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Participation in the study was entirely voluntary and the participants could withdraw at any stage of the study. This method was used for describing the systematic and objective means of the phenomenon. The advantage of this approach to content analysis is obtaining direct data from participants without imposing pre-supposed categories or theoretical perspectives.

Another important attribute of this approach is its emphasis on the subject, context, and differences and similarities among codes and categories. Three of the nurses selected were male and the others were female.

The participants were selected from various wards [intensive care unit ICU , emergency, general wards] in university hospitals in the Iranian cities of Tabriz, Uremia, Ardebil, and Tehran.

Further characteristics of the participants are presented in Table 1. The study lasted 6 months, from May until October In the first stage, participants were informed of the aim of the study by the researchers; if they agreed to participate in the research, they gave written consent.

To respect the privacy of the interviewees, numerical codes are used instead of their names. Table 1 Open in a separate window The data were collected using unstructured interviews.

Each interview lasted between 60 and 90 minutes and was performed in a private room in the hospital. Based on the initial data analysis, additional questions were asked of the respondents. A second interview was conducted with four participants to help clarify the initial interpretations of the information and emerging results.

To ensure accuracy of the data, the interviews were continued until data saturation: Data collection was ended when no new information could be collected and the data became repetitive. The interviews were tape-recorded, transcribed, and coded line-by-line by MAXQDA software which was used in the initial stages of coding.

In this way, themes and categories were generated inductively from the data. Rigor To increase the dependability of the study, data were collected and analyzed by one of the researchers; the other researchers checked and verified the data, codes, and analyses.

The transcripts were read several times and the categories and themes were discussed by the researchers until consensus was reached.

The credibility of the results of the study was confirmed through prolonged engagement with participants in the wards.

In addition, individual checking was used to examine the accuracy of the findings, and the results of the primary analysis were shared with the participants to validate the compatibility of the codes with their experiences. Transferability of the findings was made possible by the variety of the characteristics of the participants.

RESULTS Following an analysis of the data, three themes were identified as effective factors in holistic care provision: The structure of the educational system, professional environment, and motivational factors.

The themes, sub-themes, and codes are shown in Table 2. Table 2 Open in a separate window The structure of the educational system The structure of the educational system was one of the issues which most of the participants talked about. The content of educational programs If the content of educational programs is comprehensive and includes the philosophy of holistic care, it will enable nursing students to address the various needs of patients and provide holistic care.

Participant 8 The above quotation points to the important role of designed courses in training nurses in holistic care. But I was interested and regarded it as a specialized part of nursing; I practiced a lot and gradually learned how to exercise it. I wish the trainers had instructed us properly; then I would have realized the importance of it sooner. Unfortunately, the data show that the content of the educational program is poor and lacks material on the various needs of patients.

Participant 5 Another participant expressed: During the course, most of our education was about the physical problems of patients and dealing with them. Participant 13 Teaching methods Teaching methods are part of the educational structure and play an important role in holistic care formation. But, according to the results, the teaching methods are not designed to demonstrate holistic care.

In this regard, one of the participants said: The teaching methods were often educator-centered; a limited number of tasks were dictated and we were expected to do them only; we were not free to consider the other needs of patients and satisfy them.

In our education, we were not told that a patient is a whole with many different aspects and whose treatment requires that we consider all those aspects; although some of the educators advised us to consider the secondary needs of patients, there was no practical training in this field.

A participant said regarding this issue: One of our educators was sensitive to the various needs of patients, treated them with respect and attended to their various needs. Her manners influenced my behavior.

Now, I try to use her lessons in practice and provide my patients with comfort by addressing their various needs. Participant 6 Similarly, a participant referring to her trainer's holistic perception and emphasis on holistic care remarked: One of our trainers always stressed that we view a patient as a whole that has different needs; she was trying to have us realize that well-being is the result of creating a harmony among the various parts of the whole and not just the physical dimensions.

Effective Factors in Providing Holistic Care: A Qualitative Study

I believe that meeting all these needs at the same time rather than separately is much more effective. But the results show that most of the participants had no practical model for learning holistic care during their education.

Participant 6 An educator's good relationship with students is an effective factor in attracting attention to the educator's training, as well as motivation for learning. This theme consists of three sub-themes: Workload, management, and the gap between clinical performance and academic learning.

Workload Workload, one of the components of professional environment, was referred to by most of the participants as a restriction in holistic care provision. Participant 9 Management Management—with its different domains, such as evaluation, orientation programs for staff and management approaches—plays an important role in the formation of holistic care. Most of the participants emphasized its impact on the quality of nursing.

Ironically, the latter is more popular with the managers. Routine tasks are considered as evaluation criteria. But data show that the professional environment in Iranian hospitals lacks orientation programs for novice nurses and that most of the managers lack competence for their positions.

