Home-based Palliative Care: A Strategy for Keeping Intensive Care Unit Beds Vacant

The increasing prevalence of chronic diseases throughout the world is an undeniable phenomenon; 395,000 deaths occurred in Iran in 2014 and about 76% of them were related to chronic diseases.1 Cancer is one of the chronic diseases that are progressing rapidly. In Iran, cancer is known as the third cause of death. Adult morbidity rate of cancer in different regions of Iran is estimated 48-112 cases per million people among the females and 51-144 cases per million people among the males.2 Also, mortality rate related to cancer was about 53500 people in 2014.3 In fact, 13% of all deaths related to chronic diseases are caused by cancer1 and the majority of cancer patients expire in the intensive care units (ICU), whereas bed occupancy of ICUs is in crises, being about 100% in Iran. For each ICU bed, 4 people are applicants. In this situation, firstly, a number of patients do not have access to the ICU beds, and secondly, because of the need to ICU beds, the admitted patients in ICU wards are discharged earlier than the standard time for each disease. According to the head of the Intensive Care association, the shortage of ICU beds is about ten thousand in Iran, whereas setting up each ICU bed requires a high cost.4 In the current condition, due to the high cost and shortage of nurses in Iran, setting up of ICU beds is a challenge for the health system. WHO introduced home-based palliative care to improve the quality of life, quality of care, quality of death and patient satisfaction; decrease burnout in staffing and mortality in hospitals; reduce the cost, accept end of life as live days; neither accelerate death nor prolong life; consider all dimensions of human; help the patients to be active until the time of death; help the patient’s family to cope with the disease and loss of patient; and release the beds in hospitals.5 Although hospital beds are considered for healing the patients not a hospice for them, the majority of cancer patients die in the hospital and on the ICU beds, and to the last moments of life, they receive specialized cure, and occupy ICU beds, while the specialists are aware that this treatment is unfruitful, and this reality is supported by science. In the developed countries, the gap between death and specific cures is considered as an indicator of the quality of physician services and more length of time will be better indicator for physician services, while cancer patients in health system of Iran receive specific treatment and chemotherapy even to moment of death. To consider countless benefits of home care6 and the patients’ desire to receive services at home,7 if we can provide the conditions that at least 20% of end stage cancer patients in receive home based palliative care, 1000 deaths will occur at home yearly, and 1000 ICU beds will be released for use for other patients with better prognosis for survival. Therefore, health system authorities in Iran should considered home-based palliative care of cancer patients as a priority

Explaining the challenges of Iranian caregivers in provision of home health care to spinal cord injury patients: a qualitative study

Abstract Background The incidence of spinal cord injury (SCI) is increasing across the globe. The caregivers of patients with spinal cord injuries experience many problems during providing care to these patients. Identifying the problems experienced by caregivers can facilitate the process of care provision to these patients. So, the aim of this study was to explore the challenges of caregivers in provision of home health care to SCI patients. Methods This study was conducted by qualitative description approach in Iran from Apr 2021 to Dec 2022. The participants included the caregivers of SCI patients recruited by purposive sampling. The data were collected by face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. Results Two themes emerged from the data analysis, including burnout (with the categories of physical challenge and psychological challenges) and coping strategies (with the categories of social support and professional support). Conclusion Resolving the obstacles and problems faced by home caregivers can improve the circumstances of care provision so that they can be relieved of their own physical and psychological conundrums and deliver suitable home care to SCI patients. Trial registration number Not applicable

