Expectations of Multiple Sclerosis Patients and Their Families: A Qualitative Study in Iran

Background: Multiple Sclerosis (MS) is a neurological disease that is most commonly observed among young people. Drug and non-drug treatments are used to prevent the progression of the disease and to control illness-related disorders. Patients with MS often have multiple and complicated needs that require a broad spectrum of health services. Objectives: This study was conducted to identify the expectations of individuals with MS and their families for healthcare services. Patients and Methods: This article is part of a qualitative case study. The participants were selected by a purposive sampling method. In this study, semi-structured interviews of 20 individuals with MS and 8 family members were conducted to identify the expectations of MS patients and their families. In addition to the interviews, the documents related to the aim of the study, including weblogs, MS magazines, special websites of individuals with MS, and news agencies were gathered. Analysis of data was performed by a conventional content analysis method. Results: The age of the participants ranged from 22–63 years. The data obtained from this study was classified into 5 main categories as follows: being cured, need for comfort, promoting knowledge, economic welfare, and social security. Conclusions: Individuals with MS and their families had different expectations pertaining to all dimensions of life, such that not meeting the needs related to any dimension could have affect the other dimensions. Therefore, it is necessary for healthcare providers to have a holistic assessment as well as try to meet all needs and expectations

Association between Behavioral Patterns of Parents with Depression and Suicidal Thoughts among Adolescents.

Depression, one of the most common psychiatric disorders in the world, is common among adolescents. Social and psychology scientists believe that if the family plays its roles correctly in social, educative and cultural areas , they could make healthy and normal members for the society. Otherwise psychological and personality disorders will appear in the society especially among children and adolescents. So, the role of parents and interpersonal relationships with adolescents seem to be important in development and continuation of their depression, hopelessness and suicide. The object of this study is to determine association between patterns of parental behaviors with depression and suicidal thoughts among adolescents. This study is a cross-sectional, correlative research performed in 15 high schools in Isfahan- Iran. In this research, data have been collected with a questionnaire. Then, the patterns of parent-adolescent relationships have been categorized into 7 categories by the vie wpoint of the adolescents regarding content of care and protection. The final number of samples in this study was 323 adolescents at ages between 14-17 years. levels of depression and frequency of suicidal thoughts among adolescents in each category have been surveyed, and tested by One-Way ANOVA and Chi-square statistical tests by SPSS statistical software. Prevalence of depression and suicidal thoughts among adolescent students were about 43.4 and 32.7 percent respectively. The highest mean depression score(27.7) and the highest frequency of suicidal thoughts(58.3 percent) have been seen among adolescents who described their parents’ behavior as “Autocratic” and the less mean depression score(10.4) and the less frequency of suicidal thoughts(11.6 percent) have been seen among those who described to have “Democratic” parents. Also, we have found that with decreasing “control” and increasing “care” in parent-adolescent relationships, the mean depression score and relative frequency of suicidal thoughts have been decreased. These findings were significant with one-way ANOVA and Chi-square statistical tests with p=0.00 in both cases. Parent-adolescent relationship has an important role in mental health of adolescents. According to the findings of this study, the best behavior from parents is to give the adolescents more freedom and having such a relationship with them that they feel to be in love and at support, but not in continuous contro

Induced Demand after Implementing the Health Reform Plan in Selected Emergency Departments Affiliated to Isfahan University of Medical Sciences: a Cross-Sectional Study

Introduction: Exactly recognizing the effect of health reform plan (HRP) in emergency departments (EDs) is crucial given the large portion of budget assigned to this plan and the effect of introducing this plan on inducing demand and the associated potentially-unbearable costs. Objective: The present study was conducted to assess the demand induced after implementing the HRP in the selected EDs of Isfahan University of Medical Sciences, Isfahan, Iran. Method: The present quantitative and descriptive study collected data related to certain emergency services, performance indicators and working hours of emergency staff using a researcher-made checklist and based on hospital records and information in the years before and after implementing the HRP in Iran, i.e. 2013 and 2015. The data collected were analyzed in SPSS-21. Results: The obtained results suggested significant increases in emergency admissions (69.97%), radiographic images (65%), clinical tests (27.27%) and specialist visits (69.95%). Significantly increases observed in the performance indicators in the ED included the mean hospitalization duration by 61.14%, the bed occupancy rate by 15.71% and the working hours of the nursing staff by 11.43% and those of emergency medicine specialists by 44.72% in the first year after implementing the HRP compared to in the year before the implementation. Conclusion: Although implementing the HRP in Iran significantly changed the performance indicators in the ED, certain infrastructure such as human resource management and the increased demand are considered the main time-consuming and costly challenges in EDs

