The Clinical Nature of Medical-Surgical Nursing Care

Introduction: Integration of theoretical knowledge and nursing practice has led to the creation of four central concepts in nursing including individual, health, nursing, and environment. Currently, greater emphasis is placed on the two concepts of health and care as the core of nursing. Thus, the purpose of the present qualitative study was to explain the concept of clinical care in internal-surgical nursing and its changes through time. Method: This study was part of an extensive grounded theory research on 14 clinical nurses, clinical educators, and nursing students of the School of Nursing and Midwifery, Shahid Beheshti University, Tehran, Iran. The participants were selected, first, using purposive sampling method, and then, theoretical sampling. Data were collected through individual semi-structured, in-depth interviews. Data were codified using MAXQD 2007 software (VERBI GmbH, Berlin, Germany) and analyzed using grounded theory approach (Strauss & Corbin, 1998). Results: Data analysis revealed the 3 main themes of "essence of care in internal-surgical nursing", "clinical origin of care", and "the decline in nursing". Moreover, 9 subcategories were extracted including "clinical essence of internal-surgical nursing", "patient-centered care", "peaceful conscience of nurses", "meeting the basic needs of the patient", "perception of the patient", "specialization", "alienation with role", "detachment from clinical care", and "dependency". Conclusion: Care is the essence of nursing, in particular internal-surgical nursing, and the clinical environment is the care delivery site. The changes and challenges in providing nursing care necessitate the use of moral approaches, such as designing targeted educational programs and a student-centered curriculum, with emphasis on moral conscience Keywords: Care, Medical-surgical nursing, Clinical practice, Grounded theory, Qualitative researc

Lived Experiences of Cardiac Pacemaker Patients

Introduction: Permanent cardiac pacemaker implantation, and introducing a foreign body into the heart, a part of the human anatomy that symbolically represents emotions, may be considered a major life event. Therefore, it is recommended that the healthcare team gain understanding of the experience of pacemaker patients and present information based on patients’ experiences in order to actively involve the patients in the administration and management of their illness process. The aim of this qualitative study is to explore the patients' experiences of living with a permanent cardiac pacemaker. Method: In this study, descriptive phenomenological method and the Colaizzi`s proposed stages were used. Purposeful sampling of patients with single and dual chamber cardiac pacemakers was performed. Overall, 13 interview sessions were held with 10 participants. The minimum duration of an interview was 35 minutes and the maximum 54 minutes. The data were collected through semi-structured interviews. Results: The emerging themes according to the qualitative data are embedded in the Iranian socio-cultural context. They consist of five themes: living with pacemaker, pacemaker identity, balance in control, consequences and relief. Conclusion: The findings of this study, as a small image of the large and complex world, can be used in order to design and implement effective care for pacemaker patients. Having a clearer understanding of these patients’ experiences will help healthcare workers to design supportive and caring programs that will meet these patients’ needs more holistically. Keywords: Cardiac pacemaker, Patient experience, Phenomenology, Colaizzi metho

The intuitive nurse in critical care practice: a phenomenological study

Intuition in clinical practice is the ability to experience the elements of a clinical situation as a whole, and to solve a problem or reach a decision with limited concrete information. Benner theorized that the expert nurse acts on intuition, but that he/she also deals with some ambiguities. However, there is a lack of studies about intuitive nursing in the critical care arena, where more critically ill patients are admitted. So, this study was conducted to explore the features of the intuitive nurse in critical care practice. In a descriptive-phenomenological study, twelve nurses employed in critical care units of the hospitals affiliated to Kermanshah University of Medical Sciences were recruited to the study, as purposive, a semi-structured interview was administered to them, then written down verbatim. The data was managed by MAXQDA 10 software (VERBI GmbH, Berlin, Germany) and analyzed as qualitative through the seven-stage approach of Colaizzi. Of the 12 nurses who participated in the study, seven (58.3%) were female and married, 88.3% (10 people) had a Bachelor of Nursing and the mean and standard deviations of the participants’ age, job experience and critical care experience were 36.66±7.01, 13.75±6.82 and 7.66±3.36 years, respectively. From the qualitative analysis of the data, we extracted three main themes, including proficiency, connection and benevolence, and ten sub-themes. The intuitive nurses were substantially proficient in terms of knowledge, skill and experience, and relationships to patients. They desired to help the patients based on their consciences

Self-efficacy and Self-regulated Learning in Clinical Performance of Nursing Students: A Qualitative Research

Introduction: Self-efficacy and self-regulated learning play an important role in applying clinical knowledge and competencies. The aim of this study was to define self-efficacy and self-regulated learning in nursing students' clinical performance during field training. Methods: In a qualitative study, 50 participants were selected through purposive sampling method from Iran, Tehran, and Shahid Beheshti Medical Universities. Then 28 semi-structured and 3 focus group interviews were performed with volunteer nursing students. Data was analyzed using content analysis methods. Results: The definition of self-efficacy and self-regulated learning were categorized in five and three themes, respectively. Self-efficacy in clinical performance based on the viewpoints of participants was equal to acquiring clinical skills, assessing patients, and planning, executing, and evaluating care plans. The experie-nce of self-regulated learning in clinical performance was equivalent to efforts for clinical learning along with self-motivation, and practicing nursing process, as well as for acquiring professional behaviors. Conclusion: Self-efficacy and self-regulated learning affect independent patient care capability and help nursing students to promote their competencies and professional skills in this field

Persian version of Family Crisis Oriented Personal Evaluation Scales: Psychometric Properties

Background Family coping is an active process in which the family and each member of it use the available resources to decrease or control the demand. Using effective coping strategy, a family can react to stresses and adapt better to its situation. The purpose of this study was to examine psychometric properties of a Persian version of Family Crisis Oriented Personal Evaluation Scales (F-COPES) in a population of Iranian mothers with cerebral palsy children. Materials and Methods F-COPES was translated into Persian following Wild et al.’s model, face and content validities of the translated version were determined by 12 faculty board members in different nursing fields, psychology, and tool development. Afterward, to fill out the scale, 208 mothers with cerebral palsy children who had referred to Kermanshah based rehabilitation centers were selected through convenient sampling. Construct validity of the tool was determined by using confirmatory factor analysis. To examine internal consistency, Cronbach’s alpha and to examine reliability, intraclass correlation coefficient (ICC) (15 participants with 2 weeks interval) was used. The collected data was analyzed in SPSS (version 16.0) and EQS6.1. Results: Confirmatory factor analysis supported validity of the whole tool and its five subscales. Cronbach’s alpha of the whole tool was obtained alpha=0.84 and the alpha of the five subscales ranged from 0.76 to 0.94. In addition, ICC was obtained equal with 0.89. Conclusion: The Persian version of F-COPES was featured with acceptable psychometric properties so that it can be used to survey family coping in Iranian mothers with cerebral palsy child