Challenges of home care: a qualitative study

BACKGROUND

Despite countless benefits of home care, unfortunately, the variety and quality of services provided by homecare centers are uncertain. This study was conducted to explore of home care challenges.

METHODS

The present qualitative study used the content analysis approach. A total of 17 participants, including nurses, managers of home care centers, and patients, were enrolled through purposive sampling. Data were collected using semi-structured interviews and analyzed through Granheim's qualitative content analysis method.

RESULTS

In order to explain the challenges of home care, after analyzing the data, 700 primary codes, 15 initial categories, sub-subcategories and two main categories, including 'infrastructural challenges' and 'challenges related to the process of home care services provision' emerged. The main category, "infrastructural challenges", consisted of 4 sub-categories (the challenge of acculturalization of home care services, economic challenges of providing services, challenges related to human resources, and the challenge of policymaking and setting regulations and rules for home care). The second main category, "challenges related to the process of home care services provision", consisted of 2 subcategories: challenges of improving the quality of home care services and the challenge of facilities for service provision.

CONCLUSION

In order to promote and improve the quality of home care services, in addition to providing insurance coverage for the services, acculturalization and revising the bylaws, empowering the human resource, enhancing the monitoring of the performance of home care centers, and employing modern technology need to be taken into account.

How can healthcare providers involve with families in the care of patients with chronic mental illness? A mixed methods protocol study to adapt the clinical practice guideline

BACKGROUND

Chronic mental illnesses have long periods, are recurring, and require continuous care as well as an integrated and collaborative approach to organize the care. The purpose of this article is to summarize the most important steps necessary for adapting a clinical practice guideline for family-centered collaborative care of patients with chronic mental illnesses referring to the medical centers.

MATERIALS AND METHODS

As the study will be an exploratory mixed methods study, the design will be carried out as a sequential qualitative-quantitative study (QUAL quan), consisting of 3 phases, 9 modules, and 24 sequential steps, which is based on the Guidelines International Network to adapt the guideline manual. In the first phase, the prerequisites for adaptation of the clinical guideline were established. In the second phase, to collect evidence, a qualitative study (semi-structured interview) will be conducted to explore the dimensions and components of the care needs of patients with chronic mental disorders and their families from the perspectives of patients, caregivers, and healthcare providers. Additionally, a literature review to extract relevant clinical guidelines and articles will be done. A panel of experts will screen and evaluate potential clinical guidelines, and a draft guideline will be developed.

DISCUSSION

It is expected that these findings will meet the needs of patients with mental illness and their caregivers by providing integrated care and improving collaborative care within the sociocultural context of Iran.

The Relationship between Moral Sensitivity and Professional Behaviour and Its Comparison in First- and Last-Year Undergraduate Nursing Students

Background

Nursing students should be equipped with ethical sensitivity and professional behaviour because they will face challenging ethical issues in their future work environment. This study aimed to determine the relationship between moral sensitivity and professional behaviour and compare it in first- and last-year undergraduate nursing students.

Methods

This study was a cross-sectional, correlational study that was conducted at Isfahan University of Medical Sciences in 2019. The sample size of this study was 238 nursing students. The tools used in this study were the Persian versions of the moral sensitivity questionnaire and the professional behaviour questionnaire. The data were analyzed using SPSS 18 software.

Results

Linear regression showed that the total score of moral sensitivity of nursing students had a significant relationship with their professional behaviour (p  <  0.05). The result of the univariate analysis showed that the mean total score of moral sensitivity and professional behaviour was significantly higher in the last year than in first-year students (p  <  0.05).

Conclusion

Considering the relationship between moral sensitivity and the professional behaviour of nursing students, the promotion of moral sensitivity can become the basis for the development of the professional behaviour of nursing students. Therefore, it is suggested to focus on teaching the principles of nursing ethics to develop the moral sensitivity of undergraduate nursing students.

Nurses' viewpoints on factors affecting ostomy care: A qualitative content analysis

AIMS

Ostomy plays an important role in management of medical conditions, especially postoperative status of colorectal and bladder cancers. Nurses who have the highest contact level with these patients, face many situations while providing care and need to acquire adequate knowledge and practice responding to patients' needs. The aim of this study was to explore the lived experiences of nurses in caring of abdominal ostomy patients.

DESIGN

A qualitative content analysis study.

METHODS

In this qualitative content analysis study, 17 participants were selected using purposeful sampling method and data were collected through in-depth and semi-structured interviews. Data analysis was done using conventional content analysis method.

RESULTS

Analysis of the findings led to the emergence of 78 sub-subcategories, 20 subcategories and seven main themes, including 'Inefficient educational system', 'Nurse Characteristics', 'Workplace challenges', 'Nature of ostomy care', ' Counseling and preparation of patients for surgery', 'Acquaintance with ostomy complications', and 'Proper planning of patient education'. Results showed that nurses in surgical wards provide non-special ostomy care due to lack of sufficient knowledge and skills and absence of up-to-date and local clinical guidelines which is vital to provide evidence-based scientific care and avoid unfounded and arbitrary care.

CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE PERSIAN VERSION OF THE FAMILY FUNCTIONING, HEALTH, AND SOCIAL SUPPORT QUESTIONNAIRE IN A SAMPLE OF HEART FAILURE PATIENTS AND THEIR FAMILY MEMBERS

Background and Purpose: Family functioning, family health, and social support have significant roles in the management of heart failure (HF). This study aimed to translate, adapt, and assess the validity and reliability of the Persian version of the Family Functioning, Family Health, and Social Support (FAFHES) questionnaire. Methods: FAFHES questionnaire was translated into Persian, and an expert panel assessed the cross-cultural adaptation. We examined the construct validity by confirmatory factor analysis and internal consistency by Cronbach's alpha coefficients among 576 participants. Results: The Persian FAFHES confirmed the three-factor structure in the social support and the five-factor structure in the family health scales. However, the family functioning scale yielded the three-factor structure versus the four-factor structure in the original scales. The Cronbach's alpha for the three scales varied from 0.85 to 0.94. Conclusions: The adapted FAFHES seems to be valid and reliable to measure family functioning, family health, and social support in families with HF.

Family-centered collaborative care for patients with chronic mental illness: A systematic review

Background

Chronic mental illnesses (CMI) are long lasting and reoccurring and require continuous care as well as an integrated and collaborative approach to organize the care. This study sought to examine whether family centered collaborative care is an acceptable treatment option for individuals with CMI.

Materials and Methods

From the years 2000 to 2021, ten electronic databases relating to family centered collaborative care for mental illness were searched adopting Preferred Reporting Items for Systematic Reviews and Meta Analysis checklist. Twenty seven relevant articles and a thesis from among 6956 studies retrieved, were assessed their quality appraisal through four standardized tools. The studies were rated as good, moderate, or poor. Studies were calibrated, different opinions were discussed, and extracted data were done.

