Palliative Care in Iran: The Past, the Present and the Future

Futurology identifies and lists the most desirable possible future(s) out of the most likely ones, and plans for the best options according to these possibilities. Future studies in health are an instance of future studies in medical activity that have a great application in real life and present strategies that can help achieve better conditions. Palliative care for cancer is a major challenge faced by the national health system in Iran. Analyzing the trend of palliative care through exploring the current status of palliative care for cancer in the country and finding strategies to fill the gap between the current status and the desirable one is an important subject in health studies. This article addresses the trend of palliative care in Iran from the past to the present by reviewing articles, books, documents, and news in online databases, and gives an overview of the future in the context of the presenting challenges and opportunities. Although palliative care in Iran has had a slow progress, recent efforts made to promote its status appear promising. This article seeks to help improve the status of palliative care in Iran, even if only moderately, so that cancer patients can live the rest of their life in comfort

The predictors of spiritual dryness among Iranian cancer patients during the COVID-19 pandemic

BackgroundSpiritual struggles affect the wellbeing of religious people. Among them are strugglers with God which is perceived as non-responsive and distant. These perceptions were so far analyzed predominantly in Western societies with a Christian background, but not in Muslims from Iran. The aim of this study was to determine the predictors of spiritual dryness among cancer patients in Iran during the COVID-19 pandemic.MethodsCross-sectional study with standardized questionnaires (i.e., Spiritual Dryness Scale, WHO-5, BMLSS-10, Awe/Gratitude Scale) among 490 cancer patients (mean age 49.50 ± 14.92 years) referring to the selected educational hospitals in Tehran (the capital of Iran), who were selected through convenience sampling and based on the inclusion criteria, enrolled between December 2020–May 2021. Data analysis was done using SPSS software version 26 and the statistical methods including calculating the mean and the standard deviation, correlation coefficients, as well as regression analysis.ResultsThe overall experience of spiritual dryness was perceived regularly in 10.2% of Iranian cancer patients, sometimes in 22.9%, rarely in 22.9%, and never in 43.3%. The mean ± SD was 25.66 ± 5.04, and the scores ranged from 10 to 55. A higher score means greater spiritual dryness. The strongest predictors of spiritual dryness were praying activities Furthermore, the perception of burden due to the pandemic was positively correlated with spiritual dryness. Moreover, each 1 unit increase in its score changed the spiritual dryness score by 0.2 units. The regression of spirituality-related indicators, demographic-clinical variables, and health-related behaviors accounted for 21, 6, and 4% of the total SDS variance, respectively. These findings show that with an increase in praying, performing daily prayers, and the indicators related to spirituality, spiritual dryness will decrease. Most patients were able to cope with these phases often or even regularly, while 31.1% were never or rarely only able to cope.ConclusionThe results of this study showed that in times of crisis, cancer patients’ faith and confidence in God could be challenged. It is not the disease itself which seems to be associated with this form of crisis, but their religious practices. Therefore, it is necessary to support these patients during their struggle, especially as spirituality is one of the best approaches to cope with the disease

Obstacles to Parents’ Interaction with Neonates in Neonatal Intensive Care Units from Parents’ and Nurses’ Points of View

Background: This study aimed to identify the most important obstacles to proper interaction of parents with their neonates who were hospitalized in neonatal intensive care units (NICUs). Methods: This descriptive cross-sectional study was conducted on 90 NICU nurses and 400 female and male parents using census and convenience sampling methods. To collect data, in a period of three months, a researcher-made questionnaire was prepared, including the factors threatening the parents' interaction with their neonates in NICUs. Data analysis was performed using the descriptive statistics including the number, percentage and mean scores of responses in SPSS software (version 16). Results: By calculating the mean scores of responses, from the nurses' points of view, "feeling of emotional discomfort due to being away from the neonate" (3.63) and "nurses’ not understanding parents since they have no children" (1.42) were the most and the least important factors, respectively. From the mothers' points of view, "parental stress due to the neonate’s hospitalization" (3.47), and "the maternity wards being away from NICUs" (1.37) were the most and the least important factors, respectively. Also, the most and the least important obstacles in the perspectives of the fathers were "parental stress due to the neonate’s hospitalization" (3.09) and "the unwanted neonate", respectively. Conclusion: The results showed that the stress and tension of parents were the most influencing factor on the interaction of neonate-parent in NICUs. Some neonatal and organizational factors were considered less important as the barriers to neonate-parent interactions in these wards

