The Experience of Angina Pectoris characteristics and coping with Coronary Heart Disease illustrated by Iranian patients from a gender-related perspective

Coronary Heart Disease (CHD) is a major cause of death for both men and women around the world. Therefore, it is of great importance to identify effective ways and plans to prevent CHD and to ensure patients with Angina Pectoris (AP) seek medical care. A critical issue for developing these plans is to consider the symptom experiences of patients with CHD. Patients with CHD have to live and deal with this life-long disease. Nurses as health-care providers need to be aware of this process for helping patients to cope with the illness and its symptoms. Moreover, gender as a socio-cultural concept might influence how patients experience AP characteristics and cope with CHD. Thus, it needs to be investigated particularly in Iran where there is a lack of information about this issue. This doctoral thesis aims at exploring and describing experiences of AP characteristics and coping with CHD from a gender-related perspective. The doctoral thesis includes four sub-studies. The first two sub-studies regarded instrumentation. The AP characteristics questionnaire, which includes the Modified Rose Questionnaire (MRQ), the Short Form-McGill pain Questionnaire (SF-MPQ) and the accompanying symptom checklist, was utilized. The aims of sub-study I were to describe the process of translating the SF-MPQ, MRQ and accompanying symptom checklist from English to Persian and to evaluate substantial psychometric works (content and construct validity) for the entire instrument and each part of it (SF-MPQ, MRQ and accompanying symptom checklist). The aim of sub-study II was to evaluate internal consistency and test–retest reliability of the Iranian version of the AP characteristics questionnaire. The instrument was translated through a combined approach. Then, one hundred and ten patients with CHD (diagnosis on the basis of angiography) who experienced AP were selected for evaluating the reliability and validity of the instrument. According to the results, the Iranian version of AP characteristics questionnaire was a valid, consistent and reliable tool for evaluating AP in Iranian patients with CHD. The aim of sub-study III was to examine gender differences in the description, intensity and location of AP in patients with CHD to determine gender-specific variations in the characteristics of AP symptoms. In this cross-sectional study, five hundred patients with AP were chosen and filled out the Iranian version of AP characteristics questionnaire. The results indicated that, in comparison with men, women felt a greater intensity of pain, chose more pain descriptors, and were more likely to report pain in the neck and left arm, hand, and scapula. Sub-study IV which was a grounded theory study aimed at exploring and describing the experiences of and coping with CHD and how gender influences on 3 experiences reported by the participants. Twenty four patients were chosen through purposive sampling. The sampling was continued with theoretical sampling. The findings indicated that patients with CHD who experienced AP tried to cope with the illness and its consequences. The findings are presented as the process of “transitioning to normalize life” with the following categories: 1) losing normal life: experiencing emotions and consequences of illness, 2) coming to terms and using coping strategies and 3) recreating normal life. Men and women showed differences in some of the issues such as interpersonal relationships, responding to illness, searching for information and receiving the family support. In conclusion, men and women with CHD experience a variety of symptoms which can be related to various psycho-physiological, clinical, and anatomical factors, anxiety sensitivity, depression and communication abilities. During the coping process, the participants transitioned to living normally again. However, there were gender-related differences in some aspects of coping such as using coping strategies and receiving support. The findings can be useful for considering gender perspectives in health-care services, training health professionals, and also educating society to become aware of gender differences in experiencing AP characteristics and coping with CHD

Challenges of implementing family-based dignity intervention

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Psychometric evaluation of Persian version of Diabetes Acceptance Scale (DAS)