Results

Evidence included 11 randomized controlled trials (from 19 articles), one randomized control trial, three mixed methods studies (from 3 articles and 1 thesis), and a qualitative study (from 4 articles). The quality of seven studies was good, 15 were moderate quality, and seven were poor quality. According to moderate to high quality qualitative research, family centered collaborative care was considered an acceptable intervention; though a few studies supported it.

Conclusion

The findings demonstrated that family involvement in the care of patients with CMI affects no recurrence of the disease, and no re hospitalization of patients with this disorder. As a result, engaging family members in the care process can have a positive impact on the health and well being of these patients.

Identifying the dimensions of patient privacy in intensive care units: a qualitative content analysis study

In intensive care units (ICUs), patient privacy is of particular importance due to the structure of the ward environment and the critical situation of the patients. The aim of this study was to identify the dimensions of patient privacy in ICUs. For this purpose, a descriptive-qualitative-exploratory study was performed. The data collection methods included observations and interviews, which were handwritten and analyzed using qualitative content analysis with a conventional approach. A total of 27 participants were selected based on purposeful sampling and with maximum diversity of health-care providers and recipients. The study environment was the ICUs of two selected hospitals affiliated to the medical sciences universities of Isfahan and Tehran, Iran. The data were analyzed into 4 classes and 12 subclasses. The classes included physical, informational, psychosocial, and spiritual- religious privacy. Findings of the present study identified hidden layers of patient privacy as a multidimensional concept that is influenced by various factors. In order to provide holistic care, preparing the grounds for patient privacy and familiarizing the staff with its various dimensions seem necessary.

The relationship of family functioning and family health with hospital readmission in patients with heart failure: insights from an international cross-sectional study

BACKGROUND

The growing hospital readmission rate among patients with heart failure (HF) has imposed a substantial economic burden on healthcare systems. Therefore, it is essential to identify readmission associating factors to reduce hospital readmission.

AIMS

This study aimed to investigate the relationship of family functioning and family health with hospital readmission rates over six months in patients with HF and identify the sociodemographic and/or clinical variables associated with hospital readmission.

METHODS

This international multicentre cross-sectional study involved a sample of 692 patients with HF from three countries (Denmark 312, Iran 288, and Iceland 92) recruited from January 2015 to May 2020. The Family Functioning, Health, and Social Support questionnaire was used to collect the data. The number of patients' hospital readmissions during the six-month period was retrieved from patients' hospital records.

RESULTS

Of the total sample, 184 (26.6%) patients were readmitted during the six-month period. Of these, 111 (16%) had one readmission, 68 (9.9%) had two readmissions, and 5 (0.7%) had three readmissions. Family functioning, family health, being unemployed, and country of residence were significant factors associated with hospital readmission for the patients.

CONCLUSION

This study highlights the critical roles of family functioning and family health in six-month hospital readmission among patients with HF. Moreover, the strategy of healthcare systems in the management of HF is a key determinant that influences hospital readmission. Our findings may assist the investigation of potential strategies to reduce hospital readmission in patients with HF.

Barriers to family involvement in the care of patients with chronic mental illnesses: A qualitative study

INTRODUCTION

Caregivers are patients' family members or intimate friends who take care of individuals suffering from chronic mental illnesses without being paid. Evidence has supported the role of family-centered collaborative care in the treatment of patients with chronic mental illnesses. It has also been emphasized by national policies. However, carrying out this type of care is accompanied by challenges in Iran. Considering the importance of family participation in taking care of these patients as well as the necessity to determine its effective factors, the present study aimed to assess the barriers to family involvement in the care of patients with chronic mental illnesses.

METHOD

A conventional content analysis was used to conduct this qualitative study. Thirty four health care providers, patients, and caregivers were interviewed unstructured in-depth face-to-face using purposive sampling. Until saturation of data, sampling and data analysis were conducted simultaneously. Graneheim and Lundman's method was used to record, transcribe, and analyze the interviews.

RESULT

The results showed that there were many barriers to the collaboration of family in the care of patients with chronic mental illnesses. Accordingly, four main categories and twelve subcategories were extracted from the data as follows: "family-related barriers", "treatment-related factors", "disease nature threatening care", and "mental disease-associated stigma in the society".

CONCLUSION

The findings presented the barriers to family centers' collaborative care in patients with chronic mental illnesses and the necessary components of family involvement in the care to be used by healthcare managers and policymakers. The reported barriers emphasize the need for the development of structured approaches whose implementation is easy for health care providers, does not require a lot of time and resources, and can improve patient and family outcomes.

Development of a Patient Decision Aid to Help People Living with Inflammatory Bowel Disease

BACKGROUND: Patient decision aid (PDA) is a tool, which helps the improvement of shared decisionmaking and is a part of the paradigm shift from physician-centered decisions to patient-centered shared decision making. In this study, we aimed to describe the process used to develop a PDA for facilitating shared decision-making about treatment in patients with inflammatory bowel disease (IBD) who need medication (corticosteroid, azathioprine, anti-TNF, and infliximab) or surgery. METHODS: The development process of PDA included: 1) The development of a prototype based on literature review and interview 2) 'Alpha' testing with patients and clinicians 3) 'Beta' testing in real conditions and 4) The production of a final version. This process took about 12 months (2019-2020). The participants were adult patients with IBD, gastroenterologists, and nurses. RESULTS: The final PDA contains four important sections: 1) Introduction about IBD disease, the purpose of developing PDA, and emphasis on shared decision-making 2) Benefits and risks of main medicines 3) The success rate as well as the incidence of complications after surgery, and 4) The conclusion about patients' satisfaction with PDA to choose the treatment options. Besides, PDA evaluation in the real world setting showed that 100% of physicians (n=4) and 86% of patients (n=12) were completely satisfied with the content of the PDA and considered it applicable and useful. CONCLUSION: This PDA can help patients participate in the shared decision-making process and select the best medical and surgical treatment methods. The feedback received from clinicians and patients showed their satisfaction with using the PDA.

A quality assessment of clinical practice guidelines with recommendations for family involvement in the care of individuals diagnosed with schizophrenia, bipolar mood disorder, and major depressive disorder: Critical appraisal utilizing AGREE II

INTRODUCTION

Evidence suggests that family-center collaborative care is useful for individuals identified with chronic mental illness. Clinical practice guidelines offer specific recommendations primarily based on to be had studies and are beneficial in informing evidence-based practice and guiding destiny studies.

OBJECTIVE

Identify current scientific practice guidelines including family-center collaborative care suggestions for individuals with Bipolar Mood Disorder, Schizophrenia, and Major Depressive Disorder and analyze the selection of guidelines for their methodological quality.

METHODS

A systematic search was conducted on seven electronic databases (G-I-N), (NICE), (MOH), (SIGN), (WHO), (NIH) and (APA) and additional sources. Three referees independently reviewed articles and selected guidelines for inclusion criteria. Subsequently, 18 trained appraisers independently assessed all 15 guidelines using AGREE II.

