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1.  Factors Influencing Communication Between the Patients with Cancer and their Nurses in Oncology Wards 
Aims:
The purpose of this study was to demonstrate the factors influencing nurse-patient communication in cancer care in Iran.
Materials and Methods:
This study was conducted with a qualitative conventional content analysis approach in oncology wards of hospitals in Tabriz. Data was collected through purposive sampling by semi-structured deep interviews with nine patients, three family members and five nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control.
Results:
The main theme of the research emerged as “three-factor effects” that demonstrates all the factors related to the patient, nurse, and the organization and includes three categories of “Patient as the center of communication”, “Nurse as a human factor”, and “Organizational structures”. The first category consists of two sub-categories of “Imposed changes by the disease” and the “patient's particular characteristics”. The second category includes sub-categories of “sense of vulnerability” and “perception of professional self: Pre-requisite of patient-centered communication”. The third category consists of the sub-categories of “workload and time imbalance”, “lack of supervision”, and “impose duties in context of neglecting nurse and patient needs”. Characteristics of the patients, nurses, and care environment seemed to be the influential factors on the communication.
Conclusions:
In order to communicate with cancer patients effectively, changes in philosophy and culture of the care environment are essential. Nurses must receive proper trainings which meet their needs and which focus on holistic and patient-centered approach.
doi:10.4103/0973-1075.125549
PMCID: PMC3931236  PMID: 24600177
Cancer; Effective factors; Nurse-patient communication; Oncology
2.  Effect of telenursing (telephone follow-up) on glycemic control and body mass index (BMI) of type 2 diabetes patients 
Background:
Telenursing includes every nursing and care-giving services conducted remotely. In telenursing, telephone as a device, which is available for most of the people, is being used increasingly. In a telephone-based system, patients are being contacted by health care providers on regular bases and they would be provided with some information about their illness and their treatment method.
This study was conducted to determine the effect of phone-based follow-ups on diabetes patients’ metabolic control in the city of Kerman in Iran.
Materials and Methods:
This is a quasi-experimental study conducted on 50 type II diabetes patients in Kerman during 2011. Data were collected using a demographic questionnaire and also by taking physiological measurement of fasting blood suger (FBS), Glycated Hemoglobin (HbA1c), and postprandial glucose (PPG). Participants’ body mass index (BMI) was calculated by measuring height and weight. Patients completed the questionnaire at the beginning of the study and 12 weeks later. The patients were randomly divided into two groups of experiment and control. Patients in the experimental group received phone calls by the researcher for 12 weeks, and the follow-ups included instructions on self-care and advices to follow their diets, exercise, and insulin titration.
Data analysis was done using descriptive and inferential statistical methods (chi-square, analysis of variance [ANOVA], independent t-test, and paired t-test).
Results:
The decrease of HbA1c and PPG was significantly more in the intervention group compared with the controls (P < 0.001). However, there was no significant difference between the mean of FBS (P = 0.42), and BMI (P = 0.31) in both groups after the intervention.
Conclusions:
According to the results of this study, telenursing was able to improve the metabolic indices of the patients. Therefore, using this method is recommended for patients with type II diabetes.
PMCID: PMC3917127  PMID: 24554942
Body mass index; diabetes mellitus Type II; Iran; metabolic control; telenursing
3.  Lived experiences of pediatric oncology nurses in Iran 
Background:
Caring is a valuable task. The staff in any profession that involves patients’ fear, anxiety, pain, and suffering may experience similar feelings. As a professional group, oncology nurses deal with patients and their relatives and caregivers under very stressful conditions. They encounter pain, suffering, and death as a part of their daily life. A number of studies have evaluated the experiences of pediatric oncology nurses in other countries. Therefore, conducting a survey about the experiences of Iranian nurses of caring for children with cancer can reveal their demands, stress, and limitations.
