The effects of a Namaste care program on quality of life: A pilot study in Iranian women with late-stage Alzheimer's disease

The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings.

Accreditation of nursing clinical services: Development of an appraisal tool

Aim

This study aimed to determine comprehensive and applicable indicators for assessing the quality of nursing clinical services.

Design

Methodological research.

Methods

The checklist was designed in three phases (conceptualization, item generation and item reduction). In the first phase, a qualitative study using conventional content analysis was performed to clarify the concept of accreditation of clinical nursing services. In the second phase, using the views of experts was obtained in phase 1 and then by a review of the literature, related items were extracted, and item pool was formed. In the last phase, validity and reliability of the checklist were examined.

Result

Based on three phases (Conceptualization, Item Generation and Item Reduction), the accreditation indicators of clinical nursing services were extracted in three dimensions including structure, process and outcome at two levels of organizational (including structural and outcome indicators) and individual performance appraisal (process indicators) in 19 main categories.

Older adults' self-advocacy in patient safety: a cross-sectional study

BACKGROUND

patient advocacy is a major nursing role, which is linked to supporting, encouraging and reinforcing self-advocacy in patients. Patient safety is an important nursing outcome, especially in older adults.

AIMS

older adults' self-advocacy regarding patient safety behaviour and its relationship with some demographic characteristics were assessed.

METHODS

a valid older adult patients' self-advocacy questionnaire, which included subscales of behaviour, self-efficacy, attitude and outcome efficacy (range of scores=0-63), was used. In this cross-sectional study, 230 patients aged over 60 years were selected using a stratified sampling method.

FINDINGS

an association was found between total self-advocacy score (mean=40.16; SD=9.6) and rural living (β=-0.168; P=0.016) using multiple linear regression analysis. Similar findings were found between questionnaire subscales and sex, rural living, occupation and age.

CONCLUSION

older adults, especially women, those of advanced age and those in rural areas, may benefit from nursing interventions to improve their self-advocacy in patient safety.

Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study

Background

Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services.

Methods

The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire.

Results

In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance.

Conclusion

Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

Motherhood challenges and well-being along with the studentship role among Iranian women: A qualitative study

This study purposed to explore and describe the experiences of Iranian female students with the role of motherhood. This 2015 qualitative study used purposeful sampling to select 20 student mothers aged 24–50 who were studying at a state or non-state university in an urban area in northwest Iran. Data was collected through individual semi-structured interviews and analysed using a qualitative content analysis approach. Three main themes were developed during data analysis: “simultaneous management”, “facilities”, and “barriers”. The management of maternal and family affairs by female students in universities where motherhood is not supported is a challenge. The significance of mother-student roles must be emphasized and support and education provided for women to gain skills useful in playing these roles. Policy makers should devise strategies for bringing change to the traditional perspective that motherhood and educational responsibilities cannot be met at the same time by one person.

Iranian Physicians' Perspectives Regarding Nurse-Physician Professional Communication: Implications for Nurses

BACKGROUND AND PURPOSE

Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran.

METHODS

Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed.

RESULTS

Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication."

IMPLICATIONS FOR PRACTICE

Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

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.

What can we expect from grounded theory? a theoretical critique

The research approach of grounded theory (henceforth as GT) is one of the common qualitative methodology in social sciences and lately in Nursing which has constantly been confronted with ambiguities regarding its application and particularly its operationalization. It is attempted in this article to offer the true nature, application and measures for a more suitable application of this approach by reviewing its relevant literature in different disciplines. This article is the result of reviewing different databases through 1990 to 2011 and also referring to the main texts in GT research. At the end, it must be mentioned that although the GT research approach is an appealing method, especially in Nursing and enjoys a lot of rigor with regard to dealing with the favorite phenomena of the nurses, the researcher’s expectations must be realistic about it. In addition, alongside clarification, which is a social process among a group of individuals, it can be used in presenting model and instrumentation by following the principles and also for providing examination and caring manuals and the required interventions by using the qualitative outcome analysis in order to operationalize it.

