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Changes in society’s needs have increased individuals’ desire to be independent and receive health care at home. Home health care (HHC) is one of the main components of realizing these ambitions. However, there is a serious concern about the state of development of the HHC industry in Iran and the quality of its services. This study aims to explore the barriers to the development of HHC in Iran. This qualitative study with a conventional content analysis approach was conducted in Tabriz, Iran, from October 2019 to March 2020. Twenty-one key stakeholders including nurses, home health directors, physicians, policy-makers, patients, and their families participated in the study. Participants were selected using purposive sampling. Data were collected using a focus group discussion (FGD) and 18 semi-structured in-depth interviews and analyzed using Graneheim and Lundman’s techniques. Data collection continued until saturation was reached. Three main themes emerged from the analysis: quality management challenges, insufficient infrastructure and policy, and political issues. The findings show that applying standard strategies to monitor the quality of services, paying attention to infrastructure, and having a clear framework for policy-making are beneficial for the development of the HHC industry. Health managers can monitor and upgrade the quality of HHC services by defining standards and assessment indicators, as well as providing comprehensive data. It is suggested that legislators consider the principles of community-based accountability, justice, and accessibility their top priority. Moreover, policymakers need to develop a roadmap to reform policies to create the conditions for the development of this industry.

Aim:\ud There is a lack of clarity about the components which would signify appropriate psychological strengths among nursing student candidates. This study was conducted to identify such components from the viewpoint of the clinical nurses and nursing instructors. \ud \ud Design:\ud A qualitative study. \ud Methods: \ud This study comprised qualitative research using a conventional content analysis approach. Participants were 25 nurses and nursing instructors. Data were collected in audio-recorded and transcribed semi-structured interviews and were analysed using MAXQDA10 software. \ud Results: \ud Analysis revealed four main categories including "anger management," "Stress/distress management," "self-belief" and "aptitude for hard work.". Conclusions: This study identified core components for future investigations into the psychological strengths of nursing applicants. This study provides specific testable hypotheses for future research endeavours. It is recommended that the researchers investigate the appropriateness of the components identified in this study to assess the psychological strength of the applicants in the longitudinal studies.

AIM To explore the barriers and facilitators concerning nurse managers' participation in the health policy-making process. BACKGROUND Despite encouragement for participation in policy-making, nurse managers are seldom involved in this process. METHODS A qualitative descriptive research design based on purposive sampling was conducted. Semi-structured one-to-one interviews were conducted with nurse managers and key informants (n = 16). Interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The Standards for Reporting Qualitative Research (SRQR) checklist was applied to study reporting. FINDINGS Three levels of barriers were found to nurse managers' participation in health policy-making. The individual level included weakness in characteristics of nurse managers, and the organizational level constituted the inefficient structure. In addition, the environment-related level encompassed external barriers to the organization. Finally, three facilitators with the potential were identified for improving nurse managers' participation in the policy-making process, including improvements in collaboration and communication, governmental and non-governmental organizational activities, and reforms in the health policy-making process. CONCLUSION Nurse managers need to use the window of opportunity to participate in health policy-making. More importantly, they should be informed about health policy in order to meet the demands of the rapidly changing healthcare environment. Drawing upon their professional organizations and positions, nurse leaders require to network and make a space to stimulate their participation in the policy. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY Nurse managers need to develop political skills and utilize strategies to help their participation in health policy-making, leading to better implementation of policies, efficiency, and effectiveness in the health system.

Context: Self-efficacy is one of the important determinants of the behaviors that influence the physical and psychological health among patients with chronic medical conditions. Aims: This study was aimed to investigate the factors that influence the self-efficacy of patients with thalassemia. Setting and Design: This was a qualitative study using a directed content analysis design. The research population consisted of the patients with thalassemia major who referred to the thalassemia ward of the medical training centers in Iran for blood transfusion. The research sample included 16 patients with thalassemia major who were selected using the purposeful sampling method with maximum variation. Materials and Methods: Data were collected from 16 patients with thalassemia major, using a semi-structured interview in 2018–2019. Statistical Analysis Used: Data were analyzed using the Elo and Kyngas method and MAXQDA10 software (Berlin, Germany). Results: The analysis of the data resulted in 70 initial codes and the emergence of five generic categories including: (1) the performance accomplishments, (2) the vicarious experience, (3) the verbal persuasion, (4) the physiological states, (5) the self-persuasion. Conclusions: Factors influential on the creation and promotion of the self-efficacy of the patients with thalassemia include the performance accomplishments, the vicarious experience, the verbal persuasion, the physiological states, and the self-persuasion. Self-efficacy affects the onset and persistence of behavior. Therefore, designing practical programs containing factors affecting the self-efficacy of the patients with thalassemia seems necessary to improve quality of life and physical and mental health of these patients.

