Progressive exhaustion:A qualitative study on the experiences of Iranian family caregivers regarding patients undergoing hemodialysis

Objective:The aim of this study was to explore the burden of care for patients undergoing hemodialysis from the experiences of family caregivers.Methods:In this qualitative study,a content analysis approach was used for data collection and analysis.Participants were 16 family caregivers selected through purposive sampling from four medical education centers affiliated with Ahvaz Jundishapur University of Medical Sciences,Iran.Semi-structured interviews were held to collect data.Results:Four categories were developed as follows:‘care challenges’,‘psychological vulnerabilities’,‘the chronic nature of care’and“care in the shade”.The categories led to the development of the main theme of‘progressive exhaustion’experienced by the family caregivers during the provision of care to patients undergoing hemodialysis.Conclusion:Family caregivers have a significant role in the process of patient care,and this role leads them to progressive exhaustion;therefore,the overall health of the caregivers should be taken into account and more attention should be paid to their quality of life,social welfare,and satisfaction level.

Effects of physical activity by the teach-back educational method on the physical ability and quality of life in hemodialysis patients:a clinical trial

Objective:To determine the effect of physical activity by using the teach-back educational method on hemodialysis patients’quality of life(QOL)and physical ability.Methods:This is a single-blind clinical trial study involving a control group.A total of 90 patients who admitted to the dialysis centers of Beheshti and Besat hospitals in Hamadan were selected using a convenience sampling method and were randomly assigned to intervention(n=45)and control(n=45)groups.Data were collected using a demographic information checklist,a kidney disease QOL questionnaire,and a 6-minute-walk distance(6MWD)checklist.The patients’QOL questionnaire was completed,and the 6MWD was recorded before and at the end of the 2nd,4th,6th,8th,and 12th weeks of the intervention.In the intervention group,the patients were taught to perform physical activities with Pilates stretches in different resistances using the teach-back educational method during dialysis sessions for 12 weeks.Data were analyzed by using the independent t-test and chi-square test using SPSS-22 software.Results:Before the intervention,no differences were observed between the experimental and control groups in terms of demographic characteristics,QOL,and physical ability(P>0.05).The physical ability and QOL levels of patients exercising in the test group were higher than those in the control group after the intervention(P<0.05).Based on the results,the 2 groups significantly differed with regard to the scores of various dimensions of QOL and physical ability after the intervention(P<0.05).Conclusions:Physical activity by using the teach-back method can effectively increase physical ability and improve QOL of hemodialysis patients.Therefore,the recommendations and inclusion of exercise in the dialysis care plan can effectively promote patients’health.

Epidemiological status of malaria in Iran,2011-2014

Objective:To determine the status and epidemiological aspects of malaria in Iran in favor of gaining a better understanding of the national control of malaria.Methods:This epidemiological study examined the status of malaria from 2011 to 2014 in Iran.Data were collected from the Ministry of Health's protocol for controlling and eliminating malaria,which is currently in use.This malaria information reporting system is automated in all Iranian provinces and cities,and all information is submitted online to the center for communicable disease control in the Ministry of Health.Information about malaria is available for researchers to evaluate.Results:The incidence rates decreased from 2011 to 2014.There were 4.76,2.12,1.80,and 1.59 per 100 000 people,respectively from 2011 to 2014.During the four-year period(2011-2014),the highest numbers of cases occurred in those aged 16-25 years,by age,and in men,by sex.Most of the cases were workers and located in rural areas.An average 52.58%of cases were Iranian.The highest incidence rates from 2011 to 2014 were located in Sistan and Baluchestan province.There were 89.94,43.9,38.3,and 30.66 per 100 000 people.The highest numbers of malaria cases were recorded in the cities Sarbaz,Nickshahr,and Chabahar in Sistan and Baluchestan province and Bandar Abbas,Bandar Jask,and Bandar Lengeh in Hormozgan province.During the four-year period,57.05%of cases were caused by imported factors.The majority of cases were related to the trophozoite lifecycle of parasites.Regarding surveillance,there was inactive care in the majority of cases.Vivax malaria was the most prevalent.Conclusions:Despite the recendy declining trend in reported cases,the expansion of local transmission,especially in areas with cross-border travel,is very worrying.Improved malaria control interventions can be effective for elimination of malaria in Iran;these can include programs to control border travel and focused interventions for high incidence areas and high-risk groups such as rural residents,men,workers,and people < 35 years old.

Effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery: A randomized clinical trial

Objective:To determine the effect of rehabilitation education on pain,knee stiffness and performance difficulty in patients undergoing knee replacement surgery.Methods:This randomized clinical trial study was performed on 96 patients undergoing knee replacement surgery,who were randomly divided into two groups:the control group and the intervention group,with 48 patients in each group.In the intervention group,the patients received educational intervention in four stages one day before surgery,24 h and 48 h later,upon discharge from the hospital.In the control group,only the routine of the hospital was performed.Questionnaires were completed before and 6 weeks after the intervention.Results:The mean scores of pain,knee stiffness and performance difficulty were significantly decreased in the intervention group(P=0.01).Compared to the control group,the intervention group had a better outcome of the illness,including pain,knee stiffness and performance difficulty(P=0.001).Conclusion:Rehabilitation education could be a suitable way to improve the surgical outcomes of patients undergoing total knee replacement.

Nurses' lived experiences of professional autonomy in Iran

Objectives: Nurses' autonomy is a complex and multi-dimensional concept that has often been overlooked.Although many studies have addressed patients' autonomy,there has been no assessment of nurses' experience of professional autonomy.The present study aimed to assess nurses' lived experiences of professional autonomy in Shiraz,Iran.Methods: The present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018.The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences,Shiraz,Iran.The experiences of the participants were assessed through 14 in-depth semi-structured interviews.The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.Results: Based on the analysis of the interviews,4 themes,11 categories,and 13 sub-categories were extracted.The themes were: Advocacy for patients and nurses,independence in the workplace,Involvement in professional decision-making,and Professional accountability.Conclusion: Due to the intense interaction between nurses and patients,a better quality of care will be achieved if the professional autonomy of nurses is ensured.Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.