Stress Management among Parents of Neonates Hospitalized in NICU: A Qualitative Study.

Introduction: Infant hospitalization is stressful event for parent in NICU. Parents think that they have lost control because of unfamiliar environment. Therefore, stress management is very important in this period. The family as the main factor of strength and protection for infant is required as the bases of standard care in NICU. Therefore the aim of this study was to investigate stress management in Iranian NICU Parents. Methods: Using qualitative content analysis approach helped to collect and analysis data for open coding, classification, and theme abstraction. Twenty one parents with hospitalized neonates, physicians and nurses in the city of Isfahan were purposely recruited and selected for in-depth interviews. Results: The analyzed content revealed unique stress management approaches among the parents. The main themes were: 1) spirituality, 2) seeking information, 3) Seeking hope, 4) maintaining calm, 5) attachment to infant, and 6) communicating with the medical team Conclusion: Findings of this study highlights the importance of medical team's attention to stressed parents who are trying to make adjustment or adapt to the hospitalization of their infant. A revised management approach to address the emotional needs of parents of neonates in Iran seems essential for improving communication with physicians and nurses

The Necessities and Requirements of the Pediatric Angiography Ward from the Perspective of the Healthcare Team: A Qualitative Study

Background & Aims: Pediatric angiography has been widely used for the diagnosis and treatment of congenital heart disorders in children over the past two decades. The work environment of the nurses of pediatric intensive care units is highly stressful due to various technical and medical equipment and patients with life-threatening diseases. In order to improve special pediatric care environments, attention must be paid to the experiences and opinions of the nurses employed in these units. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. Considering the teamwork involved in patient care and treatment and increased number of beds in intensive care units, it is critical to evaluate the perceptions of physicians and nurses regarding the aspects of care in intensive care units. The improvement of the performance of pediatric critical care nurses and attention to their experiences and viewpoints are also essential in this regard. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. The use of pediatric angiography has increased in the past two decades. In addition, the differences in the culture, environment, and education of nurses in pediatric intensive care units, along with the differences in the hospitalized patients further emphasize on the necessity of qualitative research. However, most of the studies in this regard have been performed with a quantitative approach, while only qualitative research could determine the dimensions of the perceptions of the healthcare team. To date, no qualitative studies have assessed the experiences of the healthcare team in the pediatric angiography ward. The present study aimed to elaborate on the necessities and requirements of the pediatric angiography ward from the perspective of the healthcare team. Materials & Methods: This study was conducted using the qualitative content analysis approach in 2018. The sample population included 20 subjects, including nine nurses, four radiologists, and seven cardiologists, who were selected via purposeful sampling from the angiography unit of Hajar Hospital in Shahrekord, Iran. The inclusion criteria were the nurses and physicians with one year of work experience in the angiography or cardiology ward and willingness to participate in the study, and the exclusion criterion was unwillingness to participate. The duration of the interviews was 35-60 minutes, and the recordings were performed in accordance with ethical principles. Data collection and interviews continued until reaching data saturation. Data collection and analysis continued for four months. The semi-structured, individual interviews were initiated with the nurses and physicians with an open question ("Please explain your experiences of working in the pediatric angioplasty ward."/"What challenges have you faced in performing pediatric angiography?") The interviews continued with probing questions ("Please explain further."/"Please set an example.") The obtained data were analyzed using the qualitative content analysis method. After the researcher listened to the recorded interviews several times, he was immersed in the data to obtain an overview of the interviews. All the interviews were transcribed word-for-word, so that the words containing the key concepts would be highlighted and the codes would be extracted. After extracting the concepts and codes from important sentences and paragraphs, they were classified into categories based on the similarities and differences, and the categories were reduced to a smaller number of categories based on their correlations. In order to maximize the diversity of the participants, the research units were selected from the nurses, physicians (pediatric cardiologists), and radiologists engaged in the angiography ward. To ensure the accuracy and reliability of the research findings, the four criteria of credibility, dependability, transferability, and conformability were considered. To observed ethical considerations, a letter of recommendation was obtained from the Vice-Chancellor of Research of Shahrekord University of Medical Sciences. In addition, written informed consent and permission to record the interviews were obtained from the subjects prior to participation. Results: The mean age of the nurses was 34 years, and the mean work experience in the angiography ward was five years. The mean age of the radiologists was 31.5 years, and the mean work experience in the angiography ward was three years. The mean age of the pediatric cardiologists was 45 years, and the mean work experience in the angiography ward was five years. Data analysis yielded the three categories of the sensitivity of the ward, the necessity of the proper use of specialized equipment, and the need for education and skills training. The category of the sensitivity of the ward had three subcategories of the special conditions of the patients, sterilization of the angiography environment, and the need to become familiarized with the ward. The category of the proper use of specialized equipment had two subcategories of expensive equipment and management regulations of the maintenance of specialized equipment. The category of the need for education and skills training had two subcategories of the need for knowledge skills and the need for communication skills. Conclusion: The three most important findings of this study were the need for familiarity and proper use of specialized equipment and the necessity of education and skills training, which are like a golden treasure, the key to which is in the hands of hospital managers and officials. The training of the healthcare team in the angiography ward is a gradual and continuous process. Among the required skills for practice in the angiography ward are having adequate knowledge and the ability to properly communicate with the patients and their companions and the ability to use the specialized equipment correctly and appropriately, which could be achieved through the implementation of communication and counseling training courses, training on the use of specialized equipment, and the necessary preparations for the personnel of this ward. Considering the sensitivity of the angiography ward, the criticality of the applied procedures in the ward, and important issues such as clinical governance and accreditation, special attention should be paid to educational need assessment in order to implement proper interventions by hospital managers and health planners in terms of the training and skills of the personnel. Keywords: Angiography Ward, Children, Healthcare Tea