Induced Demand after Implementing the Health Reform Plan in Selected Emergency Departments Affiliated to Isfahan University of Medical Sciences: a Cross-Sectional Study

Introduction: Exactly recognizing the effect of health reform plan (HRP) in emergency departments (EDs) is crucial given the large portion of budget assigned to this plan and the effect of introducing this plan on inducing demand and the associated potentially-unbearable costs. Objective: The present study was conducted to assess the demand induced after implementing the HRP in the selected EDs of Isfahan University of Medical Sciences, Isfahan, Iran. Method: The present quantitative and descriptive study collected data related to certain emergency services, performance indicators and working hours of emergency staff using a researcher-made checklist and based on hospital records and information in the years before and after implementing the HRP in Iran, i.e. 2013 and 2015. The data collected were analyzed in SPSS-21. Results: The obtained results suggested significant increases in emergency admissions (69.97%), radiographic images (65%), clinical tests (27.27%) and specialist visits (69.95%). Significantly increases observed in the performance indicators in the ED included the mean hospitalization duration by 61.14%, the bed occupancy rate by 15.71% and the working hours of the nursing staff by 11.43% and those of emergency medicine specialists by 44.72% in the first year after implementing the HRP compared to in the year before the implementation. Conclusion: Although implementing the HRP in Iran significantly changed the performance indicators in the ED, certain infrastructure such as human resource management and the increased demand are considered the main time-consuming and costly challenges in EDs

The Use of Qualitative Case Study in Nursing

Introduction: Case study as a qualitative research has been used in many disciplines including sociology, anthropology, history, psychology, medicine, education, political science, and economics. Now, case study is used by nursing researchers for exploring phenomena in health care practice. The article aimed to assess the principles of the case study and its’ using in nursing. Method: Computerized search was done in Medline and Elsevier databases with case study, qualitative research, and nursing keywords among the articles in English language between 2000 and 2015. The main themes, agreement, and disagreement were assessed among the articles. Results: Case study is a research approach for providing deeper understanding of the complex and multifaceted phenomenon in real life context and checks general and significant characteristics of events. So, using this method is useful to evaluate the performance of nursing practice. This method was used in some of nursing researches. Conclusion: Qualitative case study is a method that can play an important role in the production new knowledge in nursing and health system research by providing a holistic view about a phenomenon. Keywords: Case study, Qualitative research, Nursin

Medication Errors Experiences of Nurses who Working in Hospitals of Isfahan at 1391

Introduction: Patient safety has long been a major concern for healthcare professionals. Today, hospitals should provide patient safety in order to gain accreditation. Among patient safety issues, medication error rate has been considered as a major indicator of healthcare quality. The different aspects of medication error are not clearly known and the nurses are the main source of knowledge in this field. Therefore, the researcher decided to study the experiences of nurses who have been faced with a medication error in order to clarify the various aspects of this phenomenon. It is through the exact identification of this phenomenon that it can be managed. Method: In the present study, a phenomenological qualitative approach was used. Participants in this study were nurses working in hospitals of Isfahan and had experienced medication error. Purposive sampling was adopted in the study and sample size was dependent on the data saturation. A total of 10 participants were chosen. Data collection was carried out through unstructured interviews and analysis through Colaizzi’s Method. Results: From the findings of this study, six main themes expressing participants’ experiences emerged. The six main themes include: The context of error, the error range, negligence, the consequence of error, concealment of error, and reporting of error. Conclusion: Nurses report their errors when they feel safe and do not see harmful results for them. Therefore, hospitals should review their policies on error reporting to ensure they actively encourage nurses to report medication errors, and to support a blame-free culture in the organization and a systembased approach to deal with the error. Keywords: Nurses’ medication errors, Nurses’ experiences, Patient safety, Qualitative researc