Skin Injuries and its Related Factors in the Neonatal Intensive Care Unit

Background: Skin is the most important defense mechanism of the neonate's body. The admission to the Neonatal Intensive Care Unit (NICU) is a risk factor for neonatal skin injuries. Therefore, to prevent these complications, it is essential to identify the risk factors. The present study aimed to investigate the incidence of skin injuries and its related factors in neonates admitted to the NICU.Methods: This cohort study was conducted in two NICUs in one perinatal hospital in Tehran, Iran, from January 2018 to June 2018. The sampling was performed using the census method. The data were collected through a demographic characteristics form, a risk factor assessment checklist, and the European Pressure Ulcer Advisory Panel (EPUAP) tool. The data were analyzed in SPSS software (version 19) through Fisher's exact test and chi-square test.Results: Out of 368 neonates, 126 cases had skin injuries, and the others were healthy. The mean values of weight and age of the neonates with skin injuries were 796.68±1606.82 g and 5.18±30.82 days, which was significantly lower than those of the infants without skin injury (p <0.05). The results of the risk factors analysis also showed that the second-grade injuries were the most frequent. Moreover, the drug leakage (14.2%, n=33) and nasal continuous positive airway pressure (12.06%, n=28) had the highest prevalence. The results of the effect of risk factors on the wound grade also showed that drug leakage, diaper rash, and surgical injuries had a significant effect on the wound grade.Conclusion: The results showed that in addition to neonatal conditions, equipment, and neonatal care play a significant role in the incidence of skin injuries. Skin is the most important defense barrier of the neonate's body and it is vitally important to take care of it. Therefore, it is necessary to identify and prevent such injuries

Correlation between Quality of Care and Length of Hospital Stay in Neonatal Intensive Care Unit

Background: Length of hospital stay (LHS) is the most important and practical indicator in hospitals, which largely reflects the level of hospital performance and activity. It is also an important indicator for resource planning. Moreover, the quality of care can theoretically be related to LHS. The aim of this study was to investigate the relationship between LHS and quality of nursing care in the neonatal intensive care unit (NICU).Methods: In this descriptive correlational study, the samples were 205 premature infants hospitalized in the NICU and 80 nurses working in the NICUs of selected hospitals. They were selected based on the inclusion criteria. The data were gathered using the demographics of nurses and neonates through Quality Patient Care Scale (QUALPAC). The data was analyzed in SPSS (version 21) using Spearman correlation coefficient.Results: The results showed that 47.5% of the nurses were within the age range of 29-36 years and 68.8% of nurses had a working experience of 1-5 years. There was an inverse correlation between the neonate's length of stay and the quality of care (r=-0.507, PConclusion: The findings revealed an inverse relationship between the length of stay and quality of care. By improving the quality of care, we can decrease the LHS

Clinical Assessment of Nursing Care Regarding Prevention of Ventilator-associated Pneumonia in Neonates

Background: Ventilator-associated pneumonia (VAP) is the second common nosocomial infection in NICUs leading to some complications. Nurses are one of the main resources in health care that directly influence neonatal health care. Responsibility of most of preventive strategies related to VAP complications lies with nurses; therefore, nursing care should be assessed until the nurses show standard level of performance in hospitals. The aim of this cross-sectional study, conducted within 2015-2016, was to assess nursing care regarding VAP prevention in neonatal intensive care units (NICUs) in selected hospitals affiliated to Shahid Beheshti University of Medical Sciences.Methods: In this descriptive cross-sectional study, 100 observations of nursing care regarding VAP were selected by convenience method in NICUs of Mahdiyeh, Mofid, and Imam Hossein hospitals affiliated to Shahid Beheshti University of Medical Sciences within 2015-2016. The data collection tools included demographic information questionnaire and a developed checklist related to VAP prevention. The observations were assessed and documented with two sampling methods, including time and event sampling. The data were analyzed in SPSS software (version 16).Results: According to the results of the current study, the rate of compliance of nursing care with the standards for prevention of VAP in neonates under mechanical ventilation in NICU with developed standards was estimated at 62.81 percent.Conclusion: Authorities should pay more attention to nursing cares especially incompetent cares explained in this study to increase the health of hospitalized neonates, decrease complications, length of stay, and costs. Moreover, future research is needed to investigate the reasons of this incompetency

