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Objective: To explore the process of implementing medical orders by clinical nurses, and identify specific areas of concern in the implementation process, and uncover strategies to address these concerns. Background: The implementation of medical orders is a crucial responsibility for clinical nurses, as they bear legal accountability for the precise implementation of directives issued by medical practitioners. The accurate implementation of these orders not only shapes the quality and safety of healthcare services but also presents numerous challenges that demand careful consideration. Method: This study employed a qualitative design using a grounded theory approach to construct a comprehensive theoretical framework grounded in the insights and experiences of nurses operating within the hospital settings of Iran. The study encompassed 20 participants, comprising 16 clinical nurses, two nurse managers, and two specialist doctors working in hospital settings. The selection process involved purposeful and theoretical sampling methods to ensure diverse perspectives. Data collection unfolded through in-depth, individual, semi-structured interviews, persisting until data saturation was achieved. The analytical framework proposed by Corbin and Strauss (2015) guided the process, leading to the development of a coherent theory encapsulating the essence of the study phenomenon. Findings: The primary finding of the study underscores the significance of 'legal threat and job prestige' highlighting diverse repercussions in case of errors in the implementation of medical orders. At the core of the investigation, the central variable and the theory of the study was the 'selective and tasteful implementation of orders to avoid legal and organizational accountability.' This indicated a set of strategies employed by the nurses in the implementation of medical orders, encapsulated through three fundamental concepts: 'accuracy in controlling medical orders,' 'untruth documentation,' and 'concealment of events. The formidable influence of legal threats and job prestige was further compounded by factors such as heavy workloads, the doctor's non-compliance with legal instructions for giving verbal orders, the addition of orders by the doctor without informing nurses, and pressure by nursing managers to complete documentation. The resultant psychological distress experienced by nurses not only jeopardized patient safety but also underscored the intricate interplay between legal implications and professional standing within the healthcare framework. Conclusion: Alleviating staff shortages, enhancing the professional rapport between doctors and nurses, offering legal support to nursing staff, implementing measures such as recording departmental phone conversations to deter the non-acceptance of verbal orders, fostering an organizational culture that embraces nurse fallibility and encourages improvement, and upgrading equipment can ameliorate nurses' apprehensions and contribute to the safe implementation of medical orders. [ABSTRACT FROM AUTHOR]

Background: While nursing workload is a worldwide challenge, less attention has been given to the determining factors. Understanding these factors is important and could help nursing managers to provide suitable working environment and to manage the adverse outcomes of nursing workload. The aim of this study was to discover nurses' experiences of determinant factors of their workload. Materials and Methods: In this qualitative study, the participants included 15 nurses working in two hospitals in Tehran, Iran. The data were collected through 26 unstructured interviews and were analyzed using conventional content analysis. The rigor has been guaranteed with prolonged engagement, maximum variance sampling, member check, and audit trail. Results: Resource–task imbalance was the main theme of nurses' experiences. It means that there was an imbalance between necessary elements to meet patients' needs in comparison with expectation and responsibility. Resource–task imbalance included lack of resource, assignment without preparation, assigning non‑care tasks, and patients' and families' needs/expectations. Conclusions: A deep and comprehensive imbalance between recourses and tasks and expectations has been perceived by the participants to be the main source of work overload. Paying more attention to resource allocation, education of quality workforce, and job description by managers is necessary. [ABSTRACT FROM AUTHOR]