Aim To develop and test the psychometric properties of an instrument assessing career success in nurses. Background Despite the importance of achieving success in nursing, to date, this construct has been measured using unidimensional or generic scales not fully reflecting career success as perceived by nurses. Methods This scale development study used a large sample of nurses across 10 hospitals in Tabriz, Iran. Items were generated based on existing literature and previous, research team-led, qualitative study, followed by testing content and face validity of the items. Exploratory factor analysis (N = 530 nurses) then assessed the underlying structure of the scale, and reliability was tested using Cronbach's alpha and a 2-week test-retest correlation. Findings From the initial 73 items, fourteen rated by experts as 'not relevant' and seven with poor face validity were deleted. Exploratory factor analysis further identified 13 poor items. The final 39-item solution extracted four robust career success factors: expected career progress, providing quality care, effective self-regulation, and person-organization fit. Cronbach's alpha and test-retest correlation showed excellent reliability. Conclusion This multidimensional nursing-specific scale with very good psychometric properties is suitable for individual/group-based decisions. Implications for nursing and health policy This instrument can assess current perceptions of career success in nurses, so work resources can be allocated to improve policies, services and training programmes to meet career aspirations of nurses and objectives of the organization. Having a robust scale of career success will enable future research in the field of career success as specific to nursing in a clinical setting.

Aim After the discharge of patients with burns, quality of life, psychological and social adjustment, performance and their follow‐up are ambiguous. Therefore, we decided to improve the status of family‐based care programmes in patients with the burn. Design Participatory action research. Methods The participatory action research was conducted between the Faculty of Nursing, Sina Hospital's managers and multidisciplinary burn teams from 2017–2018. The procedure for data collection included focus group meetings with key informants, interviews, observation, and questionnaire. Qualitative data were analysed using the qualitative content analysis and qualitative data were analysed by SPSSv.24. Results The study, comprised of four phases, started in May 2017 and completed in 9 months. The results of quantitative showed that quality of life has a statistically significant difference before and after the action. The qualitative data resulted were grouped into 3 categories and 28 subcategories and were analysed in the SWOT Matrix. All the multidisciplinary burn teams together with the managers as a team working of the care providers and the academic researcher resulted in enablers the changes in providing health education and services as well as improving the quality of life of patients and their families.

ObjectivesIn this qualitative study, we specify important domains of a nursing education institution that need to be measured to represent its performance via students’ perspectives, one of the most important stakeholders in higher education.SettingThis study was conducted in a nursing and midwifery faculty.ParticipantsParticipants were bachelor’s, master’s and Ph.D. students in nursing. Convenience sampling was used. The aim and methods of the study were explained to the students, and they were invited to participate in the focus groups. Four focus groups (n=27) were held.ResultsThirteen categories emerged that were assigned to three components of the Donabedian model. The structure component contained three categories: learning fields, equipment and facilities and human resources standards. The process component contained five categories: workshops for students and staff, student familiarity with the institution’s rules and plans, teaching, students evaluation and evaluation of teaching staff by students and peers. And outcome components contained five categories: results of self-evaluation by students, graduates’ outcomes, students’ outcomes, students surveys results and related medical centres performance.Conclusion(s)Based on the needs and ideas of this important group of stakeholders, we can proceed further. Once we specify what is important to be measured, then it is appropriate to develop or choose suitable and measurable performance indicators for each of the recognised categories.

Objective: In cancer care management, patients or their family are usually responsible for continuing health care. Achieving this goal requires identification of their self-care needs. The purpose of this study is to explore the perception of self-care needs of adolescent cancer survivors. Methods: This study was conducted by the qualitative content analysis method. Participants were 19 adolescent childhood cancer survivors and six parents, nurses, physicians, and charity institution staff from children teaching hospitals in Iran. Participants were selected through purposeful sampling, and individual semistructured interviews were used for data collection. Graneheim and Lundman stages of content analysis were employed for data analysis. Data were managed with the MAXQDA10 software. Results: Content analysis revealed nine subcategories as follows: (1) nutritional protection, (2) prevention from infection, (3) prevention from physical damage, (4) control over cancer recurrence, (5) informational needs, (6) pain management, (7) releasing positive thoughts, (8) continuing routine life, and (9) family protection. The first six subthemes were related to protection against physical distress, and the final three ones were related to protection against psychological distress. These two categories form one theme: “protective self-care need” as an essential self-care need in adolescent cancer survivors. Conclusions: Pediatric and school health nurses can prepare strategies to meet these needs by providing effective informational and psychosocial supports, and healthcare providers are able to check periodically the status of survivors care to provide second or third level of care to prevent escalation and incidence of the adverse outcomes of the disease.

Introduction: Transition from childhood to adulthood is an important and challenging period for both adolescents and their parents, particularly in societies undergoing development and change. In Iran, cultural and social change is inextricably linked to, and strongly impacts on, family units. Aim: To explore the experiences of parents and the strategies they use in interacting with their adolescent children. Method: Qualitative descriptive research using in-depth interviews was conducted with 23 parents of adolescents in Iran. Transcribed data were subjected to thematic analysis. Results: Parents used two key approaches to effectively interact with their adolescent children. The first, “transformed parenting” involved the parents changing their parenting style and practices. The second approach, “child orientation” involved the parents trying to control, educate, and guide their child. Implication for transcultural practice: Understanding how parents experience interactions with adolescents in the context of Iranian culture and increasing modernity will guide nurses to foster effective parenting strategies for optimal adolescent development.

