Journal of Hayat

Qualitative research and content analysis: A review of Graneheim and Lundman (2004 & 2020)

Fatemeh Bahramnezhad

Content analysis is a systematic and reproducible method through which large quantities of textual words are condensed into smaller, more understandable categories. This is achieved through coding principles. The approach is used objectively and systematically to study and analyze messages, enabling meaningful interpretation through precise measurement of variables. Content analysis is one of the oldest and most reputable methods for examining textual data, initially used in religious studies to understand metaphors and implicit meanings in sacred texts such as the Bible. The method traces its roots to eighteenth-century Scandinavia and, in the twentieth century, developed in the United States as a research technique with both quantitative and qualitative orientations. Qualitative content analysis, through coding, categorizing, and theme extraction, organizes data and provides a coherent, in-depth understanding of the phenomenon (8).
One important and widely used method in qualitative content analysis is the Graneheim and Lundman approach, which is commonly applied in conventional (inductive) studies. This method emphasizes coding, identifying main topics, and extracting fundamental concepts to offer a coherent and reliable framework for analyzing qualitative texts. Two key studies published in 2004 and 2020 by Graneheim and Lundman both presented approaches to qualitative content analysis, but their focus and details differ. Although both studies aim to extract meaning and offer precise interpretation of qualitative data, a precise understanding of their similarities and differences is of high importance for researchers.

The predictive role of spiritual intelligence on attitudes towards death and care for dying patients among intensive care unit nurses

Camellia Torabizadeh

Background & Aim: Nurses’ attitudes towards death affect their caregiving practices. Spiritual intelligence, by promoting a deeper understanding of the meaning of life and death, may improve the nurses’ attitudes towards death. This study aimed to investigate the predictive role of spiritual intelligence on attitudes towards death and care for dying patients among intensive care unit (ICU) nurses.
Methods & Materials: This descriptive-analytical study was conducted in 2023 at Shiraz University of Medical Sciences, involving a sample of 200 ICU nurses. Data were collected using instruments, including demographic questionnaires, the Death Attitude Profile-Revised (DAPR), King’s Spiritual Intelligence Scale, and the End-of-Life Care Assessment Scale (EOLCAS). Data were analyzed using SPSS software version 16.
Results: Correlation analysis showed a statistically significant positive relationship between spiritual intelligence and both caring for dying patients (P<0.01, r=0.265) and attitudes towards death (P<0.001, r=0.360). Among the dimensions of spiritual intelligence, critical existential thinking emerged as a significant predictor of attitudes towards death (P<0.001, β=1.207) and evaluation of dying patient care (P<0.001, β=0.880).
Conclusion: The findings suggest that spiritual intelligence may play a vital role in shaping positive attitudes towards death and improving the quality of care for dying patients. It is recommended that nursing managers incorporate strategies to enhance spirituality in clinical practice to optimize end-of-life care.

The effect of mental imagery on students' anxiety and cognitive impairment: A quasi-experimental study

Mahnaz Ghaljeh

Background & Aim: Cognitive disorders and anxiety are known to adversely affect students' academic progress. Interventions that can be self-administered are particularly advantageous. This study aimed to evaluate the effect of mental imagery on anxiety levels and cognitive impairment among at Zahedan University of Medical Sciences.
Methods & Materials: This quasi-experimental study involved a sample of 100 students selected through convenience sampling and subsequently randomly assigned to either an intervention or control group. Data collection was conducted using personal information forms, the Beck Anxiety Inventory, and the Broadbent Cognitive Dysfunction Questionnaire. The intervention group attended an initial in-person session designed to familiarize participants with the mental imagery technique, followed by eight sessions of imagery training delivered via audio files on WhatsApp. After a two-week interval, both groups completed the anxiety and cognitive dysfunction questionnaires again. No intervention was administered to the control group. Data analysis was performed using descriptive and inferential statistics with SPSS version 21.
Results: The results demonstrated a statistically significant reduction in both anxiety and cognitive impairment within the intervention group (P<0.05). In contrast, the control group showed no significant change (P>0.05). The analysis of covariance, controlling for baseline pre-test scores, revealed that post-intervention mean scores of cognitive impairment and anxiety differed significantly between the two groups (P<0.001).
Conclusion: Mental imagery training appears to effectively reduce anxiety and cognitive impairment among students. Therefore, educational authorities may consider incorporating this intervention to enhance students’ mental well-being and cognitive functioning, thereby potentially improving academic performance.