Construction of a Questionnaire to Assess Parental Stress in Neonatal Intensive Care Unit

Background: Once an infant is hospitalized in the Neonatal Intensive Care Unit (NICU), the entire family dynamics is disrupted due to stressors such as interruption in maternal-infant bonding, abandonment of other siblings and financial burdens. Combination of multiple stressors often ends in divorce or other devastating results. In this study, a novel survey questionnaire has been developed to assess the level of parental stress in NICU and identify the warning signs, in order to provide assistance to young couples in need of help. Methods: Qualitative content analysis was performed to survey 13couplesrecruited from various teaching hospitals in Isfahan, Iran. Results: The initial part of the questionnaire was designed to assess parents' stress level with an expected content validity index of 0.78 or above and to measure face validity of the questionnaire, all the items received a mean impact score of 1.5 or above, and the Cronbach's alpha reliability of the 12-item questionnaire equaled to 0.904. Based on the factor analysis, the items with a correlation coefficient of less than 0.4 were excluded (one item was omitted). Conclusion: Most survey questionnaires found in the existing literature have investigated the types of stressors experienced by parents with an infant in NICU. In this study, researchers offer a novel 11-item questionnaire designed to assess the level of stress among parents with a hospitalized infant in NICU

Assessment of perceived social support among selected hospital personnel in Isfahan

