RESUMEN

BACKGROUND: Troubled conscience results from the lack of attention to the voice of conscience. Regarding the fact that ICU healthcare workers are constantly faced with stressful and challenging situations, they often experience a troubled conscience. AIM: This study aimed to explain the factors leading to troubled conscience and identify the consequences of troubled conscience among ICU nurses. METHODS: Qualitative content analysis was used to answer the research question. A total of 18 ICU nurses were selected to participate in this study using purposive sampling. Data were collected using face-to-face, semi-structured interviews. FINDINGS: Four categories of "carelessness", "contextual challenges", "non-supportive and unpredictable structure" and "whirlpool of troubled conscience" were shown to constitute the main causes of troubled conscience among ICU nurses. CONCLUSION: Troubled conscience negatively impacts nurses and is associated with psychological/behavioral changes among them. The identification and explanation of troubled conscience help healthcare providers to confront it and manage its causes.

RESUMEN

BACKGROUND: The nursing system is one of the major and important fields of health and medicine in every country, responsible for providing nursing care and addressing medical and health-related community care needs. The aim of this study was to explain the challenges of the Iranian nursing system in addressing community care needs. MATERIALS AND METHODS: A conventional content analysis method was performed in this exploratory qualitative study, and 27 participants were selected through a purposive sampling method based on the inclusion criteria. In-depth semi-structured interviews were conducted with the subjects, and data saturation was achieved in the 27th interview. The main interviews with the participants were individual, in person, and face-to-face, conducted at different times (morning and evening) in a peaceful environment and at the convenience of the participants. The interviews were recorded by the researcher with the participants' consent. The duration of the interviews ranged from 50 to 70 minutes, given the participants' energy and time. Data analyses were done using Graneheim and Lundman approach. RESULTS: After conducting the interviews and the simultaneous analysis, three themes were extracted, including the challenging structure in the internal environment, the operating environment, and the social environment, with seven main categories and 26 subcategories. An inadequate number of nurses given the real needs of society, the unbalanced proportion of employed clinical nurses to the real needs of society, poor presence of nurses in community-based nursing services, insufficient attention to the optimization of the work environment, the gap between education and clinical practice in the nursing system, poor mutual accountability of the community, and policies in the health system were seven main categories in this study. CONCLUSION: In general, the results showed that the Iranian nursing system faces many micro, meso, and macroscale challenges. It is necessary to plan properly to enhance the accountability of the nursing system to the current community care needs by improving the situation.

RESUMEN

The COVID-19 pandemic has been shown to affect both physical and mental health. Because of this mental health burden, it is important to pay attention to issues such as the relationship between spiritual health, death attitudes and meaning in life - all issues made more prominent during the pandemic. This study was conducted to determine the correlation between these three factors - spiritual health, meaning in life, and death attitudes, among patients with COVID-19 discharged from the intensive care units of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran.This cross-sectional, descriptive-analytical study was conducted between April 2020 and August 2021 with 260 participants. The data collection instruments were a demographic characteristics questionnaire, Polotzin and Ellison's Spiritual Health Questionnaire, The Meaning in Life Questionnaire (MLQ), and Death Attitude Profile-Revised (DAP-R).The correlation between meaning in life, spiritual health, and death attitudes was determined by Spearman's correlation coefficient. The research results showed that there is an inverse and significant correlation between spiritual health and death attitudes (p = 0.01); an inverse, but insignificant correlation between existential health and subscales of death attitudes, except for the subscales of approach acceptance and neutral acceptance (p > 0.05); and an inverse, but insignificant, correlation between spiritual health and death attitudes, (p > 0.05). In addition, there was an inverse and significant correlation between the presence of meaning in life and escape acceptance (p = 0.002); an inverse and significant correlation between the search for meaning in life and neutral acceptance (p = 0.007); and an inverse and significant correlation between the meaning in life and death attitudes (p = 0.04). Besides, the findings showed an inverse but insignificant correlation between all spiritual health subscales and the meaning in life subscales (p > 0.05). Spiritual health has an inverse correlation with death attitudes.Also, there is an inverse correlation between the total score of spiritual health and death attitudes. Regarding the subscales of spiritual health, there is an inverse correlation between existential health and death attitudes subscales, except for approach acceptance and neutral acceptance. Also, the results showed an inverse and significant correlation between meaning in life and death acceptance and avoidance subscales, and there was an inverse and significant correlation between the meaning in life and death attitudes. Finally, the increase in spiritual health reduces patients' risks of thinking about death. The research results double the significance of the role of nurses, especially those dealing with critically ill patients and those who have experienced severe disease conditions.

