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Background & Aim: The success of the surgical safety checklist in reducing surgical mortality and morbidity largely depends on the degree of compliance with the checklist and correct implementation of its components by the staff. The aim of this review is to determine the challenges of effective implementation of the surgical safety checklist and to provide solutions for its more effective implementation.
Methods & Materials: In the present systematic review, all the relevant qualitative papers published from 2010 to October 2018, were examined. A  literature search was done in databases SID, Iran Medex, Iran doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochran Library with keywords patient safety, surgical procedures, operative, checklist, World Health Organization, implementation science, qualitative research and their equivalent terms in Persian. Inclusion criteria were articles written in English or Persian, qualitative studies and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentations, letters to editor and quantitative studies.
Results: The findings of the review of 14 qualitative studies showed that the most important challenges in effective implementation of the surgical safety checklist were unpredictable priorities, lack of collaboration and coordination of the surgical team members, mismatch between the checklist and hospital setting, lack of patient’s cooperation and lack of a planned approach towards implementing the checklist. The strategies to improve the implementation of the surgical safety checklist included checklist localization, improving the collaboration and coordination of all the team members, training and practicing, patient participation, and active organizational leadership.
Conclusion: The introduction of the surgical safety checklist to the health care setting is a permanent challenge and requires ongoing evaluations and its integration into the workflow in the hospital, active and effective leadership, explanation of why and how to use it by managers and receiving support from the organization. Continuous education, performance evaluation and the participation of all the surgical team members in the implementation of the checklist are key factors for effective implementation of the surgical safety checklist.
 

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Background & Aim: Iranian elderly population is increasing, and a high percentage of this population suffers from diabetes. Considering that the concept of active aging has not been developed in the context of chronic diseases that are common in aging (such as diabetes), the purpose of this study was to analyze the concept of active aging in diabetic elderly patients based on a hybrid model.
Methods & Materials: Three stages of hybrid model (theoretical, field work and final analysis) were used in this study. In the theoretical phase, 35 articles (published in 1990-2016) from scientific databases were analyzed. In the field work phase, 10 participants were interviewed and then a qualitative content analysis was performed. In the final phase, the findings of the two previous stages were merged and analyzed.
Results: The definition of active aging for the diabetic elderly is a comprehensive, dynamic, multidimensional and culturally dependent process that requires a sense of satisfaction, happiness, well-being, security, and physical and mental health, that is achieved through social participation, providence of appropriate health and employment services, awareness of diabetes, and financial, emotional, family, and governmental support that brings subjective and objective benefits to the international, national and individual levels (such as adaptation to illness, a sense of worth and self-esteem). In order to achieve this, paying attention to the whole life span from childhood to old age is needed.
Conclusion: The results of this study suggest that health, security, satisfaction, participation, access to health services, support and knowledge of diabetes play an important role in activating elderly people with diabetes in Iran.
 

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Background & Aim: Self-control is the capacity to organize cognitive and emotional responses in order to provide continuous and adaptive behavior with ideal standards for long-term goals. Due to the high levels of care burden of patients with chronic disease, this study aims to explain the concept of self-control in the family caregivers of patients with chronic disease based on the family-centered empowerment model.
Methods & Materials: Data were collected through in-depth, semi-structured interviews with 26 participants (19 caregivers, four nurses and three patients with chronic disease) from June 2016 to August 2017 in southwestern of Iran. Data were analyzed using the directed content analysis approach. The documents recording, accurate description of details, member checking, peer checking, and maximum variation of participants, were considered for ensuring the trustworthiness of the data.
Results: “Transcendental self-control” of family caregiver was explained by four conceptual categories: “caregiver insight", "value prioritization in care", "acceptance of care responsibilities" and "committed care". By predicting the potential risks of playing the care role and deeply understanding the conditions of care while paying attention to the value prioritization outcome-centered and virtue-based care, the family caregiver accepts the care burden through positive thinking and expediency and modestly offers "committed care" while having competent care experiences.
Conclusion: The explanation of self-control concept based on family-centered empowerment model in the real field creates a clear understanding of this concept and leads to "commitment care" by family caregivers of patients with chronic diseases and in turn provides a basis for reducing workload in the clinical setting.
 

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Background & Aim: Self-care plays an important role in the management of care for patients with chronic renal failure. In order to provide effective education, it is necessary to identify problems, concerns and challenges in this group of patients. The aim of this study was to explore the challenges of self-care in the patients undergoing hemodialysis.
Methods & Materials: This study is part of a research project on adherence to treatment regimen in hemodialysis patients referred to hospitals affiliated to Tehran University of Medical Sciences in 2019. Patients with the highest and lowest mean (SD) scores of self-care were selected by the purposeful sampling method and finally, 22 in-depth semi-structured interviews were performed with 18 interviewees. All data were recorded, transcribed and analyzed using the conventional content analysis approach proposed by Graneheim and Lundman.
Results: Findings from the data analysis included four categories: "the mismatch between the view of patient and the view of nurse", "missing loop training", "culture: a double sword ", and "dual role of religious beliefs".
Conclusion: The results of the present study showed that patients undergoing hemodialysis faced many challenges in self-care. They had difficulty in understanding the meaning of self-care and its implications. There is a need to plan for educating these patients and also changing their religious and cultural beliefs.
 

