Theoretical Sampling Research Articles

Perceptions of diabetes distress during pregnancy in women with type 1 and type 2 diabetes: a qualitative interpretive description study

BackgroundDiabetes distress is commonly seen in adults with pre-existing diabetes and is associated with worsened glycemic management and self-management practices. While a majority of women report increased stress during pregnancy, it is unknown how women with type 1 or type 2 diabetes experience diabetes distress during this unique and transitional time.PurposeThis study aimed to understand the experiences and perceptions of diabetes distress in women with pre-existing diabetes during pregnancy.MethodsA qualitative study using an interpretive description approach was conducted. In-depth, one to one interviewing was used to capture rich descriptions of the pregnancy experience. Nested, stratified, and theoretical sampling was used to recruit 18 participants with type 1 and type 2 diabetes from the quantitative strand of this mixed methods study. Constant comparative analysis was used to inductively analyze the data and develop themes.FindingsFour themes, each with several subthemes, emerged under the main finding of “Diabetes Distress”: 1) Worry for Baby’s Health – “What’s this going to do to the baby?”’ 2) Feeling Overwhelmed with Diabetes Management—“It just seemed unattainable”; 3) Living with Diabetes – “There’s no way out” and 4) Cycle of Diabetes Distress.ConclusionsThe findings from this study identify the sources and experiences of diabetes distress during pregnancy in women with pre-existing diabetes. Diabetes distress often presents as cyclical and multifaceted during pregnancy, with elements of fear for the unborn baby, difficulties with diabetes management, and having negative lived experiences of diabetes. Further work is needed to develop appropriate screening tools for pregnancy and interventions to mitigate diabetes distress. Diabetes educators are well-positioned provide emotional support and person-centred self-management education to individuals with diabetes.

“To do or not to do”, male nurses’ experiences of providing intimate care to female patients in China, a constructivist grounded theory study

BackgroundSome studies suggest that female patients have more concerns about receiving intimate care from male than female nurses. Thus, providing intimate care to female patients is a challenging experience for male nurses. The purpose of this study was to explore Chinese male nurses’ experiences and process of providing intimate clinical care to female patients.MethodsA constructivist grounded theory approach was used to develop a theoretical understanding of male nurses’ experiences. This study included participants from 3 hospitals in different locations in China. Twenty-five male nurses were recruited using purposive and theoretical sampling. Semi-structured interviews were conducted. Data analysis was completed using initial coding, focused coding, theoretical coding and memo writing to produce core concepts and categories, and theory development.ResultsChinese male nurses’ experiences of providing intimate care to female patients can be constructed as a three-stage process: (1) anticipation of the level of embarrassment, (2) deciding on the process: do it or not do it and (3) protecting both parties and dealing with embarrassment. Additionally, seven themes and associated categories were identified to represent the important factors in the process of male nurses providing intimate care to female patients in China.ConclusionsChinese traditional culture may affect the embarrassment in Chinese male nurses providing intimate care to female patients. The embarrassing situation can be divided into three different stages, and male nurses have different main concerns in each stage. Hospital nursing administrators should consider the experiences and needs of male nurses in providing intimate care and provide them with psychological support, education and training.

Health-care professionals’ barriers to anemia prevention among pregnant women in Oman

ABSTRACT Background: The incidence of gestational anemia is increasing in pregnant women. The factors affecting health-care professionals’ ability to prevent anemia among pregnant women in Oman remain unknown. Therefore, this study aimed to explore the barriers faced by health-care professionals in preventing anemia among pregnant women. Methods: This study used a qualitative design directed by the constructivist grounded theory. The researchers communicated with health-care professionals about the barriers faced within health-care institutions for anemia prevention among pregnant women. Semi-structured interviews were conducted with 22 health-care professionals. The researchers selected five primary health-care institutions, intending to reach health-care professionals who provide antenatal care to pregnant women. Purposive sampling was used at the beginning of the data collection. Subsequently, theoretical sampling was performed to achieve data saturation. Results: Data analysis identified two themes: “Internal and external challenges.” The data analysis revealed that health-care professionals faced many barriers that impacted the prevention of anemia among pregnant women, both within and outside health-care institutions. Conclusion: Understanding the barriers faced by health-care professionals could help the Ministry of Health formulate the best approach to providing health education and services for pregnant women with gestational anemia in Oman, thereby solving deficits regarding antenatal services within health-care institutions.