Materials and Methods:
In a qualitative research, in-depth, unstructured individual interviews with open-ended questions were conducted to evaluate the experiences of pediatric oncology nurses in a hospital in a metropolitan city of Iran. The subjects all consented to participate and had at least one year of working experience in the ward. Content analysis was performed to analyze the data.
Results:
The lived experiences of pediatric oncology nurses were categorized in five main themes. These themes included attachment, supportive care, trying to repress feelings, feeling of helplessness, and the need to be supported.
Conclusions:
According to these results, nurses who provide care for children with cancer require support. This research also highlighted the roles, limitations, and needs of nurses in pediatric oncology wards.
PMCID: PMC3877455  PMID: 24403935
Iran; lived experiences; pediatric oncology nursing qualitative research
4.  The outcomes of health care process in Iran's rural society 
Background:
Health care systems in rural areas face numerous challenges in meeting the community's needs and adequate attention has not been paid to this problem. The aim of this study was to describe the outcomes of health care process in rural society.
Materials and Methods:
Twenty-six participants including twenty-one rural health care providers and five clients were selected according to purposive sampling. The data were collected via semi-structured individual interviews and a mini focus group. Data were analyzed by using qualitative content analysis based on methods described by Granheme and Landman.
Results:
Data analysis eventually led to formation of one category of inefficiency in health care process in rural society including subcategories such as arbitrary self-therapy, slow care process, dissatisfaction with the care process, superficial caring, job stress and burn out of caregivers, and ineffective caring relationship.
Conclusion:
Outcomes in health care in rural society of Iran represents inefficiency of the current health care process. These outcomes are related to the cultural and social context of rural communities and the structure of the health system. These outcomes in health care in the rural society of Iran represent impairment of the current health care process. The necessity of modifying the existing care trend with new models designed to improve the health care process is felt.
PMCID: PMC3877461  PMID: 24403941
Health care; Iran; manifestations of inefficiency; outcomes; rural community
5.  Nursing students’ understanding of factors influencing ethical sensitivity: A qualitative study 
Background:
Ethical sensitivity is considered as a component of professional competency of nurses. Its effects on improvement of nurses’ ethical performance and the therapeutic relationship between nurses and patients have been reported. However, very limited studies have evaluated ethical sensitivity. Since no previous Iranian research has been conducted in this regard, the present study aimed to review nursing students’ understanding of effective factors on ethical sensitivity.
Materials and Methods:
This qualitative study was performed in Kerman, Iran, during 2009. It used semi-structured individual interviews with eight MSc nursing students to assess their viewpoints. It also included two focus groups. Purposive sampling was continued until data saturation. Data were analyzed using manifest content analysis.
Results:
The students’ understanding of factors influencing ethical sensitivity were summarized in five main themes including individual and spiritual characteristics, education, mutual understanding, internal and external controls, and experience of an immoral act.
Conclusions:
The findings of this study create a unique framework for sensitization of nurses in professional performance. The application of these factors in human resource management is reinforcement of positive aspects and decrease in negative aspects, in education can use for educational objectives setting, and in research can designing studies based on this framework and making related tools. It is noteworthy that presented classification was influenced by students themselves and mentioned to a kind of learning activity by them.
PMCID: PMC3872867  PMID: 24403928
Nursing students; professional ethics; qualitative research
6.  Teamwork improvement in emergency trauma departments 
Background:
Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments.
Materials and Methods:
Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis.
Results:
Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals
Conclusions:
Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork.
PMCID: PMC3872871  PMID: 24403932
Emergency hospital services; interprofessional relations; Iran; nurse; patient care team; physician–nurse relations; qualitative research; quality improvement; trauma centers
7.  Nursing ethical values and definitions: A literature review 
Background:
Ethical values offer a framework for behavior assessment, and nursing values influence nurses’ goals, strategies, and actions. A literature review was adopted in order to determine and define ethical values for nurses.
