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Introduction: Phenomenological investigation of nursing profession and nurses&apos perspectives in Iran in comparison to a caring-oriented nursing system (Sweden) is the main purpose of this study.

Materials and Methods: Interpretive phenomenology was used to conduct this study. Data gathering methods included observation and semi-structured interviews with 1) Iranian nurses, 2) Swedish nurses, 3) Iranian nurses who graduated from nursing in Iran but work as nurse in Sweden and 4) Iranian nurses who work as nurse in Sweden and studied nursing there. Content Analysis was used for data analysis.

Results: Except humanitarian approach to nursing in a small group of Iranian nurses, the difficulties experienced due to work conditions and environmental factors have lead them to a state of burnout. Although caring is a primacy in nursing, enough attention is not being paid to it in nursing education programs.

Conclusion: Burnout as a main theme which emerged in this study affects all aspects of nursing profession in Iran. The nature of nursing profession, its routine tasks and poor public image as well as sociocultural factors have influenced nursing negatively.

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Introduction: Pain is a phenomenon with both personal and cultural meanings. As cultural diversity increases around the world, caregivers are more and more likely to care for clients from backgrounds different from their own. Culture affects the assessment and management of pain. The aim of this study was to explore the meaning of pain experiences in 3 subcultures in Iran.

Materials and Methods: A phenomenological approach was used in order to explore the meanings of post operative pain experiences in participants. Data were gathered through series of semi structured interviews as well as goal-oriented observation and collected written narratives. Benner's interpretive method was used for data analysis.

Results: From analysis of viewpoints of 15 patients from Khorram-Abad, 13 patients from Tehran and 8 patients from Gorgan, 4 themes emerged. Considering postoperative pain insignificant compared to primary pain, need for protection, increase in spirituality and insensitivity of healthcare providers were the emerged themes.

Conclusion: While pain is a subjective and personal phenomenon and reaction to pain is influenced by cultural and personal values, in this study no difference was found in the pain experiences in 3 under-study subcultures. It seems that Iranian-Islamic culture acts as a conceptual umbrella to encompass the whole experiences and influences all subcultures.

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Background & Aim: Parents participation in management of diabetes has been recognized to be beneficent. Recognizing parents&apos worries should be addressed to plan effective health promoting programs. This study aimed to explore parents&apos worries about life problems of adolescent girls with diabetes.

Methods & Materials: In this qualitative study, 26 parents (16 mothers and 10 fathers) of adolescent girls with type 1 diabetes were recruited using purposive sampling from the Diabetes Society in west Azerbaijan. Data were collected using in-depth and semi-structured interviews. Analysis of the transcripts was guided by qualitative content analysis.

Results: Qualitative content analysis demonstrated three original categories from parents&apos worries: 1) worries about the future 2) worries about the treatments and 3) worries about the society.

Conclusion: Better perception of parents&apos concerns may promote effective communication between health professionals and parents. Modification of parents&apos personal control and perceived threat through appropriate educational programs that acknowledge and address their concerns may be a means of empowering parents.

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Background & Aim: Motivated faculty promotes nursing students&apos educational level which leads to community health promotion. Attempts should be made to recognize and analyze motivating factors including expectations. This qualitative study attempted to clarify expectations of faculty of Tehran nursing schools on management system.

Methods & Materials: This was a qualitative study. The participants were 14 nursing faculty members of Tehran, Shahid Beheshti, Artesh, Shahed, and Baghiatallah Universities located in Tehran. Purposive sampling was used to recruit the participants. Data were collected using semi-structured interviews with the participants. Qualitative content analysis was used to analyze the data.

Results: Expectations of nursing faculty were explained in eight categories: empowerment of the faculty, organizational support, fairness, appropriate performance evaluation, providing appropriate working conditions, applying appropriate management strategies, attention to welfare and financial problems and promoting quality of education and research.

Conclusion: Understanding the expectations of the nursing faculty and trying to meet them can improve performance of the faculty. Meeting these expectations can enhance motivation and job satisfaction among the faculty.

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Background & Objective: Parental participation in pediatric nursing is not ideally done due to several barriers. This qualitative study aimed to explore the barriers of parental participation in pediatric care during 2011-2012.

Methods & Materials: This qualitative study was carried out using content analysis approach. Data were gathered through face to face semi-structured interviews with a sample of pediatric nurses (n=11) who were recruited through purposeful sampling from a pediatric hospital in Tehran. After gaining data saturation, data were analyzed using content analysis method.