Asunto(s)

RESUMEN

Working as a nurse in the critical care unit may involve ethical challenges including conflict of conscience. Literature provides very limited knowledge about intensive care unit (ICU) nurses' perception of conscience. Considering the influence of culture on the perception of conscience, it is important to study it in diverse contexts. This study aims were to explore the meaning of conscience and the impact of conscience on nurses' practice in the ICU. A qualitative research approach was used to answer the research question, and qualitative content analysis guided the study. A total of 17 interviews were conducted with ICU nurses. Data were collected through semistructured tools by using videoconferencing and face-to-face interviews. Data analysis resulted in the formation of 2 main categories and 7 subcategories. The main categories included understanding the conscience and unlimited efforts in caretaking as the path to a clear conscience. The category of understanding the conscience includes 3 subcategories of conscience as an intrinsic asset and internal observer, dynamicity of conscience, and conscience as the cornerstone of morality. Also, the category of unlimited efforts in caretaking as the path to a clear conscience consists of 4 subcategories including giving full attention to the patient, putting oneself in another's shoes, taking responsibility, and working beyond the job description. Conscience plays an essential role in providing the ethical care among ICU nurses. The ICU nurses felt that they need to go above and beyond to keep their conscience clear. Nurses expressed the importance of following the call of conscience at their workplace, which demanded unlimited efforts to achieve a clear conscience.

Asunto(s)

RESUMEN

Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.

Asunto(s)

RESUMEN

BACKGROUND: Nursing education in Iran is one of the disciplines of medical sciences and it needs a design tailored to the community needs in terms of theoretical and clinical approaches. This system is currently faced with various challenges. This study aims to explore the challenges of Iranian nursing education system to address community needs. METHODS: A study was carried out through an exploratory descriptive qualitative design with content analysis method. In-depth semi-structured interviews were conducted with 21 participants from the nursing society, selected through purposive sampling. The interviews were continued until data saturation. Data analysis was performed simultaneous with data collection by using Graneheim & Lundman approach. RESULTS: Based on the interviews and simultaneous analyses, a total of 471 codes, 14 subcategories, six main categories, and two themes were extracted. The first theme, "system structure," consisted of three categories: "the need for ongoing revision of curriculum," "the need to recruit qualified students," and "the need for a proportionate educational environment." The second theme was "the education process" with three categories "the need for purposive educational design," "the need for purposive monitoring and feedback," and "the need for appropriate and early interaction with the community." The participants emphasized the continuous revision of the educational curriculum based on the current needs of the community and community-based nursing education. CONCLUSIONS: In general, the results showed that Iranian nursing education system is faced with many challenges in the educational system structure and processes. It is necessary to make appropriate plans to enhance the status of the educational system structure and develop educational designs to address community needs using a hospital/community-based approach.

RESUMEN

This study aimed to explore the spiritual pain concept in the Iranian-Islamic context using a hybrid research model during 2020-2021. During the first phase, international and Iranian-Islamic literature was systematically searched and reviewed. During the second phase, the researchers referred to oncology wards, palliative care centers, and intensive care units and conducted unstructured interviews with 19 dying patients. In the third phase, attributes, and final analysis of spiritual pain was extracted from the first phase, and following the second phase, the definition of spiritual pain was finalized. The results showed that spiritual pain is a type of unique transcendental pain in the context of a continuum, rooted in human nature. At the one end of the continuum, there is the pain of deprivation from worldly pleasures (oneself, the family, and others). At the other end, there is the pain of breaking away from and striving to return to one's origin (God). Exploring spiritual pain in the Iranian-Islamic context can help develop tools and clinical guidelines and plan for the presence of specialists at the bedside to relieve this pain.