BackgroundDefining the disrupted mothering would contribute to developing strategies to support mothers with breast cancer. The aim of this study was to analyze the concept of mothering disruption using a hybrid model.MethodsThe Hybrid method for concept analysis was implemented consisting of three phases: theoretical, fieldwork, and final analysis. In the theoretical phase, the literature was searched using electronic databases including PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, CINAHL, Wiley, Ovid, Magiran, and SID from 2000 to 2020. Any quantitative or qualitative studies published in English or Persian, which were focused on mothering disruption in mothers with breast cancer were included in the study. In the phase of fieldwork, 20 mothers were interviewed to explore the aspects of mothering disruption. The interviews were transcribed and analyzed with conventional content analysis. In the final phase, an overall analysis of the two previous phases was performed.ResultsIn the theoretical phase, the following attributes were determined: “disturbance in maternal identity and roles”, “maternal insensitivity and unresponsiveness: disconnection physically and psychologically”, “the career disruption process” and “biographical disruption”. The fieldwork phase explored three themes including “the unbalance between multiple roles”, “role failure”, and “reduced maternal sensitivity”. The final synthesis yielded that the main integrated elements of mothering disruption are “disease as threating maternal role and identity”, “inability to interpret and respond to child behaviors and needs”, and “support for transitioning from being patient toward maternal competency”.ConclusionWith a deeper understanding of the term ‘disrupted mothering’ or ‘mothering disruption’, healthcare providers will have a foundation to improve cancer care, deliver effective communication and help such mothers cross this disruption and achieve restoration of their mothering role. Future research is needed to validate this concept and explore connections with health outcomes.

Background Nurses are at the forefront of patient care during infectious disease pandemics and they play a key role in treating and preventing the upward trend of the disease. Hence, it is crucial to consider their experiences in designing action plans to combat coronavirus disease 2019 (COVID-19). Since there is not enough data in this regard, the current study aimed to investigate the nurses’ experiences in caring for patients with COVID-19 in Iran. Methods In this descriptive qualitative study, a total of 20 nurses were selected by purposive sampling. Semi-structured interviews were conducted and analyzed using qualitative content analysis to collect data. Results Data analysis revealed four main themes, including ‘duality in the form of care,’ ‘confusion and ambiguity in care planning’, ‘workload’, and ‘social isolation in spite of positive image.’ Conclusion Our findings indicated that the nurses experienced a range of paradoxes during the COVID-19 pandemic; these paradoxes included distraction from providing care due to focus on marginal factors in spite of empathy and cooperation in nurses, the presence of volunteer support staff despite the lack of equipment, lack of scientific information and the unreliability of online information, overload in the hospital due to insufficient facilities and equipment, and the physical avoidance of people in the community in spite of social support for nurses in the media. The results of this study can lead to a clear understanding for managers and healthcare policymakers in the country and aid them in taking optimal measures to support nurses and improve the quality of nursing care against COVID-19.

Background & Aim: Patient-centered care is considered a pivotal element of the mission of the healthcare system around the world. However implementing Patient-centered care is not always easy and nurses have admitted this fact reluctantly. The evidence suggests that the first step in implementing Patient-centered care is to change the professionals’ viewpoint, behavior, and understanding. This study examined nurses' perceptions of the components of Patient-centered care and its delivery. Methods & Materials: This was qualitative descriptive research with a conventional content analysis approach. Face-to-face interviews were conducted with 21 nurses, working in teaching hospitals in Tabriz, Iran, and 5 field notes were collected. Data were analyzed using the Zhang and Wildemuth method of content analysis. Results: Three main themes and eleven sub-themes were extracted. Nurses identified “Effective Communication”, “Careful Care of Distinctive Needs”, and “Valuing the Patients and Their Rights” as the main elements of Patient-centered care. Conclusion: Nurses implement some components of Patient-centered care. Yet Patient-centered care remains an ad hoc practice requiring more improvement. This study provided a deeper understanding of nurses' perceptions about the implementation of Patient-centered care and their weaknesses. The finding is consistent with current knowledge, shedding light on Patient-centered care-related practices performed by Iranian nurses and pointing to areas for improvement in implementing Patient-centered care.

Summary: Purpose: The aim of this study was to explain the experiences of Iranian nursing students regarding their clinical learning environment (CLE). Methods: Twenty-one nursing students participated in this qualitative study. Data were collected using semistructured interviews and analyzed using conventional content analysis. Results: Analysis of interviews identified six categories: educational confusion, absence of evaluation procedures, limited educational opportunities, inappropriate interactions with nursing staff, bullying culture, and discrimination. Systematic and consistent methods were not used in clinical education and evaluation of nursing students. In addition, there were inadequate interactions between nursing students and health-care staff, and most students experienced discrimination and bullying in clinical settings. Conclusion: Findings showed that the CLE of Iranian nursing students may be inadequate for high-level learning and safe and effective teaching. Addressing these challenges will require academic and practice partnerships to examine the systems affecting the CLE, and areas to be addressed are described in the six themes identified. Keywords: education, nursing, Iran, qualitative research, students, nursing

