Search

Background: Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. Aim: This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. Methods: A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. Results: Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. Conclusion: Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore nurses' experiences of providing family‐centred care in the postresuscitation period. Design: An exploratory‐descriptive qualitative design was used. Methods: In this qualitative study, in‐depth, semi‐structured interviews were conducted with 22 nurses in three educational hospitals. There were six participants who completed follow‐up interviews to resolve questions generated during initial interviews. Data were analysed using conventional content analysis. Results: Five main categories were extracted: continuous monitoring, facilitation of attendance, involvement in care, informing and emotional support. Despite the lack of organizational policies and guidelines, nurses explained how they work to provide family‐centred care for families, especially those they assessed as having less possibility of aggressive behaviour and those with a better understanding of their loved one's condition. To provide postresuscitation family‐centred care, nurses facilitated family attendance, involved them in some basic nursing care, and provided information and emotional support to the family members. Conclusion: Nurses attempted to follow the basic principles of family‐centred care in the postresuscitation period. However, to improve the provision of care by nurses, it is necessary to embed family‐centred care principles in institutional policies and guidelines and to conduct training for nurses. Implications for the Profession: Iranian nurses are interested in engaged families in the postresuscitation period. Correct implementations of such care that include all families need institutional policies and guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. Objective: To explore nurses' experiences of ethical and legal issues in post-resuscitation care. Research design: This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. Participants and research context: In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed by conventional content analysis. Ethical considerations: The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. Findings: Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. Conclusion: There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges. [ABSTRACT FROM AUTHOR]

Successful pain management in patients with cancer is a significant challenge, and paying more attention to patients' experiences of pain self-management strategies has particular importance. This study aimed to explore pain self-management strategies in Iranian patients with cancer. This qualitative study was conducted on 14 patients with cancer. Data were collected using semistructured interviews and analyzed through the Graneheim and Lundman content analysis approach. Two main categories emerged from data analysis: (1) psychological pain self-management strategies, and (2) behavioral pain self-management strategies. Psychological strategies included pain distraction techniques, spiritual tendencies, increasing social interactions and support networks, pain tolerance and self-control, and resistance to pain. Behavioral strategies included massage and touch, heat and cold therapy, opium (Taryak in Persian) and tobacco use, herbal and home remedies, and proper diet. [ABSTRACT FROM AUTHOR]

Background: Workplace violence against nursing students is a common phenomenon. This study aimed to investigate Iranian nursing students' experiences of workplace violence, including their reaction to violence and the consequences and the effects of such violence on the students. Method: The study participants were undergraduate nursing students. The data were collected using semi-structured, in-depth face-to-face interviews. Data analysis was carried out with qualitative approach using conventional content analysis. Results: Four categories were extracted from the analysis of the interview transcriptions: vertical violence, horizontal violence, reaction to violence and consequences of violence. Nurses were the major imposers of violence against students and psychological and verbal violations were the most of used forms of violence. The students reacted to violence in the forms of counteracting, reporting, disregarding and considering as commonplace. Conclusions: Workplace violence is a common phenomenon experienced by nursing students in this study, which causes devastating individual, educational, and professional impacts. Action plans including providing safe environment and appropriate support from nurses and educators should be developed in clinical settings to intervene and to prevent workplace violence. [ABSTRACT FROM AUTHOR]

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore the barriers to effective pain management in Iranian people with cancer. Design: A qualitative descriptive design was used. Methods: This qualitative descriptive study was performed on 14 people with cancer. Data were collected using semi‐structured interviews and analysed by Graneheim and Lundman's content analysis method. Results: Four main categories emerged in relation to barriers to pain management from the perspective of people with cancer. Categories included 1) accepting and enduring divine pain, 2) negative attitudes towards the effectiveness of analgesics, 3) patients' low knowledge of pain self‐management methods and 4) neglected pain management. Barriers to pain management are multidimensional in nature consisting of patients, healthcare providers and system components. Therefore, attempts should be focused on the education of patients and healthcare providers about pain management and eliminating the shortcomings of the healthcare system. [ABSTRACT FROM AUTHOR]