Background: Many women, throughout their life cycle, experience unintended pregnancy and its subsequent induced abortion. Nonetheless, women's perceptions of this phenomenon - particularly in countries prohibiting elective abortion - are poorly known. The aim of this study was to explore Iranian Azeri women's perceptions of unintended pregnancy. Materials and Methods: This was a conventional content analysis study conducted in Tabriz, Iran. The data were collected through 31 semi-structured interviews with 23 women who had recently experienced an unintended pregnancy. The study participants were recruited using the purposive sampling method. Sampling started in March 2013 and continued until reaching data saturation, i.e. till August 2013. Data analysis was carried out concurrently with data collection. MAXQDA 10.0 software was employed for managing the study data. Results: The study data analysis process yielded the formation of three main themes including negative effects of unintended pregnancy on daily life, fear of being stigmatized with violating social norms, and abortion panic, which in turn constituted the broader overarching theme of "threat supposition." In other words, following an unintended pregnancy, the study participants had experienced different levels of fear and threat depending on their personal, family, and socio-cultural backgrounds. Conclusions: Women perceive unintended pregnancy as a challenging and threatening situation. An unintended pregnancy can threaten women's lives through social deprivations, growing instability, and putting both mother and baby at risk for physical and psychosocial problems. On the other hand, an unsafe illegal abortion could have potentially life-threatening complications. To cope with such a situation, women need strong social support. Healthcare providers can fulfi ll such women's need for support by developing pre-abortion counseling services and providing them with professional counseling. Also, strengthening women's support system by policy-makers is recommended. [ABSTRACT FROM AUTHOR]

Background: Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. Objective: This study aimed to explore Iranian women’s and care providers’ perceptions of equitable prenatal care. Research design: In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. Participants and research context: A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. Ethical considerations: The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. Findings: Analysis of participants’ interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client–provider relationships, and caregivers’ competency. Conclusion: The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a rise in the number of premature births. Mothers of these newborns experience a high degree of stress over time. Since a more comprehensive understanding of this phenomenon can help the healthcare teams in detecting the deficiencies and needs of such newborns' mothers for a better and more effective intervention, the present study was carried out to describe the mothers' experiences in the area of premature birth. Materials and Methods: The present study is a qualitative study with a content analysis approach. The data collection process included 15 semi-structured and in-depth interviews with the mothers delivering premature babies during 2012-2013 in the medical educational centers of north and northwest of Iran. A purposive sampling method was used. All the interviews were recorded, typed, and finally analyzed using a qualitative content analysis with a conventional method. Results: Data analysis led to the extraction of continuous and multiple waves of emotional responses in mothers with premature birth. This has been revealed in mothers by the different categories of affective reactions, symptoms of anxiety, and mood disturbances including decline in performance, individual shortcomings, and mental irritation. Conclusions: Mothers' unpreparedness and unexpected childbirth make them encounter the multiple and continuous waves of emotional responses, which will consequently lead to decline in performance, individual shortcomings, and mental irritation among them. Therefore, in order to prevent the negative and long-term consequences of such reactions, it is recommended that more attention should be given to support these mothers as the main caregivers of such infants. [ABSTRACT FROM AUTHOR]

Background and purpose: Services of triangle centers in terms of training are counseling, prevention, and treatment in the three areas of sexually transmitted diseases, HIV / AIDS and drugs abuse. Healthcare providers of these centers have little respect for women's reproductive health needs (including safe motherhood). The health care centers do not provide enough sexual services including sexually transmitted diseases, HIV/AIDS and drug abuse to patients. The aim of this study was to determine and compare the most common SRH needs of individuals of this two types of centers. Material and Methods: In this cross-sectional study, for determining the sexual and reproductive health needs of the women in two groups, a standardized questionnaire of SRH needs assessment was used. The frequency of sexual and reproductive health needs of 600 women referred to health centers (group I: 514 women) and triangular center (Group II: 86 women) were evaluated Results: The most common SRH needs of women was cesarean section (need to safe delivery) in both two types of centers in the domain of safe motherhood, the use of traditional methods of contraception (need to spacing in childbearing) in the domain of family planning in the clients of the both two types of centers, being multi-partner of participants' husband (need to general and sexual health) in health care centers and being multi-partner of participants in triangle center in the domain of sexual history and practices (that the prevalence in two types of centers was very low, turbid and cheese form vaginal discharge (need to general and sexual health) in both types of centers in the domain of sexually transmitted infection, poor knowledge about routes of HIV transmission (need to knowledge about HIV/AIDS) in the domain of HIV/AIDS, and husband's sexual coercion (need to general, mental and sexual health) in the domain of violence. Among these needs, cesarean section (domain of safe motherhood) was more common than the others. Conclusion: Considering that the most common SRH needs was related to safe motherhood domain (high rate of cesarean section), so, in order to save sources and solve some problems including stigma, it is recommended that these two types of centers be integrated. [ABSTRACT FROM AUTHOR]