تكييف الحياة مع حقيقة السكري. حسين أريشتانب، حسين موناجي، ليلى جويباري، وحيد زمانزادة ، حسين إبراهيمي. الخلفية: السكري من أكثر الأمراض المزمنة التي تفرض التحديات وتسبب الأعباء في القرن الحادي والعشرين، والتكيف معه عملية تفاعلية ونفسية ومتعددة الأبعاد، وتتأثر بالعوامل الاجتماعية والثقافية. ويجب شرح ذلك في السياق الثقافي لكل مجتمع مع إجراء دراسات كيفية. الهدف: بحثنا في هذه الدراسة الخبرات الشخصية للتكيف مع السكري من النمط 2 بين المرضى الإيرانيين. طرق البحث: كانت هذه الدراسة كيفية تستند إلى استخدام مقاربة ذات أسس نظرية، واستخدمنا فيها اختيار مستهدف للعينة في البداية، وأتبعناها بعد ذلك بأسلوب أخذ العينات النظرية استنادا إلى الرموز المشتقة والفئات، واخترنا 20 مريضا كمشاركين رئيسيين و 7 مشاركين من نظام الرعاية الصحية وأفراد الأسرة استنادا إلى الطريقة الهادفة والنظرية لأخذ العينات، وجمعنا البيانات من خلال المقابلات ذات البنية المركبة تركيبا جزئيا، وحللنا البيانات باستخدام مقاربة شتراوس وكوربين المتزامنة في وقت واحد عند جمع البيانات. النتائج: أدت دراسة البيانات إلى 5 فئات هي: التهديد المدرك للمرض، والامتثال للحقيقة، وإعادة البناء الشامل، وتطبيع الحياة مع المرض، والعودة إلى الموارد. وأخيرا، أدى تحليل البيانات باستخدام ترميز انتقائي إلى التعرف على « مشروع إعادة بناء الحياة » باعتباره المتغير الأساسي. وقد أظهر المتغير الأساسي طريقة تكيف المشاركين مع السكري. الاستنتاج: أظهرت هذه الدراسة أن عملية التكيف مع السكري لها طبيعة ديناميكية يقوم المشاركون فيها بإجراء تغييرات كبيرة في ما لديهم من بنى معرفية وعاطفية وسلوكية من أجل الحصول على حياة طبيعية. Background: Diabetes is one of the most challenging and burdensome chronic diseases of the 21st century. Adaptation to disease is a mental, multidimensional, interactive process and is influenced by social and cultural factors. It should be explained in the cultural context of each society with qualitative studies. Aims: In this study, we explored the subjective experiences of adaptation to type 2 diabetes among Iranian patients. Methods: This was a qualitative study using a grounded theory approach. Purposeful sampling was used initially, followed by theoretical sampling based on derived codes and categories as the sampling method. Twenty patients as main participants and 7 from the healthcare system and family members were selected based on a purposeful and theoretical sampling method. Data were collected through semistructured and deep interviews. Data were analysed using the approach of Strauss and Corbin simultaneous with data collection. Results: Five categories that emerged from the data included: perceived threat of disease, reality compliance, comprehensive reconstruction, normalization of living with illness, and return to resources. Finally, data analysis on selective coding led to recognition of "endeavour to reconstruction of life" as the core variable. The core variable showed the way participants adapted to diabetes. Conclusions: This study showed that the process of adaptation to diabetes has a dynamic nature in which participants make major changes in their cognitive, emotional and behavioural structures in order to have a normal life. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Adapter les habitudes de vie a la realite du diabete. Contexte: Le diabete est l’une des maladies chroniques les plus complexes et pesantes du vingt et unieme siecle. L’adaptation a la maladie implique un processus mental, multidimensionnel et interactif, qui est influence par des facteurs sociaux et culturels. Elle doit ainsi etre apprehendee par le prisme du contexte culturel de chaque societe, a l’aide d’etudes qualitatives. Objectif: Dans la presente etude, nous avons analyse les experiences subjectives de l’adaptation au diabete de type 2 parmi des patients iraniens. Methodes: Il s’agissait d’une etude qualitative reposant sur la methodologie de la theorie enracinee. Un echantillonnage cible a tout d’abord ete utilise, suivi d’un echantillonnage theorique reposant sur des codes et categories derives. Vingt patients ont ete selectionnes a l’aide des methodes d’echantillonnage cible et theorique. Les donnees ont ete recueillies au moyen d’entretiens semi-structures et approfondis, et ont ete analysees simultanement a l’aide de l’approche de Strauss et Corbin. Resultats: Les cinq categories qui se sont degagees des donnees recueillies incluaient : la menace percue de la maladie, le fait de se conformer a la realite, la reconstruction globale, la normalisation associee au fait de vivre avec la maladie, et le retour aux valeurs de base (individuelles, familiales et sociales). Enfin, l’analyse des donnees portant sur le codage selectif a mene a l’identification de « l’effort de reconstruction de sa propre existence » comme variable fondamentale. Cette variable fondamentale a montre la facon dont les participants s’adaptaient au diabete. Conclusion: La presente etude a revele que le processus d’adaptation au diabete est de nature dynamique. Les participants modifient en effet considerablement leurs structures cognitives, emotionnelles et comportementales de facon a mener une vie normale.

In Iran, as in other nations, adolescence can be a challenging period for both parents and their children. Typically, mothers assume the main role of parenting, which can have a negative impact either directly or indirectly on paternal involvement, or conversely, play a positive role of mediation between fathers and their adolescent children. In the present study, we report on a qualitative study conducted in 2016 that explored the perceptions of Iranian parents toward the paternal role in raising adolescent children. Twenty three mothers and fathers of adolescent children were interviewed to explore their views and experiences with paternal roles in raising adolescent children. Four themes emerged from the data: (i) limited father-child interactions; (ii) mother-led parenting; (iii) father-child conflict; and (iv) united front parenting. The findings suggest that mothers maintain a prime role in parenting, but that the involvement of fathers can have a negative or positive impact on adolescent development, depending on the level and quality of that involvement. Strategies need to be explored for how parents can best support one another to engage in the development of adolescent children.