كي از مهمترين شرايط براي عملكرد مؤثر سازمانها، فراهم بودن عامل انساني است. در اين ميان، حمايت اجتماعي يـک عامـل روانشناختي مهم در محيط کار ميباشد که بر عملكرد نيروي انساني تاثيرگذار است. لذا اين مطالعه با هدف تعيين حمايت اجتمـاعي درک شده در بعد پشتيباني عاطفي در ميان کارکنان بيمارستان انجام شد. در اين مطالعهي مقطعي، ۱۲۰ نفر از کارکنان يک بيمارسـتان منتخب در شهر اصفهان به روش نمونهگيري در دسترس جهت بررسي انتخاب شدند. گردآوري اطلاعات با استفاده از پرسشنامههاي مشخصات فردي و حمايت اجتماعي كه محقق ساخته بود، انجام شد. روايي ابزار با اسـتفاده از روايـي محتـوا و پايـايي آن بـا روش بازآزمايي اخذ شدند و در نهايت دادهها با استفاده از آمار توصيفي و استنباطي (آزمون مجذورکاي) مورد تجزيه و تحليل قرار گرفتند. يافتهها نشان داد، حمايت اجتماعي درک شده در بعد پشتيباني عاطفي از سوي همکاران با ميـانگين نمـرهي ۹/۰ ± ۳۴/۳ بـيشتـر از حمايت اجتماعي درک شده در همين بعد از سوي مديران با ميانگين نمره ۸۸/۰ ±۵۸/۲ بوده است. همچنين، بين حمايت اجتماعي در بعد پشتيباني عاطفي با مشخصات فردي مثل سن و سابقهي کار مطابق آزمون square-Chi دو رابطهي معنيدار آماري وجـود داشـت (05/0<P .(با توجه به آنكه حمايت اجتماعي از کارکنان بيمارستان براي عملكرد مؤثر سازماني الزامي اسـت، مـديران بيمارسـتانهـا ميتوانند از طريق تحکيم روابط خود با کارکنان بر افزايش کارايي آنها مؤثر باشند

Female Cancer Patients’ Perceptions regarding Health-related Behaviors: A Qualitative Analysis

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

Development of National Standards of Nursing Care for the Prevention of Venous Thromboembolism

Background & Objective: Venous thromboembolism (VTE) is a major health concern, which is associated with high mortality and morbidity and treatment costs. Although prevention is considered a priority is in this regard, there are no specific standards in Iran based on the specific conditions and care culture for the prevention of pulmonary embolism. The present study aimed to develop national standards of nursing care for the prevention of VTE. Materials and Methods: In this descriptive study, the care standards for the prevention of pulmonary embolism were extracted from valid references. At the second stage, a checklist was prepared, and its validity and reliability were confirmed. Finally, the Delphi technique was used to finalize the respective checklists at the first stage by 12 experts and the second stage by 120 experts, with the consensus of over 70%. Data analysis was performed in SPSS. Results: The obtained results were finalized in four phases. The first phase was patient evaluation (four standards in the form of 67 checklists), the second phase was prophylaxis (three standards in the form of 22 checklists), the third phase was drug management and preventive measures (two standards in the form of 24 checklists), and the fourth phase was the nursing process (four standards in the form of 155 checklist). Conclusion: Based on the results of the third stage, the standards with lower consensus than 70% were eliminated, and the standards with higher consensus than 70% were established. It is hoped that these standards would improve the quality of nursing care and contribute to the prevention of pulmonary embolism in Iran. Keywords: Venous Thromboembolism, Prevention, Nursing, Standar

Collection structure national standards in neonatal intensive care unit according to the international standards in years 2006-2007.

Abstract: Background and Aim: Recently attentions to intensive care unit environments is essential because of multiplied disadvantages of undesirable environment in high risk newborn therefore determination and collection of standards for accurate practice in hospital and health centers. Materials and Methods: This research is a multiple triangulation done in years 2004-2006. First international standards were extracted from world wide webs. The using Delphi method, these standards as well as the view points of 15 clinical medical sciences experts were complied to set suggested standards in environmental health finding and in the third stage, 42 clinical medical sciences experts of the country were selected. And their suggestions were investigated regarding desirability and applicability of these standards to the executive and sociocultural situations in Iran through a descriptive survey method. The results of this stage were analyzed via descriptive statistics. Results: In the first stage standards were extracted of lo controls and states. The suggestions and assertions made by experts regarding the suitability and applicability to the environmental situations in Iran were studied and standards in environmental health were drafted and were finally approved by an 80-100 desirability percent rate. Conclusion: The findings of the third step of the research showed that most of the environmental health standards had either appropriate or fairly appropriate level. So necessary changes in final standards have been made based on subjects, viewpoint and suggestions facilities standards suggested for Iran. The findings of this research are hoped to contribute to the enhancement of the quality in Iran

