Prehospital Emergency Medical Services Challenges in Disaster; a Qualitative Study

Introduction: Prehospital Emergency Medical Care (EMC) is a critical service in disaster management. The aim of this study was to explore the challenges of prehospital Emergency Medical Services (EMS) during disaster response in Iran.Methods: A qualitative study was conducted from April 2015 to March 2017. Data were collected through in-depth, semi-structured interviews with 23 experienced individuals in the field of disaster that were selected using purposeful sampling. Data were analyzed using content analysis approach.Results: Fifteen sub-themes and the following six themes emerged in the analysis: challenges related to people, challenges related to infrastructure, challenges related to information management systems, challenges related to staff, challenges related to managerial issues and challenges related to medical care.Conclusions: Iran’s prehospital EMS has been chaotic in past disasters. Improvement of this process needs infrastructure reform, planning, staff training and public education.

Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators

<p>Abstract</p> <p>Background</p> <p>Road traffic injuries are a major public health problem, especially in low- and middle-income countries. Post-crash management can play a significant role in minimizing crash consequences and saving lives. Iran has one of the highest mortality rates from road traffic injuries in the world. The present study attempts to fill the knowledge gap and explores stakeholders' perceptions of barriers to – and facilitators of – effective post-crash management in Iranian regions.</p> <p>Methods</p> <p>Thirty-six semi-structured interviews were conducted with medical services personnel, police officers, members of Red Crescent, firefighters, public-health professionals, road administrators; some road users and traffic injury victims. A qualitative approach using grounded theory method was employed to analyze the material gathered.</p> <p>Results</p> <p>The core variable was identified as "poor quality of post crash management". Barriers to effective post-crash management were identified as: involvement of laypeople; lack of coordination; inadequate pre-hospital services; shortcomings in infrastructure. Suggestions for laypeople included: 1) a public education campaign in first aid, the role of the emergency services, cooperation of the public at the crash site, and 2) target-group training for professional drivers, police officers and volunteers involved at the crash scene. An integrated trauma system and infrastructure improvement also is crucial to be considered for effective post-crash management.</p> <p>Conclusion</p> <p>To sum up, it seems that the involvement of laypeople could be a key factor in making post-crash management more effective. But system improvements are also crucial, including the integration of the trauma system and its development in terms of human resources (staffing and training) and physical resources as well as the infrastructure development.</p

Competency and Cultural Similarity: Underlying Factors of an Effective Interprofessional Communication in the Emergency Ward: A Qualitative Study

Introduction: Despite its importance, interprofessional communication in emergency wards seems unfavorable. Identifying the underlying factors of an effective interprofessional communication can help care providers better design appropriate interventions. This study was designed to explore factors that influence interprofessional communication in the emergency wards. Method: A qualitative study was conducted by means of semi-structured interviews with 22 participants with a variety of jobs, positions, ages, genders, and work experiences. Data analysis was performed with content analysis method with inductive approach. Results: Data analysis revealed 4 categories of underlying effective factors of interprofessional communication in the emergency ward knowledge and skill, communication skills, the positive effect of religion on communication, similar demographic characteristics. These 4 categories revealed the 2 main themes of competency and cultural similarity. Conclusion: This study provided a better understanding of underlying factors in interprofessional communication in the emergency ward. Improving the knowledge and skills of health providers in the emergency ward, and employing personnel with common culture and demographic variables can improve interprofessional communication in the emergency ward. Interprofessional communication has a major role in the outcome of patient care and job satisfaction of staff thus, it is of great importance. Keywords: Interprofessional communication, Emergency ward, Underlying factors, Content analysi

Psychological Distress Model Among Iranian Pre-Hospital Personnel in Disasters: A Grounded Theory Study

Objective: Pre-hospital personnels (PHPs) who work in disasters under extreme pressure, uncertainty, and complex situations are victims of disasters themselves, and there is a link between experiencing such incidents andmental health problems. Because most studies focus on the injured and less on the psychological issues of PHPs, the present study aimed to develop a model to provide relief for PHPs in disasters from a psychological perspective. Methods: A grounded theorymethodology recommended by Corbin and Strauss (2015) was employed. PHPs (n = 24) participated in a semi-structured interview between July 2018 to May 2020. Results: In the analysis of the pre-hospital staff interviews, three main themes were extracted, namely, providing relief with struggle (complexity of incident scenes, command-organizational and occupational challenges), psychological distress (psychological regression and psychological empowerment), and consequences (resilience and job burnout). Seven categories and 22 subcategories were explored from our data via the grounded theory approach Conclusions: The PHPs managed psychological distress with two approaches: psychological self-empowerment and regression, which resulted in resilience and burnout, respectively. Due to the lack of enough support, the resilience of the PHPs was short-term, turned into burnout over time, and affected the structural factors again as a cycle