Introduction: Adolescence is a challenging period and cultural background plays an important role in families with adolescent. So exploring parents’ concerns in the specific context of Iran may improves nurses' family-based services and helps to reduce conflicts Iranian families with respect to adolescents. In this paper we explore perceptions of Iranian parents’ concerns in the family with raising adolescent children. Methods: Participants of this qualitative content analysis study were 23 parents with adolescents, who were recruited through purposive sampling. Data collection was done through semi structured in-depth interviews and analyzed based on Graneheim and Landman’s approach. Lincoln and Guba’s criteria were used to ensure the accuracy and strength of the study. Results: The theme "rebellion against parents’ authority" was supported by two categories: (1) parent-teenage conflict, and (2) difficulty in controlling. As the offspring enter adolescence, parents feel that their child is going to leave their domain. Conclusion: Findings from this study showed that the incongruity arises when traditional family norms fail to adapt to new patterns. Change of social and cultural norms in developing societies, has led to generational differences in families. This issue accompanied with adolescence, increases parents’ concern. So we recommend parental educational programs for learning effectively patterns for resisting internal challenges and communicate with adolescents.

The social context where parents live on affects their behaviors and interactions with their children. The social changes of the Iranian society in recent years have complicated the issues of families with adolescents. Discovering the experiences of parents by considering the cultural and Islamic context of Iran is an important step for the mental health of adolescents. The aim of this study was to specify the social context of parents with adolescents. This qualitative study was a conventional content analysis that was conducted in Tabriz in 2016. Participants included 13 mothers and 10 fathers with adolescent who were included in the study by purposive sampling. Data collection was done through in-depth interviews and continued until data saturation. Data analysis was carried out using the Graneheim&Lundman approach. Four criteria of Lincoln&Guba were used to provide trustworthiness of the study. The three theme reflect the social context of parents: (1)"Living in the future frame" with the categories, concerns on the child future and empowering the child regarding future, (2)"Challenges of now days", with the categories, social hazards and gap between generations, and (3)"Parental Religiosity" with the categories, Parents' religious affects, guiding the child toward religion emphasis on the doing religious teachings. Conclusion: Identifying the social context of parents has shown that tree factors of occupational-educational policies, universal advances, and superior beliefs can affect the health of families. So clarifying these issues makes simplify design micro and macro interventions.

Introduction: The staffs' attitudes, beliefs, ideologies and dutifulness, along with their individual characteristics particularly their personality traits are among the factors that are known to affect their performance. The aim of this study was to determine the effect of individual contributions to the process of intraprofessional collaboration among Iranian nurses. Methods: Twenty-three nurses from three different areas, namely Tehran, Tabriz and Ilam hospitals participated in this qualitative study. The participants were selected through purposive sampling. Data were collected using deep and unstructured interviews. Interviews were simultaneously analyzed using conventional content analysis method after being transcribed. Results: Several essential factors contributing to the process of effective collaboration among Iranian nurses were identified: (a) nurses’ perspectives and beliefs, (b) personal experiences, (c) individual characteristics and, (d) personal problems. Conclusion: The findings indicate that the features and characteristics of individual contributions are very important and effective on nurses' intraprofessional collaboration. Thus, attention must be paid to these factors in order to overcome problems and obstacles that are encountered on the way of achieving effective collaboration.

Introduction: Pain is the main reason for patients with osteoarthritis (OA) to visit health clinics. Health seeking behaviors indicate unmet patient needs and lack of understanding of OA pain patterns. This study aimed to describe the experiences of Iranian patients with OA and explore their health seeking behaviors and perceptions on pain management related to osteoarthritis. Methods: Using a qualitative approach, data was collected by interviewing 19 patients, 2 family members, and 5 health care providers from the in-patient and out-patient clinics, and physicians’ offices. Data saturation was reached after 31 in-depth and semi-structured interviews (five second interviews). Data were analyzed by qualitative content analysis, using comparison, reflection and interpretation techniques. The criteria used to enhance rigor included credibility, transferability, dependability, and confirmability. Results: Two main categories and six subcategories emerged from data analysis. The first main category included "adapting to the reality" which had three subcategories: Facing OA pain, seeking health care, and accepting pain as a part of life. The second main category included "behavior fluctuation" with three subcategory of role conflict, responsibility for self-care and, adherence to prescribed treatment versus self-treatment. Conclusion: Care seeking behaviors for chronic pain sufferers are void of cultural, emotional, social and financial situation and patient expectations. Some misconceptions emerged about the health problem and its management, which may lead to negative attitudes toward treatment and therapists and finally lead to non-adherence to treatment. Patients need for education to enhance appropriate health care utilization.