Nurses' Clinical Judgment Development: A Qualitative Research in Iran

Background:

Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion.

Objectives:

In this study we explored the process of Iranian nurses’ development in clinical judgment.

Patients and Methods:

This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method.

Results:

The study participants’ main concern was ‘being non-professional in clinical judgment’. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was ‘struggling for becoming professional in clinical judgment development’. When nurses were supported professionally, they were able to develop their professional clinical judgment.

Conclusions:

The findings of this study provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability.

Findings From a Nursing Care Audit Based on the Nursing Process: A Descriptive Study

Background:

Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally.

Objectives:

This study aimed to audit nursing care based on a nursing process model.

Patients and Methods:

This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses’ compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests.

Results:

The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses’ age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001).

Conclusions:

Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools.

Iraqi Nurses' Perspectives on Safety Issues in Maternity Services

Background:

Studies introduce maternal and neonatal safety phenomena as important challenges to the public health, particularly in low-income countries. However, few researches are conducted on the identification of safety issues in maternity hospitals in Iraq. It was the first study on nurses’ perspectives on safety issues in Kurdistan, Iraq.

Objectives:

The current study aimed to describe nurses’ perspectives on what constitutes a safe maternity service in Kurdistan, Iraq.

Patients and Methods:

A qualitative design, based on a content analysis approach, was used. Ten Kurdish nurses who worked in the delivery room of Kurdistan, Iraq maternity hospital were recruited through purposive sampling. Semi-structured interviews were performed to collect data. All interviews were audiotaped and transcribed verbatim. Sampling continued to the level of data saturation. Data analysis was performed based on the steps suggested by Graneheim and Lundman.

Results:

Thematic analysis led to the identification of six main categories including stressful job, lack of schedule and job description, providing care with limited resources, professional unaccountability, regional sociopolitical factors, and inadequate training.

Conclusions:

Iraqi nurses identified factors such as limited health resources, lack of job description, and professional unaccountability as major safety issues in maternity services. These findings alarm the need to ensure the provision of females and neonates with appropriate care. This, however, would require coordination between Iraqi Kurdistan health authorities to provide midwifery care facilities, high-quality and relevant staff training, and an effective healthcare system in the maternity units.

Cardiac patients' perception of patient-centred care: a qualitative study

AIM

The aim of this study was to explore cardiac patients' perception of patient-centred care.

BACKGROUND

Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction.

DESIGN

This study is a descriptive qualitative study.

METHODS

Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews.

FINDINGS

The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions.

CONCLUSIONS

Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care.

IMPLICATIONS FOR PRACTICE

Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care.

Perception of Iranian middle-aged women regarding moral health concept: a content analysis

Introduction:

The present study aimed at exploring and describing the perception of moral health from middle-aged women standpoints. Women’s decisive role in family is undeniable. In the family which is built upon tradition, faith and ethics, this is women’s principle which is represented in the moral health of the individual and the society, deals with the nature of the vice and virtue. This study attempted to identify the perception of Iranian middle-aged women about the concept of moral health.

Method:

The present study completed through a content analysis method. Twenty two middle-aged women were recruited through purposive sampling. Data were granted by face to face, semi-structured interview.

Result:

Our major categories are devotion, preserving moral values and moral challenges. Devotion category includes subcategories such as prioritizing the health of family members and trying to save marriage. Preserving moral values category includes subcategories such as respecting values and consolidating beliefs over time. Moral challenges category consists of individual and familial challenges subcategories.

Conclusion:

Moral health is of high importance which affects various dimensions of individual, social and familial life. The findings of the present study presented new dimensions of middle-aged women’s health regarding moral health which can finally have different consequences on familial and social moral health.

Futile care; concept analysis based on a hybrid model

Background:

Making decision about what kind of caring is entitled as futile care requires the presentation of a clear definition of such caretaking.

Objective:

To report an analysis of the concept of futile care.

Design:

The analysis in this research was carried out through hybrid model in three stages. At the theoretical stage: a review of the available literature. At the work-in-field stage: semi-structured interviews.