Results: Four main themes were emerged as barriers of parental participation in pediatric care including mutual motivation and interest in both parties (motivation and attitudes of nurses and interest in parents), management (lack of support for nurses, nursing shortage, nurses&apos workload, and poor teamwork between nurses and physicians), confidence in the nursing profession, and finally undefined role for mothers.

Conclusion: Findings revealed the barriers of parental participation in caring for their hospitalized children. Managers and nurses can take advantages of these findings to improve and strengthen parental participation in pediatric care units during hospitalization.

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Background & Aim: Nurses are informed from patients needs using effective mutual communications. This study aimed to explore the communication strategies between nurses and patient.

Methods & Materials: This study had a qualitative approach with the content analysis method. Participants included 23 nurses, patients and their families in medical and surgical wards of Imam Khomeini hospital of Tehran University of Medical Sciences. Data were collected using interviews and observations. The first and second interviews were conducted unstructured. The semi-structured interviews were then conducted according to the derived concepts from the first and second interviews. We used observation in order to gain a deeper understanding and verifying data from interviews. The observations focused on the interactions between nurses and patients during mutual communications.

Results: A final theme was emerged through the data analysis: adaptation of nurses&apos attitudes and performances. This theme derived from three main categories: caring according to acute needs of patients, creating a professional realm, and participation. The caring according to acute needs of patients included subcategories such as identifying patients&apos acute needs and nurses&apos communication behavior. Creating the professional realm implicated on the clarifying roles and maintaining of privacy communication. Participation was defined as the audience and content.

Conclusion: The findings showed that nurses, in response to the underlying conditions of nursing care, assimilate their attitudes and performances to be able to meet their professional needs and their patients&apos needs. In fact, the main character of nurse-patient communication is nurses&apos active role and patients&apos passive role.

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Background & Aim: Increase in cancer prevalence results in feeling fear of being diagnosed with cancer among individuals. Understanding concerns of patients diagnosed with cancer helps health care professionals to provide appropriate caring plans. This study aimed to understand main concerns of patients who confront cancer diagnosis.

Methods & Materials: This was a qualitative study with content analysis approach. Fifteen patients with cancer were selected from a specialized hospital, an oncology clinic, and Emdad Center of Cancer patients in Sari using a purposeful sampling method during May 2011 to June 2012. The sample size was completed regarding data saturation. Data were collected using interviews, observations and recording field notes. All interviews were tape-recorded and transcribed verbatim. Data were analyzed using descriptive content analysis and the Granhim and Landmann method.

Results: Three categories including 485 primary codes were emerged. The derived codes were as follows: 1) sever personal and family disturbance 2) imagination of despair and 3) unclear imagination of future. The main code included in all derived codes was life threatening nature of cancer.

Conclusion: The findings showed that life threatening nature of cancer is a source of fear that makes the disease frightening. Clinical staff and nurses should pay more attention to concerns of patients with cancer and design their care plan accordingly.

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  Background & Aim: Breast cancer is the most common cancer diagnosed in women in both developed and developing countries. Long-term prognosis of breast cancer strongly depends on the stage of disease at diagnosis. More than three months after detecting breast symptoms by Iranian women, they go to visit a doctor. The understanding of life-threatening symptoms and the subsequent responses are differently affected by social interaction networks as well as cultural and social contexts. This study aimed to explore the role of social interactions on health-seeking behaviors among Iranian women with breast cancer symptoms .

  Methods & Materials: A qualitative study was conducted using purposive sampling method. Twenty Iranian w omen who attended the Cancer Institute in Imam Khomeini hospital at Tehran University of Medical Sciences and complained of symptoms of breast cancer were recruited to the study du ring 2012-2013. Data were collected through semi-structured and in-depth interviews. Interviews were transcribed and analyzed using conventional content analysis in the MAXqda . 

  Results: The results revealed three themes including: 1) effectiveness of social learning 2) seeking social support and 3) feedback with a supportive approach which included seven categories of informative social learning, reliable social learning, selective disclosure, seeking information, seeking emotional support , giving reassurance and social support for decision making .

  Conclusion: E ffective social learning and supportive interactions have influential role on health seeking behavior. Thus it is necessary to improve public awareness and correct clients' social beliefs about breast cancer to shorten the patients' delay .

  

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  Background & Aim: With regard to the i ncreasing trends of information and complexities of health organizations , using of a dvanced tools and computers is necessary . Hospital staff is key members to develop health information systems, because they play not only a major role in the management of system, but also in the development, implementation and evaluation of the system. Since the evaluation of information systems is not possible without analyzing of the experiences and users ' views, thus the aim of this study was to explore nurses' experiences of the hospital information systems .

