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Background: Effective communication with patients is an essential part of nursing care. However, most researches have reported that communication of nurses with patients is weak. The quality of provided care, especially communication with the patients, is one of the main concerns of nursing education managers. Therefore, we conducted a study with the aim of improving communication skills in clinical education of nursing students. Methods: This research is a qualitative study, which was conducted in pediatric unit of Hajar Hospital, Shahrekord, Iran. Purposive sampling was used in this study whose participants were 8 nursing students (Sixth-semester) studying in the pediatric ward. Students’ experiences with this communication method were analyzed using qualitative content analysis. Data collection continued until that information was repetitive. The data were saturated after 8 participants were interviewed. Results: Based on the analysis of students’ experiences, 3 main categories of unfamiliarity with methods of communicating with patients, appeal of the interviewing method, and obstacles to communication with patients were found. Conclusion: The results of the study indicate that proper use methods of communication improved nurses’ ability to communicate with patients. It is recommended to add communication skills and interview techniques as an applied course in the undergraduate curriculum.

Cancer is one of the main causes of human death in the world, but its mortality rates have been in continual decline for the past 20 years (Siegel, Miller, & Jemal, 2015). It is a growing problem in Middle Eastern countries (Daher, 2011). In Iran, an ancient country in the Middle East (Borimnejad, Mardani-Hamooleh, Seyedfatemi, & Tahmasebi, 2014), cancer is the third most common cause of death, after heart disease and traffic accidents. The incidence of cancer in Iran is anticipated to be around 48 to 112 and 51 to 144 cases per year per million people for women and men, respectively (Seyedfatemi, Borimnejad, Mardani-Hamooleh, & Tahmasebi, 2014). As the incidence of new cases of cancer increases every year, breaking bad news to patients is very important. Bad news is described as any piece of information that could potentially be directed to negatively change a patient’s expectations, ideas, feelings, or outlook (Salem & Salem, 2013). Breaking bad news to patients with cancer is a delicate and challenging task for most health-care providers (Eng, Yaakup, Shah, Jaffar, & Omar, 2012). Bad news about cancer creates pain for patients (Zebrack, Chesler, & Kaplan, 2010). It is unexpected and often may come as a shock (Yoo, Levine, Aviv, Ewing, & Au, 2010). In this regard, despite efforts by family members to conceal cancer diagnoses from patients, the majority of patients discovered the diagnosis of their own accord (Wang, Guo, Peng, Su, & Chen, 2011). Breaking bad news to patients with cancer is diverse across different cultures (Table 1). Nondisclosure is the norm for Iranian people. However, health-care workers often want to tell patients of their diagnosis but worry that breaking bad news could evoke fear and anxiety for patients. In fact, it is difficult for health-care workers to predict cancer patients’ responses following disclosure. Therefore, a significant percent of cancer patients in many Mediterranean countries, such as Iran, are not made aware of their diagnosis, and many health-care workers prefer to disclose the cancer diagnosis directly to patients’ family members. However, the clinical experiences of the researchers show that family members rarely transfer this information to patients, and frequently prevent the disclosure of the cancer diagnosis.

Background Some ethical challenges have emerged along with advances within the field of pediatrics. Meanwhile, the residents of pediatrics face particular ethical challenges, since they have different roles in their professional career as educators, students, advocators, and clinicians. Objectives The aim of the present study was to identify ethical challenges in the field of pediatrics from the viewpoints of Iranian pediatric residents Methods This cross-sectional study was conducted during 9 months. The studied population consisted of 90 residents of pediatrics studying at Tehran University of Medical Sciences in Tehran, capital of Iran. Sampling was conducted in the form of census counts of a 32-item instrument that evaluated ethical challenges in the field of pediatrics. Validity and reliability of this questionnaire were evaluated by experts in the field of medical ethics and pediatrics. Data were analyzed using the SPSS software using descriptive-analytic statistic methods. Results The most serious ethical challenges in the field of pediatrics were providing enough information to obtain informed consent (4.74 ± 0.22), dealing effectively with the conflicts of decision-making by the sick children and their families (4.68 ± 0.14), giving bad news to the sick children or their parents as appropriately as possible (4.64 ± 0.18), and taking necessary actions in dealing with cases of child maltreatment (4.62 ± 0.16), respectively. In addition, based on linear regression analysis, there was a significant correlation (P = 0.03, r = 0.059) between the residents’ gender and their views towards ethical conflicts; female residents paid more attention to these challenges than male residents. Conclusions Paying attention to ethical challenges in the field of pediatrics helps the authorities provide favorable conditions in clinical settings. Therefore, resulting in less ethical challenges in similar situations.