The impact of an integrated educational program using case study method and the nursing process on clinical decision-making among nursing students in an oncology ward

Akram Ghahramanian

Background & Aim: Current clinical education programs in nursing often demonstrate moderate quality; despite a solid theoretical foundation, students frequently lack essential cognitive skills necessary for effective clinical decision-making. This study aimed to evaluate the impact of an integrated educational program using case study method and the nursing process on the clinical decision-making capabilities of nursing students.
Methods & Materials: This study employed a quantitative, quasi-experimental design with a pretest-posttest approach, conducted in 2019 among final-year undergraduate nursing students at the Faculty of Nursing and Midwifery in Tabriz. A census sampling method was utilized, resulting in a total sample size of 106 students. The intervention group received an integrated educational program incorporating case studies and the nursing process, whereas the control group received conventional training based on a standard logbook. Data collection occurred pre- and post-intervention using the Jenkins Clinical Decision-Making Scale. Data were analyzed using SPSS version 16 through independent t-tests, paired t-tests, and analysis of covariance (ANCOVA).
Results: Paired t-test comparisons within the control group revealed no significant change in overall clinical decision-making scores. Conversely, the intervention group exhibited a statistically significant improvement post-intervention. Between-group analyses indicated that both the total clinical decision-making scores and their four dimensions experienced significant increases after the intervention (P<0.001). ANCOVA, controlling for pretest scores and GPA (Grade Point Average) as covariates, confirmed that the differences in clinical decision-making between the two groups remained statistically significant (P=0.004), with an effect size of 0.08.
Conclusion: The integrated educational method significantly enhances clinical decision-making skills among nursing students. Therefore, nursing educators can enhance students' cognitive skills by using this method in clinical training.

The effect of written emotional disclosure on health behaviors and loneliness among family caregivers of cancer patients

Abbas Shamsalinia

Background & Aim: Emotional disclosure has been associated with improvements in psychological well-being, immune function, and physical health. This study aimed to evaluate the effect of written emotional disclosure on health behaviors and loneliness among family caregivers of cancer patients.
Methods & Materials: This is an experimental study with a pretest–posttest design and a control group. Seventy family caregivers of cancer patients who scored high on the UCLA Loneliness Scale (Version 3) and low on the health behaviors scale for family caregivers of cancer patients were selected by convenience sampling and randomly assigned to Intervention or Control groups. The Intervention group engaged in written emotional disclosure by documenting their deepest and most acute feelings for 15–20 minutes per session, over four consecutive days. The Control group received no intervention. Post-intervention assessments were conducted in both groups. Data were analyzed using SPSS version 26. Comparative analyses included chi-square tests, independent samples t-tests, and paired t-tests.
Results: At baseline, there were no significant differences between groups in health behaviors or their components (P>0.05). Post-intervention, the Intervention group demonstrated significantly higher health behaviors scores and component scores than the Control group (P<0.001). Furthermore, the mean loneliness score in the Intervention group decreased significantly after the intervention (P<0.001).
Conclusion: Written emotional disclosure has a positive and significant effect on loneliness and health behaviors among family caregivers of cancer patients. Given its ease of learning, potential for unsupervised practice, and minimal need for therapist involvement, this method may be a practical adjunct in caregiver support programs.

Comparison of the effect of counseling based on Leventhal's self-regulation model and the BETTER model on sexual function and satisfaction in women with multiple sclerosis: A randomized controlled trial