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Background & Aim: Designing healthcare spaces and physical facilities requires the identification of the patient's family needs, and it is considered an important component of nursing theories. The aim of this study was to explain the needs of family caregivers of patients undergoing gynecological surgery for physical facilities and equipment in hospital.
Methods & Materials: This study is based on the results of the qualitative part of a large hybrid study on the development and implementation of a need-based service delivery program for the caregivers of patients undergoing gynecological surgery in 2017. The selection of participants was purposefully done with maximum variation. The study data were collected using 31 (16 caregivers, 6 nurses, 4 doctors, 3 patients and 2 service workers) in-depth interviews and observations and analyzed by the conventional qualitative content analysis using the Zhang and Wildemuth approach.
Results: Data analysis led to the development of the theme "need for physical facilities", which fell into two categories "need for proper physical structure in the hospital" with the following subcategories: "need for care facilities behind the operating room door", "need to provide welfare facilities in the hospital for caregivers", "need for welfare facilities in the surgical ward", "necessity of allocating rooms to the similar patients", and category "need for appropriate hospital facilities and equipment" with subcategories "caregiver’s need for facilities and amenities", and "caregiver’s need for facilities and amenities for the comfort of the patient".
Conclusion: The results show the importance of having a physical structure tailored to the needs of family caregivers as well as the availability of appropriate facilities and equipment in hospital. One of the limitations of the study was preventing men from visiting patients in the women’s hospital. It is recommended that the needs of male companions and the necessity of their presence according to the cultural context be studied. Also, a new architectural design is suggested to create a suitable therapeutic environment and positive effect on patients’ improvement and increase patient and family satisfaction.
 

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Background & Aim: With the increasing phenomenon of elder abuse in today's societies, understanding the facilitating and inhibiting factors related to abuse seems necessary. The purpose of this study was to explain the facilitators of elder abuse in Iranian society.
Methods & Materials: This is a qualitative study that used a thematic analysis approach to collect and analyze data in order to explain the elderly’s perceptions of the facilitators of abuse. In this study, 20 elderly people in the community were selected by purposeful sampling. The data were collected by in-depth, semi-structured and face-to-face individual interviews. The Braun and Clark’s thematic analysis was used to analyze the data.
Results: The results of data analysis led to the identification of three themes including role modeling, evacuation of failures, and cultural-familial context of the society. The third theme had three sub-themes intergenerational gap, parenting style and society’s indifference.
Conclusion: Abuse is the result of a combination of causes and factors. The elderly’ experiences suggest that abuse goes beyond a personal matter and is rooted in cultural, social, and economic practices. Today, it is not acceptance of each other and disregard for the expectations of the other party that gives rise many contradictions and abuses at the family and community level.

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Background & Aim: Covid-19 is an emerging disease that has become a health crisis in the world and affected various aspects of human’s life. Understanding the experience of patients with this disease is essential for proper and comprehensive care. The aim of this study was to explore the lived experiences of patients recovered from Covid-19.
Methods & Materials: The present study was a qualitative study with an interpretive phenomenological approach that was conducted in 2021. For this purpose, 13 patients recovered from Covid-19 were selected using the purposive sampling method based on the inclusion criteria. In-depth, semi-structured interviews were used to collect the data. The interviews were recorded. Having transcribed the interviews, the transcripts were analyzed by a hermeneutic approach using the Van Manen method.
Results: Data analysis revealed four main themes: "fear of imminent death", "living in a fence", "family worries", and "the limitations suffering".
Conclusion: Patients’ experiences of being infected with Covid-19 showed that the disease affected the physical, psychological, economic, social and family dimensions of individuals. Therefore, understanding the challenges, experiences and concerns of patients about the disease, can help executive decision-makers, healthcare providers and mental health professionals to comprehensively understand the consequences of the disease.
 

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Background & Aim: Accreditation of hospitals plays an important role in promoting the quality, safety and effectiveness of medical services, and increasing the efficiency of hospitals. The effectiveness of the accreditation system depends on the quality of the accreditation standards, the comprehensiveness of the accreditation method, and the quantity and quality of the accreditation appraiser. There is a need for appropriate metrics to review and evaluate the implementation of the charter of patients’ rights in the accreditation of hospitals. The aim of this study was to explain the challenges of patients’ rights in the Iranian hospitals accreditation system.
Methods & Materials: This qualitative study was conducted using a conventional content analysis approach with the participation of 13 key informants. In parallel with the interviews, with the aim of assessing the comprehensiveness, the coverage of the patients’ rights components was assessed by accreditation metrics in four sessions. Data analysis was conducted using the Graneheim and Lundman method.
Results: The challenges of the accreditation system were explained by two categories "Content deficiencies of hospitals accreditation standards", "Managerial challenges of accreditation system".
Conclusion: Accreditation has an effective and serious role in the improvement of hospital services and can be a good monitor for observing the rights of service recipients and the charter of patients’ rights. This study provides useful information on the content deficiencies of the country's accreditation standards in terms of service recipients’ rights and its implementation challenges that can be used by policy makers.