A Study of Acid Attacks Based on Victim's Experiences: Causes and Strategies

Introduction: Acid attacks are undertaken with the intent to harm, disfigure, or kill another individual. In recent years, these attacks have had an increasing trend. Scientific research can provide a more in-depth understanding of this phenomenon. Thus, the present study investigated the nature and dimensions of acid throwing based on victim's experiences. Method: This qualitative study used the grounded theory method according to the approach of Strauss and Corbin. It was initiated by purposeful sampling and continued by applying theoretical sampling. Data saturation was achieved through semi-structured interviews with 12 victims. Data analysis was performed using the method recommended by Strauss and Corbin and was coded in 3 phases of open coding, axial coding, and selective coding. Results: The main theme of “physical and psychological wounds” emerged as a result of data analysis. The themes of self-recovery, active personal strategies and avoidance at a personal level, family and friends and social support at a medium level, and not accepting structural support also emerged. Living with substance-abusers with behavioral disorders, and lack of problem-solving skills in the face of interpersonal conflicts were shown to be causal conditions of acid attacks. Conclusion: Acid attacks result in physical and psychological wounds in victims. Due to being a multi-dimensional (illness, disability, and victimization) phenomena, it requires a wide range of strategies at different levels Keywords: acid splashing, grounded theory, physical and psychic wound

Barriers to Support for Parents of Children with Cerebral Palsy: A Qualitative Study

Introduction: Parents who have children with cerebral palsy are exposed to the complicated care procedures of the afflicted child. Thus, they need support in order to decrease problems in this respect. However, their needs are not sufficiently met. Therefore, this study was conducted to explore barriers to support for parents of children with cerebral palsy. Method: This qualitative study was conducted in 2011-2012 using content analysis. Purposeful sampling was used to select the participants and continued until data saturation was reached. As a result, 31 participants from among parents of children with cerebral palsy referred to the rehabilitation centers in Tehran, Iran, and experts were sel categories of organizational barriers (poor institutional coordination and communication, and lack of supportive laws with administrative support), professional barriers (poor teamwork, and lack of professional competency), and family barriers. Conclusion: Through understanding parents' needs and complementing supportive laws for parents with afflicted children, coordination among supportive organizations, and planning for comprehensive care along with supportive services packages, policy makers and health services managers can help eliminate parents' problems with regard to caring for their children with cerebral palsy. Keywords: Parents, Cerebral palsy in children, Support, Barriers, Qualitative study

Challenges nurses experienced in caring for patients with COVID-19 admitted to the Intensive Care Units: A Qualitative Study

Background: Nurses working in intensive care units (ICU) have experienced numerous challenges while caring for patients with COVID-19.Objectives: The aim of this study was to explore ICU nurses’ experiences of caring for patients with COVID-19.Methods: This research presents part of a qualitative study conducted using a grounded theory approach. Participants consisted of nurses and physicians from the selected hospitals in Sabzevar, Neishabour, and Mashhad, Iran. Data collection was performed using semi-structured in-depth interviews. Participants were enrolled via purposive sampling during 2022–2023. A total of 21 participants were interviewed. The method of Corbin and Strauss (2015) was used to analyze the data. We used Guba and Lincoln’s four criteria of credibility, dependability, transferability, and confirmability to ensure data trustworthiness.Results: Four main categories emerged from the data that collectively reflect the experiences of Iranian ICU nurses in caring for COVID-19 patients. These categories included ward overcrowding, changing patterns, complexity of care, and feeling exhausted. All of these categories show that Iranian ICU nurses were under intense pressure during the COVID-19 pandemic.Conclusion: This study showed that taking care of patients was very exhausting for nurses during the COVID-19 pandemic. Hospital authorities and nursing administrators have a responsibility to support nurses and provide them facilities to feel less stress and uncertainty, while caring for patients with COVID-19

Exploring Therapeutic Problems in Women with Multiple Sclerosis: A Qualitative Study

Introduction: Multiple sclerosis (MS) is one of the most important diseases of the nervous system. The incidence of this disease in women is about two to three times that of men. The main cause of this disease is not fully understood and there is no definitive treatment for it. The aim of this study was to identify the treatment problems in this group of patients. Method: In this qualitative study, content analysis method was used. Based on the purposive sampling method and theoretical saturation criterion, 23 patients with multiple sclerosis who referred to the Association for the Protection of Menthol Patients in Tehran, Iran, during the year 2014 participated in this study. Semi-structured interview method was used to collect the data. Data were analyzed using qualitative content analysis method. Results: Out of the interviews, 1100 codes were obtained in three stages of analysis. These codes fell into one category of treatment problems and five subcategories of "high cost of treatment", "lack of access to medicine", "neglecting patient's rights from doctors and medical personnel", "lack of adequate empathy from medical personnel", and "Complications of medications". Conclusion: Patients with multiple sclerosis are facing specific problems in the treatment of their illness, which require social attention and protection; they can be supported by appropriate insurance coverage and the provision of medicines, especially foreign drugs, at affordable and low-cost tariffs by the government and the community. A great contribution is needed to reduce the pain and suffering of this group of patients. Keywords: Qualitative research, Therapy, Multiple sclerosi