  Methods & Materials: In this qualitative study, we investigated the nurses' experiences of the application of hospital information systems for the rich and deep understanding of the phenomenon . The c onventional content analysis was used to collect and analyze the data . Face- to-face and semi- structured interviews were conducted with participants to achieve full saturated information. Saturation was achieved with 18 interviews . 

  Results: The emerging themes were gradual system evolution, , audit and responsibility, security, effectiveness and accessibility .

  Conclusion: Nurses' experiences were positive with the applying of the Health Information Systems. The negative experiences of the nurses were related with the application of the system and redundant work, not the system itself. Regarding to participants need, it is recommended that the system should be extended to other duties such as reporting so that more effective use of the system in order to improve the quality.

  

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  Background & Aim: Medication errors are known as the most common preventable and life threatening medical errors. This study aimed to explore perceptions of nurses on medication errors .

  Methods & Materials: This was a qualitative study with content analysis approach. Seventeen nurses were selected purposefully from the intensive care units of Shohada hospital in khoramabad in 2012. Data were gathered using semi structural interviews with the nurses. Data were analyzed using the Lundman and Graneheim method. We used the Linclon and Gouba method to ensure a ccuracy and trustworthiness of the data . 

  Results: Four main categories and six subcategories were recognized including: 1) Management factors (inefficiency in recruitment of human power, poor physical condition and workload) 2) Inefficiency in professionalism (lack of commitment among nurses, insufficient knowledge and inefficiency in the inter professional relationship) 3) Failure in the process of drug prescription by physicians and 4) Failure in production and packaging drugs by drug companies .

  Conclusion: Training and recruiting professional and committed nurses, using electronic medical files, supervision on pharmacy companies to produce and package proper medication can reduce medication errors .

  

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  Background & Aim: H ospital emergency departments in Iran are prone to crisis for different reasons. Understanding nurses’ perspectives about these crises help in crisis management. The purpose of this study was to explain the nature, causes and consequences of crisis in emergency departments from nurses’ points of views .

  Methods & Materials: This was a qualitative study with content analysis approach. Data were collected using semi-structured interviews with 12 nurses working in emergency departments of general and trauma hospital. Participants were selected through purposive sampling method. Interviews lasted between 45 minutes to an hour. The data were recorded and transcribed. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed using qualitative content analysis with conventional approach . 

  Results: Five themes were emerged through data analysis including: 1) unexpected imbalance 2) events 3) defect in service provider factors 4) positive consequences and 5) negative consequences .

  Conclusion: The results of this study revealed that every factor that can affect balance and daily tasks can make a crisis in emergency departments. Causes of the crisis can be divided into internal or external factors. Several measures should be planned to decrease the crisis in emergency departments from high rank decision making in the ministry of health and medical education to planning appropriate programs in hospitals .

  

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  Background & Aim: The ultimate goal of self-care behavior is patients' empowerment. There are limited studies on perspectives of patients with Parkinson's disease on self-care. This study aimed to explore for the process of self-care in patients with Parkinson’s disease during 2011 to 2013 .

  Methods & Materials: This exploratory qualitative study was carried out using grounded theory method. Data were collected via semi-structured in-depth interviews and field notes. We interviewed with 12 patients with Parkinson 's disease and four family caregivers . Participants were selected from two neurology clinics. Interviews were conducted at participants' homes or nursing homes. Data were analyzed using the Corbin and Strauss (2008) approach . 

  Results: Concepts of study were identified using a micro and general analysis. The 'fear of becoming crippled' was identified as a main concern. Strategies used in response to context included 'independency', 'spiritual care', 'informed self-care' and ‘seeking treatment’. 'Striving for taking independent self-care' was the most important process. Demographic, familial and social factors had important roles in self-care processes of patients with Parkinson's disease .

  Conclusion: The process of self-care in patients with Parkinson’s disease depends on the context and severity of the signs and symptoms. Health care providers especially nurses can support patients with Parkinson's disease in achieving maintain independence in self-care. In addition, attention to self-care behaviors with focus on person as self-care agent can considerably increase control and management of life .

  

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Background & Aim: Teamwork (between obstetricians and midwives) is one of the main pillars of success in the provision of appropriate services in the maternity wards. Therefore, this study aimed to identify the factors influencing teamwork in a maternity ward in a public hospital in Tehran, Iran.