RESULTS

The mean scores for domains and overall quality were computed. For the overall assessment of the guidelines, 60% reached the quality threshold with domain scores of 60%. The overall average quality rating for these guidelines was 58/29%.

CONCLUSION

The applicability of the guidelines needs to be improved in order to improve their relevance and clinical utilization. As individuals with chronic mental illnesses progress through their disease course, families and health care providers play a crucial role in helping them. The analysis of research knowledge on effective rehabilitation techniques, including the involvement of families in treatment, can be enhanced by using well-developed and appropriate methods.

Challenges to Family Caregivers in Caring for Gastric Cancer Patients from Perspectives of Family Caregivers, Patients, and Healthcare Providers: A Qualitative Study

Objectives:

Cancer affects both patients and their families. Sometimes, the effects of cancer on families are greater than its effects on patients. Family caregivers play significant roles in care for patients with cancer. Nonetheless, the data on the challenges they face in caregiving are limited. The present study explored the perspectives of patients with gastric cancer (GC), their family caregivers, and healthcare providers regarding family caregivers’ challenges in caregiving to patients with GC.

Materials and Methods:

This descriptive exploratory qualitative study was conducted in 2019–2020. Six GC patients, six family caregivers, three physicians, and five nurses took part for a total of twenty participants. Purposive sampling was performed, and data were collected through semi-structured interviews and continued up to data saturation. Conventional content analysis was used for data analysis.

Results:

Caregivers’ challenges in caregiving to patients with GC were grouped into five main categories, namely, lengthy process of GC diagnosis, delivery of bad news, management of physical symptoms, altered relationships, and psychological consequences, and 14 subcategories.

Conclusion:

Educating the public about the primary symptoms of GC and the importance of timely seeking medical care as well as using culturally appropriate protocols for delivering bad news is recommended. Empowering family caregivers for the effective management of GC symptoms and caregiving-related challenges are also recommended to reduce their caregiver burden.

Increased classical monocyte subsets in South Asians compared to White Caucasians at risk for coronary atherosclerosis

Background

South Asians (SA) have an increased prevalence of coronary artery disease (CAD) and myocardial infarction compared with age- and sex-adjusted White Caucasians (WC). The mechanism for this increased risk is poorly understood. While classical CD14++CD16- monocytes act as independent predictors of cardiovascular disease, differences in the distribution of monocyte subsets between SA and WC have not been established.

Purpose

We aimed to determine if differences exist in monocyte subsets between SA and WC at risk for CAD.

Methods

Our cohort consisted of 119 consecutively enrolled patients (59 SA, 60 WC) at intermediate or higher risk for CAD by the INTERHEART score using self-reported history and physical exam. A single blood sample was collected prospectively for the purpose of monocyte analysis. Flow cytometry using dual colour fluorescence (CD14, CD16) within the monocyte gate was used to identify monocyte subsets (classical, intermediate and non-classical) by staff blinded to the individuals' characteristics.

Variables were compared using Mann-Whitney U test and Chi-squared test, as appropriate. Eta coefficient was calculated to analyze the relationship between ethnicity and proportion of monocyte subsets. Eta squared values were calculated to assess the impact of ethnicity on monocyte subset proportions.

Results

The SA group consisted of 64% males with a mean age of 54 (± 9), while the WC group consisted of 55% males with a mean age of 59 (± 7). Both groups had similar body mass index, rates of hypertension, dyslipidemia and family history of premature CAD. Compared to WC, SA had higher prevalence of diabetes (36% vs. 13%, p=0.005) and hemoglobin A1C levels (6.0±1.1% vs. 5.6±0.6%, p&lt;0.001). SA patients had a higher proportion (85.3±10.7% vs. 81.4±11.0%, p=0.009) and total level (449.0±180.4 vs. 388±127.4, p=0.010) of classical CD14++CD16- monocytes compared to WC. There was no difference between the two groups in the proportion of intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes. There was no association between diabetes and the proportion of monocyte subsets. Ethnicity had a moderate association with the proportion of classical CD14++CD16- monocytes (Eta coefficient = 0.525) with a large effect size (Eta squared = 27.5%). The association of ethnicity with intermediate CD14++CD16+ and non-classical CD14+CD16++ monocytes was either weak or negligible with minimal to no effect size.

Conclusion

In patients with substantive risk for CAD, SA had a significantly higher proportion and level of classical CD14++CD16- monocytes compared to WC. Our findings provide a novel insight into the potential mechanism of increased CAD susceptibility amongst SA compared to WC. Future studies are needed to determine whether these ethnic differences in the distribution of monocyte subsets can predict susceptibility to developing CAD and suffering atherothrombotic events.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Academic Practice Plan grant at the University of British Columbia

The Effect of an Educational Intervention based on Pender's Health Promotion Model on Treatment Adherence in the Patients with Coronary Artery Disease

Background:

Increasing of hospitalization rates of Coronary Artery Disease (CAD) management have created major challenge for the health system. Poor adherence to treatment is one of the main reasons for treatment failure, prolongation of treatment, and increase care costs. The aim of this research was to determine the effect of educational intervention based on Pender's Health Promotion Model (HPM) on adherence in patients with CAD.

Materials and Methods:

This randomized controlled clinical trial was held in an educational hospital in Isfahan, Iran, February 2018–May 2019. Data were collected from 64 patients with CAD, before, 1 and 3 months after the intervention. The instrument used included treatment adherence questionnaire and a checklist Pender's HPM. The study group received dietary, exercise, and medication education based on Pender's HPM in four sessions which were held in 4 weeks. The control group received the routine educational program of the hospital. The data was analyzed using descriptive statistics, repeated measures ANOVA, independent t, Chi-square, and Mann–Whitney tests via SPSS software.

Results:

The mean score of treatment adherence was significantly different between two groups in one (z = 5.28, df = 2, p < 0.001) and three (z = 4.51, df = 2, p < 0.001) months after the intervention. The mean (SD) of treatment adherence in the study group was 139.82 (27.44) 3 months after the intervention.

Conclusions:

Educational intervention based on Pender's HPM is more effective on treatment adherence than the routine method in the patients with CAD. It is recommended to integrate the Pender's HPM as a nursing care program for these patients.

Value of Emergent Neurovascular Imaging for "Seat Belt Injury": A Multi-institutional Study

BACKGROUND AND PURPOSE

Screening for blunt cerebrovascular injury in patients after motor vehicle collision (MVC) solely based on the presence of cervical seat belt sign has been debated in the literature without consensus. Our aim was to assess the value of emergent neurovascular imaging in patients after an MVC who present with a seat belt sign through a large-scale multi-institutional study.

MATERIALS AND METHODS

The electronic medical records of patients admitted to the emergency department with CTA/MRAs performed with an indication of seat belt injury of the neck were retrospectively reviewed at 5 participating institutions. Logistic regression analysis was used to determine the association among age, sex, and additional trauma-related findings with blunt cerebrovascular injury.