Background: One of the essential aspects of the provision of care is cultural issues. Cultural sensitivity is the key for cultural care. The aim of this study was to explore culturally sensitive care in pediatric nursing care in Iran.Materials and Methods: This study was a conventional content analysis. Participants were consisted of 25 nurses and 9 parents selected through purposive sampling from three pediatric referral centers in Tabriz and Tehran, Iran. Data was collected using semi-structured interviews and field notes and were concurrently analyzed by using Graneheim and Lundman (2004) method. Data was transcribed verbatim, words, sentences, and phrases were considered meaning units, abstracted, labeled and compared for developing categories.Results: Culturally sensitive care of a sick child was consisted of three themes: ‘cultural exposure’, ‘intercultural communication’ and ‘the reconciliation of cultural conflict in families/care’. During the ‘cultural exposure’ nurses were informed of the cultural manifestations, strived to identify and understand patients/families with cultural diversities and respect their cultural beliefs. The nurse used the native language in ‘intercultural communication’ or a combination of verbal and nonverbal communication methods to reach a common understanding. Finally, a nurse in the conflict between the culture of child/family and care took actions for making decisions to develop a compliance between care and the family culture and amended parents’ harmful desires through negotiation and appropriate care.Conclusion: Understanding the concept of culturally sensitive care, can help with resolving the problems of cultural exchanges in Pediatric wards. Providing cultural facilities and interpreters to communicate with patients/family increase their satisfaction.

Purpose: Even though holistic care has been widely discussed in the health care and professional nursing literature, there is no comprehensive definition of it. Therefore, the aim of this article is to present a concept analysis of holistic care which was developed using the hybrid model. Methods: The hybrid model comprises three phases. In the theoretical phase, characteristics of holistic care were identified through a review of the literature from CINAHL, MEDLINE, PubMed, OVID, and Google Scholar databases. During the fieldwork phase, in-depth interviews were conducted with eight nurses who were purposely selected. Finally, following an analysis of the literature and the qualitative interviews, a theoretical description of the concept of holistic care was extracted. Results: Two main themes were extracted of analytical phase: “Holistic care for offering a comprehensive model for caring” and “holistic care for improving patients' and nurses' conditions.” Conclusion: By undertaking a conceptual analysis of holistic care, its meaning can be clarified which will encourage nursing educators to include holistic care in nursing syllabi, and consequently facilitate its provision in practice.

Objectives: Nurses, as the largest group providing health care services, play a critical role in the continuity of care and respond to services commensurate with their competence. Professional competence in nursing is a complex and ambiguous concept and needs the redefinition of competence and development of its definition and concept. In this study, we aimed to conceptually analyze professional competence in nursing. Methods: In this study, a hybrid concept analysis was used. In the literature review phase, the concept of ‘competence’ was investigated through valid databases limited to 2000 - 2018 and the participants’ experiences also appeared in the fieldwork phase. In the fieldwork phase, the participants revealed some aspects of professional competence in nursing, which were not well-addressed in the literature. Finally, the comprehensive definition of professional competence in nursing was presented after integrating the findings obtained in these two phases. Results: According to the findings, professional competence in nursing is a combined, complex, multidimensional, and context-dependent concept, and consists of different domains. Based on the analysis results of the fieldwork phase, this concept was classified into 16 domains and the participants largely contributed to the provision of a comprehensive definition based on the definitions of professional competence presented in the literature. Conclusions: Based on the domains of professional competence in nursing obtained from this study, an appropriate instrument can be developed to assess professional competence in nursing for students and nurses.

Background: Caring is one of the main concepts in nursing and its modes of delivery in different diseases have been widely studied. Hematopoietic Stem Cell Transplantation (HSCT) is a novel, complex, and time-consuming clinical intervention which is applied as a final medical choice in several life-threatening diseases. The aim of the current study was to explore the process of caring for patients undergoing HSCT. Materials and Methods: In this article, we present a qualitative research study conducted between 2011 and 2013 in accordance with the procedures of grounded theory methodology. Data were gathered by interviewing and observing health professionals involved in HSCT process, as well as patients and their families. The study participants consisted of 18 HSCT nurses, 2 physicians, 12 patients, and 7 members of patients’ families. The initial sampling in the study was purposeful, followed by theoretical sampling. Data were analyzed using the Corbin & Strauss (2008) method. Results: Four main categories, reflecting 13 sub-categories, were emerged by analyzing the data: struggling of patients between life and death, trying to reduce the chance of patient’s death, enforcing patients’ spirit and caring achievements. The core variable of study, defined as “supporting patients to go through the HSCT process successfully”, represented the nature and efficiency of care delivered to HSCT patients in the study setting. Conclusion: HSCT patients enter the caring process in the context of life-and-death limbo. The caring strategy in HSCT patients is aimed at trying to reduce the chance of the patient’s death, as well as enforcing patients’ spirit. The HSCT process affects all areas involved in various ways and has some outcomes. The findings and the theoretical conclusions of this study are potentially valuable in improving nursing practice, designing of educational programs and setting of caring policies.

Supportive care is an important strategy that can help cancer survivors manage changes and problems during their follow-up care. Identifying patients' care needs is one of the primary steps of the nursing process to plan effective nursing interventions. The aim of this study was to explore adolescent cancer survivors' supportive care needs. Purposeful sampling was adopted to select 49 participants from hospitals to participate in face-to-face, semistructured interviews. The qualitative content analysis method was conducted for data analysis. Ten subcategories and four main categories - empathetic care, information about survival period, instrumental support, and cooperation in care - were extracted from the data. These four categories formed a major theme, "supportive care", as the primary healthcare need. This study highlights that supportive care should be developed collaboratively by family and healthcare providers to meet the needs of adolescent cancer survivors. Survivors' strengths and limitations should be identified, and then supportive care can be provided, such as giving appropriate information, enabling survivors to access supportive networks, and improving survivors' confidence and autonomy with their self-management.