Materials and Methods:
This literature review was conducted based on the Centre for Reviews and Dissemination guidelines. The key words used to search relevant sources were nursing, ethics, ethical values, and nursing values. The search of articles in English was carried out in Medline, CINAHL, PubMed, Scopus, Ovid, and Proquest databases. The search of articles in Persian was conducted in databases of Magiran, SID, and Irandoc publications. After assessing and analyzing the obtained data, 17 articles which had a distinct definition of ethical values were chosen and subjected to a thorough study.
Results:
The search yielded 10 nursing ethical values: Human dignity, privacy, justice, autonomy in decision making, precision and accuracy in caring, commitment, human relationship, sympathy, honesty, and individual and professional competency.
Conclusions:
This study showed that common ethical values are generally shared within the global community. However, in several areas, influences of social, cultural, and economical status and religious beliefs on values result in a different definition of these values. This study revealed that based on humanistic nature of nursing, common values in nursing protect human dignity and respect to the patients. Recognizing and definition of ethical values can help to improve nursing practice and develop codes of ethics.
PMCID: PMC3748548  PMID: 23983720
Ethics; literature review; nursing; professional values; values
8.  Iranian Nurses' Attitudes and Perception towards Patient Advocacy 
ISRN Nursing  2012;2012:645828.
Patient advocacy is an inherent component of professional nursing ethics; in other words, nurses' enough knowledge would be essential to gain a positive attitude towards nursing advocacy. Using a descriptive-analytic design, this study aimed to assess the correlation between nurses' perception and attitudes towards patient advocacy, amongst 385 nurses in Kerman, Iran; hence, a three-part questionnaire was applied: part I, a demographic data sheet, part II, attitude measuring instrument, and part III, perception measuring instrument in nursing advocacy. The results implied that fairly positive attitudes and perception were found amongst the participants, and nurses' attitudes, in general, were positively correlated to their perception toward nursing advocacy. This means that with an improvement in perception, the attitude would also improve. In addition to our findings, it seems that these nurses needed more advocacy educational programs and support from responsible employers.
doi:10.5402/2012/645828
PMCID: PMC3544248  PMID: 23326680
9.  Nurses’ perception of ethical climate and job satisfaction 
The high turnover of nurses has become a universal issue. The manner in which nurses view their organization’s ethical climate has direct bearing on their job satisfaction. There is little empirical evidence confirming a relationship between different sorts of ethical climate within organizations and job satisfaction in Iran.
The aim of this study was to determine the correlation between nurses’ perception of ethical climate and job satisfaction in the Teaching Hospital of Kerman University of Medical Sciences.
A descriptive analytical design was used in this study. The sample consisted of 275 nurses working in 4 hospitals affiliated with the Kerman University of Medical Sciences. The instruments used in this study included a demographic questionnaire, Ethical Climate Questionnaire (ECQ), and Job Satisfaction Scale (JS). Data analysis was carried out using Pearson’s correlation, one-way ANOVA, T-test and descriptive statistic through Statistical Package for Social Science (SPSS), version 16.
Across the five dimensions of ECQ the highest mean score pertained to professionalism (mean = 13.45±3.68), followed by rules climate (mean = 13.41±4.01), caring climate (mean = 12.92±3.95), independence climate (mean = 11.35±3.88), and instrumental climate (mean = 8.93±2.95). The results showed a positive correlation among ethical climate type of: professionalism (p=0.001), rules (p=0.045), caring (p=0.000), independence (p=0.000) with job satisfaction, and no correlation was found between instrumental climate and job satisfaction.
The result of this research indicated a positive correlation among professionalism, caring, rules, independence climate and job satisfaction. Therefore managers of hospitals can promote nurses’ job satisfaction by providing ethics training programs that establish a working team and a culture that strengthens team spirit among nurses.
