 8 weeks after the last session. Data analysis was performed in SPSS version 16 using descriptive analysis and inferential statistics.

Results

There were no significant differences between the 2 groups in various health-promoting behaviors before the program. However, the intervention group’s scores for nutrition (34.92±1.09 vs. 27.87±4.23), physical activity (24.40±2.94 vs. 17.40±5.03), stress management (26.35±2.60 vs. 23.05±4.27), spiritual growth (34.02±3.00 vs. 30.22±5.40), interpersonal relationships (30.82±2.38 vs. 27.60±4.61), and health responsibility (31.60±2.71 vs. 28.22±4.59) were significantly higher than the control group’s 8 weeks after the program had ended. Moreover, there was a significant difference in the total score of health-promoting behaviors for the intervention group compared to the control group (179.00±9.22 vs. 151.42±20.25, p=0.001).

Conclusions

An empowerment program for women workers led to significant improvements in the health-promoting behaviors of the participants. Similar programs can ultimately improve women’s health in the workplace.

Concept analysis of the Four-Season-Symphony of Intellectuality-Spirituality-Ethics-Esthetics (FSS: I SEA) in nursing research

BACKGROUND

The Four-Season-Symphony of intellectuality, spirituality, ethics, and esthetics (FSS: I SEA) in nursing research is a new concept that has not been addressed in previous nursing theories and studies.

AIM

This study was conducted to clarify the concept of the FSS: I SEA in nursing research.

DESIGN

Wilson's method of concept analysis was used.

DATA SOURCE

Empirical and conceptual literature.

REVIEW METHOD

This study has been conducted based on Wilson's 11-step approach by searching keywords with Symphony, Rationality, Intellectuality, Spirituality, Ethics, Esthetics, and Nursing research in databases including Google Scholar, PubMed, Scopus, CINAHL, Sid, Oxford Dictionary, Dehkhoda Dictionary, and nursing theory textbook.

RESULTS AND CONCLUSION

Richness and elegance of the symphony in nursing research cannot be achieved by a single-tool benchmark; rather, a more integrated assessment can be achieved with the use of a tool combining different intellectuality, spirituality, ethics, and esthetics tools. This symphony contains a philosophical and deep understanding of the meanings of researcher, research problem, research process, and symphonic product. Through identifying the facilitators and barriers of this concept, nursing researchers, professors, and practitioners will be able to design and implement their research activities on FSS basis to pave the way for the continued transcendence of comprehensive nursing care.

Perspectives of parents on the meaning of happiness in children with long-term illness: A hybrid concept analysis

Aim

To define the concept of happiness among children with chronic disease.

Background

Happiness is an old human quest, the existing literature on the definition of happiness among children with chronic diseases is sparse.

Methods

The three-phase hybrid model was used. In the first (theoretical) phase, a literature review was conducted. In the second (fieldwork) phase, the semi-structured interview data were analysed through content analysis. Ten participants were purposively sampled. In the third (final analytic) phase, the practical definition of the concept was identified.

Results

The practical definition of happiness in a Ghanaian chronically ill child is the "subjective and positive lifelong process of adapting to biological, physiological, psychosocial, economic and environmental changes caused by the disease trajectory, which affects the well-being of the child and the family."

Conclusions

This study offers a background for selecting appropriate health indicators and outcome measures in promoting happiness in children with chronic diseases.

Superstition in health beliefs: Concept exploration and development

Concept exploration and development of superstition is the aim of this research. Superstition is a complex concept, needs to be clarity, removes it from its mundane state, and gives it a scientific richness. To use a list of questions extracted from a review of the literature to analyze, develop, and explore superstition. It was assessed according to studies conducted in three fields sociology, psychology, and nursing. The maturity of the concept was determined in four areas, epistemology, practicability, semantics, and deduction/logic. Nurses must discover people's beliefs and superstitions. Although the concept of superstition is commonly used, many of its features and aspects were still unclear.

The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial

OBJECTIVE

To evaluate the effects of self-management education tailored to health literacy on medication adherence and blood pressure control.

METHOD

This randomized controlled trial was conducted in 2018 with 118 elderly people with uncontrolled primary hypertension and inadequate health literacy. Self-management education was developed on the basis of the health literacy index. Medication adherence and blood pressure were assessed using 8-items Morisky Medication Adherence Scale and a mercury sphygmomanometer, respectively.

RESULTS

At baseline, there were no significant between-group differences regarding participants' demographic characteristics, medical history, and medication adherence. After the intervention, between-group comparisons adjusted for pretest scores showed a significant reduction in the mean score of systolic and diastolic blood pressure and increase adherence to medication due to intervention (P < 0.05). However, the proportions of controlled systolic and diastolic blood pressure were not statistically significant different between-group (P > 0.05).

CONCLUSION

Self-management education tailored to health literacy significantly promotes medication adherence but has no significant effects on control of blood pressure.

PRACTICE IMPLICATION

To promote adherence to antihypertensive medications, tailored patient education to Health literacy is recommended. Limited pieces of evidence are available on the effectiveness of health literacy index-based interventions, so further studies are required.