Asunto(s)

RESUMEN

INTRODUCTION: One of the most important wards of the hospital is the emergency department (ED). Due to the increasing number of referrals, overcrowding has become a significant problem. It means an increase in patients' referrals and swarms at the ED, limiting their medical staff access. This study investigates the nurses' experiences and perceptions about the reasons for ED overcrowding. MATERIALS AND METHODS: Twelve emergency nurses were purposefully selected to take part in this study. Data collection was through face-to-face semi-structured interviews until data saturation was finalized. Data analysis was conducted using Graneheim and Lundman's conventional content analysis. RESULTS: Nurses' experiences with the reasons for ED overcrowding came into two main categories. The first was "increased referral to the emergency department," which had three subcategories: "increased referral due to health system reform plan," "increased referral due to corona pandemic," and "improper triage." The second was "increased patients' length of stay at the ED" with seven subcategories including "shortage of bed," "shortage of nursing staff," "lack of physical space," "turtle para-clinic," "on-call specialists' delay," "timely medical record documentation requirements," and "delaying in patients' transfer from the ED to the ward." CONCLUSION: The results showed ED overcrowding is inevitable. Intentional or unintentional changes in the health system, such as implementing the health system reform plan or the corona pandemic, can also increase overcrowding. Findings showed ED overcrowding increased referrals and patients' length of stay. This study suggests the health system authorities pay more attention to this phenomenon and look for solutions.

RESUMEN

The chronic nature of severe mental illnesses is necessary for constant care provided by the family caregivers. Considering the significance of family caregivers in providing care, it is imperative to ensure their self-care if they are to play the role of caregiving effectively and efficiently well. The present study was conducted using the purposive sampling method and in-depth semi-structured interviews among 13 family caregivers and five health team members. The data were analyzed via a conventional content analysis approach. In the data analysis, seven main categories and 18 subcategories emerged: "A troublesome patient and me," including "Care-induced distress," "Caring dilemma," "Emotional fluctuations," and "Self-forgetfulness"; "Passive-destructive individuality," including: "Mental stereotypes" and "Unhealthy lifestyle"; "Family turbulence," including: "Family malfunction" and "Break in family ties"; "The conjoined influencing social factor," including "Lack of awareness at the family and community level" and "Social stigmatization"; "lack of well-organized health care system," including "Biomedical-oriented health system," "Disruption in continuity of care," and "Problems associated with the support provided by the health system"; "Disturbed economic conditions," including "Difficulty in life with disrupted financial capability," "Problems related to education and promoting awareness," and "Family health care problems"; "Dysfunctional Public mental health," including "Macro-dysfunction of mental health education," and "Disruptive advocacy activities to support families of patients with mental disorders." There are several barriers to family caregiver self-care planning that require health professionals to develop appropriate interventions.

RESUMEN

Introduction: Discomfort in patients admitted to the ICU occurs due to various reasons and leads to a stressful situation in these patients. Discomfort significantly affects the ability to cope psychologically, the process, and results of treatment. The aim of this study was to investigate the experiences of discomfort and its self-management strategies in patients admitted to the ICU. Methods: This qualitative study was conducted in the period of September 2019 to December 2020 through in-depth interviews with 13 patients admitted to the ICU who were selected by purposive sampling. Interviews continued until data saturation. All interviews were recorded, transcribed, and analyzed using MAXQDA18 software by the conventional Lundman and Graneheim content analysis method. Results: The two main themes including "hospitalization with anxiety" and "coping with the horror of ICU" emerged from the uncomfortable experiences of patients admitted to the intensive care unit. "Hospitalization with anxiety" included five subthemes: "fear of disability and possible death," "separation from family," "understanding ambiguity and contradiction in treatment," "environmental disruptors," and "painful and unfamiliar devices and treatments." "Coping with the horror of ICU" included three subthemes: "recourse to spirituality," "benefiting from psychosocial coping," and "information search."

RESUMEN

The study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. A qualitative approach guided the study, which was undertaken between April 2020 and April 2021. A total of 15 registered nurses working in intensive care units were recruited through purposive sampling. Individual semistructured interviews were conducted. The data were analyzed using a qualitative content analysis. The analysis revealed two themes: "conflict of conscience in relation to the structure" and "conflict of conscience based on context." Conflict of conscience in relation to the structure consisted of two categories: conflict of interest and conflict of conscience and law. Conflict of conscience based on context consisted of two categories: care dilemmas and arbitrary behaviors with end-stage patients. A variety of factors were accompanied by a conflict of conscience for nurses in intensive care units. Given that conflict of conscience has negative consequences for the health and quality of nursing care, health care managers need to tailor strategies to reduce the negative consequences considering the findings of the study.