Setting:

Data collection was on cancer unit and palliative care unit.

Participants:

A total of 7 participants were recruited in the study. The inclusion criteria were: having at least a bachelor’s degree in nursing, having at least 5 years of experience in critical care or cancer units, and being willing to participate in the study.

Results:

Three themes emerged: “low quality of life”, “lack physiologic return to life” and “performing non-professional duties”.

Conclusion:

Futile care consists giving clinical cares irrelevant to a nurse’s job and giving cares through which the return of patient would be impossible both physiologically and qualitatively.

Professional support as a facilitator to the development of Iranian nurses' clinical judgment: A content analysis

BACKGROUND

Nurses' clinical judgment development is essential for the professional nursing practice. The aim of this study was to explore the facilitators to the development of Iranian nurses' clinical judgment.

MATERIALS AND METHODS

A qualitative design using conventional content analysis method was employed in the study. A purposive sample of 24 participants was recruited from three hospitals located at Sanandaj, Iran. Study data were collected in 2013 by using semi-structured individual interviews. A content analysis approach was used to analyze the study data and MAXQDA was used for coding and categorizing the data.

RESULTS

The main theme of the study was "professional support as a facilitator to the development of nurse's clinical judgment." The sub-themes of this main theme included "provision of direct support to nurses" and "provision of clinical judgment resources." The first sub-theme consisted of different types of managerial, clinical, educational, and social supports. The two categories of the second sub-theme included the provision of necessary clinical evidence and the provision of medical equipments.

CONCLUSION

The study findings highlighted the importance of providing nurses with adequate professional support for facilitating the development of their clinical judgment.

Compliance with treatment regimen in women with gestational diabetes: Living with fear

BACKGROUND

Gestational diabetes mellitus is a prevalent pregnancy complication that seriously endangers mothers' and babies' health. The aim of this study was to explore factors affecting treatment compliance among women with gestational diabetes mellitus.

MATERIALS AND METHODS

A qualitative content analysis approach was employed. Twenty-five semi-structured interviews were conducted with hospitalized pregnant women with gestational diabetes mellitus. The research was conducted in four teaching hospitals in Tehran, Iran; purposive sampling was used.

RESULTS

Participants' experiences regarding factors that influence treatment compliance fell into six categories: Unexpected diagnosis, the need for urgent change, temptation to consume inappropriate foods, life in the shadow of the illness, risk avoidance, and seeking adjustment.

CONCLUSIONS

Holistic education of families on gestational diabetes, training specialist diabetes nurses, and referral to public health centers and diabetes clinics could increase treatment compliance. These findings could serve patients and the healthcare system in general, if considered by healthcare officials and policy makers. Furthermore, providing outpatient services, considering cultural dietary conventions when recommending diets, and alleviating the stigma associated with diabetes through mass media could also promote treatment compliance.

Parents' participation in taking care of hospitalized children: A concept analysis with hybrid model

BACKGROUND

Although today parents' participation in taking care of hospitalized children is considered as an indispensable principle, it is still among the concepts with no consensus about. The main objective of this study is to define parents' participation in taking care of hospitalized children.

MATERIALS AND METHODS

The concept of "parents' participation in taking care of hospitalized children" was analyzed using a hybrid model in three phases: Literature review (theoretical phase), fieldwork, and combination of literature review and fieldwork (analytical phase).

RESULTS

Based on the results of theoretical (literature review), fieldwork, and analytical phases, the best definitions for the concept of "parents' participation in taking care of hospitalized children" are mutual relationship and gaining parents' trust toward nurses, giving the required information and education to the parents about care and treatment process, assigning the needed home care to the parents, involving the parents in caregiving process, and finally, defining their participation in decision making (clarifying the parents' role) in order to improve the quality of care given to the children.

CONCLUSIONS

The findings of this study showed that the dimensions of parents' participation can be applied in pediatric wards, and nurses can improve the quality of care through application of the obtained findings.

Nursing professionalism: An evolutionary concept analysis

BACKGROUND

Professionalism is an important feature of the professional jobs. Dynamic nature and the various interpretations of this term lead to multiple definitions of this concept. The aim of this paper is to identify the core attributes of the nursing professionalism.