Identifying factors affecting a healthy lifestyle in the post-COVID-19 era.

A healthy lifestyle is one of the important global concepts in the post-COVID-19 era, which can lead to maintaining and improving the health of societies. This study aimed to identify the factors affecting a healthy lifestyle in the post-COVID-19 era. The current research is a qualitative study that was conducted in the field by theoretical sampling method. The qualitative method used in the current research was Strauss-Corbin's method. The data collection tool in the current research was a semi-structured interview. The researcher reached theoretical saturation by the end of the 13th interview, and for more certainty, the interviews continued until the 15th interview. The statistical population of the research was all professors and experts with specialized doctorate degrees in Mashhad University of Medical Sciences, and finally, 15 people were selected according to the entry and exit criteria for the study. Data analysis was done by summarizing and coding and analyzing the hidden content from expert interviews using MAXQDA software. The factors affecting a healthy lifestyle in the post-COVID-19 era (cultural norms, social norms, biological norms, technological factors, and economic factors) emerged from the intuitive opinions of experts. Providing and maintaining health is not a simple task, as it involves biological, individual, familial, cultural, societal, economic, political, and health factors. Promotion of healthy lifestyles is not merely the responsibility of health-related organizations and bodies; rather, they necessitate extensive coordination and empathy among educational, health, cultural, service, and even political institutions and bodies.

Making sense of COVID-19: manifestations of health capital during the pandemic.

Grounded in Bourdieu's theory of human practice, this study aims to examine how individuals as social agents made sense of and acted upon their COVID-19 experiences. A recent conceptualization of health capital is utilized to explain the practices of patients in the pandemic, in relation to their biographical background. This is a qualitative research in which the data were collected by biographical narrative interviews through a theoretical sampling approach. Eighteen interviews with COVID-19 patients were conducted and 8 of them were analyzed by the Documentary Method. The informants made sense of their illness experiences through their health capital, which is manifested in their self-perception of health, their attitudes towards the healthcare system, their conception of terms such as luck, their work status, and the gendered division of labour at home in the COVID-19 pandemic. All the manifestations are mediated by the social, cultural, and economic capital of the informants, and their habitual practices are based on their symbolic capital. The study depicts how social agents' health capital manifested in the pandemic, relying on their symbolic capital, and shaping their practices. Further research across diverse contexts is needed to fully understand extra dimensions of health capital as a descriptor of the social determinants of health.

Teacher and Parent Communication Patterns in Increasing Student Learning Motivation in Elementary Schools

Purpose: This research aims to describe the process, obstacles and solutions to teacher-parent communication patterns in increasing student learning motivation during the pandemic in grade 3 elementary school. Methods: This type of research is field research using Grounded Theory. Participants in this research were 20 parents and students as well as two teachers at an elementary school in Jepara. Data collection was carried out by interviews, observation and documentation with primary data sources including homeroom teachers, parents and students. The validity of the data uses a credibility test with triangulation techniques. Researchers carry out data analysis using several stages, namely problem formulation, use of theoretical studies (if necessary), data collection and sampling, data analysis, and drawing conclusions. Results: The results of the research show that: 1) Teacher and parent communication patterns in increasing student learning motivation during the pandemic in grade 3 elementary school are divided into three forms, namely: One-stage communication pattern, the communication pattern carried out by parents does not provide feedback to Teacher. Two-stage communication pattern: communication between teachers and parents has feedback. In the three-stage communication pattern, the communication carried out has feedback, and the communicant here can convey the information he obtains to other people. 2) Barriers to communication patterns, namely parents as communicants do not immediately provide feedback, and sometimes the feedback does not match the message conveyed by the teacher. 3) The solution is that parents must take the initiative in giving messages. Motivate children to be patient, open and empathetic, provide religious education as early as possible, and provide encouragement. Conclusion: This research reveals communication patterns between teachers and parents to increase student learning motivation during the pandemic. Communication patterns are divided into three stages, with challenges such as delayed feedback from parents. Thus, it is necessary to involve parents proactively, to take communication initiatives, form patience and empathy in children, provide religious education as early as possible, and provide ongoing support, thereby creating an environment that supports student motivation and learning.