Background: Nursing education is both formal and informal. Formal education represents only a small part of all the learning involved; and many students learn more effectively through informal processes. There is little information about nursing student informal education and how it affects their character and practice. Materials and Methods: This qualitative study explores undergraduate nursing student perceptions of informal learning during nursing studies. Data were gathered through semi-structured interviews with a sample of undergraduate nursing students (n = 14). Strauss and Corbin's constant comparison analysis approach was used for data analysis. Results: The categories that emerged included personal maturity and emotional development, social development, closeness to God, alterations in value systems, and ethical and professional commitment. Conclusion: Findings reveal that nursing education could take advantage of informal learning opportunities to develop students' nontechnical skills and produce more competent students. Implications for nursing education are discussed. [ABSTRACT FROM AUTHOR]

Teaching ethics to nurses leads to their involvement in providing high quality care, enable them to duly encounter ethical issues. One of the key elements of educational systems is nursing instructors. Even though lots of studies show the role of instructors in students' learning, their role in promotion of professional ethics has been attended to less. The objective of this study is surveying the experience of nursing students with respect to the role of instructors in promotion of professional ethics. This qualitative study enrolled 15 undergraduate nursing students from three nursing schools in Teheran whom depth interview was performed. The interview was semistructured with open ended questions. The analysis was accomplished by use of qualitative content-analysis method. Data analysis demonstrated 2 main themes and 7 subcategories in regard to the role of instructors in promotion of professional ethics in nursing students including: 1) the effective professional role model 2) facilitating creative learning. The effective professional role model encompasses individual characteristics and beliefs, clinical skills and professional commitment of role model. Creative learning facilitates by encouraging critical thinking and decision-making, Providing supportive learning conditions, providing proper space for sharing knowledge followed by evaluation and creative feedback. The findings of this study provides a background for strengthening the role of instructors in promotion of professional ethics with more emphasis on research which increase capability of instructors at nursing education centers [ABSTRACT FROM AUTHOR]

Health-promoting behaviors have been recognized as major factors for maintenance and improvement of health. The objective of this study was to determine the status of health-promoting behaviors and their predicting factors in Iranian women of reproductive age. This was a population-based cross-sectional study in which 1359 Iranian women of reproductive age were selected by proportional random multistage cluster sampling in Tehran. Questionnaires including sociodemographic characteristics, Health-Promoting Lifestyle Profile-II (HPLP-II) and Personal Resource Questionnaire 85-Part 2 (PRQ85-Part 2) were completed by interview. The association between the dependent variables (HPLP-II and subscales) and the independent variables (social support and sociodemographic characteristics) was analyzed using the multivariable linear regression model. Among the six dimensions of health-promoting behaviors, women scored highest in interpersonal relations (3.08±0.51) and lowest in physical activity (2.04±0.64). The Pearson test indicated perceived social support to be significantly correlated with HPLP-II (r = 0.53; p < 0.001) and all its subscales (r = 0.12-0.60; p < 0.001). Multivariable regression analysis indicated social support to be a predictor of HPLP-II and all its subscales, except for physical activity. Social support and sociodemographic characteristics accounted for 29.8% of the variance in the HPLP-II score and 6.9-39.3 in the six subscales. The findings of the present study confirm the importance of social support and modifiable variables (sociodemographic) in the occurrence of health-promoting behaviors in women and accredit the theoretical relationships among the concepts of the health-promotion model. [ABSTRACT FROM AUTHOR]