Asunto(s)

RESUMEN

BACKGROUND: In the turbulent and stressful work environment of prehospital emergencies, the conflict among emergency medical technicians (EMT) and other health-care providers is inevitable. This study aims to examine the concept of workplace interpersonal conflict (WIC) in prehospital emergencies. MATERIALS AND METHODS: The eight-step Walker and Avant's concept analysis approach was adopted to define the concept. Iranmedex, SID, Magiran, ISC, PubMed, Scopus, Embase, and Web of Science searched with keywords such as WIC and hospital emergencies. After an extensive review of online national and international databases, one dictionary, nine books, and 25 articles in English and Persian were retrieved for the purposes of the study. RESULTS: The antecedents, attributes, and consequences of the concept identified. EMT must learn how to eliminate their destructive effects while enhancing constructive effects. CONCLUSION: Conflict is an inevitable part of life, and EMT must learn how to reduce their destructive effects while increasing constructive results.

RESUMEN

BACKGROUND: Nursing organizations play an important role in fulfilling the professional demands of nurses. The Iranian Nursing Organization (INO) is also using diplomatic activities in this direction. AIM: This study was conducted to explain the diplomatic activities of INO. METHODS: A descriptive qualitative study was conducted using conventional content analysis. A purposive sampling approach was used. Data were collected via in-depth, unstructured, face-to-face interviews with 21 nurses at various INOs in different cities from March to July 2020. The data collection process continued until data saturation. Interviews were analyzed using Graneheim and Lundman's (2004) guidelines. The MAXQDA software (v. 10) was used. FINDING: The results showed that the diplomatic activities of INO comprise professional (three categories), social (two categories), and diplomacy in power network (two categories). CONCLUSION: INO carries out diplomatic activities at organizational, national and international levels and pursues its professional nursing goals through diplomacy. INO also uses social diplomacy and political diplomacy to influence decision-makers in the community and network of power.

Asunto(s)

RESUMEN

AIM: To explore the factors affecting the emergence of diplomacy in Iranian nurse managers. BACKGROUND: Today, with the development of complex health systems, diplomacy in health care can take place at organizational, national and international levels. INTRODUCTION: Diplomacy's role is to convince others peacefully to achieve goals. Diplomacy in nursing can facilitate professional development and direct policy and decision-making process towards the development of a healthcare system. METHODS: The study used a qualitative descriptive approach. The sampling method was purposeful, and data were collected via in-depth, unstructured and face-to-face interviews with 16 participants. The interviews were digitally recorded, transcribed verbatim and analysed through conventional content analysis based on Graneheim and Lundman's work. RESULTS: In total, 212 codes were generated, which were grouped into three main categories, namely paradigmatic socio-political changes (two subcategories), nurses' dissatisfaction with their status in healthcare system (two subcategories) and multidimensional development of the nursing profession (four subcategories). DISCUSSION/CONCLUSIONS: Socio-political changes, development of the nursing profession and nurses' dissatisfaction with the health system have led to the emergence of diplomacy roles in nurse managers, the recognition and development of which can improve the effectiveness of nurse managers in policymaking. IMPLICATIONS FOR NURSING & HEALTH POLICY: The recent COVID-19 pandemic outbreak has demonstrated the urgent need to use diplomacy to solve health problems and adjust or develop policymaking at the national and international levels. Strengthening their role in diplomacy, nurse managers can play an important role as diplomats at various levels of policymaking and in health crisis management.

Asunto(s)

RESUMEN

Background: Exploring emergency medical technicians' (EMTs) experiences of COVID-19 epidemic, help to identify the challenges they face in their daily work and develop strategies that address these challenges. This study aimed to explore EMTs' experiences of the challenges of prehospital care delivery during the COVID-19 pandemic. Methods: This qualitative study was conducted in March-July 2020 using conventional content analysis approach. Fifteen EMTs were purposively selected from the Emergency Medical Services (EMS) Center in Qom, Iran. For data collection, semi-structured interviews were conducted until data saturation was reached. Results: EMTs' experiences of the challenges of prehospital care delivery during the COVID-19 pandemic were classified into three main categories including "restless society", "difficult care delivery conditions", and "unprepared organization". The emergent subcategories were "need for information", "limited perception of the COVID-19 risk", "obsessive use of disinfectants", "fear over the transmission of COVID-19 to self and others", "burnout due to heavy workload", "altered communication with hospital staff", "ethical conflicts", "lack of a definite treatment plan", "lack of protective equipment", "staff shortage due to the affliction of EMTs by COVID-19", and "inadequate support by authorities". Conclusion: During COVID-19 pandemics, EMTs face many challenges including emotional and occupational stress, social strains, risk of affliction by infections, heavy workload, and ethical conflicts and hence, experience difficulties in quality care delivery. Developing appropriate strategies, guidelines, and policies are needed to effectively manage these challenges and improve the quality of prehospital care delivery in COVID-19 epidemic.

