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Objective: The present study was investigate parents' experiences of children with Epidermolysis bullosa. So, this descriptive phenomenological qualitative study was conducted on 17 parents of children with EB from five hospitals affiliated with the University of Medical Sciences, west of Iran. Data was collected through semi-structured interviews. COLAIZZI's method was also used to analyze the data., Results: Three main themes were extracted in this study: invasion of psychological crisis, alive but no living, and comprehensive support, including 10 categories. The parents of these children are the target of psychological crises that severely reduce their quality of life. In this regard, they need extensive support to improve their living conditions. Therefore, it is suggested to provide cultural and institutional contexts in which all components of the children's dignity are emphasized., (© 2024. The Author(s).)

Background: Respecting the dignity of child labor is one of their most urgent needs. In many cases, the dignity of child labor is not maintained in countries with unfavorable economic conditions. The aim of the present study was understand adolescents' perceptions of their dignity in child labor., Methods: This study is a qualitative research with conventional content analysis approach. Twenty teenagers who having work experience as child labor were selected from one welfare center and three charity centers in using purposeful sampling method in 2022-2023. Data was generated through individual, deep, and semi-structured interviews. In order to analyze the data was used Granheim and Lundman's method., Results: Three main themes were presented in this study including, "preservation of privacy and security", "honoring individual identity to develop dignity" and "comprehensive support", and 9 categories., Conclusion: understand adolescents' perceptions as child labor of their dignity, privacy and security of child labor victims and respect for their identity and all-round support are defined. And in this supportive environment, the dignity of working children is preserved and appropriate behavioral consequences are created. Therefore, it is suggested that a cultural and institutional background be provided in which all components of the child labor's dignity are emphasized., (© 2024. The Author(s).)

Background: Chlorhexidine mouthwash is a common oral hygiene product used in intensive care units, but it may have some adverse effects. Licorice, a natural herb, could be a potential alternative to chlorhexidine. However, the effect of licorice mouthwash on the oral health of intubated patients has not been studied yet. Therefore, this study aimed to compare the effects of licorice and chlorhexidine mouthwash on the oral health of intubated patients., Methods: This was a triple-blind clinical trial. The sample included 130 intubated patients admitted to an intensive care unit in Iran. The samples were selected by convenience sampling and randomly assigned to two groups: A and B. In group A, the main researcher applied 15 ml of 0.2% chlorhexidine mouthwash after each brushing (twice a day for 5.5 days) and suctioned it after 30 s. In group B, 20% licorice mouthwash was used instead of chlorhexidine. The demographic information questionnaire and the Beck Oral Assessment Scale (BOAS) were completed by one of the nurses before and on the sixth day of the study., Results: Finally, 60 patients in each group completed the study. There was no significant difference between the groups in terms of demographic variables or oral health before the intervention (P > 0.05). The oral health of patients in both the chlorhexidine and liquorice mouthwash groups improved significantly after the intervention (P < 0.05). However, there was no significant difference in oral health between the two groups at postintervention (P = 0.06)., Conclusion: The results demonstrated that both mouthwashes exerted a comparable effect on dental and oral health. However, the chlorhexidine mouthwash showed a greater impact on the reduction of dental plaque and the thinning of saliva compared to licorice mouthwash. In essential cases, licorice mouthwash can be employed as an alternative to chlorhexidine., (© 2024. The Author(s).)

Introduction: Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers., Materials and Methods: This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method., Results: Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services CONCLUSION: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field., (© 2024. The Author(s).)