RESULTS

Five hundred thirty-five adult and 32 pediatric patients from June 2003 until March 2020 were identified. CTA findings were positive in 12/567 (2.1%) patients for the presence of blunt cerebrovascular injury of the vertebral (n = 8) or internal carotid artery (n = 4) in the setting of acute trauma with the seat belt sign. Nine of 12 patients had symptoms, signs, or risk factors for cervical blunt cerebrovascular injury other than the seat belt sign. The remaining 3 patients (3/567, 0.5%) had Biffl grades I-II vascular injury with no neurologic sequelae. The presence of at least 1 additional traumatic finding or the development of a new neurologic deficit was significantly associated with the presence of blunt cerebrovascular injury among adult patients, with a risk ratio of 11.7 (P = .001). No children had blunt cerebrovascular injury.

CONCLUSIONS

The risk of vascular injury in the presence of the cervical seat belt sign is small, and most patients diagnosed with blunt cerebrovascular injury have other associated findings. Therefore, CTA based solely on this sign has limited value (3/567 =  a 0.5% positivity rate). We suggest that in the absence of other clinical findings, the seat belt sign does not independently justify neck CTA in patients after trauma.

Factors associated with family functioning in patients with heart failure and their family members: An international cross-sectional study

AIMS

To describe and compare family functioning, family health, and perceived social support from nurses and to identify the variables that are associated with family functioning in patients with heart failure (HF) and their family members in Denmark, Iran, and Iceland.

DESIGN

An international multi-centre cross-sectional study.

METHODS

A sample of 1382 participants (692 patients and 690 family members) from Denmark, Iceland, and Iran were included from January 2015 to May 2020. Data were collected using the Family Functioning, Health, and Social Support questionnaire.

RESULTS

The significant factors associated with family functioning in patients were country, New York Heart Association classification (NYHA), education level, age, family health, social support, and there was a significant interaction effect between NYHA class and gender. The significant factors associated with family functioning in family members were country, education level, work status, family health, and there was a significant interaction effect between education and work status.

CONCLUSION

This study indicated that the strongest factor associated with higher family functioning was family health for both patients and family members. Women in NYHA class I and younger patients and those with an academic education had a lower level of family functioning. Moreover, unemployed family members with an elementary education and family members with elementary and high school educations who were self-employed or employees had a lower level of family functioning.

IMPACT

This is the first international study to investigate family functioning, family health, and social support and adds to the literature on the factors associated with family functioning in patients with HF and their family members. Our findings may help nurses to identify the most vulnerable families living with HF, thereby being able to provide special support to enhance their family functioning to promote self-management strategies.

Nutritional challenges of gastric cancer patients from the perspectives of patients, family caregivers, and health professionals: a qualitative study

PURPOSE

This study aims to explore the perceptions of gastric cancer patients, their family caregivers, physicians, and nurses of nutritional challenges.

METHODS

Using a descriptive qualitative method, this study was conducted in 2019-2020. Twenty participants (6 patients, 6 family caregivers, 3 physicians, and 5 nurses) were selected through purposive sampling. Data was collected through in-depth semi-structured interviews and examined using qualitative content analysis.

RESULTS

Data analysis revealed three categories, each with two subcategories: eating, an unpleasant experience that contains "a feeling like hyperemesis gravidarum" and "childish food excuses"; flexibility while adhering to a proper diet, which consists of "dietary dos and don'ts" and "nutritional leniency"; and nutrition with distress that contains "patient's sense of being an extra burden" and "provision of nutrition with suffering in caregivers."

CONCLUSION

Because of the significant physical and psychological impact of nutritional problems on patients and their caregivers, the need to provide care and education to these patients and their families using a multidisciplinary team is becoming more important.

Perspective and Experience of Hospital Operating Room Nurses with the Concept of Excellence: A Qualitative Study

INTRODUCTION

The provision of care according to the code of ethics is of the highest priority in operating rooms (OR). However, the exposure of the surgical team to a high level of stress may result in unethical behavior and undermine their pursuit of excellence. Since the concept of excellence is complex and there are limited published studies in the nursing literature, there was a need for in-depth research.

OBJECTIVE

The present study aimed at evaluating the perspective and experience of OR nurses with the concept of excellence.

STUDY DESIGN

The conventional qualitative content analysis method was employed to explore the concept of excellence among OR nurses.

PARTICIPANTS AND RESEARCH ENVIRONMENT

The current study was conducted on 20 OR nurses in the elective and emergency operating rooms of hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. The data were collected through in-depth semi-structured face-to-face interviews and field notes from April 2017 to June 2018.

FINDINGS

The four categories extracted from the interview data were "enhanced personality traits", "growth and development", "knowledge enhancement", and "effective teamwork". In addition, a total of 10 sub-categories were extracted.

DISCUSSION

The findings of the present study indicated that OR nurses can achieve personal, professional, organizational, and social excellence through enhancing personality traits, peer learning, teaching ethics to the surgical team members, and educating and training patients and family caregivers through effective teamwork. A close collaboration between OR nurses and nursing managers would develop a culture of pursuit for excellence.

CONCLUSION

The findings of the present study provided a better understanding of the perception of OR nurses with the concept of excellence; based on which, optimal ethical care and an environment for the pursuit of excellence can be developed. The findings also provided evidence-based recommendations to nursing managers on how to gain the trust of patients and family caregivers, and promote the pursuit of personal, professional, organizational, and social excellence.

The Relation between Different Aspects of Quality of Life with Coping Style in Adolescents with Thalassemia in Comparison to a Healthy Group

Background: Thalassemia as a chronic disease could affect different aspects of a patient’s life. On the other hand, when encountering the symptoms of a chronic disease as a stressful factor, the coping strategy of the adolescents and their families could have an important role in the quality of life of these patients. The present study was conducted to determine the relation between different aspects of quality of life with coping styles in the adolescents with thalassemia in comparison to a healthy control group. Materials and Methods: The present study is a case-control research in 2017. Studied samples were 200 adolescents with thalassemia and healthy adolescents. Data gathering tools were demographic characteristics checklist and the coping style and quality of life questionnaire by the World Health Organization. Data were analyzed by SPSS 20 using independent t-test, linear regression and correlation coefficients. Conclusion: Results of Pearson statistical test showed a positive and significant relation between the total mean score of quality of life and its physical, social and mental aspects with emotion-oriented coping style (p<0.01). Also a direct significant relation was observed between the total mean score of quality of life and its social and physical aspects with problem-oriented coping style(p<0.01). Conclusion: According to the results of the present study, educating the adolescents and their families for paying attention to the coping style for stressful factors and preparing these adolescents for passing toward the youth period, which could be challenging for them, are highly recommended. 