MATERIALS AND METHODS

We followed Rodgers' evolutionary method of concept analysis. Texts published in scientific databases about nursing professionalism between 1980 and 2011 were assessed. After applying the selection criteria, the final sample consisting of 4 books and 213 articles was selected, examined, and analyzed in depth. Two experts checked the process of analysis and monitored and reviewed them.

RESULTS

The analysis showed that nursing professionalism is determined by three attributes of cognitive, attitudinal, and psychomotor. In addition, the most important antecedents concepts were demographic, experiential, educational, environmental, and attitudinal factors.

CONCLUSION

Nursing professionalism is an inevitable, complex, varied, and dynamic process. In this study, the importance, scope, and concept of professionalism in nursing, the concept of a beginning for further research and development, and expanding the nursing knowledge are explained and clarified.

Implementation of evidence-based nursing practice for diabetic patients: an Iranian experience

Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice.

Exploring sources of knowledge utilized in practice among Jordanian registered nurses

RATIONALE, AIMS AND OBJECTIVES

Understanding sources of knowledge used in everyday practice is very helpful in improving the quality of health care services. There is a consensus in the literature that nurses mostly relied in their practice on experiential knowledge gained through their interactions with other members of health care professionals and patients. The general aim of this study is to explore the sources of knowledge Jordanian registered nurses use during their practice.

METHOD

A descriptive correlational design was used to collect data from 539 Jordanian registered nurses from 10 hospitals using a self-administered questionnaire.

RESULTS

The mean year of experience of the sample was 7.08 years. Of the 615 questionnaires distributed, 555 were returned. This yields a response rate of 87.6%. Results revealed that the top five ranked sources used by Jordanian registered nurses include: the information that nurses learned during nursing education, personal experience in nursing over time, what was learned through providing care to patients, information gained through discussion between physicians and nurses about patients, and information from policy and procedure manuals.

CONCLUSION

Jordanian registered nurses recognize the value of research and that research utilization (RU) is an important issue and must not be ignored. The study has many implications for practice, education and research. Health care managers and decision makers need to play a more visible and instrumental role in encouraging RU to improve patients' quality of life.

Critical thinking dispositions of nursing students in Asian and non-Asian countries: a literature review

Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.

A qualitative study on Iranian nurses’ experiences and perspectives on how to provide safe care in clinical practice

Nurses are the healthcare providers who are well positioned to strengthen patient safety through providing safe care in clinical practice. The purpose of this study was to explore and describe the experiences and perspectives of Iranian nurses in relation to how to provide safe care in clinical practice. A qualitative design by using a content analysis approach was applied for the data gathering and analysis. After employing a purposive sampling to choose 16 bachelor’s degree nurses working in the medical and surgical wards of a referral teaching hospital in an urban area of Iran, semi-structured interviews were conducted to collect data. During the data analysis, three main themes emerged: ‘providing safe care as the patient’s right’, with the subthemes: ‘feeling a personal commitment’ and ‘incorporating patients’ feelings of safety into providing safe care’, ‘encouraging reciprocal accountability in healthcare professionals’ and ‘leadership commitment to safe care’. The findings suggest that educators should provide more information during nurses’ education to focus on the moral duty to provide safe care. In addition, the provision of safe care needs the commitment and collaboration of all healthcare professionals, as well as the leadership of nursing for removing obstacles to nurses’ efforts to making the healthcare system safer.

Facilitating safe care: a qualitative study of Iranian nurse leaders

Aim  The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background  The health-care system's success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method  A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results  The data analysis resulted in three main themes: 'providing environmental prerequisites for safe nursing practice', 'uniting and integrating health-care providers', and 'creating an atmosphere of safe care'. Conclusion  The results indicate that to facilitate providing safe care, nurse leaders should improve nurses' working conditions, develop the nurses' practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers' professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management  Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety.