Prehospital emergency care nurses experience severe workplace violence. However, despite the widespread violence they experience, this phenomenon has not been well studied among these nurses. Therefore, the purpose of this study was to explore the experiences of Iranian nurses working in prehospital setting regarding workplace violence with a focus on the factors leading to such violence. In this qualitative descriptive study, 23 prehospital nurses participated purposefully. The data were collected by individual face-to-face semistructured interviews and analyzed using content analysis methodology. Data analysis led to the identification of 4 main themes, including job competency mismatch, inadequate resources, criticality of the situation and circumstances, and inadequate awareness and misplaced expectations of society. These nurses have not completed specialized training courses, work in a system that is in a critical situation, and face many barriers and deficiencies in terms of intra- and interorganizational coordination. On the other hand, people in the community do not have sufficient awareness about the duties and services provided by prehospital nurses and thus have unrealistic expectations to receive services. The results showed that there was a deep gap between the prehospital emergency realities and public expectations, leading to workplace violence. Therefore, efforts to improve the working conditions of nurses with an emphasis on teaching specialized prehospital emergency courses, especially violence control courses, promoting intra- and interorganizational coordination, and increasing the equipment and personnel of ambulances for special missions, as well as raising the public awareness and outlining more realistic expectations, may reduce the prevalence of violence against prehospital nurses. [ABSTRACT FROM AUTHOR]

BACKGROUND: Returning to work after cancer is a complicated phenomenon. OBJECTIVE: This study aimed to explore Iranian cancer survivors' concerns during returning to work. METHODS: This qualitative study was conducted on 19 cancer survivors at a referral center of cancer Northwest of Iran. Data were collected through individual semi-structured interviews and analyzed using a conventional content analysis method. RESULTS: "Taking an obscure path" emerged as a main concern of cancer survivors in returning to work which included three categories of limited Information, hesitation in personal abilities and worry about the reactions of workplace. CONCLUSIONS: Cancer survivors were uncertain about returning to work. This uncertainty can distress cancer survivors in the process of returning to work and may cause them to delay the process. The staff of healthcare systems including physicians, nurses and occupational rehabilitation specialists must address the concerns of cancer survivors and prepare them to return to work. Moreover, by working in collaboration with employers, rehabilitation specialists must provide appropriate conditions for cancer survivors to safely return to the workplaces. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of Iranian nurses working in pre‐hospital emergency care services and the strategies used to manage of workplace violence. Background: Pre‐hospital emergency nurses are subject to workplace violence; however, little research addresses their experiences, particularly related to their strategies in dealing with workplace violence. Methods: A descriptive qualitative study that involved nineteen male nurses who were working in pre‐hospital services collected data using semi‐structured interviews and analysed it using qualitative content analysis. Results: Data analysis yielded four descriptive categories including no reaction to violence (tolerance and acceptance as common workplace conflicts), situational management (patient and scene management), confrontation (direct and indirect) and escaping the scene. Patient management was the dominant strategy used and had the best outcomes related to both patient and personnel safety. Conclusion: This study showed that pre‐hospital nurses use different strategies to manage violence and patient management was a common and useful strategy for managing workplace violence. However, the pre‐hospital nurses have little training, insufficient support and are poorly prepared to manage workplace violence. Implications for Nursing Management: The development of context‐based guidelines, continuing education, better‐equipped ambulances that include medical and defence equipment, as well as better coordination of the police force in ambulance operations, can help to reduce workplace violence. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the experiences of Iranian family caregivers with regard to the burden of caregiving. This is in the context of illuminating and identifying the experiences of family members from different contextual perspectives. In this qualitative study, purposive sampling was conducted in 2016. Data were collected using semistructured interviews and were analyzed using content analysis. Data analysis identified 4 categories and 8 subcategories: (1) burnout (physical problems and psychoemotional stress), (2) role conflict (balancing caring roles and family responsibilities; failure in professional or educational roles), (3) health system tensions (inadequate support from health professionals; ignorance of family members in health structure), and (4) social challenges of cancer (economic burden; taboo of cancer). In conclusion, nurses need to provide individualized support and counseling that address the sources of burden. This highlights the benefit of training health care professionals to provide culturally sensitive support based on family caregivers' needs and circumstances. [ABSTRACT FROM AUTHOR]