Social aspects of multiple sclerosis for Iranian individuals‏

Abstract PURPOSE: This study aimed to determine the social aspects of multiple sclerosis (MS) in the Iranian individuals. METHODS: A qualitative case study approach was used for this study, which is a part of a larger qualitative study about health care delivery system of MS. Participants were selected on the basis of purposive sampling method. Semi-structured interviews regarding the social aspects of MS were conducted with 18 MS patients, 6 family members and 7 health care providers. Besides interviews with the participants, documents related to the aim of the study, including weblogs, MS magazines, special websites of individuals with MS and news agencies. Data analysis was performed using the qualitative content analysis technique. RESULTS: Data obtained has been categorised into five main categories, including confronting stigma symbols, the outcome of stigma, walling-in due to stigma, disturbance in normal life and concern about job. CONCLUSION: There are multiple social effects of MS on the afflicted individuals, which affect various dimensions of their life. Policy makers and health care providers must also consider these effects of MS on other dimensions of the individuals' life. Implications for Rehabilitation Multiple sclerosis (MS) is a disease which restricts social life for patients, in addition to physical impacts. Individuals with MS experienced stigma as well as problems with employment and marital life, due to improper information about MS in society. We recommend that health care workers offer proper information about MS to patients and their family members to minimise the social problems faced by them. We recommend that mass media offers proper information about MS to people in society to disseminate the correct picture of MS. We recommend that the rehabilitation team offers psychological support to patients and their families for their empowerment, to facilitate dealing with the impacts of the disease. We recommend that health care providers teach the family members about patient support and communication skills

The practice of intensive care nurses using the closed suctioning system: An observational study

Background: Endotracheal suctioning (ETS) is an essential procedure performed for mechanically ventilated patients. ETS can be either performed by open or closed suctioning system (CSS). There may be some concern on how closed-system ETS is practiced by intensive care nurses. This study was designed to investigate closed-system ETS practices of critical care nurses and to compare their practice with standard recommendations. Materials and Methods: A prospective observational study was conducted during August and December 2012 to establish how critical care nurses (N = 40) perform different steps in a typical ETS practice and to compare it with the current best practice recommendations through a 23-item structured checklist. The results were categorized into three sections: Pre-suctioning, suctioning, and post-suctioning practices. Results: Pre-suctioning, suctioning, and post-suctioning practices mean scores were 7.5, 11.75, and 8.5, respectively, out of 16, 16, and 12, respectively. The total suctioning practice score was 27.75 out of 44. Most discrepancies were observed in the patients' assessment and preparation, infection control practices, and use of an appropriate catheter. Spearman correlation coefficient indicated a significant statistical positive correlation between suctioning education period and suctioning practice score (P < 0.0001) and between working experience and suctioning practice score (P = 0.02). Conclusions: The findings revealed that critical care nurses do not fully adhere to the best practice recommendation in CSS. We recommend that standard guidelines on ETS practice be included in the current education of critical care nurses

The challenges of healthcare delivery to people with multiple sclerosis in Iran.

BACKGROUND Multiple sclerosis (MS) is a chronic disease prevalent in young and middle-aged people. Patients with MS often have numerous complicated needs and, consequently, require a broad range of health services. Results of a number of studies indicate that patients' needs are only partially met. AIMS This study was conducted to explore the challenges of healthcare delivery to patients with MS in Iran. MATERIALS AND METHODS In this qualitative case study, 43 participants selected through purposeful sampling were interviewed using semi-structured method in the cities of Isfahan and Tehran in 2012-2013. Besides the interview, documentations relevant to healthcare delivery were collected from different sources, including websites of all Iranian universities of medical sciences, insurance organizations, patients' weblogs, news agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were analyzed through the constant comparative analysis. RESULTS The data were categorized into four main categories, including functional challenges (diagnosis problems, failure to pay attention to patient needs, failure to follow-up, and miscommunication), administrative challenges (resource allocation and supervision), policy-making challenges (lack of comprehensive services, bureaucracy, and problems in provision of medications), and structural challenges (difficult access to services, lack of comprehensive centers, space limit, and long wait). CONCLUSION Despite all attempts of governmental and nongovernmental organizations for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients. In this regard, service providers and administrators should pay more attention to the needs and expectations of patients and their families

Performance of ICU nurses in providing respiratory care

Background: Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care. Materials and Methods: The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation. Results: According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73). Conclusions: Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care