Human dignity (HD) in patient care is an important concept in clinical ethics that has various definitions in existing literature. This study aimed at analyzing the concept of HD in patient care. To this end, Rodgers' evolutionary concept analysis was used. For this purpose, scientific databases PubMed, Elsevier, ScienceDirect, Scopus, OVID, Web of Science, CINHAL, IRANDOC, Google Scholar, Magiran, SID and IranMedex were searched fusing the words “human dignity”, “patient care” and “ethics”. The main criterion for inclusion in the final analysis was the literature published in English and Persian from 2006 to 2016 in online scientific journals within the context of health care disciplines. Ultimately, 21 articles were selected for the study. The attributes of the concept under study were identified in two areas of individual HD and social HD. Antecedents included facilitators and threats, and the consequences consisted of both favorable and unfavorable consequences. HD forms the essence of patient care and is a value-based and humanistic concept based on respect for the integrity of human beings and their beliefs. This concept, with its holistic approach to humans, takes into account all stages of disease, old age and the end of life period. HD in patient care is influenced by cultural, social, spiritual and religious factors, and with its justice-based approach emphasizes equality of all patients and extends patient care to all areas of society rather than restricting it to hospital settings. In this study, a clear definition of HD is introduced.

Background: Cancer is a growing challenge worldwide. Although it affects both sexes, women tend to be more vulnerable to it than men. This study aims to elucidate the perceptions of women afflicted with cancer regarding health-related behaviors. Methods: This is a qualitative study with content analysis. Participants included 22 women with cancer in Tehran. The participants were recruited by purposive sampling and were administered semi-structured, face-to-face interviews. The interviews were transcribed and reviewed to yield the findings. Initially, semantic resemblances and differences were reviewed and subcategories were defined. Subsequently, after repeated review, the related subcategories were placed in one category. Results: The participants in this study were aged 27 to 65 years, most were married (14 women) and homemakers (20 women). Moreover, their education ranged from elementary school to a bachelor’s degree. Regarding cancer type, most were diagnosed with breast cancer (12 women) and the duration of the disease ranged 2-5 years. Data analysis yielded 2 categories and 4 subcategories. The category “physical health-related behaviors” consisted of two subcategories: “health-related behaviors pertaining to physical activities after cancer” and “physical activities after treatment”. The category “psychosocial health-related behaviors” consisted of two subcategories: “mental health-related behaviors” and “socio-cultural health-related behaviors”. Conclusion: Our findings highlight the fact in order to improve the health of women with cancer, aspects of health other than physical health (e.g. psychosocial health) need to be addressed. Since, according to our findings, health-related behaviors of women with cancer are deeply affected by culture, it appears that countering the cultural taboos pertaining to cancer will improve these women’s health. Achieving this outcome requires extensive cultural interventions in the healthcare system. We propose community-based educational interventions to correct cultural beliefs of the community to improve health for this vulnerable group.