OBJECTIVE The aim of this study was to determine the barriers and facilitators shaping the development of an intent to leave the nursing profession, from the perspective of Iran's clinical nurses. METHOD The study was completed using qualitative content analysis And included 21 Participants who were clinical nurses with a variety of work experience across a range of clinical posts. Semi-structured interviews were used to collect data and data obtained from the interviews were analyzed and interpreted utilizing a content analysis method. RESULTS During data analysis, 2 main themes, 5 categories and 12 subcategories were extracted as follows. Facilitators include: (I) spoiled identity (weak social status and violation of dignity), (II) frustration (feeling subordinate including a lack of appreciation), and (III) experience of hard labor (job stress, hard work and shift work). Inhibitors include: (I) positive management behaviors (rewards and support systems), and (II) being valuable (spiritual satisfaction, the efficient presence and professional capabilities development). CONCLUSION Based on the findings, it can be concluded that managers can prevent nurses from leaving clinical nursing by providing appropriate activities for them and increasing their motivation and satisfaction. Resumo OBJETIVO Este estudo teve como objetivo determinar as barreiras e facilitadores que definem o desenvolvimento de uma intenção de abandonar a profissão de enfermagem, sob a perspectiva de enfermeiros clínicos do Irã. MÉTODO O estudo foi realizado através da análise de conteúdo qualitativo e incluiu 21 participantes que eram enfermeiros clínicos com vasta experiência de trabalho em uma variedade de cargos clínicos. A coleta de dados foi realizada através de entrevistas semiestruturadas, e os dados obtidos com as entrevistas foram analisados e interpretados através do método da análise de conteúdo. RESULTADOS Durante a análise dos dados, 2 temas principais, 5 categorias e 12 subcategorias foram obtidos como indicado a seguir. Os facilitadores incluem: (I) identidade debilitada (status social vulnerável e violação da dignidade), (II) frustração (sentimento de subordinação, incluindo falta de reconhecimento) e (III) experiência de trabalho árduo (estresse ocupacional, trabalho árduo e trabalho por turnos). Os inibidores incluem: (I) gestão de comportamentos positivos (recompensas e sistemas de apoio) e (II) ser útil (satisfação espiritual, eficiência e desenvolvimento de habilidades profissionais). CONCLUSÃO Com base nos achados, pode-se concluir que supervisores responsáveis podem impedir os enfermeiros de abandonarem a enfermagem clínica, delegando-lhes atividades pertinentes e aumentando sua motivação e satisfação. Resumen OBJETIVO Estudio objetivando determinar obstáculos y facilitadores condicionantes del desarrollo de la intención de abandonar la profesión de enfermería, en la perspectiva de enfermeros clínicos de Irán. MÉTODO Se aplicó análisis cualitativo de contenidos. El estudio incluyó 21 participantes, todos ellos enfermeros clínicos con variada experiencia laboral en el campo de la enfermería clínica. Datos recolectados mediante entrevistas semiestructuradas, posteriormente analizados e interpretados por método de análisis de contenido. RESULTADOS Durante el análisis de datos fueron establecidos 2 temas principales, 5 categorías y 12 sub categorías, a saber. Los facilitadores incluyen: (I) identidad damnificada (status social debilitado y violación de la dignidad), (II) frustración (sentimiento de subordinación incluyendo falta de reconocimiento), y (III) percepción de alta carga laboral (estrés laboral, trabajo duro y turnos de trabajo). Los inhibidores incluyen: (I) comportamientos positivos de gestión (sistemas de recompensas y soporte), y (II) sentirse valorado (satisfacción espiritual, presencia eficiente y desarrollo de capacidades profesionales). CONCLUSIÓN En base a estos hallazgos, puede concluirse en que los gestores pueden prevenir el abandono de la profesión de los enfermeros clínicos brindándoles actividades apropiadas para ellos e incrementando su motivación y satisfacción.

Objective: Clinical nursing is the most important feature of the nursing profession and similar to the global community. The study objective was to identify and describe the challenges and why Iranian nurses leave their profession. Methods: Qualitative methods were applied to describe nursing practice challenges through in-depth and semi-structured interview of 16 Iranian nurses with 2 to 15 years of work experience in 2014 by asking: “Please tell me about your challenges at work and why nurses are leaving the nursing profession?” Obtained data were analyzed using conventional content analysis. Results: Analyzed data revealed four thematic categories as 1) unfriendly workplace, 2) lack of opportunity for professional advancement, 3) work stress, and 4) ethical issues. Conclusion: Recognizing nursing challenges in clinical setting can help faculty in academia and administrators in healthcare institutions to develop policies to reduce pitfalls and prevent attrition.

The aim of this study was to explore the process of Iranian male nurses’ professional socialization and how they negotiate a gendered identity. A purposive sample of 22 male nurses was recruited from six public hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Study data were collected by conducting semi-structured interviews. Data collection was continued until reaching data saturation. Totally, 25 interviews were conducted. Data analysis was carried out using Corbin and Strauss’s techniques for qualitative data analysis. The core category of the study, that is, the socialization process of male nurses who participated in the study, was “maintaining equilibrium.” Our participants’ strategies for socialization included informing, conforming, and self-establishing. The study findings can be used for developing effective strategies for male staff recruitment and retention.

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.