It was very difficult for me. I was under pressure and lost my motivation to continue my profession, provide proper care and pay attention to the patients and their needs. However, the participants declared that upon entering the clinical environment, they were faced with the limited conformity of their environment with professional norms. Disregard for the principles of proper nursing forms a sub-category of this phenomenon. The participants stated that upon embarking on their careers, they were faced with a prevalent disregard for the principles of proper nursing, at both the professional and ethical level.

Attention to professional principles is the prerequisite of holistic care; but in most cases they are ignored. To quote a participant: When I started, I saw that many of the points that were stressed during our education were simply ignored here. Many novice nurses would adopt the same wrong practices and ignore the professional principles; the standards and techniques were pushed aside and the patients forgotten. Disregard for ethical matters in nursing is another component of negligence of proper nursing principles.

Many nurses are guilty of such disregard and ignore their patients and their various needs. They would close the doors and drink tea and chat away! It was not easy to act morally under those circumstances: You could be ostracized. It was like swimming against the current.

Unfortunately, many of my friends would imitate them, too, and were totally indifferent to the patients and their needs, as if they were machines.

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Participant 8 Motivational factors Motivational factors play an important role in encouraging nurses to provide holistic care as well as facilitating such provision. Motivational factors include personality traits, personal experiences of hospitalization, and input sources.

They also confide in me, which lets me know about and satisfy many of their needs. Participant 7 Being sensitive and compassionate contributes to providing holistic care on the part of nurses. I help my family too and enjoy being a comfort.

That's why I feel good when my patients are satisfied. Participants mentioned that this expertise is important for patients because it is related to the quality of care.

If you can answer a care-related question, it gives the patient a certain peace of mind.

It signals: she knows what she's talking about. Only then can patients make decisions about their own care. Respondent 15, nursing home focus group In addition to substantive expertise, participants stated that nursing experience is also of influence.

According to them, a junior nurse has too little experience to respond creatively to sometimes complex care situations. However, according to participants, junior and senior nurses can learn from each other: they should work as a team and collectively pursue their common objectives.

In their view, experience is gained through practice. According to participants, this can be characterised as 'expertise'. When you suspect someone is contemplating suicide, you need to know how serious this is. Has the patient already made plans, does the patient have a death wish, or is it an impulsive thought? In that sense you need to reflect on the signals very carefully. You can only learn this from practice. Respondent 1, mental health care focus group Priority setting As stated by participants, various activities can occur simultaneously during the daily care of patients.

According to them, nurses should assess what care is needed and then flexibly coordinate diverse actions with each other. In the view of participants, prioritisation is about the organisation of nursing care. Patients need nurses who have clinical experience in order to coordinate care. Nurses must decide what choices to make, what is urgent and what is important. Those choices influence patient experiences. Prioritisation is very important. It means that you have to coordinate the daily care and decide which activities have priority.

Patients sometimes have to wait for help. It shows immediately. The restlessness affects the other patients. Respondent 18, nursing home focus group Participants said that patients sometimes have to wait before they are taken care of, or that nurses are not immediately available to answer questions or deal with problems. Collaborative working relationships According to participants, it is important to develop and maintain collaborative working relationships with professionals, including those in their own field.

In the view of participants, collaborative working relationships exist when all the involved professionals interact and operate in a complementary manner, and show mutual respect that is based on knowledge and expertise. Participants stated that all professionals need to discuss and influence patient care on the basis of their own expertise.

Participants believe that problems will be solved sooner when ideas and thoughts are exchanged. In their view, it is about sharing information and communication.

As stated by participants, communication and aligning with each other is needed so that no conflicting information is given and uniformity in care or treatment is provided. This generates, according to the participants, composure and clarity towards patients. Participants believe that collaboration and communication affect how patients experience the quality and effectiveness of care.

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We have a patient who is very compulsive. We made agreements about how to approach and handle this patient. We continually need to communicate with each other, physicians, psychologists, nurses. Clear communication is so important, and I miss that sometimes. Oxygen Therapy Cannula Method B: Administering Oxygen by Mask Method C: Administering Oxygen using Oxygen Tent: Administering Steam Inhalation: Assessment of Oxygen Saturation using Pulse Oximeter: Assisting the Patient with the use of an Incentive Spirometer: Performing Chest Physiotherapy: Performing Postural Drainage: Performing a Venipuncture for Intravenous Therapy: Administering of an Intravenous Infusion: Changing an Intravenous Container, Tubing and Dressing: Discontinuing an Intravenous Infusion A: Administration of Blood Blood Transfusion B: Policies on Drug Administration: Administering Oral Medication: Withdrawing or Preparing Medications from Vial and Ampoule: Administering a Subcutaneous Injection: Administering an Intradermal Injection: Administering an Intramuscular Injection: Administering Bolus Medications through Intravenous Route: Instilling Medication into Ear: Instilling Medication into Eyes: Administering Nasal Drops: Administering Metered Dose Inhalation: Administering Rectal Suppositories: Inserting Medication into Vagina: Administration of Medication through Nasogastric Tube: Assisting with Application of Splints: Assisting with Application of Slings: Assisting with Application of Skin Traction: Applying Bandages: Applying Binders: Pinsite Care in Skeletal Traction.