Background: Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health. Methods: A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence. Results: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking. Conclusion: Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management. [ABSTRACT FROM AUTHOR]

Introduction: Family, especially mother, is faced with numerous challenges by experiencing a premature birth. Since knowing about mother's efforts regarding prematurely born infant helps us in our comprehensive understanding of the impact of this incident on the family system and its performance. The present study was carried out to explore the mothers' strategies regarding prematurely born infant. Methods: In a conventional qualitative content analysis, data was collected through purposive sampling by semi-structured deep interviews with 18 mothers who had prematurely born infant during 2012-2013 in the teaching hospitals of the north and northwest of Iran. All the interviews were recorded, typed, and finally analyzed. Results: Data analysis resulted in the extraction of categories of "asking for help, elevating capacity and reducing personal responsibilities and commitments". These categories were revealed in mothers respectively by the different sub-categories of "religious appeal and relying on beliefs, seeking information from the treatment and caring team, participating in infant's care, companionship and support of family and friends", "focusing on positive thinking and imagination, patience and strength " and "ignoring some routine affairs and reducing role-related activities and duties". Conclusion: Considering the uniqueness of the mother's role in responding to the needs of infants, healthcare system should consider mothers as real target in the intervention strategies in order to promote health and quality of life, so maybe this way, the burden of care and management of critical situations caused by a premature birth on the mother can be reduced. [ABSTRACT FROM AUTHOR]

Background: Accurate and timely diagnosis of endometriosis is associated with confusion. Clinical manifestations, imaging techniques, biomarkers and surgical techniques are used as diagnostic approaches. This paper reviews current evidence on clinical manifestation in order to help practitioners and perhaps improve women's health.Methods: A review of the literature on clinical diagnosis of pelvic endometriosis that appeared in the English language biomedical journals was performed using PubMed, Science Direct and Google Scholar. The search strategy included the combination of key words 'endometriosis' and 'diagnosis' or 'clinical diagnosis' in the titles or abstracts of articles. The search included all papers published during the year 2000 to 2014. Then, the findings were classified in order to summarize the evidence.Results: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, in all 51 papers were found relevant and included in this review. In general we found three categories of diagnostic approaches for clinical manifestation including: i) diagnosis via symptoms obtained from history taking, ii) diagnosis via signs obtained from physical examination and iii) diagnosis via risk factors obtained from history taking.Conclusion: Diagnosis of endometriosis is a matter of concern. Since the disease is associated with diverse clinical symptoms and signs, deeper and more comprehensive consideration according to patient's history and clinical findings is recommended for early and more accurate detection in order to prioritize women for further investigation and contribute to its early management. [ABSTRACT FROM AUTHOR]

Background: The prevalence of endometriosis is considerable but its diagnosis is a dilemma. The aim of this study was to explore the perception and experiences of endometriosis patients and physicians about occurrence and diagnosis of endometriosis.Methods: A qualitative research using content analysis was used to obtain data from purposely selected endometriosis patients (12 participants) and gynecologists (6 participants) from January to September 2013 in Tehran. Data were coded and analyzed using a thematic approach.Results: Seven themes emerged: 1) pain localization, 2) Severity of pain and struggle for pain relief, 3) Feeling inability to play the role of femininity, 4) Reducing physical health, 5) Disruption of social life, 6) Looking for a reliable diagnostic indicator, 7) Uncertainty of physical examination. The results highlighted that patients with the disease can experience different feelings that interfere with their wellbeing and their lives, and sometimes could be disabling.Conclusion: Patients and physicians are looking for a certain, noninvasive and inexpensive diagnostic method. This study helps to promote clinical diagnostic view and knowledge development about description of endometriosis diagnosis to decrease diagnostic delay and mismanagement. [ABSTRACT FROM AUTHOR]