Background and Purpose: Preceptors play a key role in the transition experience of new nurses. Preceptorship is a stressful role and is influenced by contextual factors. There is a lack of sufficient understandings of the perspectives and lived experiences of Iranian nurse preceptors of preceptorship. The aim of this study was to explore the perspective and lived experiences of Iranian nurse preceptors of preceptorship. Methods: A qualitative design using a hermeneutic phenomenological approach was used. Six Iranian nurse preceptors were chosen using a purposeful sampling method from a large paediatric teaching hospital in an urban area of Iran. Data was collected using in-depth semi-structured interviews and was analysed using the Diekelmann et al.'s method of hermeneutic phenomenological analysis. Results: The data analysis resulted in the development of a constitutive pattern of 'living with moral distress', which was constituted of two major themes: 'asking for and being unable' and 'the experience of conflict'. Implications for Practice: The findings of this study can improve nurses' understandings of the preceptor's role and associated factors influencing the implementation of the preceptorship programme. 'Moral distress' caused by the preceptor role can influence nurse preceptors' mental health and also the patient care outcomes. More studies are required to explore this phenomenon in different contexts and cultures and design strategies for reducing the burden of taking this role on nurse preceptors. Also, policies are needed for developing a formal preceptor support system to help preceptors take this stressful and demanding role in healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Compassionate care is an international priority of healthcare professionals. There is little understanding about how workplace issues impact provision of compassionate care in nursing practice. Therefore, it is important to address the workplace issues and organizational factors which may hinder compassionate care delivery within nursing practice. Objective: The aim of this study was to explore workplace and organizational barriers to compassionate care from the nurses' perspective. Research design: The study used a qualitative exploratory design, and data were analyzed by conventional content analysis. Participants and research context: A total of 15 nurses working in different fields of nursing were recruited from four hospitals at northwest of Iran. Participants were selected by purposive sampling. Semistructured interviews were conducted for data collection. Ethical consideration: Ethical approval of this study was gained from the Ethical Review Board of Tabriz University of Medical Sciences. Findings: The main theme which emerged from data analysis was "unsupportive organizational culture." This theme had two main categories including "excessive workload alongside inadequate staffing" and "the lack of value on compassionate care". Discussion: Organizational barriers to development of compassionate in clinical practice were identified in this study. A closer examination of these barriers is required to move compassionate practice from an individual responsibility to a collective responsibility that is owned and shared by organizations. Conclusion: For compassionate care to flourish, policy makers, managers, and healthcare providers must foster an organizational atmosphere conducive to compassionate care. [ABSTRACT FROM AUTHOR]

This qualitative study was conducted to explore the empowerment experiences of family caregivers of patients with cancer. Empowerment consisted of 3 main categories: (1) seeking tranquility with the help of religious beliefs, (2) developing a positive attitude, and (3) restoring control over the situation. Results may help nurses for planning spiritual and supportive care. [ABSTRACT FROM AUTHOR]

Background: Compassion is an important ethical foundation of all healthcare professionals especially for nursing. However, there is little understanding of factors which could help and motivate nurses to deliver compassionate care in modern healthcare practices today. Moreover, a cultural context may affect the way compassionate care is delivered by healthcare professionals. Aims and objectives: This study aimed to explore what facilitates compassionate care in daily practice from the unique perspective of Iranian nurses. Research methods: This qualitative exploratory study was conducted in four hospitals. In this study, 16 nurses were selected from various wards. Data were collected by in‐depth, face‐to‐face interviews. For data analysis, a conventional content analysis approach was used. Results: As the most important theme, the theme ‘deepening individual's capacity for compassionate care’ emerged, which consisted of three categories: the personal system of values and beliefs, patient experience and positive role models of compassion. Conclusions: Addressing and developing nurses’ capacity for compassion is possible by providing organisational support and professional education, next to recruiting nurses with a high motivation to relieve patient suffering. These recommendations would help to provide high‐quality compassionate care in healthcare practices. Moreover, nurses could improve their individual capacity for compassion by following their value and belief system and by considering their colleagues as a role model of compassionate practice. [ABSTRACT FROM AUTHOR]