Early childhood experiences, parenting and the process of drug dependency among young people in Tehran, Iran

INTRODUCTION AND AIMS

Substance abuse has become a major public health problem in Iran. The process of developing an addiction is complex and multifaceted. Early childhood experiences are thought to be one of the important determinants of addictive behaviour. The aim of this qualitative study is to explore the early childhood experiences, especially the experiences within the immediate family, of current substance-using young adults in Iran.

DESIGN AND METHODS

The study is qualitative in nature. In-depth interviews were conducted with 15 young men and women who were either in treatment for their addiction or were active drug users at the time of the interviews. Moreover, four interviews have been conducted with family members of participants.

RESULTS

The majority of the participants experienced traumatic events during childhood and came from dysfunctional families. There appears to be a significant disconnect between these individuals and their families. An obedience-instilling parenting style and parents' knowledge and attitude toward drug using and prevention were also identified as important determinants of substance use.

DISCUSSION AND CONCLUSIONS

The results of this research point out the need for early interventions for at-risk families as well as at-risk individuals.

Patient safety: nursing students' perspectives and the role of nursing education to provide safe care

BACKGROUND AND AIM

Nurses as the largest group of healthcare providers are in the best position to improve patient safety. In preparing future nurses, nurse educators have an important role in developing the knowledge, skills and attitudes among nursing students related to patient safety. The aim of this study was to explore Iranian nursing students' perspectives regarding patient safety and the role of nursing education in developing their capabilities to provide safe care.

METHODS

A purposeful sampling strategy was used to recruit 17 junior and senior nursing students for qualitative, semi-structured interviews. Content analysis of the interview transcripts was conducted to identify several relevant themes.

FINDINGS

Three main themes emerged from the data analysis: 'safety as patient comfort', 'not being knowledgeable or experienced enough' and 'being helped to internalise the principles and values of patient safety'. The third theme consisted of two categories: 'adopting a humanistic approach towards patients' and 'practising conscientiously in the workplace'.

CONCLUSION

The present study adds insights on how nursing students understand and may be helped to internalise concepts of patient safety within their practice. Nursing education curriculum designers need to go beyond theoretical concepts of patient safety education and devise strategies to increase the application of safety knowledge and competencies in nursing practice.

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

BACKGROUND

Communication is the source of patients' health promotion, and nurses cannot do their duties without communicating with patients. Nurses with good communication skills have a great role in alleviating the stressful identity of hospitalization for both patients and their families.

AIM

To explore cultural and contextual factors influencing nurse-patient communication according to lived experiences of Iranian nurses and patients.

METHODS

The participants in this qualitative study consisted of eight bachelor's degree nurses and nine patients hospitalized in surgical and medical wards of a referral teaching hospital in Tehran, Iran. Data were gathered through unstructured and semi-structured interviews as well as observations. The data were analysed using a content analysis approach.

FINDINGS

The data analysis revealed the following theme that encompassed nurse-patient communication in Iranian nursing: 'a patient-centred attitude in the shadow of mechanistic structure'. This theme consisted of three categories: (1) communication as the essence of nursing care, (2) reactive communication and (3) difficulties of nurse-patient communication.

CONCLUSION

In spite of the nurses' and patients' belief in the importance of communication, in practice each party's role in communication leaves much to be desired. This is because of some structural and socio-cultural factors that hinder effective communication. More attention should be paid by policy makers to remove factors that hinder the nurse-patient communication process.

Perspectives of Iranian male nursing students regarding the role of nursing education in developing a professional identity: a content analysis study

AIM

The purpose of the present study was to explore the perspectives of Iranian male nursing students regarding the role of nursing education in developing a professional identity.

METHODS

A qualitative design, based on the content analysis approach, was used to collect the data and analyze the perspectives of 14 Iranian male nursing students who were chosen by using a purposive sampling strategy. After the selection of the participants, semistructured interviews were held in order to collect the data.

RESULTS

During the data analysis, three main themes emerged: "reality-expectation incompatibility", "being supported by the educational system", and "nursing image rectification". The second theme consisted of two categories: "feeling trusted" and "being defended".

