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Nurses play various roles and have various responsibilities in helping patients or other members of the society for example in training, providing support, caring, and in coordinating. The proper performance of these services is dependent on their undertaking of these various responsibilities. Nurses with increased knowledge as to their responsibilities and the proper fulfilling of these in the various fields can be influential in the success of treatment measures. This research is a descriptive study to assess the nursing staff’s perception of their roles and activities at hospitals affiliated to the Tehran University of Medical Sciences, conducted on a random sampling in the years of 2001 -2002. Some 104 male and female members of the nursing staff, randomly chosen, participated in this research. The data was collected by means of some questionnaires of 3 parts containing 8 questions related to demographic characteristics, 41 questions related to the quadric roles namely, teaching, supporting, protecting, coordinating, and 2 open questions regarding obstacles and their suggestions in preventing these obstacles. Analysis of data has been done by using SPSS descriptive and inferential statistics. The results with respect to the roles of nurses in different fields show that most of their roles were in teaching activities in relation to patients, in support relating to stressful and upset patients, in the field of protection during catheterizing and dressing and coordinating daily visits. Results relating to the level of performance of these responsibilities are as follows 31.7% in training activities, 35.6% supporting activities, 38.45% protection and 54.8% coordinating activities, respectively, stood at a favorable level. The greatest percentage of unfavorable performance was noted in the supporting role of the nurses. The results also showed that the level of readiness of the nurses to perform the above mentioned four roles was registered as average to good. In addition some factors such as frustration, lack of on the job training, insufficient number of personnel, lack of proper facilities, and insufficient income…, have a great impact on nurses and the removal of obstacles in the performance of their duties.

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Statistics show that brain death constitutes 1-4% of hospital deaths and 10% of the deaths occurred at the intensive care units (1). In the United States, brain death accounts for less than 1% of all deaths (about 15000 to 20000) (2). According to Iranian statistics, more than 15000 brain deaths occur every year in Iran, and driving accidents are one of its main causes (3-6). Then, these patients are taken to the ICUs to be cared for by nurses (7).

Considering the great number of brain deaths in Iran, and also the great number of patients needing transplant who die due to lack of obtaining an appropriate transplant organ, the Ministry of Health has notified to the universities of medical sciences the regulation number 54/100 dated 23.01.1394. In the 4^th clause of this regulation, accurate and specialized medical care in accordance with the instructions, preserving the vital organs of brain death patient (maintaining electrolytes, kidneys, liver, heart, lungs, and stabilizing vital signs) are emphasized which shows the necessity and importance of accurate training for all staffs specially nurses involved in caring for the brain death patients.

Given the high rate of brain death, most patients that ICU nurses face are the brain death patients (8). The caring process of brain death patients has different challenging and undiscovered dimensions due to its difficult and complicated nature which has attracted attention of researchers from all over the world to study its different dimensions. Some of the most important challenges which ICU nurses referred to in the caring process of brain death patients in studies are as follows: understanding the concept of brain death by the ICU nurses is one of the most challenging dimensions of this process (9). Although the meaning of brain death and caring for these patients is one of the vital components of nursing practice at the ICUs (10), understanding the concept of brain death is very difficult for most nurses and challenges all their previous beliefs about death and dying (11) because the concepts and implications for understanding brain death are beyond the understanding of the normal death of a person. This phrase is translated as actual death which means there is no hope for improvement, while the physical appearance of brain death patients, the presence of family members and nurses’ caring activities at the bedside of patients give the impression that they are alive, and all of these contribute to this ambiguity. But this conflict is naturally emotional and experimental for nurses (12). Ronayne in their study found that despite the knowledge about the physiology of brain death, its experience is stressful for nurses even long after facing these patients (8).

