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Background: Non-adherence to medications and lifestyle recommendations in heart failure is associated with poor clinical outcomes including recurrent hospitalization, deterioration of the disease condition, and increased health care costs. Objectives: This study aimed to identify the contextual stimuli related with adherence to treatment among the patients with heart failure based on Roy Adaptation Model in the cultural and socio-economical context of Iran. Methods: This qualitative study was performed in 6 cardiovascular referral centers using the conventional content analysis. Data were collected through semi-structured interviews in 2017-2018. Each interview was started using general questions about self-care behaviors and barriers/ facilitator to adherence to treatment. Also, the Three-step content analysis approach proposed by Elo was used for data analysis. Results: The concepts considered in the experiences of participants as contextual stimuli of treatment adherence were categorized into 16 subcategories and also 4 categories as follows: cultural factors, socioeconomic factors, physical / psychological stress, coping abilities and strategies. Conclusion: Given that HF patients experience numerous self-management challenges to adherence to treatment, Nurses can play an important role in promoting the adaptation and improving the patient adherence through managing the contextual stimuli mentioned in this study by applying Roy Adaptation Model. The relationships among numerous contextual stimuli mentioned in this study should be tested through quantitative studies, and nursing interventions should be developed and tested to improve the adherence to treatment. [ABSTRACT FROM AUTHOR]

Background: Personal Knowing is an expression of self-knowledge concerning others. Besides, Personal Knowing is the most difficult as well as the most essential pattern of knowing in nursing. The current study aimed to explore how nurses apply personal knowledge in patient care. Methods: This qualitative study was performed based on the grounded theory method. The study was performed in different hospital wards of Tehran City, Iran. The required data were generated using semi-structured interviews and clinical observations. Finally, 15 interviews and 8 sessions of observation were included in the data analysis. Strauss and Corbin's constant comparison method (2008) was used to analyze the collected data. Results: The obtained findings suggested that nurses use the Personal Knowing pattern in 3 forms of the therapeutic use of self, self-centering, and elimination of therapeutic communication. The therapeutic use of self was accompanied by kindness and amiability; efforts to strengthen the patients' spirit; giving comfort and hope; humor; talking in a friendly manner, and gaining the patient's trust and cooperation. Self-centering was characterized by establishing silence in the ward, strict enforcement of the rules, setting more rules, and developing rules for the method of care provision. Eliminating the therapeutic communication was accompanied by the referral of patients to others, avoidance, reluctance, and mechanical care. Conclusion: The obtained findings added to the knowledge of the patterns of knowing in nursing. The therapeutic use of self leads to a positive outcome of care as well as the satisfaction of nurses and patients. However, a self-centering and eliminating therapeutic relationship will raise an inappropriate image of nursing. [ABSTRACT FROM AUTHOR]