CONCLUSIONS

This study will be useful to nurse educators and administrators in relation to what constitutes nursing students' professional identity within the Iranian culture and context and how nursing education can play an effective role in developing their professional identity in order to devise strategies to attract male students to the nursing profession and promote their retention after graduation.

Workplace violence against Iranian nurses working in emergency departments

BACKGROUND

Nurses working in emergency departments (EDs) are in the most danger of workplace violence (WPV) because of the critical nature of the wards.

AIMS

This study aimed to find the frequency and nature of physical and verbal WPV against Iranian nurses working in EDs.

METHODS

A cross-sectional study was carried out using consensus sampling of 196 bachelor's degree nurses working in 11 EDs of teaching hospitals in Tehran, Iran. The data were collected through the adapted version of a self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization/Public Services International on WPV in the health sector. The gathered data were analysed using descriptive and inferential statistics.

RESULTS

The participants were mostly (89.1%) female and their work experiences (63.2%) in nursing were between 1 and 5 years; 19.7% of the nurses had faced physical violence. All of the physical violence incidents were without-weapon; 91.6% of the participants experienced verbal abuse during the past year. Patients' relatives were the most common source of violence. Dissatisfaction was reported on the way the incidents were handled.

CONCLUSION

It is believed that finding the pattern and nature of WPV is the first step to develop suitable strategies to deal with the issue. Establishing WPV management teams and enacting appropriate laws can improve workplace safety for nurses and patients' care quality.

Ambiguity in knowledge transfer: The role of theory-practice gap

BACKGROUND

In spite of much literature written about the theory-practice gap in the international nursing journals, there is evidence that indicates this subject has not been probed comprehensively since nursing education was transferred to universities in Iran. In the recent years, the public and the government have criticized Iranian nurses because of poor quality of patient care. Although this subject has been lamented by some researchers, there is no comprehensive work on how this gap resulted. In the process of a larger study on "nursing knowledge translation to practice", of one PhD thesis, this process was explored.

METHODS

Using grounded theory analysis, indepth interviews were undertaken with a purposive sample of 29 nurses, with different levels of experience, from the school of nursing in Tehran University of Medical Sciences in 2006 from January to August. Data were analyzed using the constant comparative method.

RESULTS

Three main themes emerging from this study included clinical behavior structure, paradoxical knowledge and practice, and divergent nursing organization.

CONCLUSIONS

It seems that nursing education with some praxis and paradoxes in the realm of nursing knowledge and practice, along with divergent organizational structure have decreased nurses' ability in applying their professional knowledge and skills in order to bridge the gap between theory and practice. Moreover, in spite of increased academic input into nursing education, clinical behaviors of both education and practice settings was perceived as "traditional routine-based".

Iranian nurses' constraint for research utilization

Background

This paper identifies the views of Iranian clinical nurses regarding the utilization of nursing research in practice. There is a need to understand what restricts Iranian clinical nurses to use research findings. The aim of this study was to identify practicing nurses' view of aspects which they perceived constrain them from research utilization that summarizes and uses research findings to address a nursing practice problem.

Methods

Data were collected during 6 months by means of face-to face interviews follow by one focus group. Analysis was undertaken using a qualitative content analysis.

Results

Findings disclosed some key themes perceived by nurses to restrict them to use research findings: level of support require to be research active, to be research minded, the extent of nurses knowledge and skills about research and research utilization, level of educational preparation relating to using research, administration and executive challenges in clinical setting, and theory-practice gap.

Conclusion

This study identifies constraints that require to be overcome for clinical nurses to actively get involved in research utilization. In this study nurses were generally interested to use research findings. However they felt restricted because of lack of time, lack of peer and manager support and limited knowledge and skills of the research process. This study also confirms that research utilization and the change to research nursing practice are complex issues which require both organizational and educational efforts.