Nurses are continuously involved with ethical problems in their area of practice and need to possess a satisfactory level of moral sensitivity in order to be able to offer moral care. Additionally, they act as agents for proper management of ethical dilemmas and are therefore required to have high self-esteem. This study aimed to determine the correlation between moral sensitivity and self-esteem in nurses. In this descriptive-correlational research, sample study included 204 nursing personnel working in hospitals affiliated with Iran University of Medical Sciences. Participants were selected by convenience sampling. The data were collected using a demographic form, Lützén’s Moral Sensitivity Questionnaire, and Rosenberg’s Self-Esteem Questionnaire. Then, the data were analyzed using descriptive and analytical statistics. Written informed consent was obtained from each subject who participated in the research. The mean score for moral sensitivity of the samples was 69.15 ± 5.70, and 20.01 ± 4.76 for their self-esteem. Pearson’s correlation coefficient test indicated a meaningful and positive relationship between the two variables under study (r = 0.472 and P = 0.001). There was no correlation between the participants’ demographic data and moral sensitivity (P > 0.05), but a significant relationship was found between the participants' level of education and the variable self-esteem (P < 0.05). Since there was a positive and significant relationship between moral sensitivity and self-esteem among the nursing staff, nursing managers should focus on improving the quality of patient care by promoting nurses’ moral sensitivity inspired by high self-esteem.

Ethical conflicts are recognized as critical aspects in assessing competence in clinical communication. Moreover, pediatrics residents may face more problems, compared to other disciplines; due to the specific characteristics of the age group receiving services as well as the presence of their families. This study has been conducted with the aim of determining the attitude and perspective of pediatric residents toward ethical conflicts in the field of pediatrics. This descriptive, cross-sectional study was carried out on all residents of Tehran University of Medical Sciences (90 residents), selected through census method, in 2014. The data collection tool was a 32-item research-based questionnaire. Its validity and reliability were confirmed by the researchers and the medical faculty members. To analyze data, descriptive and inferential statistics were used. However, based on the results, lack of an advanced directive and written procedure for withdrawing life-sustaining treatment of an incompetent or critically-ill child (4.38 ± 0.80), lack of provision of sufficient information on obtaining informed consent (4.12 ± 1.10), and the absence of a legal written process for doing not resuscitate (DNR) orders (3.98 ± 0.95) were the most salient causes of ethical conflicts in pediatrics. Furthermore, in accordance with the linear regression analysis of demographic characteristics, there was a significant relationship (P = 0.04, r = 0.046) between residents’ year of education and attitude toward ethical conflict; however, this relationship was not observed in other demographic characteristics. Taking the priorities of ethical conflicts in pediatrics into account may help improve the designing of medical ethics education programs in hospitals for residents, thereby reducing the conflicts related to the issues of medical ethics.

The current study describes Iranian nurses' challenges in caring for older adults. Participants included 22 nurses who were selected by purposeful method and underwent semi-structured, face-to-face interviews. The interviews were reviewed, and three categories and seven subcategories were noted. The category older adults–nurse interaction challenges included: specific characteristics of older adults and inappropriate interaction between nurses and older adults. The category structural problems included: shortage of nurses, inappropriateness of ward environment, and service problems. The category educational gap included: lack of training on principles of older adult ethics in nursing curriculum and shortage of personnel training on manner of relationship with older adults. The current study is the first qualitative study regarding nurses' challenges in caring for older adults in Iran, and the results reveal aspects of nurses' understanding about the said challenges in this country. There is a need for culture-based caring programs that are responsive to older adults' needs. [Res Gerontol Nurs. 2017; 10(3):115–120.]