Background: Child laborers are often defined as work that deprives children of their childhood, their potential and their dignity, and that is harmful to physical and mental development. Child laborers are one of the most vulnerable groups in domestic violence. Domestic violence severely affects the physical and mental health, and consequently affects substance dependence and resilience to suicide of these children. Accordingly, it is essential to examine domestic violence, substance dependence, and suicidal ideation in working children., Objectives: the present study aimed to investigate the relationship between exposure to domestic violence and substance dependence and suicide resilience on the other among child laborers in Iran., Methods: This study employed cross-sectional research. 600 child laborers were selected via convenience and snow ball sampling from one rehabilitation and welfare center and three charity organization societies in the west of Iran, from January to August 2022. They completed questionnaires. Data were analyzed by SPSS software version 22 and with using descriptive statistics (frequency, percentage, mean and standard deviation) and ANOVA, independent t-test and the multiple linear regression model with a backward strategy., Results: Findings showed that exposure to domestic violence has a strong and direct correlation with substance dependence (r = 0.94, p < 0.001) and strong and indirect correlation with suicide resilience (r =- 0.91, p < 0.001). Also substance dependence has a strong and direct correlation with suicide resilience (r = -0.87, p < 0.001) in child laborers. Variables of substance dependence, suicide resilience, gender, guardian's disease status, living status and age can predict 76.51% of the variance in domestic violence in these children., Conclusion: Child laborers experience a lot of domestic violence, which severely affects their suicide resilience and substance dependence in them. Therefore, there is an urgent need for systematic support programs with content (teaching self-care behaviors, stress management, avoiding tense and violent environments) in order to support of these children and reduce domestic violence against them and subsequently reduce substance improve abuse resilience to suicide in these children., (© 2023. The Author(s).)

Background: The COVID-19 epidemic has globally challenged medical practices, including cardiopulmonary resuscitation (CPR). Numerous challenges affect healthcare providers (HCPs) who are members of the resuscitation team and the resuscitation process in COVID-19 patients. As a result, HCPs may experience different dilemmas about CPR. Failure to recognize these experiences can harm both HCPs and patients. This study aimed to explore the HCP's experiences of CPR in patients with COVID-19., Methods: A qualitative study was conducted using semi-structured interviews with 26 participants in the emergency departments of Besat, Golestan, and Imam Reza hospitals (in the west of Iran) using the hermeneutic phenomenology approach. The data were analyzed using the 6-step Smith interpretative phenomenological analysis (IPA) method., Results: The mean age of the participants was 38 years. Most of them (61.5%) were male and had a Bachelor's degree in nursing (46.1%).The data analysis resulted in extracting four super-ordinate and nine sub-ordinate themes. "Human aspects of Care", "Perceived Psychological Effects of Resuscitation in COVID-19", "HCP's perceptions of factors affecting the resuscitation process in COVID-19", and "Perceived differences in COVID-19 resuscitation compared to non-COVID patients" were super-ordinate themes., Conclusions: The participants experienced a wide range of difficult feelings and emotions while resuscitating the patients with COVID-19, suggesting the effect of the COVID-19 epidemic on HCPs and the resuscitation process. They experienced stress and fear, and the resuscitation process was influenced by their compassion, underlying patient conditions, resuscitation futility, and participants' fatigue or lack of oxygen due to the use of personal protective equipment (PPE)., (© 2022. The Author(s).)

Background: Spinal cord injury (SCI) is one of the most serious types of physical trauma and has become a major life-threatening condition in the recent decade. It is essential that the life perception and experiences of patients with SCI be studied and evaluated in different cultural contexts so that their needs and the challenges they face can be properly determined. The present study aims to explore the how patients with SCI in the south of Iran perceive facing life's challenges., Methods: The present study is a qualitative research with a descriptive phenomenological design. Participants were identified through purposive sampling of patients with spinal cord injury admitted to two state hospitals affiliated with a university of medical sciences in western Iran. The researchers collected data using semi-structured, in-depth interviews with 25 SCI patients conducted between August and October 2021. Data was analyzed according to Colaizzi's method using MAXQDA v. 2007., Results: Analysis of the data led to the emergence of three themes and nine sub-themes. The three main themes were emotional shock (crisis making and mental rumination, persistent depressive disorder, pitying behaviors, fear of the future), loss of dignity (poor self- care, sexual dysfunction, loss of job and educational status), and lack of effective support (lack of financial institutions and sponsors, lack of social support)., Conclusion: Patients with spinal cord injuries face various issues in their care and social lives. Attention to their psycho-emotional needs along with comprehensive health support play key roles in generating a sense of self efficacy and promoting the mental well-being and dignity of patients with spinal cord injuries. Accordingly, healthcare administrators and caregivers are recommended to provide more comprehensive health support to SCI patients to meet their needs more effectively., (© 2022. The Author(s).)