Methods & Materials: In this qualitative study, nine midwives and four obstetricians were selected through purposive sampling. Data were collected through semi-structured interviews from an affiliated hospital of Tehran University of Medical Sciences in 2013-2014. Data were analyzed using conventional content analysis.

Results: Two themes including the teamwork barriers (four categories) and facilitators (three categories) were extracted from the data analysis. The main categories of teamwork barriers were the underlying issues (inter-professional conflicts, legal issues, and salary and financial issues), individual problems (physical problems, negative personality characteristics and domestic problems), lack of skills (lack of abilities and motivation, educational weakness and lack of experience) and the external management system (inappropriate policy making and planning, hierarchical structure, lack of team evaluation and lack of justice). The main categories of teamwork facilitators were the internal management of team (good leader or manager, appropriate workplace climate, values clarification of the team members’ practices, and proper implementation of regulations), cooperation, collaboration and empathy (help and cooperation and empathy and support), and essential personal qualities for teamwork (good communication and good personality characteristics).

Conclusion: In this study, the teamwork barriers and facilitators in the maternity wards were comprehensively identified at different levels. According to the results, interventions can be designed and implemented to enhance teamwork.

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Background & Aim: Females’ quality of sexual life is one of the key issues of sexual and reproductive health. This is a subjective concept and defined as individual’s perception of sexual aspect of life. The aim of this study was to explore the factors affecting Iranian women’s quality of sexual life.

Methods & Materials: This qualitative study was conducted by conventional content analysis. Data were collected by 17 in-depth, unstructured interviews and 14 sexual life narratives through purposeful sampling among married and reproductive aged women from five university-affiliated health centers in Tehran and Shiraz. Constant comparative method was used to analyze data.

Results: According to the participants’ experiences, 3 themes emerged as direct factors affecting the quality of sexual life including ‘preparation before sexual relationship’, ‘couple’s interaction and harmony in sexual relationship’ and ‘previous sexual relationship outcomes’. ‘Marital life status’ and ‘passive sexual socialization’ were explored as the factors which can conceptualize the context of females’ quality of sexual life.

Conclusion: In this study, factors affecting females’ quality of sexual life were identified. Attention to these factors is suggested to design appropriate interventions by health care system in Iran.

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Background & Aim: Error always occurs in the health system and it can lead to irreparable consequences. Therefore, error prevention must be taken into account by the health systems. Detection of factors contributing to error is a key factor for the prevention of error. Hence, the aim of this study was to explore factors contributing to nursing error in emergency department.

Methods & Materials: This study was conducted using a qualitative approach. 17 emergency nurses participated in this study. Semi-structured interview was used to collect the data. Sampling was started as the purposive sampling and continued until the saturation of data was reached. Data were analyzed using the Elo & Kyngas (2008) qualitative content analysis approach. To achieve trustworthiness, participants were selected with maximum variation in terms of age, gender, work experience, and educational background.

Results: The analysis of data led to the emergence of 500 open codes and four categories including the predisposing factors of nurse-related error, predisposing factors of organization-related error, predisposing factors of error related to the culture of emergency department and predisposing factors of patient-related error.

Conclusion: Factors contributing to nursing errors in emergency department were very wide and multifactorial. Identifying the factors contributing to error is a first step to prevent errors. For reducing nursing error, nursing managers should pay special attention to the contributing factors of error identified by this study and implement interventions to reduce and mitigate these factors.

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Background & Aim: Culturally sensitive care is an essential component of professional development process and one of the predictive factors of nurses’ cultural competency. This care is the most important approach to improve the quality of nursing care in culturally diverse groups. The current study aimed to explore the consequences of culturally sensitive care in pediatric nursing.

Methods & Materials: This study is a qualitative study using conventional content analysis. 25 nurses and 9 parents were purposefully selected with maximum variation sampling from the pediatric wards of three referral teaching hospitals in Tabriz and Tehran in 2015-2016. Data were collected through in-depth interviews and field notes and simultaneously analyzed using MAXQDA software version 10.

Results: The consequences of culturally sensitive care in pediatric nursing emerged in two categories: justice-based care (with three subcategories: the lack of cultural bias, culture-based communication and effective participation) and cultural satisfaction (with two subcategories: reduced cultural stress and safe care). Culturally sensitive care prevents misunderstandings and improves nurse-child/parents communication and leads to parents’ honesty to share information and express cultural needs. The expression of cultural needs decreases stress levels in parents and children and results in safe care by reducing intractable traditional treatment.