The Relation between Different Aspects of Quality of Life with Coping Style in Adolescents with Thalassemia in Comparison to a Healthy Group

Background: Thalassemia as a chronic disease could affect different aspects of a patient's life. On the other hand, when encountering the symptoms of a chronic disease as a stressful factor, the coping strategy of the adolescents and their families could have an important role in the quality of life of these patients. The present study was conducted to determine the relation between different aspects of quality of life with coping styles in the adolescents with thalassemia in comparison to a healthy control group. Materials and Methods: The present study is a case-control research in 2017. Studied samples were 200 adolescents with thalassemia and healthy adolescents. Data gathering tools were demographic characteristics checklist and the coping style and quality of life questionnaire by the World Health Organization. Data were analyzed by SPSS 20 using independent t-test, linear regression and correlation coefficients. Conclusion: Results of Pearson statistical test showed a positive and significant relation between the total mean score of quality of life and its physical, social and mental aspects with emotion-oriented coping style (p<0.01). Also a direct significant relation was observed between the total mean score of quality of life and its social and physical aspects with problem-oriented coping style(p<0.01). Conclusion: According to the results of the present study, educating the adolescents and their families for paying attention to the coping style for stressful factors and preparing these adolescents for passing toward the youth period, which could be challenging for them, are highly recommended.

The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian social security organization

The present study was conducted to determine the relation between nurses’ moral distress and the ethical climate in selected hospitals of the Iranian Social Security Organization (ISSO). This descriptive-analytical correlational study was conducted in 6 hospitals under the coverage of the Iranian Social Security Organization in 2016. Three hundred nurses were selected by convenience sampling method. Data were gathered using Corley’s Standard Moral Distress and Olson’s Hospital Ethical Climate Scales. Data were analyzed using SPSS software version 19.

The mean score of the nurses’ moral distress was 1.94 ± 0.66, which is considered moderate. The mean score of ethical climate was 88.97, indicating desirable ethical climate in these hospitals. The frequency score of moral distress had a unilateral reverse correlation with the total score of ethical climate as well as its dimensions, including colleagues, patients, hospitals and physicians. The score of the intensity of nurses’ moral distress also had a unilateral reverse correlation with the total score of ethical climate and the scores of the hospital and physicians dimensions.

These results emphasized the importance of creating a positive ethical climate to decrease moral distress as well as the need for professional interventions to increase support in moral issues.

Ethical challenges of obtaining informed consent from surgical patients

BACKGROUND

Informed consent can be obtained by various methods, by various people, and with use of various types of consent forms. Persistent effort is necessary to reveal the practical realities of informed consent to improve ethical and legal standards.

OBJECTIVE

To determine the ethical challenges of obtaining informed consent from surgical patients.

METHODS

The present study was a descriptive cross-sectional study using two researcher-made questionnaires and a checklist for data collection. Data were collected from nursing personnel (n = 95) and surgical patients (n = 203) on the surgical wards of three university hospitals in Isfahan, Iran. Data were analyzed using descriptive statistics, Spearman's rank correlation, Pearson's correlation coefficient, and the t-test.

ETHICAL CONSIDERATIONS

The study was approved by the Ethics Committee of Isfahan University of Medical Sciences (No: 396478).

RESULTS

The mean scores (maximum 100) of awareness, competency, and authority were 36.3, 67.7, and 57.6, respectively. The overall quality of the informed consent was poor (score 53.9 of 100). The higher educational level in patients was correlated with lower awareness of and less authority to give informed consent. Only 12.6% of the nurses stated that patients were given sufficient information to assure informed consent. In 89.2% of the consent forms, the risks of the treatment were mentioned. However, alternative methods and risks and advantages of rejecting the treatment were not mentioned in any of the forms.

CONCLUSION

Ethical challenges to obtaining informed consent include patients' poor awareness of their rights, a failure to provide adequate information to patients, absence of consideration of patients' educational level, an unclear definition of who is responsible for obtaining informed consent from the patients, time constraints, and use of unclear language and medical jargon. Constructing an ethical framework may guide nursing staff in dealing with the ethical challenges involved in obtaining informed consent.

Gender identity development in the shadow of socialization: a grounded theory approach

Gender identity is one of the basic forms of identity which has a key role in the mental health during adolescence. The present study was conducted to determine the process of gender identity development among Iranian female adolescents. In this grounded theory study, semi-structured interviews were conducted with 55 purposefully and theoretical selected participants including 30 female adolescents and 25 key informants who lived in urban society of Isfahan, Iran, in 2016-2018. Data were analyzed using Strauss and Corbin's mode of analysis (2008), through constant comparative method, applying levels of open, axial, and selective coding with MAXQDA software. Development of gender identity in the shadow of socialization was presented as the core category extracted from the data in this study. Female adolescents would use "sexual self-expression during puberty," "attachment to parents and peers," "tendency towards the opposite sex," and "effort for social acceptance" as the main strategies in the development of gender identity until achieving "stabilized gender identity." "Girls' communicational skills" and "parents' empowerment" were the causal conditions in this process. "Gender differences" and "sociocultural texture of the society" were the contextual conditions and the influence of "peers" and "media" was the interventional conditions in the development of gender identity in female adolescents. Improving girls' communicational skills, empowering parents for managing their interactions with their daughters, adjusting gender roles in the society, and creating appropriate content by the media could have an important role in helping female adolescents achieving stabilized gender identity.

Caring Burden and Quality of Life of Family Caregivers in Patients Undergoing Hemodialysis: A Descriptive-Analytic Study

BACKGROUND

Caring role, especially in chronic diseases, has a negative impact on the health of family caregivers and can affect their quality of life. Therefore, this study aimed to investigate the care burden and quality of life in family caregivers of hemodialysis patients and their relationship with some characteristics of caregivers and patients.

METHODS

This study was conducted as a descriptive-analytic study in Isfahan from January to February 2017. Sampling was done using census. The number of participants was 254. The data gathering tools consisted of a three-part questionnaire including demographic characteristics, the Zarit questionnaire for caring burden, and SF-36 quality of life questionnaire. Data were analyzed using descriptive statistics, Pearson correlation coefficient test, Spearman's coefficient, ANOVA, and univariate general linear regression. A significant level of 5% was considered.

RESULTS

The mean scores of the quality of life and caring burden were 30.54±9.89 and 44.98±6.82, respectively in caregivers. The age of the patient under care (P<0.001), cost of medications (P=0.008), and hours of care in 24 hours (P<0.001) had a significant relationship with care givers' quality of life. Also, univariate general linear regression revealed that care burden had a significant relationship with the quality of life (P=0.003).

CONCLUSION

Family caregivers who experienced more caring burden had a low quality of life. The researchers suggest that supportive and educational programs should be designed and implemented for this group of patients and their caregivers.

Effectiveness of a self-care education program on hypertension management in older adults discharged from cardiac-internal wards

BACKGROUND

The aim of the present study was to determine the effectiveness of a self-care education (SCE) discharge program with telephone follow-ups in managing hypertension (HTN) in older patients.