One of the other challenges is the announcement of brain death to the patient’s family. Although this is one of the physician’s responsibilities, nurses are also involved in because of their constant presence at the hospital and easy access of patients’ family members to them. This announcement is very stressful and challenging for nurses and is one of the most important parts of caring process (13) because nursing care is not only limited to the patient but also includes facing the specific needs of patient’s family members who are in crisis and experiencing an acute, complex and stressful clinical situation (14). Other nurses’ challenges in the caring process of brain death patients are ethical and legal aspects especially in the field of brain death and organ donation (4). Studies in Iran show that only half of physicians and medical staffs have sufficient awareness about organ donation and its laws, but they do not attempt to encourage organ donation for the fear of increasing mental pressure on patient’s family members (4). However, training is considered an effective factor in facilitating organ donation process (15).

Caring for a brain death patient and possible potential members to donate is another nurses’ challenge in caring process. Caring for a brain dead patient has been always a big challenge for the ICU nurses (14). According to different studies, most nurses believe that they are not ready enough to care for a patient who is a candidate for organ donation (16). So, one of the most difficult responsibilities of ICU nurses is caring for a brain dead patient who is a candidate for organ donation after her/his family’s consent (12). Studies showed that nurses feel hopelessness, inadequacy and depression after caring for a brain dead patient. These feelings may interfere in the quality of patient care and lead the nurse to be burnout (17). Ronayne found that because of the stress of caring for the brain dead patients, some nurses experience cognitive dissonance (8). One of the most important and controversial aspects of caring process is to give the request form of organ donation to the patient’s family. Given that caring process at the ICU involves both the patient and her/his whole family (18), the attitude of staffs especially nurses towards organ donation is very important since their positive attitude leads them to try more to prepare families for organ donation consent (13).

Some research has shown that providing opportunities for training nurses in this area, promotes organ donation and transplant rates since potential donors are timely identified and introduced to the organ bank (19). Nurses found that they need training and support on all aspects of caring for a brain death patient, organ donation and supporting her/his family (15). So, accurate and comprehensive understanding of the caring process of brain death patients especially from the nurses’ perspectives is very important for high quality and comprehensive caring. Due to the shortage of organ donation and the importance of organ health for transplantation, accurate and high quality caring for patient is necessary to make sure that organs remain healthy. Therefore, it is necessary to consider the caring process of the brain dead patient in order to develop an appropriate caring program for these patients.

Thus, considering that nurses are responsible for one of the most stressful caring processes including both caring for a brain dead patient and facing her/his family members (who may not be able to accept their patient’s brain death), and given the necessity of increasing the organ donation rate, and as well as the lack of targeted education on caring for the brain dead patients and insufficient nurses’ knowledge in this area, there is a need for accurate training on this caring process more than before.

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Background & Aim: The availability of information regarding people's experiences of returning to work after heart surgery, taking into account the socio-cultural context of Iranian society, is limited. The aim of this study is to discover the process of returning to work after heart surgery.
Methods & Materials: A qualitative study using the grounded theory approach was conducted between 2021 and 2022. Through purposive and theoretical sampling, 21 participants who had undergone heart surgery and were in the process of returning to work were selected. They were chosen from the cardiac surgery ward of Amiralmomenin Hospital in Kordkuy, as well as among patients seeking treatment from cardiac surgeons in Golestan province. Data were collected through conducting semi-structured interviews and taking field notes. Data analysis was conducted using the method proposed by Corbin and Strauss in 2015.
Results: "Feeling of doubt about return-to-work", "perceived psycho-social support", "personal and occupational factors", "unfavorable consequences of heart surgery" and "limited support from governmental/non-governmental institutions" were determined as contextual factors influencing the process of return-to-work. Moreover, "effort to adjust the job", "situation evaluation" and "self-management" were introduced as strategies, while "adaptability to the job" were identified as the consequence of returning to work. Finally, the core variable of the study was determined to be "the thoughtful effort to match the job".
Conclusion: Based on the results, it was determined that several individual and environmental factors influence the process of return-to-work for people who have undergone heart surgery. To facilitate a successful return to work, it is crucial to provide psycho-social support from both the family and work environment. It is recommended that policy makers in the health and social affairs sectors take active steps to empower people during the post-recovery period. Additionally, fostering collaboration between the Ministries of Labor and Health, as well as insurance organizations, can greatly facilitate the return to work of individuals after heart surgery.