Compassionate Care Among Iranian Nurses Caring for Candidate Brain Death Organ Donor Patients: A hermeneutic study

Apart of cares provided at the end oflife of patients in intensive care unitsis allocated to the care of brain deathpatients, which is considered under title of one caringunit. Many nurses tend to provide high-quality and compassionatecare. However, studies indicated that almost allpatients do not receive compassionate cares. This researchwas carried out to explain the living experiences of nursesin intensive units providing care for brain death patients.In this hermeneutic phenomenological study, van Manen’smethodology was used. Ten nurses (9 women and 1 man)working in Intensive Care Units were interviewed usingsemi-structured interviews. The data derived from the interviewswas analyzed after recording and transcribing.The main theme of this study, which manifested the importantand innovative aspect of caring the brain deathpatients, was “compassionate care”. It included two subthemesof commitment and devotion with sub subthemesof responsible caring and kindness in caring and sympatheticsupport with sub subthemes of providing emotionalsupport to family and emotional influence.According to the results of this research, it can be concludedthat providing care for brain death patients, whowere candidate for donation, despite imposing psychologicalburden on nurses, has provided a compassionate carefor patient and family. This care is due to commitment,professional responsibility and deep emotional effects inthem. The research results provide the conditions for educationalplanners to train nurses in order to improve theircare provided for the patients and support the nurses

Effects of Continuous Care Model on Depression, Anxiety, and Stress in Iranian Elderly in Shiraz

Background: Psychological disorders such as depression, anxiety, and stress are among the most common health problems in old age. Continuous care and support can be effective and help elderly people to adapt to successive losses, especially if provided within the framework of a model. The present study aimed to determine the effects of the continuous care model (CCM) on depression, anxiety, and stress (DAS) in the Iranian elderly in Shiraz. Methods: The present quasi-experimental study was performed on older adults who attended the Soroush elderly day care center in Shiraz (Iran) from September 2014 to June 2015. A total of 50 eligible elderly participated in the study and were randomly assigned to an intervention group (N=25) and a control group (N=25). The CCM was implemented in the intervention group, whereas the control group received the routine care as offered by the day care center. CCM involves four stages, namely orientation, sensitization, control, and evaluation. The data were collected using the depression, anxiety, stress Scale (DASS-21) questionnaire and a demographic data sheet. The data were analyzed using the SPSS software (version 22.0) with the independent sample t test, paired sample t test, Chi-square test, fisher exact test, multivariate analysis of covariance and the Pearson correlation coefficient. P<0.05 was considered statistically significant. Results: The majority of the participants were women, 44 (88%), with the mean age of 63.4±2.96 years. Following the implementation of the CCM, there was a statistically significant difference in the mean DAS scores between the intervention and control group (P<0.001). Conclusion: The implementation of CCM not only reduced psychological problems (DAS) in the elderly, but also improved and strengthened their psychological condition

Effects of psycho-educational intervention on health-related quality of life (QOL) of patients with chronic liver disease referring to Shiraz University of Medical Sciences

BACKGROUND: Chronic liver diseases (CLDs) are progressive disorder which has a significant impact on the well-being of patients and leads to significant morbidity. CLDs are characterized by disturbances in physical, psychological and social aspects of well-being. It causes significant health-related quality of life (QOL) impairment. Psycho-educational interventions targeting to functional factors could be beneficial for patients with CLDs. METHODS: An interventional study was conducted on 110 patients with CLDs in Shiraz Liver Transplantation Center (SLTC). Subjects with the required CLDs criteria were selected and randomly divided into experimental (55) and control (55) groups. A two part questionnaire with 25 items concerning demographic and general information and 29 items regarding QOL was used. The psycho-educational needs of the experimental group were assessed in a session before the intervention, then the experimental group took part in 3 sessions individually and one session in groups. The questionnaires were filled in again for both groups but the control group did not receive the intervention program. The questionnaires were filled in again for both groups one day and three months after the intervention. RESULTS: Findings revealed no significant differences between the two groups from the view point of demographic characteristics such as marital status, gender, etc... (p > 0.05) and from the point of clinical variables no statistically significant differences were found (p > 0.05). Findings revealed statistically significant differences in all domain of QOL in the experimental group three months after the intervention (p = 0.001), while there was no statistically significant differences in the control group. CONCLUSION: The results of this study revealed that psycho-educational intervention had a significant effect on QOL of patients with CLDs