A comparison of symptom management for children with cancer in Iran and in the selected countries: A comparative study

Aim: The aim of this study is to describe the experiences of other countries regarding the status of pediatric palliative care in the field of symptom management and to compare it with the current status in Iran to achieve an appropriate level of symptom management for children with cancer. Materials and Methods: This is a comparative study. The research population includes the palliative care systems of Jordan, England, Australia, and Canada, which were ultimately compared with Iran's palliative care system. Results: The results showed that in the leading countries in the field of palliative care, such as Australia and Canada, much effort has been made to improve palliative care and to expand its service coverage. In the UK, as a pioneer in the introduction of palliative care, a significant portion of clinical performance, education and research, is dedicated to childhood palliative care. Experts in this field and policymakers are also well aware of this fact. In developing countries, including Jordan, palliative care is considered a nascent specialty, facing many challenges. In Iran, there is still no plan for providing these services coherently even for adults. Conclusion: Children with cancer experience irritating symptoms during their lives and while they are hospitalized. Regarding the fact that symptom management in developed countries is carried out based on specific and documented guidelines, using the experiences of these successful countries and applying them as an operational model can be useful for developing countries such as Iran

The relationship between social support and the quality of working life of neonatal intensive care unit nurses in selected hospitals of Ahwaz University of Medical Sciences-2016

AbstractIntroduction: Social support has a key role in improvement of quality of working lifeof nurses. The present study aimed at measuring the quality of nurse’s working life andperceived social support and examine their relationship in neonatal intensive care unitnurses.Methods: In the present descriptive-correlational study, the statistical populationconsisted of nurses working at neonatal intensive care units of selected hospitalsaffiliated to Ahwaz University of Medical Sciences, selected by census. Overall, 98nurses were selected. Since the number of employed nurses was approximately thesame, all nurses were selected by the census method and based on the inclusioncriteria.Tools used included the "Demographic Questionnaire”, “MultidimensionalScale of Perceived Social Support" and "Quality of Nurses' Work Life". Validity of thequestionnaires was confirmed by 12 experts, and its reliability was confirmed by theCronbach's alpha coefficient. Data were analyzed using the SPSS-20 software.Results: The highest mean value in social support belonged to the "family" dimension(5.19± 1.05) and the lowest to "friends" (4.50± 1.11), and overall mean social supportvalue was 4.78 ± 0.99. The quality of working life had the highest mean value in the"working life" dimension (3.67± 0.72) and the lowest in "personal life" (3.38± 0.89),and overall mean value of quality of working life was 3.57± 0.57 in nurses. The obtainedresults showed a positive correlation between social support and the quality of workinglife in nurses (r=0.25, P=0.02).Conclusions: The obtained results showed a significant and positive relationshipbetween perceived social support and quality of nursing working life. However, therelationship between subscales of these two variables was mildly confirmed. Generally,the present study results are in accordance with the results of previous studies

Barriers to the Implementation of "Newborn Individualized Developmental Care and Assessment Program" from the Perspectives of Nurses and Physicians

Background: "Newborn Individualized Developmental Care and Assessment Program )NIDCAP(" is a caring approach based on individual neonatal behaviors that provides preventive measures for injuries caused by environmental stimuli. The present study aimed to investigate the barriers to the implementation of NIDCAP from the perspectives of nurses and physicians.Methods: This descriptive-comparative included 100 nurses and 21 physicians working in the Neonatal Intensive Care Unit (NICU). They were selected using a complete enumeration sampling method. Data were collected using a researcher-made questionnaire. The validity and reliability of the questionnaire were determined in this study. The data were analyzed in SPSS software (version 25) through descriptive and inferential statistics.Results: According to the nurses' perspective, the most imperative hurdles to the implementation of NIDCAP were environmental-structural, human resources, and communicational barriers. On the other hand, environmental-structural barriers obtained the highest score by the physicians and were placed in the first rank contrary to the management and human resources barriers that were placed in the second rank with equal scores. Furthermore, family-based care and communication were not considered obstacles to the implementation of the NIDCAP.Conclusion: According to the findings of this study, environmental-structural barriers were considered the main hurdles to the implementation of NIDCAP. Therefore, hospital administrators should make efforts to eradicate the existing barriers by making appropriate decisions in order to improve the quality of this method of care