Exploring the Position of Community-Based Nursing in Iran: A Qualitative Study

Background: Community-based nursing focuses on providing health services to families and communities in the second and third levels of prevention and this can improve the individuals, families and communities’ quality of life, and reduce the healthcare costs. The aim of this study was to explore the status of community-based nursing in Iran. Methods: This qualitative study was conducted from March to November 2015, in Tehran, Iran, using the content analysis approach. The study setting consisted of Iran and Tehran Faculties of Nursing and Midwifery, Tehran, Iran. The purposive sampling method was used. Twenty faculty members and Master’s and PhD students were interviewed by using the face-to-face semi-structured interview method. Moreover, two focus groups were conducted for complementing and enriching the study data. The data were analyzed using the Graneheim and Lundman’s approach to content analysis. The trustworthiness of the study findings was maintained by employing the Lincoln and Guba’s criteria of credibility, dependability, and confirmability. Results: In total, 580 codes were generated and categorized into three main categories of conventional services, the necessity for creating infrastructures, and multidimensional outcomes of community-based nursing. Conclusion: Introducing community-based nursing into nursing education curricula and creating ample job opportunities for community-based nurses seem clearly essential

Community-based interventions and willingness for screen prostate cancer in the elderly based on the health belief model: Examination and analysis

Prostate cancer is one of the most common malignant cancers among men worldwide. One way to control this disease is screening. One of the models that can be used to identify and change the beliefs and attitudes of the elderly and their families is the health belief model. Considering the lack of similar studies, this study was performed to determine the effect of community-based intention to perform screening behaviors on prostate cancer screening in the elderly based on the Health Belief Model. Methods: This study was a randomized field trial. The statistical population included all older men over 60 years of age with electronic files in comprehensive health service centers in Malayer in 2020-2021. The samples were 250 eligible elderlies who were divided into control and intervention groups by stratified random sampling. For the intervention group, training based on the health belief model was performed. The data collection tool was a standard questionnaire, which consisted of two sections: demographic information and intention to perform screening behaviors for cancer prostate-based health belief model. Questionnaires were given to both groups before and after the intervention. Data were analyzed using SPSS software version 22 and statistical tests, MANOVA, chi-square, and Fisher's exact test.&nbsp

Exploring COVID-19 Patients’ Experiences of Healthcare System Responsiveness during the Disease Course: A Qualitative Study

Background: One of the basic steps to improve the quality of services provided to patients with COVID-19 is to recognize the dimensions of providing such services from the perspective of recipients. Accordingly, this study aimed to explain the COVID-19 patients’ experiences of healthcare system responsiveness during the disease course.Methods: The present qualitative study was conducted using the conventional content analysis method in Iran from April 2020 to April 2021. Participants in this study included COVID-19 patients who were selected via purposive sampling. Data were collected through 34 telephone and face-to-face interviews and analyzed according to the method proposed by Graneheim and Lundman.Results: Qualitative analysis of the data led to the identification of impaired health system responsiveness as the main theme. The main theme consisted of two categories including the collapse of hospitals (with the subcategories of lack of resources and defects in process management) and providing low-quality care (with the subcategories of providing low-quality nursing services, lack of comprehensive care, and threats to patient safety).Conclusion: To provide quality care services to COVID-19 patients, the health system must consider improving its responsiveness to patient needs, expanding the physical space of healthcare centers, equipping hospitals with the accommodations and amenities required by patients, and providing conditions for the staff to be able to immediately respond to patient needs

The Effect of Theory Based Nutritional Education on Fat Intake, Weight and Blood Lipids

Introduction: Though Nutrition plays a key role in the control of hypertension, it is often forgotten in Iranian patients’ diet. In fact, dietary behavior can be regarded as unsatisfactory among Iranian patients. This study was aimed to assess the effectiveness of theory based educational intervention on fat intake, weight, and blood lipids among rural hypertensive patients. Methods: This quasi experimental study was conducted on 138 hypertensive patients who had referred to Ardabil rural health centers during 2014. The nutritional education based on DASH and Health Promotion Model (HPM) was treated for six sessions. The pre-test and post-test had intervals of two and six months. Data were analyzed using SPSS-18 and Chi-square, independent-samples t-test, paired-samples t-test and repeated measure ANOVA. Results: After treating intervention, weight, dietary fat, LDL_C and Total cholesterol, systolic and diastolic blood pressures decreased significantly in the intervention group compared with the control group (p < 0.001). In contrast, HDL_C increased significantly in the intervention group. Conclusion: Educational intervention, provided based on Pender’s health promotion model, affecting fat intake, blood lipids, and blood pressure, led to their decreas