Background: Being on the frontline of the battle against COVID-19, nurses and nursing students have been under considerable psychological stress and pressure. The present study is done to explore death anxiety, moral courage, and resilience in nursing students caring for COVID-19 patients in the south of Iran., Methods: The present study is cross-sectional research conducted between September and December 2021. A total of 420 senior nursing students (nursing interns) who were undergoing their clinical training courses were invited to participate in the study by convenience sampling method from three hospitals affiliated with the University of Medical Sciences of Southern Iran. Data were collected using a demographics survey, Nurses' Moral Courage Questionnaire, Connor-Davidson Resilience Scale, and Templer's Death Anxiety Scale.  RESULTS: The nursing students participating in this study had a death anxiety mean score of 12.78 ± 1.17. The results showed that there was a significant and indirect correlation between death anxiety on the one hand and moral courage (r = -0.91, p < 0.001) and resilience (r = -0.89, p < 0.001) on the other in nursing students caring for patients with COVID-19. Also, it was found that there was a significant and direct correlation between the students' resilience and moral courage scores (r = 0.91, p < 0.001)., Conclusion: The nursing students caring for COVID-19 patients had experienced high levels of death anxiety in the past few months. Considering the persistence of the COVID-19 crisis in Iran and other countries, there is an urgent need for measures to preserve and improve the physical, mental, and spiritual health of nursing students, enhance their moral courage and resilience and reduce their death anxiety., (© 2022. The Author(s).)

Background: The operating room nurses have encountered several challenges during the current COVID-19 Pandemic, which subsequently impact their clinical performance. The present study aimed to investigate the experiences of operating room health care professionals' regarding the COVID-19 pandemic challenges in southern Iran., Methods: This is a descriptive qualitative study. The required data were collected using in-depth and semi-structured interviews. Accordingly, 19 operating room health care professions were included in this study through purposive sampling. The data were collected from February 2020 to August 2021 and then analyzed using the Granheim and Lundman's method., Results: Three main themes and 9 sub-themes were presented in this study. They included: 1- Challenges of applying protocols and standards of care in the COVID-19 pandemic in the operating room (lack of specific guidelines regarding care protocols and standards for crisis management of Covid-19 in the operating room and impossibility of keeping social distance in the operating room). 2- Professional challenges (tedious and hard work, professional burnout, lack of adequate support by the managers and lack of personal protective equipment). 3-Psychological crises (indescribable anxiety and worry, parenting stress, and weakened resilience)., Conclusion: Based on the findings of the present study, it was indicated that lack of a specific guideline in the COVID-19 pandemic led to a sense of indecision and confusion among operating room staff. In this regard, performing tedious tasks, feelings of tiredness and exhaustion, lack of support by the authorities, and lack of access to adequate facilities and equipment were reported as the professional challenges of the healthcare staff in the current COVID-19 pandemic, which consequently affected the quality of care and patient's safety. It seems that hospital officials can use the results reported in this study for efficient planning and effective management during the COVID-19 pandemic., (© 2021. The Author(s).)

Background: Oral mucositis is one of the most emerging and debilitating complications of chemotherapy during the treatment period, which strongly affects the nutritional status and physical and mental condition of these patients. Zinc increased protein synthesis and improved cell membrane stability so passible effective in prevent and treat oral mucositis and promote oral health. Therefore, this study aimed to evaluate the effect of zinc chloride mouthwash on the prevention, incidence, and severity of oral mucositis in cancer patients undergoing chemotherapy., Methods: The present study was a randomized control trial study. 96 patients with a cancer diagnosis selected from one oncology clinic in the west of Iran. Then they assigned randomly to the zinc chloride group and placebo group. The patients in each group should rinse their mouths every 8 h two times and each time 2 min with 7.5 ml from mouthwash. The severity of mucositis and weight loss examined blindly at the baseline and 3-week follow-up., Results: The incidence and severity of oral mucositis between groups were significant higher at the end of the second (p < 0.002) and third (p < 0.001) week. The mucositis severity decreased well during the third weeks in the zinc chloride group. The difference in the weight loss was significant higher between the zinc chloride and the placebo group (p < 0.01)., Conclusion: Zinc chloride mouthwash was effective in preventing and reducing the severity of oral mucositis and improving weight in patients undergoing chemotherapy. Trial registration We can therefore recommend more studies examine the effects zinc chloride as preventive care at the beginning of chemotherapy to improve oral health and subsequently preventing weight loss in these patients., (© 2021. The Author(s).)