Background: The neonatal care in the first few minutes after birth could affect the newborn’s quality of personal life and thus its entire lifetime. Objectives: The aim of this study was to examine the integration of the newborn resuscitation-training program in pediatric nursing teaching. Methods: The present study was a mixed-method study, which began with qualitative and quantitative data collection at the same time. That is why the qualitative and quantitative steps performed at the same time. The qualitative phase was conducted based on the qualitative content analysis. Purposeful sampling was performed. Saturation occurred with10 interviews. The quantitative phase was performed based on a researcher-made questionnaire. The content validity of the questionnaire was confirmed by the feedback of experts and its reliability was assessed by Cronbach’s alpha 92%. The number of students at this stage was 48. Results: Based on the results of the qualitative phase, two main categories of clinical skills promotion and the necessity of attention to educational needs of students were obtained, which was in accordance with the results of the quantitative step. Based on the results of the quantitative step, the following results were obtained: areas of the resuscitation-training program improved my skills (83% strongly agree and 17% agree); I am satisfied with resuscitation-training program (94% strongly agree and 6% agree); I agree with continuing resuscitation program in future terms (77% strongly agree, 21% agree, and 2% disagree); the resuscitation-training program conformed with students’ needs (92% strongly agree, 4% agree and 2% disagree); and the quality of resuscitation training program was appropriate (94% strongly agree and 6% agree). Conclusions: Performing the newborn resuscitation for nursing students and increasing their knowledge and skills may lead to increase student motivation, reduce hospital costs and increase the quality of care.

Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients’ perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients’ informational needs in Iran.

Background: Palliative care is an important part of effective cancer care Objectives: The purpose of our study was to explore the lived experiences of nurses providing psychological palliative care for cancer patients in Iran. Methods: A hermeneutic phenomenological study was performed. We interviewed 11 oncology nurses to understand their lived experiences in cancer wards about psychological palliative care. We employed a seven-stage process of data analysis. Results: One constitutive pattern ‘palliative care as the driving force for providing psychological comfort to patients with cancer’ and three associated themes, namely ‘stress management’, ‘empathetic behavior’, and ‘all-embracing outlook’, were identified. Conclusions: The findings present better understanding of the lived experiences of oncology nurses in Iran regarding the phenomena under study.

Background The increasing population of patients with cancer highlights the need to develop an understanding of the patients' lived experiences. Objective The purpose of our study was to explore the lived experiences of Iranian patients regarding living with cancer. Methods A hermeneutic phenomenological study was performed. Twelve patients with cancer were interviewed to understand their lived experiences. We employed the seven-stage hermeneutical process of data analysis. Findings One constitutive pattern ‘cancer patients' effort to return to normal life' and two associated themes, namely ‘pass through limitations and challenges' and ‘emotional and informational support seeking', were identified. ‘Pass through limitations and challenges' had two subcategories: ‘acceptance of reality' and ‘resist cultural taboos'. ‘Emotional and informational support seeking' also had two subcategories: ‘family and friends support' and ‘healthcare providers support'. Conclusion The findings present better understanding of the lived experiences of patients with cancer in Iran regarding the phenomena under the study. Implications for Practice Nurses have an obligation to educate patients with cancer about anticipated changes in their life.

Background: Family-centered care is an essential concept in cancer but there is no consensus about its meaning and it remains an abstract concept. This study was conducted with the purpose of analyzing the concept of family-centered care in cancer. Methods: Concept analysis of family-centered care was conducted using hybrid model that has 3 phases: theoretical, field work and final analytical phase. For the theoretical phase attributes of family-centered care were identified through a review of the literature (without time limitation). In second phase 6 nurses were interviewed. In third phase final analysis were extracted from the first and second phase. Results: In general, original categories in the family-centered care context encompass; existence of family in clinic, family security and family support, communication between nurse and family, family participation in care, exposure to tension and family participation in decision making. Conclusion: By identifying the facilitating and preventive factors about the concept of family care center in cancer, we will be able to run our activities based on scientific findings which could provide the necessary conditions for good implementation of family care center in cancer.

Background: cancer patients require palliative care. Aim: the purpose of this study was to explore the experiences of nurses, who provide palliative care for cancer patients, within the context of Iranian culture. Methods: we conducted a hermeneutic phenomenological study. Semi structured in-depth interviews with 10 nurses were audio taped and transcribed. The transcriptions were then analyzed by Van Manen’s method. Results: one of the most important themes that emerged was “human relationships”, which also contained the subthemes of “comprehensive acceptance” and “psychological support”. Conclusions: the results provide deep understanding of human relationships in palliative care of cancer patients in Iran.