Effect of lifestyle education based on Pender model on health-promoting behaviors in HIV positive individuals: A randomized clinical trial study

Background & Aim: Human Immunodeficiency Virus (HIV) prevalence is increasing, and this disease has become a crisis for the modern world. Today, the survival of patients has been increased, such that HIV is considered a chronic disease. So, Paying attention to health-promoting intervention is necessary. Thus, the current study aims to determine the effect of educating lifestyle based on the Pender model on health-promoting behaviors in HIV patients. Methods & Materials: In this randomized clinical trial study, 70 HIV patients who had inclusion criteria were selected and then divided into intervention and control groups randomly. The intervention group received 6 one-hour education sessions weekly based on Pender lifestyle (nutrition, physical activity, stress management, spiritual growth, interpersonal relationships, and health responsibility). A demographic questionnaire and HPLP2 were used, which were completed by both groups before the intervention and 8 weeks after the intervention. Chi-Square, Fisher, Independent t, and ANCOVA statistical tests and SPSS 16 software were used to analyze data. Results: results showed that there was no significant difference in various dimensions of health-promoting lifestyle between two groups before intervention. However, intervention group scores for nutrition (28.08±6.23 vs. 23.58±6.04), physical activity (22.26±6.46 vs. 16.39±6.09), stress management (25.03±5.14 vs. 19.96±6.41), spiritual growth (29.49±6.11 vs. 25.45±8.54), interpersonal relationships (29.17±6.14 vs. 23.11±7.45) and health responsibility (28.36±6.06 vs. 23.89±5.74) were significantly higher than control group 8 weeks after intervention. Moreover, the total score of health-promoting behaviors had a significant difference in the intervention group compared to the control group (166.7±28.43 vs. 134.5±35.68, p<0.001). Conclusion: Based on the findings, it can be said that educating lifestyle based on the Pender model causes HIV patients to use health-promoting behaviors, which are recommended as a useful theory-based program for managers and providers of health services.

Children's description of pain through drawings and dialogs: A concept analysis

AIM

To present a concept analysis of pain in children's drawings and dialogs.

INTRODUCTION

The complexity and subjectivity of the concept of pain in children remain ambiguous. As a result, children are exposed to inappropriate diagnosis and inadequate treatment. Children can describe or draw their painful experiences. Analysing the concept of pain based on children's experiences can help identify, assess and properly manage and treat pain in children.

DESIGN

Concept analysis.

METHODS

Walker and Avant's framework for concept analysis was used in this current study.

RESULTS

Major aspects of pain revealed in this concept analysis are affected by children's different concerns about pain. The description of pain in children with chronic diseases or chronic pain is completely different from that in healthy children. Children perceive pain to be internal, external and emotional. Pain in children is associated with poor psychological and emotional conditions, which add new features and aspects to the concept of pain. Children's descriptions and drawings of pain indicate different concepts of pain in their minds. From the perspective of children, pain has an identity that is formed based on reality.

CONCLUSION

When developing pain evaluation tools, it is necessary to address the characteristics of pain. In the case of chronic pain, emotional effects of pain on children's psyche need extra attention. Child-based pain management guidelines can then be formulated with the results of relevant concept analyses. Pain assessment is a major part of pain management in children. By considering the characteristics of the concept of pain, the efficiency and usefulness of developed tools can be enhanced to create advancement in paediatric pain management.

Experiences of nursing students of Evidence-Based Practice Education according to Rogers' Diffusion of Innovation Model: A Directed Content Analysis

INTRODUCTION

Evidence based practice (EBP) education is essential in promoting of clinical care, but an effective educational strategy for teaching EBP in nursing faculties is not available. The aim of this study was to explore the experiences of nursing students of EBP Education according to Rogers' Diffusion of Innovation Model.

METHODS

This qualitative study was carried out using a directed content analysis method and purposeful sampling. Data were collected until saturation by fourteen semi-structured face-to-face individual interviews and two focus group discussions with nursing students from two nursing faculties in Tehran, Iran. Rogers' Model was used in this study.

RESULTS

Data were classified into five themes and 11 categories according to the Rogers's Model. Themes and main categories were knowledge (educational enrichment, new strategy for education), persuasion (internalization of education, improvement of motivation), decision (acceptance, use in the future), implementation (objectivity, consolidation of learning) and confirmation (learning and teaching, achieving a goal, self-confidence).

CONCLUSIONS

EBP Education, based on the teaching strategy of Rogers's Model, leads to an improved EBP learning. All the necessary steps for a better education of it are included in this educational approach which can be used to teach any new subject like EBP.

Nursing Students' Competencies in Evidence-Based Practice and Its Related Factors

Background:

Evidence-Based Practice (EBP) is one of the nursing professional roles that can lead them to provide the best and more effective care. However, no studies are available on nursing students’ competencies in EBP.

Objectives:

This study aimed to investigate the nursing students’ knowledge, attitude and intention to implement EBP and its related factors in two nursing and midwifery faculties in Tehran, Iran.

Materials and Methods:

In this cross-sectional study, 170 undergraduate nursing students were selected from two faculties of nursing and midwifery in Tehran, Iran. A census sampling method was applied and they were all before graduation in 2013. The Rubin and Parrish questionnaire was used to assess the students’ knowledge, attitude and intention to implement EBP as well as factors affecting the implementation of EBP. Students completed the instrument through self-report. Descriptive statistics, Independent sample t-test and Pearson correlation coefficient were used to analyze the data.

Results:

The students mean scores of knowledge, attitude and intention to implement EBP was 31.08 ± 5.77, 50.40 ± 9.58, 36.01 ± 4.64, respectively. The students’ age was inversely correlated with their scores of knowledge, attitude and intention to use EBP (P < 0.05). However, the students’ GPA was in direct association with their knowledge, attitude and intention to implement EBP (P < 0.05). No significant differences were observed between the males and females mean scores in the three subscales. However, significant differences were found between the students mean scores in the two subscales of knowledge and attitudes toward EBP in terms of familiarity with statistics and research methods (P < 0.05). Neither familiarity with research methods nor familiarity with EBP could significantly affect the students’ intention to implement EBP.

Conclusions:

The present study showed that nursing students have not a high mean score in the three subscales of knowledge, attitude and intention to implement EBP. It is essential for faculties and nurse managers not only to focus on education of EBP, but also to support nurses and nursing students to implement it in the process patient care.