Background: The nurses act as the guardians of people's health by preventing, controlling, and curing emerging diseases, including coronavirus, a highly infectious and contagious disease which has presented the caregivers in the Iranian healthcare system with many clinical challenges. In view of lack of research on the clinical challenges which arise during health crises, emerging diseases included, there is need for further investigation of those clinical challenges and dilemmas. The aim in present study was to describe the caregivers' experiences of the caring challenges in patients with coronavirus (COVID-19)., Methods: The present study is a qualitative work with a phenomenological-descriptive design. Data were collected via semi-structured, in-depth, individual interviews. The collected data were analyzed according to Colaizzi's method. The participants were 23 members of the medical staff responsible for coronavirus patients in Iran who met the inclusion criteria. The participants were selected via purposeful sampling which was continued to the point of data saturation., Results: The results yielded 3 main themes "psychological tension", "inefficient management", and "contextual factors" with 11 categories., Conclusion: In dealing with coronavirus patients and providing quality care to them, nurses face various clinical challenges which affect their performance. Administrators must, alongside giving instructions to people on how to prevent the coronavirus disease and taking effective safety measures, make sure that clinical centers are managed efficiently in order for nurses to fulfill their caring objectives satisfactorily.

Background: The bereaved families of COVID-19 victims are among the most vulnerable social groups in the COVID-19 pandemic. This highly infectious and contagious disease has afflicted these families with numerous psychological crises which have not been studied much yet. The present study is an attempt at investigating the psychological challenges and issues which the families of COVID-19 victims are faced with. The present study aims to identify the Mental Health crises which the families of COVID-19 deceased victims are going through., Methods: A qualitative research, the present study uses a conventional content analysis design. The participants were 16 members of the families of COVID-19 victims selected from medical centers in Iran from February to May 2020 via purposeful sampling. Sampling continued to the point of data saturation Data were collected via semi-structured individual interviews conducted online. The collected data were analyzed according to the conventional qualitative content analysis approach., Results: Analyses of the data yielded two main themes and seven categories. Emotional shock included (feelings of guilt and rumination, bitter farewell, strange burial and concern about unreligious burial), and fear of the future included (instability in the family, lack of job security and difficult financial conditions, Stigmatization and complications in social interactions)., Conclusion: The families of COVID-19 deceased victims are affected by various psychological crises which have exposed them to a deep sense of loss and emotional shock. Therefore, there is an urgent need for a cultural context which recognizes and supports all the various aspects of the mental health of these families.

Objective: Delivery is a challenging event in women's lives. What happens during childbirth is stressful for most women. Regarding the short and long-term effects of stressors of the delivery ward on childbirth and neonatal outcomes, and given that understanding the stressors are influenced by existing social culture and factors, the present qualitative study was conducted to investigate women's perception of stressors in the delivery ward. Participants were 13 newly delivered women who were monitored in the recovery room at the Fatemieh Hospital of Hamadan, Iran. Purposive sampling was performed and continued until data saturation. The data collection method was in-depth and semi-structured., Results: The content analysis of qualitative data led to the emergence of two themes of human stressors and environmental stressors as well as four categories; i.e., personal factors, care staff-related factors, environmental factors, and equipment-related factors. The research findings indicated that several personal, environmental, staff-related, and equipment-related factors could lead to stress in the labor and delivery ward. Although ignoring them and increasing stress during childbirth may jeopardize the childbirth consequences, most of them are ignored and overlooked. It is necessary to consider measures to control these factors as much as possible.