Systemic family therapists and dementia: A constructivist grounded theory study

AbstractThis article presents research that explored the ways that systemic and family therapists might approach the support of families living with dementia. A constructivist grounded theory methodology was used to interpret interviews with four systemic family therapists working in the United Kingdom. All participants had professional and/or lived experience of dementia. Transcript analysis and theoretical sampling led to the development of five categories, each related to different aspects of considering systemic therapy in a dementia context. These categories were further developed into a ‘systemically informed dementia orienteering’ conceptual framework, which is presented in this paper as a learning resource. Findings are related to existing literature, and recommendations for future research are made.

Training Management Styles in Physical Education and Sports

The aim of this research is to discover a theoretical structure that expresses the styles in which coaches manage their training in Turkey. For this purpose, the research was carried out using the Grounded Theory Research model. The number of participants was determined by the theoretical sampling method. In order to ensure the theoretical saturation of the categories, the research was completed with 11 coaches. “Semi-Structured Interview Questionnaire” developed by the researcher was used as a data collection tool in the study. Categories were discovered by analyzing the data with ‘open, selective, and theoretical coding’ processes. As a result of the research, the theoretical structure of Training Management Styles in Physical Education and Sports consisting of the core categories of Contemporary, Situational, Liberal, Authoritarian, and Planned Training Management was discovered.

Development of the social burnout scale for college students.

Although fruitful achievements have been explored about job burnout, little is known about burnout in the field of social interaction among college students. To address this limitation, this study defined the concept of Social Burnout and developed a measurement tool for it. The study adopted the method of combining qualitative research with quantitative research. After the qualitative study, we gathered examples of social burnout and finished item writing. Using convenient sampling and theoretical sampling methods, six different samples were recruited for reliability and validity testing. Confirmatory factor analysis (CFA) revealed the scale's two-factor structure: emotional exhaustion and depersonalization. Cronbach's alpha measured the internal consistency of the social burnout scale (SBS), which was excellent (Cronbach's alpha of emotional exhaustion = 0.94; depersonalization = 0.82; the overall = 0.92). Susequently, the method of calculating AVE and CR evaluated the scale's convergent and discriminant validity, which were relatively good (AVE of emotional exhaustion = 0.60, depersonalization = 0.59; CR of emotional exhaustion = 0.93, depersonalization = 0.81). Then, regression analysis verified the nomological network and criterion-related validity (r = -0.30, p < 0.01; r = -0.39, p < 0.01; β = -0.25, p < 0.01). The SBS was shown to be a reliable and appropriate measure for assessing students' social burnout. Furthermore, the SBS is recommended for use in academic research and by healthcare professionals to measure students' social distress. Further validation studies of this scale are needed in other cultural contexts.

Vitality of older adults through internal and external connectedness

BackgroundVitality is a relatively unresearched concept and defined in existing literature either on the premise of one's functioning, or in terms of feeling alive. There is, however, little known about the significance of a sense of connectedness to life for vitality, especially from the perspective of older adults. This research aims to explore the association between the concept of connectedness and the perspective of vitality as a sense of aliveness, in order to formulate a theoretical understanding grounded in the subjective perceptions that older adults themselves hold of vitality. MethodsFollowing a constructivist grounded theory approach and theoretical sampling, constant comparative analysis was performed on the transcripts of 15 semi-structured interviews, conducted in the Netherlands with older adults (mean age 73 years, eight females and seven males), regarding their vitality. Concurrently, empirical and theoretical findings were translated into a theoretical conceptualisation. ResultsAccording to the older participants, connecting to life itself enhanced their sense of vitality. This connection was achieved through internal connectedness (connecting to one's own life, intrinsic stimuli and intrinsic goals in an independent manner) and external connectedness (social connectedness, environmental connectedness, engagement with the external world). Furthermore, our findings revealed distinct interactions between internal and external connectedness and facilitating tools, such as freedom from physical constraints, financial freedom and adaptation. ConclusionsOur findings provide a holistic concept of vitality and connectedness and consolidate existing perspectives on vitality into an overarching framework, which can contribute to the development of effective care policy, healthcare interventions and welfare services.