Asunto(s)

RESUMEN

The aim of this study was to present the concept analysis of creativity in nursing care using the Walker and Avant (2019) approach. In this regard, the keywords "creativity" and "nursing care" were searched through PubMed, Ovid, Scopus, EMBASE, Google Scholar, SID, and Web of Science between the years 2000 and 2018 along with hand searching of reference lists extracted from more than 342 articles. Finally, 37 articles that had inclusion criteria were examined based on the eight stages mentioned in Walker and Avant's concept analysis approach. Results revealed that creativity in nursing care includes fluidity of mind and the creation and acceptance of new ideas for patient care in such a way that the new methods are simple, useful, efficient, affordable, and safe. This requires a creative vision, creative sensitivity, and creative thinking. If there is a supportive environment, motivation, sensitivity, and divergent thinking skills, individuals can demonstrate their creativity. This may result in successful decision-making in the clinical setting and therefore contribute to increasing the organization's effectiveness and the quality of care. All nurses can act as agents encouraging change by the use of creativity to improve the quality of care. It is an educational guide for future nurses to implement creativity in practice. Also, this finding can be used for future research and the development of specific tools. Finally, it is suggested to consider creativity in the other aspects of clinical practice as well.

RESUMEN

Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses' ethical performance. This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study's conclusions. In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase' results were categorized into three themes: "perception of conscience", "commands of conscience", and "obedience to conscience. The final definition was reached by merging the theoretical and field stages. This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.

RESUMEN

Aim: To define the concept of happiness among children with chronic disease. Background: Happiness is an old human quest, the existing literature on the definition of happiness among children with chronic diseases is sparse. Methods: The three-phase hybrid model was used. In the first (theoretical) phase, a literature review was conducted. In the second (fieldwork) phase, the semi-structured interview data were analysed through content analysis. Ten participants were purposively sampled. In the third (final analytic) phase, the practical definition of the concept was identified. Results: The practical definition of happiness in a Ghanaian chronically ill child is the "subjective and positive lifelong process of adapting to biological, physiological, psychosocial, economic and environmental changes caused by the disease trajectory, which affects the well-being of the child and the family." Conclusions: This study offers a background for selecting appropriate health indicators and outcome measures in promoting happiness in children with chronic diseases.

Asunto(s)

RESUMEN

Concept exploration and development of superstition is the aim of this research. Superstition is a complex concept, needs to be clarity, removes it from its mundane state, and gives it a scientific richness. To use a list of questions extracted from a review of the literature to analyze, develop, and explore superstition. It was assessed according to studies conducted in three fields sociology, psychology, and nursing. The maturity of the concept was determined in four areas, epistemology, practicability, semantics, and deduction/logic. Nurses must discover people's beliefs and superstitions. Although the concept of superstition is commonly used, many of its features and aspects were still unclear.

RESUMEN

Early motherhood may develop various stresses for the teen mothers and have adverse consequences. Current research aims at exploring experiences of teen mothers with stress and stressors of early motherhood. This qualitative study was conducted using conventional content analysis through in-depth semistructured interview. Eighteen Iranian teen mothers, who experienced parenting stress, with maximum variation in the age of first pregnancy, child's age, place of residence, and financial condition took part in this research. Data collection continued until saturation and were analyzed using MAXQDA10 software. Data analysis led to extraction of five categories including "storm of anxiety," "wander identity," "an unaccompanied way," "unarmed combat," and "a tired body." Teen mothers experienced tensions such as fear and worry, isolation and loneliness, regret, shame, depression, and doubt. These tensions originated from identity conflicts, inadequate social support, role inefficiencies, physical problems, and responsibilities. Teen mothers are influenced by various physical, psychological, social, and economic stressors which are in relation with the teenage, motherhood role, and the environment. Nurses are the major source of support for the teen mothers. Nurses should identify stress and stressors in teen mothers and strengthen well-being feeling in the teen mothers and their children through care, educational, consultative, and coordination interventions.

Asunto(s)