Mediators of the effect of the psycho-educational intervention on the psychological well-being of caregiving daughters and daughter in-laws of stroke survivors

Background: The objective of this study was to determine whether the randomly assigned intervention is associated with a change in the mediators including threat appraisal, coping behaviors, confidence in knowledge, and preparedness which is in turn accompanied by changes in the caregivers’ psychological well-being. Methods: A total of 96 caregiving daughters and daughter in-laws of stroke survivors participated in the study in which 49 cases were randomly assigned to the intervention and 47 to the control group. Data was collected before, immediately after and 12 weeks following interventions. Results: The results of mixed ANOVA revealed a statistically significant difference in psychological well-being score between intervention and control groups. Our findings from the multiple mediator analyses supported the mediating effect for only two of the five hypothesized mediators. The intervention affected psychological well-being indirectly through changes in threat appraisal and perceived preparedness. Multiple mediator models accounted for 34.3% of the variance in the psychological well-being change. Conclusion: The results of this study show the importance of mediators’ evaluation in interventional studies of stroke survivor caregivers

Development and evaluation of a psycho-educational intervention program to enhance the psychological well-being of daughter and daughter-in-law caregivers of stroke survivors

This study was aimed to develop, implement and evaluate a psycho-educational intervention program to enhance the psychological well-being (PWB) of daughter and daughter-in-law caregivers of severe ischemic stroke survivors after hospital discharge. The study followed an action research approach, which employed a collaborative cycle of reflection, re-planning, and taking action. The study includes four following steps: 1) exploration of caregiver needs and coping behaviors, 2)construction of the program, 3) action taking, and 4) randomized evaluation of the program. The data analysis from focused group and face to face interview revealed seven main categories that provided a perspective on daughters and daughters in-law needs and coping behaviors which includes: information and training, financial support, home health care assistance, self-care support, adjusting with the cultural imperative in providing care for a parent in-law, dissatisfaction with the health care system and needs for teaching problem-oriented coping approaches. There was no obvious theme specific to the type of relationship except cultural imperative in providing care for a parent in-law. In addition, content analysis of focus group interview with a panel of clinical and academic nurses revealed two major themes which include preventing burnout and information and training. Based on caregiver needs and nursing panel suggestion at phase І, literature review, and conceptual framework of the study a hospital-home transition program (HHTP) was established,validated, and modified with daughter and daughter in-law caregivers. After construction of the program, it was implemented to ensure acceptability and feasibility in a small sample of three caregivers. In the action research process, an individualized hospital-home based support program which consisted of seven sessions was implemented and evaluated in a larger sample (n=96) through a randomized sampling design. In the randomized study, the relationship between caregivers and stroke survivor’s demographics with PWB was examined at pre-intervention stage on a total sample of 96 caregivers to identify covariate variables. Only positive religious coping significantly affected caregivers’ psychological well-being. About 7.2% of changes in PWB can be explained by positive religious coping. Therefore, pre-intervention of the positive religious coping was used as the covariate in the next analysis. The results of the Mixed-ANCOVA revealed a statistical significant difference in psychological well-being score between intervention and control groups by time [F (1.45, 135.652) =8.53, p<0.01, η2 =0.084)] that showed the effectiveness of the new program. In addition, multi mediation analyses demonstrated that reductions in threat appraisal and increases in perceived preparedness (accounting for other mediators) mediated the effects of the intervention on psychological well-being. Intervention affected psychological well-being indirectly through changes in threat appraisal (β=0.1008 CIBCA=-0.0516–0.1726) and preparedness (β=0.0939 CIBCA=-0.0103–0.2044). The multiple mediator model accounted for 34.28% of the variance in the PWB change (p <0.001). These findings supported the mediating hypothesis for two of five hypothesized mediators. The results of this study would be a good starting point for focusing on the reasons for the success and or failure of intervention program by testing mediating factors in intervention studies