'Moving on' for Adults With a Learning Disability and Their Families: A Constructivist Grounded Theory Study.

Ending familial co-residence, termed 'moving on' by participants, is an increasingly relevant life transition for people with a learning disability due to increasing life expectancy and policy developments. Nevertheless, there is an absence of research exploring this transition experience in a United Kingdom (UK) context. This constructivist grounded theory study therefore aimed to explore, conceptualise, and theorise the 'moving on' experiences of adults with a learning disability and their families. This article reports the experiences of five adults with a learning disability and nine family members in England, UK. Narrative interviews and creative storybook methods were used to collect data between April 2015 and May 2016. Constant comparative methods, theoretical sampling, and memo writing were used throughout data collection and analysis. Participants with a learning disability presented personal growth and greater life fulfilment over the course of the transition; they flourished. In parallel, family members relinquished their care responsibilities. Importantly, the iterative and reciprocal relationship between flourishing and relinquishing shows that ongoing family member involvement is crucial during and following relocation. Family members identified factors that potentially inhibit relinquishing: pressure to 'let go', different perceptions of independence between family members and service providers, inadequate future investment, and rapport with professional carers. These novel insights led to the generation of the first known mid-range theory concerning this transition, entitled 'Moving on: flourishing and relinquishing'. Findings will guide future research in this field and facilitate the design of appropriate support for people with a learning disability and their families.

Fluctuating cohesion: A grounded theory study of nursing students engaged in a combined debriefing format

AimThis study explored the social processes enacted by nursing students when they engage in a combined format of structured peer debriefing followed by instructor-led debriefing after in-person simulation. The aim was to gain insight into nursing students’ perceptions and how peer processes influenced reflection and learning. BackgroundDebriefing, a key component of clinical simulation, promotes development of nursing students’ reflective processes and enhances learning. In-person group-debriefing led by faculty/instructors is the most used debriefing format in healthcare simulation education. Yet, recent studies indicate instructor-led formats may increase students’ anxiety and limit their capacity for reflection, a crucial step in clinical reasoning and decision making. Investigations into learner-centered formats support peer debriefing as a reasonable alternative to traditional instructor-led debriefing. However, current peer debriefing studies provide little insight into the social interactions and processes supporting reflection and learning; and little theoretical basis exists for the integration of alternatives to instructor-led debriefing formats (such as peer debriefing) into simulation-based education. DesignThis qualitative study used a Straussian grounded theory design. MethodsSenior-level baccalaureate and associate degree nursing students from an U.S. public university with first-hand experience using the combined format of peer debriefing followed by instructor-led debriefing were recruited to participate in focus-group interviews. Data gathered from semi structured interviews were analysed using the iterative process of constant comparison. Theory building was aided using memoing, theoretical sampling and conceptual diagramming. ResultsThe sample consisted of 34 students. Study findings revealed the core category of the constructed theory, ‘Fluctuating cohesion’, involved students’ pervasive sense of going back and forth between a sense of unity (we-ness) and separatism (me-ness) while engaged in the combined debriefing format. The theory integrated five related categories: discovering the process, normalizing experiences, developing mutuality, dynamic balancing and engaging informal social connections. Findings illustrated the processes students enacted to take ownership for learning and proactively discuss their clinical decision-making with the instructor. In turn, reflection was enhanced by increased receptiveness to subsequent expert feedback. ConclusionsThe study findings demonstrated that augmenting instructor-led debriefing with peer debriefing leveraged the beneficial nature of peer interactions, promoted psychological safety, facilitated nascent team behaviors and enhanced reflective thinking. The resultant theory that was generated from the findings and grounded in participants’ experience, provides a meaningful framework that may inform future learner-centered debriefing formats aimed at optimizing debriefing effectiveness.