METHODS

The study was conducted on 56 older patients with HTN who had recently been discharged from the cardiac wards of hospitals in Isfahan, Iran, in 2017. Participants were randomly allocated to the intervention and control groups. The intervention was a 60-minute SCE discharge program with 4 re-educative telephone follow-ups every 2 weeks based on 4 chapters of the designed SCE program and booklet. After coding the data and entering them into SPSS software, data were analyzed for the comparison of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as frequency of managed HTN in the intervention and control groups at baseline (before discharge), and 2 and 3 months after discharge.

RESULTS

Statistical tests showed no significant difference in any of the demographic and confounding variables as well as baseline BPs (P > 0.050), but at post-intervention follow-ups, after Mauchly's sphericity test, repeated measurements ANOVA showed that the effect of time (P < 0.001) and group (P = 0.043) on SBP was significant. The effect of time (P = 0.036) and group (P = 0.047) on DBP was also significant. McNemar's test showed that the frequency of managed HTN (normal BP), 3 months after discharge, was significantly higher in the intervention group compared to the control group [87.5% (n = 21) vs. 23.1% (n = 6), respectively] (P < 0.001).

CONCLUSION

SCE discharge program with telephone re-educative follow-ups was effective in reducing mean BP. The use of this program as a discharged plan for older adults with HTN and comparison of readmission rates for a longer period are recommended.

The relationship between ethical conflict and nurses' personal and organisational characteristics

INTRODUCTION

Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict.

AIM

The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses.

METHODS

This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0).

ETHICAL CONSIDERATIONS

All participants were informed about the study's aim and were assured that participation in and withdrawal from the study would be voluntary.

FINDINGS

The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was "working with professionally incompetent nurses or nurse assistants." Married nurses, nurses with official employment, nurses with master's degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager's conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict.

CONCLUSION

Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses' exposure to ethical conflict.

How Is Developing the Sense of Belonging in Iranian Adolescent Girls? A Qualitative Study

BACKGROUND:

Communicating with adolescents is associated with many challenges for parents and healthcare providers.

AIM:

This qualitative study was conducted for exploring the sense of belonging in Iranian adolescent girls.

METHODS:

In this study, deep semi-structured interviews were carried out with 27 adolescent girls, 10 experts, and 10 parents. Purposeful sampling was used and continued until data saturation. The data were coded and categorised through a conventional content analysis method by MAXQDA 10.

RESULTS:

Three main categories were obtained from the analysis of the participants’ descriptions: “family; a haven of tranquillity”, “dominated by peers”, and “concerns about differences in gender socialization”. According to our results, most of the girls achieved calmness through being emotionally accepted by their families. But this sense of belonging and tranquillity was shaken by their peers’ showing off, in a way that adolescent girls were always struggling to gain acceptance among their peers. Also for fear of being rejected by their peers’ group, they sometimes began to make friends with the opposite sex. Meanwhile, traditional attitudes towards gender roles and adolescent girls’ feelings about their lower social participation as compared to that of boys had also led to their concern about differences in gender socialization and a lower sense of community belonging among some adolescent girls.

CONCLUSION:

Adequate parental education and the proper management of girls’ interactions with the family and society can play an important role in the development of a sense of belonging among adolescent girls.

Effect of moral empowerment program on moral distress in intensive care unit nurses

BACKGROUND

Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system.

OBJECTIVE

The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care.

METHODS

This research was a randomized clinical trial conducted in two groups and three stages before, after 2 weeks, and 1 month after the intervention in order to evaluate the changes in moral distress of 60 nurses working in adults' intensive care unit wards of Al-Zahra teaching hospital of Isfahan University of Medical Sciences. Data were collected using the standard Hamric's Moral Distress Scale (2012) and analyzed using SPSS software version 22.

ETHICAL CONSIDERATIONS

This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran.

RESULTS

Results showed that in the three stages, there was no significant difference between the mean score of moral distress before (4.12 ± 2.70), 2 weeks after (4.23 ± 2.70), and 1 month after the intervention (4.04 ± 2.54) in the control group (p > 0.05), while in the experimental group, there was a significant difference between the three stages (p < 0.05). The mean score of moral distress in the experimental group before intervention (4.05 ± 2.26) and 2 weeks after the intervention (3.38 ± 2.11) was not significant (p > 0.05). However, this score significantly decreased 1 month after the intervention (2.64 ± 2.23; p < 0.05).

CONCLUSION

In this research, it was observed that moral empowerment program has been effective in reducing the mean score of moral distress. Therefore, it is recommended that nursing managers and hospital directors implement empowerment program, in order to reduce the moral distress of nurses and improve the quality of care.

Midwifery students' experiences of learning clinical skills in Iran: a qualitative study

METHODS

A qualitative study was used. Midwifery students from three universities in Iran participated. The study used a convenience sample of eighteen students. Data for this study was collected using semi-structured interviews (N=12) and focus groups (N=6). Data were recorded on a digital audio recorder and then transcribed. The qualitative data were analyzed using a content analysis approach.

RESULTS

Six broad themes emerged from the analysis: Limited opportunities to experience skills, difficulties with course plan gaps, need for creating a supportive clinical environment, learning drives, confusion between different methods, and stress in the clinical setting. Short verbatim quotations from the participants were presented to provide evidence for the interpretation of data.

CONCLUSIONS

The findings of this study have provided a clear picture of the factors and mechanisms involved in learning clinical skills by midwifery students. This study showed that students had some difficulties and concerns during learning of clinical midwifery skills. The findings of this study suggest that midwifery educators conduct further studies to tackle these issues in clinical skills learning. The findings of this study are subject to some limitations which are discussed.

Effects of an ethical empowerment program on critical care nurses' ethical decision-making

BACKGROUND

Nurses require empowerment if they are to make ethical decisions. Ethical empowerment has always been one of the main concerns in nurse training programs.

RESEARCH AIM

The present study was conducted to determine the effect of an ethical empowerment program on critical care nurses' ethical decision-making.

RESEARCH DESIGN

This is a clinical trial study with two groups and pre and post design.

PARTICIPANTS AND RESEARCH CONTEXT

In this study, 60 nurses working in Intensive Care Unit were selected through random sampling and then divided into a control and an experimental group after filling out the Moral Sensitivity Questionnaire. Both groups completed the questionnaire again immediately and 2 months after the ethical empowerment workshop had been held for the experimental group. The collected data were analyzed in SPSS-16 using descriptive and inferential statistics.

ETHICAL CONSIDERATIONS

The goals of the study were explained to the participants and then a written informed consent was received from them.

FINDINGS

The results showed no significant differences between the two groups in terms of their ethical sensitivity scores at the beginning of the study; however, immediately and 2 months after the intervention, the mean score increased significantly in the experimental group. Moreover, the scores obtained 2 months after the workshop increased compared to the pre-intervention scores but showed a drop compared to the scores reported immediately after the workshop.