 

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Background & Aim: Various factors play a significant role in shaping the professional identity of nursing students, and among these factors, the impact of the hidden curriculum holds utmost importance. However, this process remains still unknown.  The aim of the study is to explore the role of hidden curriculum in the formation of professional identity among undergraduate nursing students.
Methods & Materials: This is a qualitative research using the grounded theory approach. The participants in this study included 35 undergraduate nursing students from Tehran University of Medical Sciences during the 2020-2021 academic year who participated in semi-structured interviews. The interviews lasting between 30 and 60 minutes were conducted with each participant. Subsequently, the interviews were transcribed and analyzed following the framework proposed by Strauss and Corbin in 2008.
Results: After analyzing the data, three main categories and 12 subcategories have emerged. The theory developed in this research was formed through the core category of “identity instability within the nursing profession”. The main categories that emerged were “ambiguity and lack of motivation in professionalization”. The study identified "the governance of a discriminatory culture" as the underlying process, while “the promotion of demotivation resulting from inefficient patterns” served as the basis of this study.
Conclusion: Based on the study's findings, the process of developing a professional identity can be metaphorically likened to a river. In this analogy, discrimination serves as the clouds hovering over this river, casting a shadow on the identity development process. While inefficient patterns can be likened to lightning bolts that further complicate the process. Furthermore, the rocky bed of the river, symbolizing the lack of motivation among learners towards professionalism, makes it even more challenging to build a strong professional identity.
 

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Background & Aim: In recent years, significant changes have occurred in the dynamics of childbearing within familial context. Notably, Iranian families have witnessed a noticeable decline in the desire for childbearing and having additional children. The aim of this study was to explore the determinants of childbearing decision-making among women and men of reproductive age.
Methods & Materials: This study adopts a qualitative research design using the conventional content analysis approach in 2023. The participants comprised 19 married women and men of reproductive age living in Zanjan, who were purposively selected to ensure maximum variation. After obtaining informed consent, the participants were invited to participate in individual, semi-structured interviews. Data collection continued until data saturation was reached, with concurrent analysis conducted throughout the process. The textual data were managed using MAXQDA software, version 2020.
Results: Throughout the inductive data analysis process, seven main categories emerged as determinants of decision-making about childbearing. These categories included social role modeling, reflection within family structure, social and economic requirements, contemporary concerns in parenting, avoidance of responsibility and comfort-seeking, unpleasant past experiences and age-related challenges. Among these categories, social and economic requirements emerged as the most prevalent concept across all interviews, with a total of 505 open codes associated with this category.
Conclusion: The normalization of reduced childbearing rates within the society, accompanied by shifting values and attitudes towards the significance of children, as well as economic and social problems have contributed to an increasing preference for smaller families. Furthermore, the desire for fewer children can be viewed as a response to the individualistic tendencies of women and men, as well as a means of avoiding parenting concerns.

 

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Background & Aim: Infectious diseases represent a significant health concern within human communities. Considering the importance of pregnancy, the present study was conducted with the aim of exploring the health behaviors exhibited by pregnant women during the COVID-19 pandemic.
Methods & Materials: This qualitative study employed the conventional content analysis approach to examine a cohort of 16 pregnant women in 2021. The research was conducted within the health centers of Ilam, employing the purposeful sampling technique and unstructured interviews to collect the data. Simultaneous to the data collection, conventional content analysis was employed to analyze the data. MAXQDA version 10 software was utilized for data management purposes.
Results: The participants had a mean age of 30 years, while the average gestational age was 30.38 weeks. Through analysis, three main themes and eight categories were derived from the collected data. The main themes identified were as follows: 1- self-care practices for disease prevention, 2-  the adverse effects of the pandemic on pregnancy, and 3- changes in the healthcare system.
Conclusion: The results of the present study highlight the emergence of a novel form of self-care among pregnant women as a consequence of the COVID-19 pandemic. The adverse effects of the pandemic, such as quarantine measures, were associated with the development of negative ruminations within pregnant women. Following the quarantine restrictions, significant modifications were observed in the ways through which women sought health-related information and engaged in daily activities. Moreover, alterations were made to care policies. Paying attention to the comprehensive health needs of pregnant women, including both physical and mental health, is imperative within the context of pandemic-related health services.