La ley de eutanasia y experiencias profesionales: tensiones en la práctica clínica

ObjectiveTo analyze the process of assisted death provision in Catalonia and identify the main tensions, difficulties, and/or sources of discomfort related to professional practice. MethodA qualitative study was conducted based on interviews (n=29) and focus groups (n=19) with professionals who participated in the euthanasia process. The selection of participants combined the snowball and maximization of variability procedures, taking into account the variables of professional profile, setting, gender, age and territoriality. Intentional and theoretical sampling process. ResultsThe assisted death process is divided into four main moments: 1) reception of the request, 2) medical-bureaucratic procedure, 3) the actual procedure, and 4) closure. At each of these moments, difficulties arise that can be a source of discomfort and have to do with the limits and tensions between the legal and moral, the conception of one's own professional role, the lack of recognition of some professional roles, stress and overload, the lack of formal and informal support, and the relationship with the patient and his/her family. The bureaucratic-administrative stress derived from a protective law, with both prior and subsequent verifying control, stands out, given that it stresses the professionals immersed in a healthcare system already under high pressure after budget cuts and the COVID-19 epidemic. ConclusionsThroughout the assisted death process, the sources of distress are diverse and of a psychological, psychosocial, and structural nature. These results may lead to interventions for psychological and peer support, information, training, institutional involvement, and burden reduction.

Emergence of a Constructivist Theory on Nurses’ Caring Decisions for Patients Being Withdrawn from Ventilatory Support

This research is centered on developing a constructivist grounded theory that reflects how intensive care unit (ICU) nurses carry out their caring decisions for patients withdrawn from ventilatory support as captured from the Filipino context. To frame an exhaustive discussion, the researcher utilized Charmaz’s constructivist grounded theory approach with semi-structured interviews, observational field notes, and memos as data collection methods. Employing theoretical sampling, twenty senior ICU nurses, four doctors and ten patients’ family members provided data that formulated the theory. The formulated core category of Perspicacity in Caring Decisions is indicated by ICU nurses' ability to develop a deeper concept of wisdom and understanding gained through clinical and life experiences. This constructivist theory stands on a strong foundation built from five interlinked subcategories: Voicing Out, Establishing realities, Navigating transitions, Taking the time, and Serving a Good Death. This brings together and contextualizes what was happening throughout the processes of nurses’ end-of-life caring decisions. This research concludes that moving into a realm where death becomes an acceptable outcome, recognizing the Filipino cultural background, the patient made comfortable, and their family supported to understand the change of direction in approach are essential parts of the nurses’ caring decisions.

Psychological adjustment to death anxiety: a qualitative study of Chinese patients with advanced cancer

ObjectivesDeath anxiety (DA) refers to the negative emotions experienced when a person reflects on the inevitability of their own death, which is common among patients with cancer. It is crucial...

Ontological basis of the creative accounting phenomenon as a financial misstatement

PurposeThis article aims to contribute to the accounting knowledge literature by presenting the framework of creative accounting factors and evaluating their identified factors through an argumentation-based total interpretive structural modeling (TISM) approach.Design/methodology/approachThis study adopted mixed, inductive and deductive approaches to develop an integrated framework, validate its practicability and verify its effectiveness in selected manufacturing firms listed on the Tehran Stock Exchange (TSE), respectively. In developing the framework and implementation procedure, the study employed an exploratory data collection (qualitative) approach to review the phenomenon of creative accounting factors. Then, in this study’s second phase, TISM is used to develop the framework of creative accounting design. This study used two types of theoretical sampling in the qualitative part, including theoretical and snowball sampling. Also, the participants in the TISM process in this study were specialized analysts of the TSE.FindingsBased on the mixed method of this study, the result in the qualitative part provides the creative accounting framework of the existence of three categories. There are 6 components and 35 themes during 12 interviews. In the quantitative section, it was determined that two factors, namely the type of ownership firms and intrinsic objectivity, are the most effective drivers for the formation of creative accounting in TSE firms.Originality/valueSo far, it is rare to find preceding studies that have proposed, validated and practically tested an integrated creative accounting framework within the context of financial markets. Thus, the authors understand that this is the very first research focused on the development of a framework for capital market companies to continuously be competitive and could help financial decision-makers, practitioners and academicians in their perception of knowing more about the financial functions of firms.