DISCUSSION

The ethical empowerment program, given to the critical care nurses in this study, improved their ethical sensitivity in making decisions significantly over time. Despite the extensive methods, available for teaching nursing ethics, the ethical empowerment program, adopted in this study, had long-lasting effects in terms of ameliorating the process of ethical decision-making in clinical situations.

CONCLUSION

The ethical empowerment of nurses requires the adoption and application of proper methods and patterns of complying with nursing ethics.

Empowering Nurses in Providing Palliative Care to Cancer Patients: Action Research Study

Background:

Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses.

Materials and Methods:

This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation). Participants (33 samples) included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis.

Results:

Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients’ symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country.

Conclusions:

To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers.

Ethical Considerations in Sexual Health Research: A Narrative Review

Background:

There is an assumption that sexual health research has great influence on the quality of human life through elevating sexual health standards, and their results will eliminate the burden of sexual health challenges on family relationships. The aim of this study was to review ethical considerations in sexual health research.

Materials and Methods:

This narrative review was conducted between January 1990 and December 2017 based on the five-step approach of York University. The keywords used to search for the studies included ethical issues, research, sexual health, reproductive health, and sensitive topics. The language of the literatures was English and the search process was performed on PubMed, Elsevier, Ovid, Springer, Google Scholar, ResearchGate, SAGE Publishing, ProQuest, WHO website, Kinsey Confidential, and Worldsexology.

Results:

After assessing the quality and eligibility of 94 articles, 13 were selected. The results of the present study showed that the most important ethical considerations were protecting the confidentiality and privacy of participants, obtaining informed consent, and paying attention to vulnerable people.

Conclusions:

The review of literature exhibited several considerations that sexual health researchers are faced with. In order to manage these considerations, the researcher should have sufficient understanding of them. The important matter is that strategies to manage these challenges should be completely rational and practical according to each context. These strategies can also be applied in other societies with great similarities in their context.

Exploring the challenges of clinical education in nursing and strategies to improve it: A qualitative study

BACKGROUND

Clinical education is the heart of professional education in nursing. The perspective of nursing students and clinical nursing educators as the main owners of teaching-learning process are of determinants affecting clinical education process. This study was conducted to explore and to describe the clinical education problems and strategies to improve it from the perspective of nursing students and clinical nursing educators.

MATERIALS AND METHODS

The study was conducted using a descriptive qualitative method in 2017. Participants included 35 baccalaureate nursing students and 5 clinical nursing educators from nursing faculty of Isfahan University of Medical Sciences, Isfahan, Iran. Participants were selected using purposeful sampling method. Data were collected through semi-structured individual interviews and used qualitative content analysis for analysis.

RESULTS

The 2 main categories, 7 subcategories, and 19 sub-sub categories extracted from interviews. The two categories were "challenges of clinical education in nursing with four subcategories: fear, insufficient readiness of student, incompetency of clinical educators, unpleasant atmosphere of clinical environment," and "strategies for improving clinical education of nursing with three subcategories: the use of nursing education models and methods, improvement of communication between faculty and practice, and holding orientation stage at the beginning of training."

CONCLUSIONS

The findings show that clinical strategies, including employing experienced clinical educators, attempting to enhance the learning environment, developing the relationship between faculty and practice, participation of clinical nurses in clinical education, paying attention to entering behavior, and holding orientation stage at the beginning of training, can improve clinical education of nursing.

Ethical Challenges of Embryo Donation in Embryo Donors and Recipients

Background:

Embryo donation, as one of the novel assisted reproductive technologies (ART), has remained a controversial issue. This is due to this methods' need for individuals from outside the family circle. Their presence can cause many ethical issues and complicate the designing and planning of the embryo donation process. The present study was conducted with the aim to assess the ethical challenges of embryo donation from the view point of embryo donors and recipients.

Material and Methods:

This descriptive, cross-sectional study was conducted on 192 couples (96 embryo donators and 96 embryo recipients) referring to Isfahan Fertility and Infertility Center and Royan Institute, Iran. The subjects were selected through convenience sampling. The data collection tool was the researcher-made Ethical Challenges Questionnaire. Data were analyzed in SPSS software.

Results:

Embryo donors and recipients expresses the most important ethical challenges of embryo donation in the principle of justice (70.20%) and respect for autonomy (42.57%), respectively.

Conclusions:

The four ethical principles are important in the view of embryo donors and recipients; however, they highlighted the importance of the principle of respect for autonomy considering the existing barriers in the services of infertility centers. Legislators and relevant authorities must take measures toward the development of guidelines for this treatment method in the framework of ethics principles and incorporate all four principles independently.

Fear, an unpleasant experience among undergraduate midwifery students: A qualitative study

Fear is a normal emotion that can evoke an appropriate response when facing threat. However, sometimes the consequences of fear can lead to responses that are maladaptive. Fear can have negative effects on learning. Research has focused on the experience of fear and its consequences among midwifery students during their undergraduate program. A qualitative analysis was conducted of interviews with ten midwifery students in different years of an undergraduate program. The data was analyzed through a content analysis approach. Two main categories and five subcategories emerged. The first category, areas of fear in midwifery students, consisted of the following subcategories: fear of doing harm, fear of encountering their first childbirth, and fear of penalties. The second category, consequences of fear, consisted of the following subcategories: general physical and psychological consequences and interference in adopting the professional role. In this study, fear not only raised the students' stress levels thereby, leading to physical and psychological issues but also hindered their adoption of their professional role. These findings will potentially inform support and retention strategies within midwifery undergraduate programs in the future.

BACKGROUND

Maternity care in Iran is provided mainly within a medical model of care. The majority of women give birth in hospital, where care is provided by midwives who work under the direction and supervision of an obstetrician. Midwives within the medically dominated system lack autonomy and have very little opportunity to gain experience in providing continuity of care for women as midwife-led models of care are rare. This practice context means that midwifery students have very little opportunity to gain experience in autonomous midwifery practice. Midwifery undergraduate program in Iran is for four years. Admission to the undergraduate program is implemented via a direct entry route. Nearly all of the midwifery students are school leavers with their first exposure to university and hospital systems. Most of the midwifery students have chosen this career without sufficient understanding about midwifery and the work that it involves (Arfaee et al., 2008). The midwifery undergraduate program comprises theoretical and clinical elements. After the first semester, students enter clinical settings under the supervision of their clinical instructors.

Clinical trials in dermatology

Clinical trials are the backbone of modern day medicine. Randomized, double-blinded, placebo-controlled studies are critical for advancement in medicine and dermatology. Skin conditions such as psoriasis and atopic dermatitis are among the most common health problems in the United States. Clinical trials can provide treatments that not only offer objective improvements in clinical disease status but also subjective improvements in the quality of life of patients who are afflicted with the disease. In this article, we discuss the processes and resources of a clinical trials unit and the challenges that can be encountered during the study process. It is critical to engage in clinical trials to treat patients most effectively with new and innovative therapies that are rooted in trial-validated, evidence-based medicine.