Abstract: The nursing profession is focused on serving others and has high expectations that each member behaves professionally and ethically, as articulated in nursing codes of practice and conduct. Where these are not upheld, inappropriate and unprofessional workplace behaviors follow. Regrettably, unprofessional behavior is neither new nor constrained to the nursing profession, but is known to negatively impact staff and workplace relationships, and importantly, patient safety and care. The aim of this qualitative study was to explore Iranian nurses’ experiences of professional communication between colleagues in the emergency department. Fifteen individual interviews were conducted. The overarching theme to emerge from the data was workplace communication, supported by two subthemes: unprofessional behavior and stressors in the workplace. Individually and collectively, these subthemes demonstrated staff attitudes and behaviors that are inconsistent with expectations of professional behavior and practice. Management proactively addressing unprofessional workplace behaviors is fundamental to establishing and maintaining positive workplace environments and supporting safe, quality patient care. [ABSTRACT FROM AUTHOR]

Preceptors should possess attributes which help them in successfully performing the demanding and challenging role in the preceptorship. This research utilises a qualitative hermeneutic phenomenological approach to explore the attributes of new nurse preceptors. Six preceptors of a teaching hospital in Northwest of Iran who were selected by means of purposive sampling. Data were collected during eight months from July 2014 to March 2015 through in-depth semi-structured personal interviews. Interviews were recorded and transcribed and then were analyzed with the interpretive approach using the Diekelmann's seven-stage method in the MAXQDA10 software environment. Findings included two main themes “feeling proud and honored” and “professionalism” with subthemes including empathy, being nonjudgmental, patience, and spirit of self-sacrifice. The spirit of self-sacrifice was a unique attribute revealed in this research. Preceptors possessed several important attributes which are usually stressed in the literature as selection criteria for preceptors. These attributes could be further drawn upon when selecting new preceptors. Preceptors are role models. Existence of the spirit of self-sacrifice among preceptors could contribute to transferring of such spirit to new nurses and future preceptors as well as to preceptors' patience with challenges of their role. Effective preceptorship needs preceptors who possess specific professional and personal attributes. These attributes could be drawn upon more objectively in the process of selection, preparation and evaluation of preceptors by clinical and educational nursing managers. [ABSTRACT FROM AUTHOR]

Aims and objectives The study explored the psychosocial effects of transitioning from home to an aged care home for older Iranian people. Background Moving from one's own home to a communal aged care home is challenging for older people and may give rise to numerous psychosocial responses. The extent and intensity of such changes have rarely been explored in Middle Eastern countries. Design Data were collected through purposive sampling by in-depth semi-structured interviews with 20 participants (17 people living in aged care homes and three formal caregivers). All the interviews were recorded and typed, and conventional qualitative content analysis was used, eliciting common themes. Results There were four common themes: communication isolation, resource change, monotone institutional life and negative emotional response. Participants lost their previous support systems when transitioning to an aged care home and were not able to establish new ones. Routine care was provided by formal caregivers with little attention to individual needs, and minimal support was given to help maintain the older person's independence. These losses gave rise to negative emotions in some of the participants, depending on their previous lifestyle and accommodation arrangements. Conclusions The extent and intensity of psychosocial changes occurring in most of the participants following their transition to an aged care home indicates the need for a review of Iranian aged care services. Implications for practice To assist older Iranian people adapt more readily when making the transition to aged care home and to meet their unique psychosocial needs, a family-centred approach to service delivery is recommended. [ABSTRACT FROM AUTHOR]