Conclusion: According to the findings of this study, it is suggested that effective culturally sensitive interventions in pediatric wards should be included in in-service courses and nursing curriculum.

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Background & Aim: Pedestrians are the most vulnerable road users. In many cases, pedestrian-vehicle crashes are often the result of their risky road crossing behaviors. So, this qualitative study aimed to explore the reasons for risky road crossing behaviors among young people.

Methods & Materials: The current study was designed as a qualitative content analysis. Twelve males and females who had a car-accident were purposefully selected with maximum variation sampling. Data were collected and analyzed by semi-structured individual interviews.

Results: Conformity with the masses including “conformity with peers and conformity with the public space of society”, and anomie emerged as the most important social reasons for young pedestrian’s risky road crossing behaviors.

Conclusion: According to the results of this study, young pedestrian’s risky road crossing behaviors are affected by conformity with the masses and peers and as well as anomie so that risky behaviors have been commonplace and inevitable and a part of their lifestyle.

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Background & Aim: The physiologic childbirth program in Iran is an emerging program that needs to be evaluated like any other program to improve its quality and process. Evidence suggests that the implementation of the physiologic childbirth program faces some challenges. The present research aimed to explore the challenges of the physiologic childbirth program from the perspective of service providers.
Methods & Materials: This qualitative research was carried out through a content analysis method in two mother-friendly hospitals of Ahwaz and Mashhad in 2016-2017. Data were collected through semi-structured interviews with 17 physiologic childbirth service providers. The content analysis method of Elo and Kyngas was used for qualitative data analysis.
Results: Data analysis led to five main categories: low motivation of midwives in performing physiologic childbirth; barriers related to manpower; medical interventions in physiologic childbirth; challenges from the environment and facilities; and educational barriers.
Conclusion: Different challenges in interaction with each other create a complex environment in which the implementation of physiologic childbirth program becomes more difficult. Therefore, policymakers, authorities, doctors, midwives and mothers need to work in a coordinated way to resolve the mentioned challenge.
 

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Background & Aim: Concerns over limited equipment and resources particularly in the intensive care units have raised the issues of medical futility, futile treatment, and futile care. Considering that there is no consensus in the definition of the concept of futile care, this study aimed to explore the concept of futile care, especially in terms of clarifying it with the concept of futile treatment.
Methods & Materials: This is a qualitative study conducted using the conventional content analysis approach. In this study, 22 nurses, eight medical specialists, four medical ethics specialists, and one sharia specialist, were purposively recruited with the consideration of maximum variation. Data were collected using individual, in-depth, semi-structured interviews.
Results: The main theme of the study was “care is never futile: care as goal”. This theme is consisted of four main categories including: 1. care as an indispensable service; 2. care as an ongoing process focused on human existence; 3. care as a sacred and essential process in Islam; 4. the necessity for differentiating between care and cure: futile treatment instead of futile care.
Conclusion: Although, in some cases, and depending on the circumstances, medical interventions may be futile, care is never futile. According to the findings of this study, the terms medical futility and futile care cannot be used interchangeably because interchangeable use of these terms can devalue the nature of care. Thus, it is necessary to use the term of “futile treatment” instead of “futile care”.
 

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Background & Aim: Creating and maintaining a safe environment is an important part of care in psychiatric wards. The results of previous studies indicated that some features of the physical environment facilitate the ward’s safety. The experiences of people who are most likely to be present in these environments can be the best source for identifying these features. Therefore, this study was conducted to explain patients’ and employees’ perceptions toward the features of a safe physical environment in psychiatric wards.
Methods & Materials: In this exploratory qualitative descriptive study, seven patients at discharge time and nineteen employees working in psychiatric wards were interviewed about their experiences in psychiatric wards and 84 hours of field observation was done. The data were analyzed using a qualitative content analysis approach according to the method proposed by Graneheim and Lundman.
Results: The results showed a safe physical environment in psychiatric wards meant “having an accident-free environment”. This theme was abstracted from two main categories included “Accidents prevention through design” and “having a natural life environment”, which, according to the experience of the staff, is required to balance the two. The subcategories of “having the design of accidents prevention” were “eliminating or modifying accident-causing objects”, “wards based on the characteristics of the patients” and “conditions for facilitating staff performance” and the subcategories of “having a natural life environment were “meaningful activities", “healthy and pleasant conditions” and “preserved privacy”.
Conclusion: According to the results of the study, it is necessary to create a physical environment free of accidents and at the same time to meet the daily needs of patients in order to prevent physical and psychological damage to patients and staff in psychiatric wards.