Ethical values in nurse education perceived by students and educators

BACKGROUND

Education is considered the first function and mission of the university, and observing educational ethics guarantees the health of the teaching-learning process in the university.

AIM

The aim of this study was to explore ethical values in nursing education from the perspective of Iranian nursing students and educators.

RESEARCH DESIGN

This qualitative study was conducted using the Thematic Content Analyses method. The data were collected from seven semi-structured individual interviews and three focus group discussions from July to November 2015. Participants and research context: The participants were faculty educators of nursing and nursing students in Tehran, capital of Iran, who were selected through purposive sampling. They were recruited gradually. Sampling was continued until data saturation when no new codes were extracted. Ethical committee: This study was conducted after obtaining the approval of Shahid Beheshti University of Medical Sciences Ethics Committee, and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process.

FINDINGS

Seven major themes emerged: human dignity, constructive human relations, educational justice, competency enhancement, excellence view, wisdom, and commitment and accountability.

CONCLUSION

The results of this study indicated that although many of the values, as universal values, were similar to those of other countries-which can be a reflection of the globalization process in the nursing profession and the presence of humanistic and spiritual approaches at the roots of the discipline, some differences could be found in the content of values due to factors such as the people's beliefs, culture, and religion. Iranian nursing students and educators revealed a unique and culture-based set of ethical values.

Effects of progressive muscle relaxation, guided imagery and deep diaphragmatic breathing on quality of life in elderly with breast or prostate cancer

BACKGROUND AND OBJECTIVES

Due to the increasing number of elderly and an increase in the number of cases of cancer by age, cancer is a common problem in the elderly. For elderly patients with cancer, the disease and its treatment can have long-term negative effects on their quality of life (QoL). The purpose of this study was to evaluate the effect of progressive muscle relaxation, body image and deep diaphragmatic breathing on the QoL in the elderly with cancer.

MATERIALS AND METHODS

This study was a randomized controlled trial in which 50 elderly patients with breast or prostate cancer were randomized into study and control groups. Progressive muscle relaxation, guided imagery, and deep diaphragmatic breathing were given to the study group, but not to the control group. The effect of the progressive muscle relaxation, guided imagery and deep diaphragmatic breathing was measured at three different time points. European Organization for Research and Treatment of Cancer and QoL Questionnaire-Core questionnaires was completed before, after and 6 weeks after the intervention for the patients in both groups simultaneously. The data were analyzed by SPSS.

RESULTS

There was statistically significant improvement in QoL (P < 0.001) and physical functioning (P < 0.001) after progressive muscle relaxation, guided imagery and deep diaphragmatic breathing intervention.

CONCLUSIONS

The findings indicated that concurrent application of progressive muscle relaxation, guided imagery, and deep diaphragmatic breathing would improve QoL in the elderly with breast or prostate cancer.

Nurses' commitment to respecting patient dignity

BACKGROUND

Although respecting human dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing care. Therefore, the present study aimed to investigate nurses' commitment to respecting patient dignity in hospitals of Isfahan, Iran.

METHODS

This descriptive-analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from different wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient-nurse relationships, privacy, and independence. All items were scored based on a five-point Likert scale. The collected data were analyzed using descriptive statistics and Chi-square tests. P < 0.05 were considered significant in all analyses.

FINDINGS

Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection as moderate/good. Only 6.5% of the subjects rated it as excellent. The majority of the patients (84.4%) believed their independence was maintained. These subjects also approved of taking part in decision-making.

CONCLUSION

According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing authorities and policy makers are thus required to introduce appropriate measures to improve the existing conditions.

Effects of Collaboration Care Model on the Quality of Life in Patients after Coronary Angioplasty: A Randomized Controlled Clinical Trial

BACKGROUND

Coronary artery diseases and therapies such as coronary angioplasty would lead to changes in the quality of life in patients. The aim of this study was to determine the effects of collaborative care model on the quality of life in patients after coronary angioplasty.

METHODS

This randomized controlled clinical trial was conducted in Isfahan, Iran during 2015. In this study, 50 samples were selected by simple sampling and randomly allocated into two equal groups of intervention and control. Collaborative care model was performed in the intervention group for 3 months. Data were collected using quality of life (SF-36) questionnaire which includes 36 questions on physical and psychological dimensions and was completed before and one month after the intervention in both groups. Data were analyzed using descriptive and analytical statistics and by independent t- test, paired t test, Chi square and Mann-Whitney tests through SPSS 18.

RESULTS

After the intervention, the mean score of quality of life in the intervention group was significantly higher than the control group (P<0.05). The results of independent t-test showed a significant difference between both groups regarding the mean of changes in the score of quality of life and its dimensions in patients undergoing coronary angioplasty 3 months after the intervention (P<0.001).

CONCLUSION

Results revealed that patients who had been cared based on collaborative care model had better scores of quality of life in all the physical, mental and social dimensions than the control group. Therefore, using this model for taking care of patients after coronary angioplasty is recommended. Trial Registration Number: IRCT2015120120912N4.

Effects of a Lifestyle Modification Program on Knowledge, Attitude and Practice of Hypertensive Patients with Angioplasty: A Randomized Controlled Clinical Trial

BACKGROUND

Lack of knowledge, attitude and practice are some of the barriers of having a healthy lifestyle and controlling high blood pressure. This study aimed to determine the effectiveness of a lifestyle modification program on knowledge, attitude and practice of hypertensive patients with angioplasty.

METHODS

This study was a randomized controlled clinical trial conducted from November to April 2014 on 60 hypertensive patients with angioplasty in Shahid Chamran hospital of Isfahan, Iran. The samples were randomly assigned to two equal groups. Data collection was performed in three stages by a researcher-made questionnaire. The intervention plan was 6 education sessions and then follow up were done by phone call. The gathered data were analyzed via SPSS (V.20), using t-test, Chi-square, repeated measurement, and post hoc LSD test and ANOVA statistics.

RESULTS

The mean score of knowledge, attitude and practice in the experimental group immediately after the intervention was 77.8±7.2, 88.3±6.4 and 86.2±6.5, respectively and one month after the intervention was 80.8±7.4, 91.1±3.5 and 92.5±2.2, respectively. But in the control group, the mean score of knowledge, attitude and practice immediately after the intervention (34.90±11.23, 61.11±6.28, and 38.64±7.15) and one month after the intervention was (38.64±7.15, 59.56±6.31 and 37.27±7.26.

CONCLUSION

Lifestyle modification program can be effective in promoting the knowledge, attitude and practice of hypertensive patients with angioplasty. Nurses can use this program in their care provision programs for these patients. Trial Registration Number:IRCT2015062420912N3.