Nasim Bahrami

Background & Aim: Multiple sclerosis (MS) is a common autoimmune disorder of the central nervous system that can adversely affect patients’ sexual lives. This study aimed to compare the effects of counseling based on Leventhal’s self-regulation model and the BETTER model on sexual function and satisfaction in women with MS.
Methods & Materials: This randomized controlled trial with three parallel groups was conducted from April to September 2024 at the Neurology Clinic of Bu Ali Hospital in Qazvin, Iran. A convenience sample of 100 women with MS were randomly assigned to the study groups using a balanced block randomization method with a block size of six. Participants in the intervention groups received three weekly counseling sessions. The control group received educational materials on sexual health after study completion. Data were collected at baseline, and at one and three months post-intervention using the demographic questionnaire, the Female Sexual Satisfaction Scale, and the short form of the Female Sexual Function Index (FSFI). Data were analyzed with repeated-measures ANOVA using SPSS version 26.
Results: There were no significant differences in demographic or clinical characteristics between the groups at baseline (P>0.05). The analysis showed significant effects of time and group, as well as a significant time-by-group interaction for sexual satisfaction and function (P<0.05). Both the BETTER-model and Leventhal-based interventions produced significant improvements in mean scores on sexual satisfaction and function compared to the control group (P<0.05). However, no statistically significant difference was found between the BETTER and Leventhal interventions in improving sexual satisfaction and function (P>0.05).
Conclusion: Counseling grounded in either the BETTER model or Leventhal’s self-regulation model appears to be effective for enhancing sexual satisfaction and function in women with MS.
Clinical trial registry: IRCT20221120056555N1

The effect of warm foot baths on occupational fatigue and quality of life among nurses working in intensive care units: A randomized controlled trial

Mohammad Aghaali

Background & Aim: Occupational fatigue reduces the quality-of-life of healthcare workers. Warm foot baths have been suggested as a simple, traditional intervention for prevention and management. The present study aimed to investigate the effect of warm foot baths on occupational fatigue and quality of life among intensive care unit (ICU) nurses.
Methods & Materials: A randomized controlled trial was conducted with 50 ICU nurses at Shahid Beheshti Hospital, Qom, in 2023. Participants were recruited by convenience sampling and randomly assigned to an intervention or a control group. The intervention consisted of immersing the legs below the knees in warm water for 15 minutes each night for two weeks. The control group received no intervention. The Swedish Occupational Fatigue Inventory (SOFI) and a quality-of-life questionnaire were completed at baseline and after the intervention. Data were analyzed using chi-square tests and t-tests in SPSS version 22.
Results: The total fatigue score (P=0.014) and the physical discomfort subscale (P=0.012) showed significantly greater reductions in the intervention group compared to the control group. No significant differences were observed in other fatigue subscales. Changes in quality of life and its subscales did not differ significantly between groups.
Conclusion: The findings indicate that warm foot baths effectively reduce occupational fatigue among ICU nurses. Therefore, the use of warm foot baths is recommended as an affordable, easy, and fast-acting solution to alleviate nurses' fatigue.
Clinical trial registry: IRCT20220109053677N1

The effect of a pre-operative education program on ostomy self-efficacy among patients undergoing gastrointestinal ostomy surgery: A randomized clinical trial

Mahnaz Ilkhani

Background & Aim: Gastrointestinal ostomy surgery changes the normal digestive function of patients. Insufficient knowledge and skills regarding ostomy care can lead to physical, psychological, and social complications. The present study aimed to determine the effect of a pre-operative education program on ostomy self-efficacy in patients undergoing ostomy surgery.
Methods & Materials: This randomized clinical trial included patients scheduled for colostomy or ileostomy surgery at hospitals affiliated with Shahid Beheshti University of Medical Sciences during 2022-2023. Participants were randomly assigned to two groups: the intervention group (41 patients) and the control group (44 patients). The control group received only routine education before discharge, while the intervention group participated in the pre-operative education program. The modified ostomy self-efficacy questionnaire was administered to patients before the intervention and one month post-surgery. Data were analyzed using descriptive and inferential statistics in SPSS software version 20.
Results: One month after surgery, the ostomy self-efficacy scores were significantly higher in the intervention group compared to the control group (P<0.001). Furthermore, within the intervention group, the post-intervention ostomy self-efficacy scores were significantly greater than pre-intervention scores (P<0.001). Additionally, the length of hospitalization following surgery was significantly shorter in the intervention group than in the control group (P=0.007).
Conclusion: The results showed that pre-operative education enhances ostomy self-efficacy and reduces the length of hospitalization. Therefore, implementing pre-operative education on ostomy care for patients undergoing ostomy surgery is strongly recommended.
Clinical trial registry: IRCT20220731055588N1