Iranian nurses' attitudes toward research utilisation

Research utilisation poses significant challenges for the nursing profession in Iran. Nurses' attitudes toward research and their motivation to engage in research utilisation have repeatedly been identified as potential barriers. Yet little is known about the attitudes of Iranian nurses' regarding research. Therefore, there is a need for a study that focuses particularly on Iranian nurses' attitudes toward research utilisation. The objective was to assess the attitude of Iranian clinical nurses and nurse educators towards nursing research. A self-administered questionnaire based on a cross-sectional survey conducted on 410 respondents from 15 educational hospitals and nursing schools affiliated to Tehran Medical Sciences University, Iran. According to the self-report, nurses generally held positive attitudes toward research. Education, professional role and research activities had a statistically significant relationship with their research attitudes. Although the attitudes towards research were positive, they do not perceive that research is relevant to the day-to-day work of nursing and research is not applicable to nursing as well. The majority of nurses are still not convinced of the importance of research to nursing practice and to the nursing profession. This, in turn, means that nurses do not implement research findings in clinical practice. There is an immediate need to improve research training in our teaching hospital to facilitate the development of the local literature both in terms of research utilisation and production.

Professional ethics as an important factor in clinical competency in nursing

It is imperative to understand the factors that influence clinical competency. Consequently, it is essential to study those that have an impact on the process of attaining clinical competency. A grounded theory approach was adopted for this study. Professional competency empowers nurses and enables them to fulfill their duties effectively. Internal and external factors were identified as affecting clinical competency. A total of 36 clinical nurses, nurse educators, hospital managers and members of the Nursing Council in Tehran participated in this research. Data were obtained by semistructured interviews. Personal factors and useful work experience were considered to be significant, based on knowledge and skills, ethical conduct, professional commitment, self-respect and respect for others, as well as from effective relationships, interest, responsibility and accountability. Effective management, education systems and technology were named as influential environmental factors. Personal and environmental factors affect clinical competency. Ethical persons are responsible and committed to their work, acquiring relevant work experience. A suitable work environment that is structured and ordered also encourages an ethical approach by nurses.

Effect of local refrigeration prior to venipuncture on pain related responses in school age children

INTRODUCTION

Painful medical procedures are the major sources of distress among children; and for those with chronic diseases, the procedure-related pain can be worse than that of the illness itself.

OBJECTIVE

The purpose of the study was to determine the effect of local refrigeration prior to venipuncture on pain-related responses in school-age children.

DESIGN

Quasi-experimental study.

SETTING

This study was undertaken in a paediatric emergency ward of a paediatric centre.

SUBJECTS

The subjects were 80 children 6 to 12 years of age selected by purposive sampling after being referred to the paediatric emergency ward.

INTERVENTIONS

Two groups were chosen for the study: the test and control groups, in order to test the effect of local coldness in reducing the pain of venipuncture. In the test group, the injection site was refrigerated for three minutes using an ice bag. In the control group, the procedure was performed according to usual routine. Physiological responses (ie. blood pressure, pulse, and respiration), behavioural responses (using the Children's Hospital of Eastern Ontario Pain Scale: CHEOPS), and subjective responses (or intensity of pain using the Oucher scale) were measured in the two groups. A non-invasive (electronic) sphygmomanometer was used before and 5 minutes after the procedure to measure the physiological responses. The measurement of behavioral responses by CHEOPS was done at two time points (during the procedure and 5 minutes after the procedure), measuring six areas of behavior: cry, facial expressions, child verbal, torso, touch and leg movement in reaction to painful stimulation. Finally, the subjective responses were measured at 5 minutes after the procedure.

MAIN OUTCOME MEASURES

In this study the main outcome measures were: range of physiologic responses, and scores of behavioral and subjective responses. The study hypothesised there would be a lower score in the test group than the control group in behavioural and subjective responses and a lower range in physiologic responses.

RESULTS

Results showed no significant difference between the two groups for physiological responses (before and after procedure). However behavioural responses during and after the procedure (p = 0.0011), and subjective responses after the procedure (p = 0.0097) were significantly lower (ie. the test group had lower scores in behavioural and subjective responses compared to the control group.

CONCLUSION

The results of this study suggest that the use of local refrigeration prior to venipuncture can be considered an easy and effective intervention of reducing venipuncture-related pain.