PMCID: PMC3714120  PMID: 23908759
Ethical climate; Job satisfaction; Nurses
10.  A comparative study on effect of e-learning and instructor-led methods on nurses’ documentation competency 
BACKGROUND:
Accurate recording of the nursing care indicates the care performance and its quality, so that, any failure in documentation can be a reason for inadequate patient care. Therefore, improving nurses’ skills in this field using effective educational methods is of high importance. Since traditional teaching methods are not suitable for communities with rapid knowledge expansion and constant changes, e-learning methods can be a viable alternative. To show the importance of e-learning methods on nurses’ care reporting skills, this study was performed to compare the e-learning methods with the traditional instructor-led methods.
METHODS:
This was a quasi-experimental study aimed to compare the effect of two teaching methods (e-learning and lecture) on nursing documentation and examine the differences in acquiring competency on documentation between nurses who participated in the e-learning (n = 30) and nurses in a lecture group (n = 31).
RESULTS:
The results of the present study indicated that statistically there was no significant difference between the two groups. The findings also revealed that statistically there was no significant correlation between the two groups toward demographic variables. However, we believe that due to benefits of e-learning against traditional instructor-led method, and according to their equal effect on nurses’ documentation competency, it can be a qualified substitute for traditional instructor-led method.
CONCLUSIONS:
E-learning as a student-centered method as well as lecture method equally promote competency of the nurses on documentation. Therefore, e-learning can be used to facilitate the implementation of nursing educational programs.
PMCID: PMC3249805  PMID: 22224113
Knowledge; attitude; practice; nursing documentation; lectures; e-learning
11.  The effects of regular breathing exercise and making bubbles on the pain of catheter insertion in school age children 
BACKGROUND:
Treatment procedures are the most common sources of pain in children. Children with chronic diseases such as thalassemia experience many pains during painful procedures including at times of diagnosis, treatment and control of their disease. Several methods have been reported to reduce pain. Clinical professionals usually use distraction techniques to reduce pain. However, there is no agreement between them that which distraction technique is better for reducing pain. The aim of this study was omparing the effects of regular breathing exercise and making bubbles on the pain of catheter insertion in school age children.
METHODS:
This was a clinical trial on 60 children in the age range of 6 to 12 years, who were suffering from thalassemia and had a file in the Center for Thalassemia. Participants were randomly divided into two groups of experiment and control. Bubble making was performed for the first group and regular breathing exercise was performed for the second group. Data were collected using a demographic questionnaire, a scale for pediatric pain behavioral symptoms and Numeric Pain Rating Scale. Data were analyzed using descriptive (frequency, mean and standard deviation) and inferential statistics (ANOVA, Kruskal Wallis, and Mann Whitney U tests and Spearman correlation).
RESULTS:
The mean pain score based on the numerical scale was 5.60 ± 3.13 in the control group, 1.60 ± 1.75 in the bubble-making group and 1.85 ± 1.42 in the breathing exercise group. The mean score of behavioral pain symptoms was 3.80 ± 2.80 in the control group, 1.15 ± 1.13 in the bubble-making group, and 0.96 ± 0.75 in the breathing exercise group. Results showed a significant difference in the mean pain scores (based on numeric scale and pain behavior scale) between the control group and other groups after the injection, but the difference in the mean pain scores between the two groups of experiment after the injection was not significant.
CONCLUSIONS:
According to the results of this study, both distraction methods of regular breathing exercise and bubble-making can reduce the pain of catheter insertion in children and since there was no difference between their effects, they can be used based on the individual child's interest.
PMCID: PMC3249769  PMID: 22224103
Pain; thalassemia; distraction; school-age children
12.  Effects of health belief model-based video training about risk factors on knowledge and attitude of myocardial infarction patients after discharge 
BACKGROUND:
Ischemic heart diseases are the most common cardiovascular diseases. This study aimed to assess the effects of video training about risk factors based on health belief model on knowledge and attitude of myocardial infarction patients after discharge.
METHODS:
This was a quasi-experimental study conducted in 2010. Eighty patients were randomly assigned to either intervention or control group. Data was collected by a researcher-made questionnaire.
RESULTS:
Study results showed that the mean score of knowledge about disease, diet, physical activity and perceived benefit, severity, and susceptibility after video training was increased significantly.