The effects of empathy skills training on nursing students’ empathy and attitudes toward elderly people

Abstract Background Nursing students’ empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students’ empathy and attitudes toward elderly people. Methods This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan’s Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance. Results The results showed that the empathy skills training program had a significant impact on the students’ mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group’s mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention. Conclusions Empathy skills training improved the nursing students’ empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum

Investigating the status of successful aging based on selection, optimization and compensation model and its relationship with some demographic variables in elderly population of Shiraz, southwest of Iran, 2018

Introduction and Objectives: Increasing growth of the elderly population in many developed countries has drawn attention of researchers to this age group. Thus, one of the goals of community-based health studies has always been maintaining high quality of life at old age and helping the elderly people to have a successful aging, and this will not be possible without a proper understanding of the status of the elderly people in community. The objective of this study was to investigate the status of successful aging based on Selection, Optimization and Compensation Model and its relationship with some demographic variables in the elderly population in Shiraz-Iran. Materials and Methods: In a cross-sectional study, 197 eligible elderly people were selected by multistage cluster sampling from four districts of Shiraz in 2018. To collect the data, the short version (12 items) of the&nbsp;Baltes &amp; Baltes (1999) Selection, Optimization and Compensation Questionnaire (SOC) and Demographic Questionnaire were used. Data were analyzed through SPSS 16 software and Spearman, Mann-Whitney, and Kruskal-Wallis tests. Results: a total of 99 males (55.3%) and 80 females (44.7%) aged 60 to 97 years with a mean age of 72.4 &plusmn; 8.70 years participated in this study. Mean and standard deviation of successful aging score was 6.58 &plusmn; 3.42 [Min = 0 and Max = 12]. Based on the results, gender had no significant correlation with the mean score of successful aging and its dimensions (P value &gt;0.05). Discussion: However, the age variable was inversely correlated with the compensation strategy (P value = 0.048). Level of education showed a direct and significant correlation with the mean scores of all three dimensions of successful aging (selection, optimization and compensation strategies) (P value = 0.0001). Based on the results, there was an inverse and significant correlation between marital status and mean score of optimization and compensation (P value = 0.008). The number of children was also significantly correlated with change-based selection and overall successful aging (P value = 0.007 and P value = 0.043; respectively). Conclusion: Based on the results, the studied elderly people accounted for more than half of the score of successful aging. Successful aging scores were significantly correlated with variables such as age, level of education, marital status, and number of children. Hence, it is recommended to pay more attention to these variables in future research and planning

Challenges of nurses' empowerment in the management of patient aggression: A qualitative study

Background: Patients' aggression in the mental care setting is a global health problem with major psychological, physical, and economic consequences; nurse empowerment to manage this aggressive behavior is an important step in psychiatric nursing. The aim of this study was to explore psychiatric nurses' experiences of the challenges of empowerment in the management of patients' aggression. Materials and Methods: This qualitative study was performed among 20 nurses working in a major referral psychiatric center in Iran during 2014–2016. The purposive sampling method was used for selecting the participants. Data were collected through semi-structured interviews, observations, and filed notes. Inductive content analysis was used for data analysis. Results: Three categories and ten subcategories were identified: inefficient organizational policy (limited human resources, mandatory shifts, shortage of protective equipment, lack of motivational sparks); insufficient job growth (failure to implement training programs, insufficient effort for job competence, lack of clinical guidelines); and deficiencies in the organizational culture (inadequate autonomy and authority, lack of the culture of prevention, culture of fault and blame after an incident). Conclusions: Psychiatric nurses were not satisfied with organizational empowering conditions for the management of patients' aggression and reported low levels of access to learning opportunity, receiving support and essential resources that led to unnecessary use of containment measures. Managers must make every effort to create organizational context that make it possible to empower nurses for optimal practice