Community-based interventions and the attitude towards prostate cancer screening in the elderly based on the health belief model: Examination and analysis

Introduction: Prostate cancer is one of the most common malignant cancers among men worldwide. One way to control this disease is screening. One of the models that can be used to identify and change the beliefs and attitudes of the elderly and their families is the health belief model.&nbsp; Due to lack of similar studies, this study was performed to determine the effect of community-based interventions on subjects’ perception of screening behaviors prostate cancer based on the Health Belief Model in the elderly. Methods: This study was a randomized field trial. The statistical population included all elderly men over 60 years of age with electronic files in comprehensive health service centers in Malayer in 2020-2021. The samples were 250 eligible elderlies who were divided into control and intervention groups by stratified random sampling. For the intervention group, trainings based on the health belief model were performed. The data collection tool was a standard questionnaire, which consisted of two sections: demographic information and subjects’ perception of screening behaviors for prostate cancer based on health belief model. Questionnaires were given to both groups before and after the intervention.&nbsp

Exploring the Barriers of Home Care Services in Iran: A Qualitative Study

With increasing chronic diseases, the use of home care is rising in the world. Home care in Iran has many challenges and to improve that, we should identify the challenges and barriers of home care. The aim of this study was to identify and explore the barriers of home care in Iran. This is a qualitative study with content analysis approach that was conducted in Iran in 2015. Fourteen key informants comprising health policymakers, faculty members, nurses, and physicians as well as patients and families engaged in home care purposefully participated in this study. Data was obtained using face-to-face semistructured interviews. A focus group discussion was also used to complete the findings. Graneheim and Lundman’s approach was used for analysis of data and Lincoln and Guba’s criteria were used to confirm the trustworthiness of study’s findings. The data were divided into three main categories and eight subcategories. Main categories included treatment-based approach in the healthcare system, cultural dimensions, and the lack of adequate infrastructure. A position for home care in the healthcare system, considering cultural dimensions in Iranian society and providing an appropriate infrastructure, can be beneficial to improve the situation of home care services in Iran

The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients

Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent -test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors

Customers’ satisfaction about prehospital emergency medical services in Lorestan, Iran

Introduction: Patient’s satisfaction with health care in ambulance services is an important quality indicator and a helpful tool for managers of prehospital emergency services. This study aimed to measure patient satisfaction with health provided by prehospital emergency medical services (EMS) in Lorestan, Iran. Methods: This cross-sectional study was conducted on patients (n=450) transferred by EMS to hospitals of Lorestan University of Medical Sciences in a two-year period (2013–2014). Data collection was performed by patient questionnaire, which is a standard LKFR tool. Validity and reliability of the instrument was confirmed by scientific method. Collected data were analyzed by SPSS Version 19. Descriptive and inferential statistics such as Chi-square, paired-samples t-test, independent-samples t-test, ANOVA, Pearson’s product-moment correlation coefficient, and Fisher’s exact test were used. Results: One hundred ninety-two (42.8%) and 257 (57.2%) patients were female and male, respectively (mean: 41 years, r: 37–83). Patient satisfaction of the dispatcher was good, and satisfaction level in regards to the technicians’ performance, physical situation, and facilities inside the ambulance was moderate. The Wilcoxon test did not show any significant difference between pain severity before and after arriving EMS in the cardiac and respiratory patients (p=0.691), but severity of pain in orthopedic patients after arriving EMS was decreased (p=0.001). Cardiac and respiratory patients had low satisfaction of EMS, and the Chi-square test was significant (p=0.001). Orthopedic patients had the most satisfaction of EMS. Conclusion: Generally, patients’ satisfaction of EMS was low. Satisfaction with pain relief in orthopedic patients was better than pain relief in cardiac and respiratory patients. It is recommended to take necessary actions to improve the level of patient satisfaction of EM