CONCLUSIONS:
Using videos for educating myocardial infarction patients is a useful method for preventing recurrence of the disease.
PMCID: PMC3214303  PMID: 22091231
Video Recording; Myocardial Infarction; Models; Psychological
13.  Professional Ethical Competence in nursing: the role of nursing instructors 
Teaching ethics to nurses leads to their involvement in providing high quality care, enable them to duly encounter ethical issues. One of the key elements of educational systems is nursing instructors. Even though lots of studies show the role of instructors in students’ learning, their role in promotion of professional ethics has been attended to less.
The objective of this study is surveying the experience of nursing students with respect to the role of instructors in promotion of professional ethics.
This qualitative study enrolled 15 undergraduate nursing students from three nursing schools in Teheran whom depth interview was performed. The interview was semi-structured with open ended questions. The analysis was accomplished by use of qualitative content-analysis method.
Data analysis demonstrated 2 main themes and 7 subcategories in regard to the role of instructors in promotion of professional ethics in nursing students including: 1) the effective professional role model 2) facilitating creative learning. The effective professional role model encompasses individual characteristics and beliefs, clinical skills and professional commitment of role model. Creative learning facilitates by encouraging critical thinking and decision-making, Providing supportive learning conditions, providing proper space for sharing knowledge followed by evaluation and creative feedback.
The findings of this study provides a background for strengthening the role of instructors in promotion of professional ethics with more emphasis on research which increase capability of instructors at nursing education centers.
PMCID: PMC3714123  PMID: 23908738
Nursing; Nursing student; Ethics
14.  Compatibility of personality and major among freshman undergraduate nursing students of the Kerman University of Medical Sciences 
BACKGROUND:
Personality traits are major effective factors on student’s learning, educational achievements and employer’s job satisfaction. Metacognitive characteristics such as personality are only changeable up to 30% in the best educational condition. Therefore, students should be evaluated for such characteristics including their personality compatibility with their major. The present study investigated the personality compatibility of freshman undergraduate nursing students of the Kerman University of Medical Sciences in 2008 with nursing profession.
METHODS:
This was a descriptive study using a standard questionnaire based on Holland’s career and personality theory on 82 freshman nursing students of Kerman University of Medical Sciences in 2008. Data were analyzed using SPSS software.
RESULTS:
More than 50% of the participants evaluated their information of nursing profession average. The personality of 41.3% was not compatible with nursing profession and the personality of 26.2% was relatively compatible. Only 32.5% of the participants had completely compatible personalities with this profession.
CONCLUSIONS:
Considering the limitations of the present study and previous studies, further studies are recommended. It seems that students’ knowledge of majors and careers are increasing, but it is necessary to plan and make more effort to recognize personal characteristics and personality compatibility with professions. Knowledge of professions and personalities along with each other are valuable and neglecting one would be an obstacle to achieve goals including decreasing job resignation, increasing job efficiency and satisfaction.
PMCID: PMC3093179  PMID: 21589786
Personality; nursing students; professional role
15.  Caring for People at the End of Life: Iranian Oncology Nurses' Experiences 
Indian Journal of Palliative Care  2009;15(2):141-147.
Aim:
To explore the meaning of Iranian oncology nurses' experiences of caring for people at the end of life.
Materials and Methods:
A phenomenological hermeneutic approach was applied. Fifteen nurses working in oncology units were interviewed in 2007 regarding their experiences of caring for people at the end of life.
Results:
Participants experienced caring for people at the end of life as sharing space and time to be lost within an organizational context. This main theme was divided into three subthemes including being attentive to the dying persons and their families, being cared for by the dying persons and their families, and being faced with barriers.
Conclusion:
The study suggests that the nurses' success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.
doi:10.4103/0973-1075.58461
PMCID: PMC2902116  PMID: 20668594
Caring for dying people; Lived experience; Iran; Oncology nurses; Palliative care

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