Experience of Clinical Adaptation among Nurses in Intensive Care Unit

Purpose : This study aimed to explore and describe intensive care unit (ICU) nurses’ experience of clinical adaptation.Methods : The participants were 14 ICU nurses with more than two years of working experience in the ICU. Data were collected through in-depth individual interviews conducted between July and October 2021. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using the Strauss and Corbin method.Results : A total of 79 concepts, 37 subcategories, and 16 categories were identified through open coding. Axial coding based on the paradigm model revealed that the central phenomenon was “The harsh adversity faced in the nursing field where life and death are determined” and the core category was “Enduring the adversity of caring for critically ill patients and achieving self-realization.” ICU nurses’ clinical adaptation process was explained in five phases: “confrontation period,” “turbulent period,” “seeking period,” “struggling period,” and “stabilized period.” The five phases that affect interventional conditions were “Support from reliable people,” “Recognition of administrative and financial support.”Conclusion : This study provided novel insights for a comprehensive understanding of ICU nurses’ clinical adaptation processes. Furthermore, the findings are expected to be used as basic data to develop multifaceted strategies to help ICU nurses’ adaptation to critical care.

Cultural Heritage Service Design and Experience Innovation: A Case Study of Taiwan

This paper delves into the evolving landscape of community engagement, exploring innovative methods to enhance the involvement and awareness of young individuals. Employing a comprehensive content analysis through a multiple case study approach, this research investigates cultural heritage initiatives in Taiwan, emphasizing the pivotal role of technology and digital platforms in engaging young audiences. The study utilizes theoretical sampling and triangulation methods, incorporating semi-structured interviews, secondary sources, and participant observation. The findings underscore the significance of digital experiences as supplements to physical presence, offering a gateway to cultural heritage. The practical implications advocate for heritage sites to leverage digital platforms, collaborating with external partners to enrich visitor experiences. The paper furnishes valuable recommendations for enhancing customer engagement and communication with the younger demographic, contributing to the field of cultural heritage in Asia. This research marks a transition from physical to online service design, harnessing technology to inspire and engage, ultimately attracting diverse generations and retaining the interest of existing visitors.

How palliative care professionals develop coping competence through their career: A grounded theory

Background: Palliative care professionals face emotional challenges when caring for patients with serious advanced diseases. Coping skills are essential for working in palliative care. Several types of coping strategies are mentioned in the literature as protective. However, little is known about how coping skills are developed throughout a professional career. Aim: To develop an explanatory model of coping for palliative care professionals throughout their professional career. Design: A grounded theory study. Two researchers conducted constant comparative analysis of interviews. Setting/participants: Palliative care nurses and physicians across nine services from Spain and Portugal (n = 21). Theoretical sampling included professionals who had not continued working in palliative care. Results: Professionals develop their coping mechanisms in an iterative five-stage process. Although these are successive stages, each one can be revisited later. First: commencing with a very positive outlook and emotion, characterized by contention. Second: recognizing one’s own vulnerability and experiencing the need to disconnect. Third: proactively managing emotions with the support of workmates. Fourth: cultivating an integrative approach to care and understanding one’s own limitations. Fifth: grounding care on inner balance and a transcendent perspective. This is a transformative process in which clinical cases, teamwork, and selfcare are key factors. Through this process, the sensations of feeling overwhelmed sometimes can be reversed because the professional has come to understand how to care for themselves. Conclusions: The explicative model presents a pathway for personal and professional growth, by accumulating strategies that modulate emotional responses and encourage an ongoing passion for work.

A grounded theory of the implementation of medical orders by clinical nurses

ObjectiveTo 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.BackgroundThe 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.MethodThis 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.FindingsThe 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.ConclusionAlleviating 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.