Purpose To illuminate the meaning of the lived experiences of resuscitation team members with the presence of the patient's family during resuscitation in the cultural context of Iran. Design An interpretative phenomenology was used to discover the lived experiences of the nurses and physicians of Tabriz hospitals, Iran, with family presence during resuscitation (FPDR). A total of 12 nurses and 9 physicians were interviewed over a 6-month period. Methods The interviews were audio recorded and semistructured, and were transcribed verbatim. Van Manen's technique was used for data analysis. Findings Two major themes and 10 subthemes emerged, including destructive presence (cessation of resuscitation, interference in resuscitation, disruption to the resuscitation team's focus, argument with the resuscitation team, and adverse mental image in the family) and supportive presence (trust in the resuscitation team, collaboration with the resuscitation team, alleviating the family's concern and settling their nerves, increasing the family's satisfaction, and reducing conflict with resuscitation team members). Conclusions Participants stated that FPDR may work as a double-edged sword for the family and resuscitation team, hurting or preserving quality. It is thus recommended that guidelines be created to protect patients' and families' rights, while considering the positive aspects of the phenomenon for hospitals. Clinical Relevance A liaison support person would act to decrease family anxiety levels and would be able to de-escalate any potentially aggressive or confrontational events during resuscitation. Well-trained and expert cardiopulmonary resuscitation team members do not have any stress in the presence of family during resuscitation. Resuscitation events tend to be prolonged when family members are allowed to be present. [ABSTRACT FROM AUTHOR]

This study explored Iranian patients' experiences of cancer disclosure, paying particular attention to the ways of disclosure. Twenty cancer patients were invited to participate in this qualitative inquiry by research staff in the clinical setting. In-depth, semistructured interview data were analyzed through content analysis. The rigor of the study was established by principles of credibility, transferability, dependability, and confirmability. Four themes emerged: the atmosphere of non-disclosure, eventual disclosure, distress in knowing, and the desire for information. Non-disclosure was the norm for participants, and all individuals involved made efforts to maintain an atmosphere of non-disclosure. While a select few were informed of their diagnosis by a physician or another patient, the majority eventually became aware of their diagnosis indirectly by different ways. All participants experienced distress after disclosure. The participants wanted basic information about their prognosis and treatments from their treating physicians, but did not receive this information, and encountered difficulty accessing information elsewhere. These challenges highlight the need for changes in current medical practice in Iran, as well as patient and healthcare provider education. [ABSTRACT FROM AUTHOR]

Background Family-witnessed resuscitation remains controversial among clinicians from implementation to practice and there are a number of countries, such as Iran, where that is considered a low priority. Objective To explore the lived experience of resuscitation team members with the presence of the patient's family during resuscitation. Design The hermeneutic phenomenology. Settings The emergency departments and critical care units of 6 tertiary hospitals in Tabriz, Iran. Participants There were potentially 380 nurses and physicians working in the emergency departments and acute care settings of 6 tertiary hospitals in Tabriz. A purposive sample of these nurses and physicians was used to recruit participants who had at least 2 years of experience, had experienced an actual family witnessed resuscitation event, and wanted to participate. The sample size was determined according to data saturation. Data collection ended when the data were considered rich and varied enough to illuminate the phenomenon, and no new themes emerged following the interview of 12 nurses and 8 physicians. Methods Semi-structured, face- to- face interviews were held with the participants over a period of 6 months (April 2015 to September 2015), and Van Manen’s method of data analysis was adopted. Results Three main themes emerged from the data analysis, including ‘Futile resuscitation’, ‘Family support liaison’, and ‘Influence on team’s performance’. A further 9 sub-themes emerged under the 3 main themes, which included ‘futile resuscitation in end-stage cancer patients’, ‘when a patient dies’, ‘young patients’, ‘care of the elderly’, ‘accountable person’, ‘family supporter’, ‘no influence’, ‘positive influence’, and ‘negative influence’. Conclusions Participants noted both positive and negative experiences of having family members present during cardiopulmonary resuscitation. Welltrained and expert resuscitation team members are less likely to be stressed in the presence of family. A family support liaison would act to decrease family anxiety levels and to de-escalate any potentially aggressive person during the resuscitation. It is recommended that an experienced health care professional be designated to be responsible for explaining the process of resuscitation to the patient’s family. [ABSTRACT FROM AUTHOR]