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Background Chronic renal failure is one of the major causes of mortality and disability worldwide. Although dialysis treatment is considered as a life‐saving treatment for these patients, their caregivers face various problems making the atmosphere of caring uncertain. Aims This study is aimed to explore and describe the experiences and perspectives of family caregivers of the patients undergoing haemodialysis. Methods In this study, 20 haemodialysis family caregivers were selected by purposeful sampling. Data gathering techniques in this research were in‐depth and unstructured interview and field observation. The researchers used an inductive thematic analysis approach to analysing the interviews' data. Findings Three main themes emerged from the data indicating the patients' care are conducted in a state of uncertainty including constant struggle to learn, effort and adherence to the divine thread, and in disease's captivity. Conclusions Caring in an uncertain atmosphere leads to decreased efficiency and quality of family caregivers' care. To promote and improve the efficiency of care, healthcare planners should pay attention to the challenges and perspectives of caregivers of the patients undergoing haemodialysis.

Background: Caregivers of hemodialysis patients spend a large amount of time providing care to these patients while tolerating fatigue and stress. This study evaluated a family-centered empowerment program on the care burden and self-efficacy of hemodialysis patient caregivers based on social cognitive theory. Methods: In this randomized clinical trial, 70 family caregivers of hemodialysis patients in Isfahan, Iran, were selected and randomly allocated to intervention and control groups, in 2015-2016. Two questionnaires were used to collect the family caregivers' characteristics, care burden, and self-efficacy, and patients' negative and positive outcomes expectancies. Data were analyzed using SPSS before, immediately after, and 2 months after the intervention. Results: There was no significant difference in the mean scores of care burden, positive outcomes expectancies, negative outcomes expectancies, and self-efficacy between the two groups before the intervention. However, there were significant differences in the post-test and follow-up data analyses (P<0.05). Conclusion: Given the degenerative nature of chronic kidney disease, it can be considered as a source of long-term and chronic stress for caregivers. Therefore, by implementing an empowerment program, caregiving behaviors can be improved, positive outcomes expectancies can be increased, and negative outcomes expectancies can be reduced.

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Background:Adolescence is a transition period from childhood to early adulthood. Because of the immense pressure imposed on adolescents due to the complications and ambiguities of this transition, their level of excitement increases and sometimes it appears in the form of sensitivity and intense excitement.Objectives:This study aimed at determining the effectiveness of assertiveness training on the levels of stress, anxiety, and depression of high school students.Materials and Methods:This quasi-experimental study was conducted on high school students of Isfahan in academic year 2012 - 13. A total of 126 second grade high school students were collected according to simple random sampling method and divided into two groups: experimental with 63 participants and control with the same number. Data gathering instruments included a demographic questionnaire, Gambill-Richey assertiveness scale, and depression anxiety stress scales (DASS-21). Assertiveness training was carried out on the experimental group in 8 sessions; after 8 weeks, posttest was carried out on both groups. Statistical tests such as independent t test, repeated measures ANOVA, Chi-square test, and the Mann-Whitney test were used to interpret and analyze the data.Results:The Chi-square and Mann-Whitney tests did not show significant statistical differences between the two groups in terms of demographic variables (P ≥ 0.05). Repeated measures ANOVA showed no significant difference between the mean scores for assertiveness before (100.23 ± 7.37), immediately after (101.57 ± 16.06), and 2 months after (100.77 ± 12.50) the intervention in the control group. However, the same test found a significant difference between the mean score for assertiveness in the experimental group before (101.6 ± 9.1), immediately after (96.47 ± 10.84), and 2 months after (95.41 ± 8.37) implementing the training program (P = 0.002). The independent t test showed no significant difference in the mean score for anxiety and stress between two groups before the assertiveness training program; however, 2 months after the intervention, the mean score for anxiety in the experimental group was found significantly lower than the control group. As for the mean score for depression, the independent t test showed no significant difference between two groups before training; however, despite the decrease in the mean scores for depression in the experimental group following the intervention, the difference was not significant (P = 0.09).Conclusions:The results of the current study show that conducting assertive training in high school students decreases their anxiety, stress, and depression. Given that high school years are among the most sensitive stages of one’s life plus the fact that conducting such training programs besides their safe and low cost nature are effective and practical, it is highly recommended that such programs be carried out among high school adolescents.

Background:Sleep disorders are considered as one of the most important problems in hemodialysis patients, making their everyday life a serious hazard. Sleep quality of hemodialysis patients and consequences of sleep disorders on other aspects of health such as spiritual well-being are important issues.Objectives:This study examined the relationship between spiritual well-being and quality of sleep in hemodialysis patients in Isfahan, Iran.Patients and Methods:This study was a correlation research, carried out on 190 hemodialysis patients. Data collection Questionnaires included demographic forms, Pittsburgh sleep quality index (PSQI), and Ellison and Paloutzian spiritual well-being scale. Data were analyzed using descriptive and inferential statistics (Pearson correlation and linear regression analysis) at P < 0.05 significance level, by SPSS software version 18.Results:Of 190 study participants, 163 (85.78%) with scores more than five index had sleep disturbances and 27 (14.12%) had no sleep disturbance; 3 (1.52%) had mild, 163 (85.78%) moderate, and 24 (12.30%) good spiritual health conditions. Pearson correlation test showed significant relationship between the sleep quality items of Pittsburg and spiritual well-being (P < 0.04, r = 0.149). Through the regression analyses of spiritual health, family, education, financial status, marital status, occupation, and use of sleep medication, the predictive power of these variables was found 0.417% and prediction of spiritual well-being was more than others (ß = 0.209).Conclusions:Considering bed as one of the most vital physical, mental, and emotional needs, it is very important in mental and spiritual well-being of hemodialysis patients as an influencing factor in mental relaxation and reducing disease tensions. Paying attention to sleep quality and spiritual well-being components of hemodialysis patients in formulating and promoting healthcare programs is recommended.

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The focus of attention was on the stress management coping skills of the caregivers of haemodialysis patients together with their ability to cope with complex problems. Healthcare providers, by taking into account these skills and strategies of empowerment, can help other caregivers of haemodialysis patients cope with their heavy care conditions and better define their purposes in caretaking.