The Art of Nursing Practice 9. Assisting with Walking using Walker and Cane: Performing a Wound Dressing: Dressing a Burns Wound: Removal of Sutures and Staples: Recording an Electrocardiogram ECG: Preparation of Patient and Assisting with Cardiac Catheterisation: Preparation of Patient and Assisting with Pacemaker Implantation: ACLS Algorithm: Performing a Heimlich Manoeuvre Adult: Assisting with Arterial Puncture: Preparation for and Assisting with Digital Subtraction Angiography: Preparation for and Assisting with Cerebral Angiography A: Flushing a Central Venous Catheter C: Changing the Central Venous Tubing: Assisting with Bronchoscopy: Assisting with Endotracheal Intubation: Assisting with Tracheostomy: Providing Tracheostomy Care: Performing Oropharyngeal Suctioning: Assisting with Thoracentesis: Assisting with Removal of Chest Drainage Tubes: Performing Gastric Suctioning: Assisting with Upper Gastrointestinal Endoscopy: Assisting with Endoscopic Sclerotherapy: Performing a Gastric Lavage or Stomach Wash: Preparation of Patient and Assisting with Barium Enema: Preparation of Patient and Assisting with Colonoscopy: Preparation of Patient and Assisting with Proctoscopy: Assisting in Abdominal Paracentesis: Preparation for Ultrasonography: Assisting with Liver Biopsy: Preparation for KUB X-ray xvi.

Assisting with Renal Biopsy: Preparation of Patient and Assisting with Cystoscopy: Preparation for Skull and Spine X-ray: Assisting with Lumbar Puncture: Assisting with Computerized Axial Tomography Scan: Assisting with Bone Marrow Aspiration and Biopsy: Fluid Resuscitation in Acute Burns: Providing Exercises for Postburn Patients: Performing a Surgical Scrub: Conducting a General Preoperative Assessment and Checklist: Performing Skin Preparation for Surgery: Applying Mask and Sterile Gown: Performing Sterile Gloving: Positioning Patients for Surgery: Admitting a Patient in Psychiatric Unit: Discharging a Patient from Psychiatric Unit: Conducting Process Recording: Assisting with Hypnosis Therapy: Assisting with Insulin Subcoma Therapy: Performing an Antenatal Abdominal Examination and Palpation: Teaching Antenatal Exercises: Performing an Oxytocin Challenge Test: Preparing a Prenatal Patient for Ultrasound Examination: Assisting with an Amniocentesis: Admitting a Client to Labour Room: Assisting with Induction of Labour: Performing Vaginal Examination for a Patient in Labour: Conducting a Normal Vaginal Delivery.

The Art of Nursing Practice Performing an Examination of Placenta: Performing and Suturing an Episiotomy: Assisting with Forceps Delivery: Assisting with Ventouse Extraction: Assisting with Dilatation and Curettage Procedure: Providing Perineal Care: Measuring Involution of Uterus: Teaching Postnatal Exercises: Providing Immediate Newborn Care: Performing a Newborn Assessment: Performing Neonatal Resuscitation: Assisting with Breastfeeding: Care of Baby Undergoing Phototherapy: Care of Newborn in Incubator Isolette: Assisting in Exchange Transfusion: Bathing a Newborn: Giving Sponge Bath for a Newborn: Weighing a Newborn: Growth Assessment for Children Anthropometry: Cardiopulmonary Resuscitation for Children: Performing Heimlich Manoeuvre for Children: Performing Handwashing at Home: Performing Bag Techniques at Home: Taking Anthropometric Measurements: Checking Weight and Height: Performing Urine Analysis: Collection of Specimens for Laboratory Investigations: Checking Temperature at Home A: Estimation of Hemoglobin at Home using Haemoglobinometer B: Dressing a Wound at Home A: Medical Surgical Nursing Skills List Read each of the required clinical skills for a Registered Nurse working on a typical acute medical-surgical unit.

Write the number that corresponds to the level of.

When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your. Writes three sets of vital signs a. Identify general information pertaining to the nursing assistant course B. List requirements. Place a check-mark where indicated for each core group you are requesting.

Review education and basic. Policy Objective: To delineate the training, supervision and scope of practice for Medical Assistants. A a Characteristics of the specialization. Clinical objectives are posted by instructor at each.Author s : Mary F. Participants believe that collaboration and communication affect how patients experience the quality and effectiveness of care.

Instilling Medication into Eyes: Most nursing procedures prescribed for undergraduate education by Apex bodies in India are included. The aim of the study is to present the basic skills of critical thinking, to highlight critical thinking as a essential skill for nursing education and a fundamental skill for decision making in nursing practice.

Critical thinking, combined with creativity, refine the result as nurses can find specific solutions to specific problems with creativity taking place where traditional interventions are not effective. Strubert H, Carpenter D.

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