Theoretical Reflexivity in Qualitative Research

Introduction: Theoretical reflexivity is a concept that has been widely accepted in health research and most researchers have acknowledged the importance of reflexivity in the clarity and increased accuracy of qualitative research. The purpose of this study was to introduce, explain the importance of, and describe reflexivity ‎as an important characteristic of qualitative research. Method: This research was conducted using library and internet resources without time limitation until 2015. Information was collected by searching library resources and scientific websites. Then, relevant articles were selected and their contents were extracted. Results: There are many factors for the improvement of the quality of a qualitative study; one of these factors is reflexivity‎. Reflexivity ‎is a characteristic of research that can be considered during the whole process of qualitative research and is not limited to a certain stage. It is an extensive activity in which the researcher tries to be aware of his/her ideas, attitudes, and beliefs and make their influence on his/her own research clear for him/herself and sometimes the audience. Despite the existing doubts about the ability to conduct it, almost all experts in qualitative research have emphasized its necessity in qualitative research, especially in the field of health. Creating reflexivity in qualitative research and preserving it during the development of qualitative research will increase their precision and accuracy. Conclusion: Reflexivity ‎can enrich qualitative research, improve their quality, and prevent the occurrence of bias. Therefore, attention to this factor is recommended in every step of qualitative research. ‎ Keywords: Reflexivity, Qualitative research, Theoretical reflexivity, Precisio

Explaining the Process of Spiritual healing of Critically-ill Patients: A Grounded Theory Study

BACKGROUND: Spiritual healing is one of the most intriguing category of alternative and complementary medicine. The aim of this study was to explain the process of spiritual healing in patients with refractory diseases in Iran.METHODS: This grounded theory study was conducted in Iran from 2018 to 2019. The participants were 14 patients with refractory diseases and 4 healers whom were first selected through purposeful and then theoretical sampling. Semi-structured interviews were used to collect data on patients and healers. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories and analyzed using the Strauss and Corbin’s approach (2008).RESULTS: Four main categories emerged from data analysis including: I) frustration to initial acceptance II) disbelief to trust III) evaluation to action and IV) doubt to certainty.CONCLUSION: The results of our study provide context-specific factors affecting the complex and multifactorial nature of spiritual healing process in patients with refractory diseases. Health care professional can use these findings in designing and implementing appropriate interventions to integrate spiritual healing into their holistic practices of care.

Concept Analysis of Futile Care in the Oncology Nursing: A Hybrid Model

BACKGROUND: With the advances in medical technology and care of patients with cancer, the concept of futile care attracted more attention in the field of oncology. Futile care in the context of oncology nursing is an ambiguous and complex concept. Despite the importance of it in the professional care for patients with cancers, it was not defined clearly in the social and cultural contexts of Iran. OBJECTIVE: The aim of this study was to clarify and identify the components and inner structures of futile care from the perspective of nurses dealing with patients with advanced cancer using a hybrid model. METHODS: In the present study, the concept of futile care was analyzed based on the hybrid model in three phases including theoretical, fieldwork, and final analytical phase. In the theoretical phase, the related studies were analyzed. In the fieldwork phase, 10 interviews were conducted with nurses in oncology departments. Finally, the concept attributes were determined through a general analysis of the results of theoretical and fieldwork phases. RESULTS: The definition of the concept of futile care in oncology is continuous clinical services without reaching to desired outcome with simultaneous unrelated responsibilities for nurses. These services were provided to patients that have poor prognosis and they do not result on improve of patient’s survival or quality of life. The most important consequences of futile care are job burnout for nurses, unnecessary suffering for patients, and heavy expenses for health system. CONCLUSION: Futile care in oncology nursing has severe outcomes on nurses. Based on the definition, new scales can be developed to assess the futile care among nurses in oncology settings

A concept analysis of hope to patient recovery among nurses in intensive care: A hybrid model

Introduction: Nurses are considered as one of the most essential members of patents’ health care team. They play an important role in patient recovery or any other changes in patient health conditions. However, it seems that nurses’ caring of patients depended on their hops of recovery. Therefore, it is expected that nurses’ hopes be a fundamental part of the offering of any care. With due attention to this issue, this study analyzed the concept of nurses’ hope of patient recovery. Method: The hybrid model, which includes theory, practice, and final analysis, was used and interviews were analyzed according to the analytical method of inductive content analysis. Results: In the theoretical stage, nurses’ hopes were characterized by availability, professionalism, positive expectations, future-oriented, targeted, and etcetera. In the next stage, the practical definition of the concept (the nurses’ hopes is a necessity in the quality of health care) was studied. In the final analysis stage, the concept was defined with the characteristics of dynamic, realistic, and goal-based expectations. It was also defined as leading to better performances and attitudes in offering effective health care and nurses’ tranquility. Conclusion: The analysis of the concept of hope in nurses illustrated that nurses’ awareness of concepts such as hope in health care (the most important task of a nurse) could lead to their better performance. Keywords: Hope of recovery, Nurse, Patient, Intensive care, Concept analysis, Hybrid mode