Introduction: Hepatitis B is the most prevalent type of viral hepatitis. Psychological reactions among patients with hepatitis B infection is considerably different and affects their decision about treating and following up the disease. The present study aims at explaining the psychological demonstrations experienced by these patients. Methods: In this qualitative study, a total of 18 patients with hepatitis B (8 women and 10 men) were selected by purposive sampling method. Data were collected by unstructured in-depth interviews during 2014-2015 in the medical centers of three cities in Iran. All interviews were recorded, typed and analyzed by the conventional content analysis approach. Results: By analyzing the data, the main theme including psychological instability, with three sub-themes were emerged: grief reaction (stupor, denial, anger and aggression), emotional challenges (worry and apprehension, contradiction with beliefs, fear of deprivation, fear of stigma, waiting for death and prognosis ambiguity) and inferiority complex (social withdrawal, sense of humiliation and embarrassment and sense of guilt and blame) were acquired. Conclusion: The findings indicate that patients with hepatitis B experience various psychological reactions that need to be controlled and managed by themselves or healthcare providers. Thus, implementation of health interventions with emphasis on psychological care to prevent problems and execution of educational and consultation programs about hepatitis especially by medical centers and mass media is seems necessary.

Introduction: The concept of self-esteem has several definitions in different paradigms. Nursing has a unique and combined paradigm; therefore it is necessary to explore nursing students’ understanding of the concept of self-esteem. The present study aimed to discover the extent and characteristics of the concept of self-esteem from the perspective of Iranian nursing students through a qualitative approach. Methods: This study was conducted using the conventional content analysis method with the participation of 14 nursing students. Purposive sampling was used to recruit participants and data were collected through in-depth semi-structured interviews and analyzed simultaneously. Results: Study findings showed that the nursing students’ self-esteem is related to the sense of worthy they perceived as being a nursing student. Nursing students’ self-esteem was determined through sense of worthy related to their perceived professionalism level, socialization into the profession, and enthusing of them about being a nursing student. Conclusion: If a nursing student was proud of her or his nursing role, then he or she would enjoy the nursing course and all that entailed; such as communication with colleagues, performing the tasks and, generally her or his career.

PURPOSE/AIMS The aim of this study was to explore specialized clinical nurses' (SCNs') perceptions of "good care" through descriptions of actual care experiences. DESIGN We used a qualitative design with a conventional content analysis approach. METHODS We conducted semistructured interviews with 24 SCNs. These nurses have passed specialized clinical courses, are master's or bachelor's degree prepared, have additional course work beyond the bachelor degree, and practice with an expanded scope of responsibility. The participants were purposively sampled from general and specialty hospitals, and 6 field notes were collected. RESULTS We identified 3 overarching themes to classify the findings: patient-centered care, knowledge-based care, and skillful practice. Participants regarded these 3 components as interdependent and related, which we conceptualize as 3 sides of an equilateral triangle termed the Good Care Triangle. CONCLUSIONS The Good Care Triangle provides a heuristic approach to consider professional standards from the perspectives of SCNs and provides needed insight into SCNs' perspectives on the fundamental yet underexplored concept of good care. Clinical leaders can consider how the 3 themes identified are reflected and enacted in the care practices of SCNs. Future research could examine the utility of the Good Care Triangle in guiding nursing education and evaluating SCNs' perspectives of the care that they are providing.

Background Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing. Aims The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran. Methods The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed. Results In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing. Conclusion With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.

Aim The aim was to explore nurses' perceptions of career success. Introduction Career success is a concept which leads to improving professional behaviours. Research that focused on conceptualizing career success found it to be a complex, value-driven construct likely to be perceived differently across work and cultural contexts. It is not yet clear what constitutes career success, and how it is perceived by nurses in Iran. More comprehensive exploration of this concept in nursing is needed, so research and policymaking can advance in informed, data-driven manner. Method This is a qualitative descriptive study. The setting was teaching hospitals of Iran. Twenty-seven nurses participated in face-to-face interviews, and six field notes were collected. Data were analysed using conventional content analysis. Findings Analyses identified five themes of career success: providing high-quality care, being exemplary employee, embarking on career growth, having positive personal attributes and being internally satisfied. Conclusion Findings confirmed that career success in Iranian nurses was a multidimensional concept that represented five internally and externally driven dimensions set within its cultural and religious context. Policymakers and clinical educators can now plan interventions aimed at fostering career success in nursing staff. Implications for education, nursing and health policies Future nurses could use these finding to reflect on their developed attributes throughout their studies and clinical placements and adjust their career preparation and learning to bridge any identified gaps. Organizational values and intervention for nursing staff could also be redesigned to align with the aspects of career success.

OBJECTIVE: The study aimed to explore Iranian cancer survivors' experiences of returning to work. METHODS: Semistructured interviews were conducted with 20 cancer survivors at their workplace and in a referral cancer center. Data were analyzed using a conventional content analysis technique. RESULTS: Three main categories were identified as important in cancer survivors' experiences of returning to work: (1) individual perspectives, (2) nature of disease, and (3) access to support system. Results showed that returning to work contained different meaning for men and women. Also, it was found that cancer survivors had limited information about the disease and return to work that made them doubtful about returning to work. CONCLUSION: Cancer survivors have different individual perspectives that affect their decision about returning to work. Their perspectives should be assessed before returning to work, and necessary support should be provided for them in returning to work process. In this regard, health care systems and rehabilitation specialists should inform cancer survivors about the disease and return to work. Also, employers should prepare work places for cancer survivors' entrance.