Background: Acceptance of diabetes is a psychological adaptation to the potential limitations of the disease. Poor acceptance of diabetes impairs efective self-management of diabetes, leading to worsening metabolic control. This study aimed at determining the psychometric properties of the Persian version of the Diabetes Acceptance Scale. Methods: This cross-sectional methodological study was performed on diabetic patients in Iran in 2021. The ques tionnaire consisted of two parts: demographic characteristics and Diabetes Acceptance Scale. The questionnaire was translated into Persian through the forward–backward translation method. The face validity and content validity were performed qualitatively and quantitatively. Exploratory (n=200) and confrmatory (n=200) factor analysis were performed to evaluate the validity of the structure. Internal consistency and temporal stability were estimated to determine reliability. Results: Exploratory factor analysis on the polychoric correlation matrix obtained three factors: Rational dealing, Resentment and Avoidance, which explained 68.8% of the total DAS variance. Confrmatory factor analysis showed that the 3-fractor model had a good ft to a second independent data set. Finally, Ordinal Cronbach’s alpha coefcient was 0.96, 0.94 and 0.93, respectively for the Rational dealing, Resentment, and Avoidance factor. Also, using intraclass correlation coefcient, the stability of the instrument was 0.97. Conclusion: Based on the fndings of this study, the Persian version of DAS has sufcient validity and reliability to measure the admission of Iranian diabetic patientsinfo:eu-repo/semantics/publishedVersio

Design and implementation of clinical competency evaluation system for nursing students in medical-surgical wards

Background: In nursing, it is important to ensure the evaluation of students' clinical competency and using a valid and reliable evaluation system is necessary. The aim of this study was to design a clinical competency evaluation system for nursing students in medical-surgical wards and determine its validity and reliability. Methods: This cross-sectional study was conducted on the nursing students who were spending their practicum courses at the medical-surgical wards. First, the educational objectives and applicable evaluation tools were determined. Then, three tools of: Direct Observation of Procedural Skills (DOPS), Mini Clinical Evaluation Exercise (Mini-CEX), and Clinical Work Sampling (CWS) were determined as appropriate tools. Finally, the evaluation system was designed and its validity was confirmed using content validity index (CVI) and content validity ratio (CVR). Reliability of the tools was calculated using Cronbach's alpha coefficient. Results: CWS tool had CVI = 0.91 and CVR = 0.93, DOPS tool had CVI = 0.98 and CVR = 0.94, and Mini-CEX tool had CVI = 0.93 and CVR = 1. These results indicated desirable validity of the designed evaluation system. In addition, all items had appropriate CVR. Reliability was also higher than 0.7. Significant difference was found between the results of students' evaluation using the School's current evaluation method and the designed evaluation system. From the perspective of teachers and students, the designed evaluation system was accepted. Conclusion: The designed evaluation system had high reliability and validity. Its application satisfied the majority of teachers and students. Therefore, it can be used as a useful evaluation system for assessing clinical competencies in medical-surgical wards

The caregiver burden of Alzheimer’s patients: an evolutionary concept analysis

Introduction and purpose: Due to increasedpopulation of the elderly, the risk of developing chronicdiseases including Alzheimer’s in the society increases. Theburden, caused by the elderly care affects various physical,psychological, social, and spiritual dimensions of the caregivers.Although the concept of caregiver burden has beengenerally used in medicine and nursing, it has no clear andspecific definition. This analysis will result in identificationof the characteristics of caregiver burden concept, andits developing conditions and outcomes, which may beeffective in domain of research and practice to reduce thecaregiver burden. The present study aimed to clarify theconcept of caregiver burden among caregivers of patientswith Alzheimer’s disease.Method: In the present study, through Rogers’s evolutionaryconcept analysis method, all papers published from2010 to 2017 were reviewed. The search was limited to paperswith Persian and English full texts. The data, associatedwith the attributes, antecedents, concept consequences,surrogate terms and the data, related to nursing contextand its changes over time, were summarized and coded.Results: Concept analysis showed that the caregiver burdenconcept in patients with Alzheimer’s disease has twomajor attributes in familial (women as the most importantcaregivers, increased economic costs) and personal (shortageof time, increased responsibility, and the workload ofthe caregivers) dimensions.Discussion: The antecedents are also determined in threedimensions of patients’ characteristics (disease symptoms,comorbidity), caregivers’ characteristics (knowledge andawareness, caregivers’ experiences), and support resources(economic, social, and familial resources). Furthermore,the outcomes were specified in four dimensions includingphysical diseases, psychological disorders, impairedsocial function, and development of a sense of pleasureand hope.Conclusion: The caregiver burden concept is multidimensionaland complex and includes a wide range of behaviorsand characteristics. Furthermore, it is dynamic andchanges over time. This analysis, in addition to identificationof the characteristics of caregiver burden concept,will be a starting point for further research and developmentof this concept and nursing knowledge expansio