Factors involved in nurses' responses to burnout: a grounded theory study

BACKGROUND: Intense and long-standing problems in burn centers in Tehran have led nurses to burnout. This phenomenon has provoked serious responses and has put the nurses, patients and the organization under pressure. The challenge for managers and nurse executives is to understand the factors which would reduce or increase the nurses' responses to burnout and develop delivery systems that promote positive adaptation and facilitate quality care. This study, as a part of more extensive research, aims to explore and describe the nurses' perceptions of the factors affecting their responses to burnout. METHODS: Grounded theory was used as the method. Thirty- eight participants were recruited. Data were generated by unstructured interviews and 21 sessions of participant observations. Constant comparison was used for data analysis. RESULTS: Nurses' and patients' personal characteristics and social support influenced nurses' responses to burnout. Personal characteristics of the nurses and patients, especially when interacting, had a more powerful effect. They altered emotional, attitudinal, behavioral and organizational responses to burnout and determined the kind of caring behavior. Social support had a palliative effect and altered emotional responses and some aspects of attitudinal responses. CONCLUSIONS: The powerful effect of positive personal characteristics and its sensitivity to long standing and intense organizational pressures suggests approaches to executing stress reduction programs and refreshing the nurses' morale by giving more importance to ethical aspects of caring. Moreover, regarding palliative effect of social support and its importance for the nurses' wellbeing, nurse executives are responsible for promoting a work environment that supports nurses and motivates them

The process of emergency nurses' encounter with potential legal issues: A grounded theory study

Aims: Considering the continuous rise in legal complaints against nurses, especially emergency nurses, they consider their work environment to be a threatening place, negatively affecting their professional care performance. This study aimed to explain the process of confrontation of emergency department nurses with potential legal issues.  Methods: In this qualitative study data were collected from six observations and in-depth semi-structured interviews with 15 nurses and one emergency physician in the emergency departments. The participants were initially selected by purposeful sampling, followed by theoretical sampling. Data were finally analyzed based on Corbin and Strauss grounded theory approach (2008). Results: The core variable in this study was “perceived fear of litigation risk” and consisted of four categories: “avoidance of involvement in legal issues”, “cautious performance”, “double-checking”, and “acquitting oneself”. Emergency nurses face these issues after assessing the likelihood of legal problems, based on the severity of their perceived fears. This assessment is an ongoing and dynamic process, and increasing the likelihood of a legal issue occurring and thus increasing fear can lead to a change in the approach used or the simultaneous (cumulative) use of several approaches. &nbsp

A model of patient participation with chronic disease in nursing care

Introduction: Chronic diseases are one of the greatest challenges that health systems facing with them today. Recently, patient participation is considered as a key element in chronic care models. However, there are few studies about participation of patients with chronic disease in caring activities. The aim of this study was to identify the factors, which are relevant to patient participation and the nature of participation in caring activities. Material and Methods: A qualitative approach with a basic theory method was used in this study. 22 persons including 9 patients, 8 nurses, and 5 family members were recruited using purposeful and theoretical sampling in three hospitals affiliated with Iran University of Medical Sciences. Data were collected with semi-structured interview and participant observation. Constant comparison was used for data analysis. Results: Findings of this study indicated that participation of patients with chronic disease in nursing care is a dynamic and interactive concept that occurs between nurse, patient and family member in a care-servicing system. The core theme of this study was "convergence of caring agents" that included four categories: adhering, involving, sharing and true participation. Conclusion: This study suggests a pyramid model for explaining patient participation. Participation occurs in different levels, which depends on the factors related to caring agents

Self-rated health and general procrastination in nurses: a cross-sectional study

Introduction: nurses are responsible for taking care of the health of the general public. Nurses´ own health is among the important factors affecting the quality of patient care. Self-rated Health (SRH) is one of the indicators used extensively in health research for the assessment of the health status of individuals. The present study was conducted to evaluate Self-rated Health and its relationship with general procrastination in nurses. Methods: the present cross-sectional study was conducted in 2019 on 305 Iranian nurses selected by stratified random sampling. The relationship of Self-rated Health with procrastination was determined using an ordinal logistic regression analysis after adjustments for personal and occupational factors. Results: self-rated Health was poor/bad in 11.3% of the nurses, fair in 23.7%, good in 34.3% and excellent in 30.7%. After adjustments for personal and occupational factors, a significant relationship was observed between procrastination and Self-rated Health (OR=0.95; 95%CI 0.92, 0.98). Conclusion: the results showed an unfavorable health status in nurses. Given the significant relationship between procrastination and poor Self-rated Health in nurses, it is essential to consider this relationship for improving nurses´ health

Development and psychometric evaluation of nurses’ health-related procrastination scale

There is no valid scale to measure health related procrastination, especially in nurses. This study was conducted to design and assess the psychometric properties of the health-related procrastination scale in nurses. This exploratory mixed method study was conducted between April 2017 and May 2019. The design and psychometric assessment of the nurses' health-related procrastination scale (NHRPS) was carried out through quantitative and qualitative phases. In the qualitative phase, nurses were interviewed and a review of literature was carried out to generate the items. In the quantitative phase, the scale validity was evaluated using the face, content and construct validity and its reliability was evaluated through the Cronbach's alpha, McDonald's omega, intra-class correlation coefficient, standard error of measurement, minimal detectable changes. The results of the exploratory factor analysis showed that, with 29 items and five factors, the NHRPS explains 54.81% of the variance in NHRPS. The results of confirmatory factor analysis also confirmed the final fit of model with five factors (RAMSEA: 0.08, CMIN/DF: 2.42, NFI: 0.92, PNFI: 0.83, CFI: 0.95, IFI: 0.95, RFI: 0.91, SRMR: 0.074). The Cronbach's alpha of the scale was 0.947, its intra-class correlation coefficient was 0.944, the Half-fold consistency coefficient was 0.970 and Omega internal consistency coefficient was 0.96. The NHRPS has good psychometric properties. This scale is suitable for research purposes, especially to plan for nurses' health promotion