Evaluating the effect of Matricaria chamomilla and Melissa officinalis on pain intensity and satisfaction with pain management in patients after orthopedic surgery

Introduction: The most important compliant of post-operative orthopedic patients is severe and intolerable pain. This pain has negative impacts on patient's satisfaction with pain management and bone healing after surgery. This study was conducted with the aim of evaluating the effects of Melissa officinalis (Melissa) tea and Matricaria chamomilla (Chamomile) tea on pain intensity and satisfaction with pain management in patients after lower limb orthopedic surgery. Methods: This was a randomized controlled trial conducted on 96 patients after lower limb orthopedic surgery in Ayatollah Kashani hospital of Shahrekord city, Iran. Patients were randomized to M. officinalis, Chamomile and control groups with blocking randomization method. For M. officinalis group, 1 g of Melissa tea, for Chamomile group 1 g chamomile tea and for control group black tea was prescribed 3 times a day. Study variables were evaluated before and 30 min after each stage of intervention and then the mean changes of pain intensity and satisfaction before interventions and after each step of intervention were compared between groups. Significance level was considered as P< 0.05. Results: Before intervention, the mean scores of pain intensity and satisfaction with pain management had no significance difference between groups. The mean changes of pain intensity and satisfaction with pain management (after first 3 steps of intervention) in M. officinalis and M. chamomilla groups were significantly greater than the ones in control group (P< 0.05). Conclusion: Prescription of M. officinalis tea or Chamomile tea might be used as effective remedy for reducing pain and increasing satisfaction with pain management after orthopedic surgery

Stress Management Experience of Caregivers of Thalassemia Children: A Qualitative Research

Background: Children with thalassemia do not have favorable psychological health. Today, the use of different therapeutic regimes for caregivers with thalassemia has increased life expectancy; however, these patients have other various needs and requirements such as constant professional training. The aim of the present study was to explain stress management in caregivers with thalassemia children. Materials and Methods: The method applied in this study was phenomenological qualitative research with conventional content analysis. This study was done in 2016-2017 in Shahrekord, Iran. A total of 15 participants, including 10 mothers, 1 grandmother, and 4 fathers participated purposely in this study. There were two sessions of interviews each of which lasted for 30 minutes. The content of interview was recorded and analyzed through conventional content analysis method after documentation. Results: Following content analysis, three categories were obtained: seeking for hope included two subcategories of seeking for hope and trusting in God, seeking for information included two subcategories of seeking for information from parents and seeking for information from physician and nurse, and seeking for new treatment included two subcategories of seeking for new treatment and seeking for transplant. Conclusion: This findings of the present study showed that planners and healthcare team can contribute caregivers of thalassemic children in coping with this disease using three adaptation approaches; that is, offering caregivers hope and providing them with proper information about the disease and treatments

Perceived factors to providing palliative care for patients with cancer - a qualitative systematic review

Palliative care (PC) is one of the necessary cares given throughout a patient's experience with cancer. The aim of this study was to identify the perceived factors to providing PC for patients with cancer. Our study was a systematic review of qualitative literature. To this end, electronic databases, including CINAHL, PubMed, PsycINFO, Ovid, and Web of Science as well as Persian databases were searched and qualitative studies on the role of PC in patients with cancer published between Jan 2008 and Dec 2017 were selected. Generally, 12 studies were reviewed. A thematic synthesis approach was used to analyze the data. Exploring the selected articles, the findings on the perceived factors to providing PC for patients with cancer were categorized into three themes, including organizational factors, ethical factors, and psychological factors. This qualitative systematic review expands our knowledge about factors influencing the provision of PC for patients with cancer. It is necessary for health system managers and caregivers to pay attention to all aforesaid factors in order to improve PC for cancer patients