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1.  Patient Dignity in Coronary Care: Psychometrics of the Persian Version of the Patient Dignity Inventory 
Aim
The Patient Dignity Inventory (PDI) is a valid and reliable questionnaire. This questionnaire was created by Chochinov in 2002 and is used to measure various sources of distress related to the dignity of patients. The present study investigated the characteristics of items, reliability and validity measurements, and the application of the PDI for Persian-speaking cardiac patients.
Place and Duration of Study
The study was performed in Kerman, Iran in 2014.
Methodology
The PDI was translated into Persian. Then, it was distributed among 220 cardiac patients along with another 4 questionnaires related to anxiety, depression, hopelessness, and quality of life. Cronbach's coefficient alpha was calculated and principal component analysis and correlation analysis were performed. Construct validity was assessed using these validated questionnaires: the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), and SF-36 Health Survey.
Results
Factor analysis supported 4 dimensions, including the loss of human dignity, emotional distress and uncertainty, changes in ability and mental image, and loss of independence. The loading factors ranged between 0.5 and 0.83. The Cronbach's alpha of the questionnaire was high at 0.85, and those of the 4 dimensions were also high, ranging between 0.80 and 0.91. A desirable correlation was found between the Persian version of the Patient Dignity Inventory (PDI-P) and the 4 other questionnaires.
Conclusion
This tool can be useful in measuring coronary patients' dignity and the distress associated with dignity that these patients comprehend, and it can be used in Persian-speaking countries.
doi:10.9734/BJMMR/2015/16657
PMCID: PMC4456668  PMID: 26052504
Dignity; distress; patient dignity inventory; coronary care
2.  Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication 
Journal of Caring Sciences  2015;4(2):165-178.
Introduction: The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example.
Methods: We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). At the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity.
Results: From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items), informational support (seven items), emotional support (five items), problem solving (seven items), patient activation (10 items), intimacy/friendship (six items) and spirituality strengthening (14 items). Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93.
Conclusion: This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.
doi:10.15171/jcs.2015.017
PMCID: PMC4484991  PMID: 26161370
Cancer; Communication; Content validity; Data collection
3.  Experiences of patients with cancer and their nurses on the conditions of spiritual care and spiritual interventions in oncology units 
Background:
Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses’ and patients’ experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz.
Materials and Methods:
This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purposive sampling by conducting unstructured interviews with 10 patients and 7 nurses and analyzed simultaneously. Robustness of data analysis was evaluated by the participants and external control.
Results:
Three categories emerged from the study: (1) “perceived barriers for providing spiritual care” including “lack of preparation for spiritual care,” “time and space constraints,” “unprofessional view,” and “lack of support”; (2) “communication: A way for Strengthening spirituality despite the limitations” including “manifestation of spirituality in the appearances and communicative behaviors of nurses” and “communication: Transmission of spiritual energy”; and (3) “religion-related spiritual experiences” including “life events as divine will and divine exam,” “death as reincarnation,” “trust in God,” “prayer/recourse to Holy Imams,” and “acceptance of divine providence.” Although nurses had little skills in assessing and responding to the patients’ spiritual needs and did not have the organizational and clergymen's support in dealing with the spiritual distress of patients, they were the source of energy, joy, hope, and power for patients by showing empathy and compassion. The patients and nurses were using religious beliefs mentioned in Islam to strengthen the patients’ spiritual dimension.
Conclusions:
According to the results, integration of spiritual care in the curriculum of nursing is recommended. Patients and nurses can benefit from organizational and clergymen's support to cope with spiritual distress. Researchers should provide a framework for the development of effective spiritual interventions that are sensitive to cultural differences.
PMCID: PMC4325410  PMID: 25709687
Cancer; Iran; religion; spiritual interventions; spiritual care
4.  Factors Creating Trust in Hospitalized Children’s Mothers towards Nurses 
Iranian Journal of Pediatrics  2014;24(6):729-738.
Objective:
Trust is proposed as the necessary foundation to achieve better performance in the nursing of children. In this regard, Pediatric nurses need to achieve a deeper understanding of parents’ experiences, and find out how these experiences are being related to the nursing practice. So to increase nurses’ understanding of this concept based on the experiences of the recipients of nursing, the present study aims to express the factors that affect the formation of trust in mothers of hospitalized children towards the nurses.
Methods:
In this study, a qualitative design, conventional content analysis, was used. Pediatric Ward of hospitals in Yazd, Iran were the research environment. 14 mothers whose children were hospitalized in pediatric wards were selected through purposive sampling. They were deeply interviewed and data was analyzed with conventional content analysis.
Findings:
Data analysis led to emerging a major category “nurses’ attempt for professional nursing” which includes sub-categories of commitment and empathetic caring, skill in performing duties, mothers’ participation in the process of caring, being interested in pediatric nursing and establishing effective communication.
Conclusion:
Findings from the study showed that mothers know different factors involved in establishing confidence in nurses. Managers and people in charge in the field of nursing - regarding these findings - can design and perform necessary training programs to increase knowledge and skills for pediatric nursing, to win the trust of mothers and children in hospital for an effective step towards providing a better nursing care.
PMCID: PMC4442835  PMID: 26019779
Trust; Nurse; Commitment; Participation
5.  Nurses’ perspectives on breaking bad news to patients and their families: a qualitative content analysis 
Breaking bad news is quite often not done in an effective manner in clinical settings due to the medical staff lacking the skills necessary for speaking to patients and their families. Bad news is faced with similar reactions on the part of the news receiver in all cultures and nations. The purpose of this study was to explore the perspectives of Iranian nurses on breaking bad news to patients and their families. In this research, a qualitative approach was adopted. In-depth and semi-structured interviews were conducted with 19 nurses who had at least one year work experience in the ward, and content analysis was performed to analyze the data.
Five major categories emerged from data analysis, including effective communication with patients and their families, preparing the ground for delivering bad news, minimizing the negativity associated with the disease, passing the duty to physicians, and helping patients and their families make logical treatment decisions.
The results of this study show that according to the participants, it is the physicians’ duty to give bad news, but nurses play an important role in delivering bad news to patients and their companions and should therefore be trained in clinical and communicative skills to be able to give bad news in an appropriate and effective manner.
PMCID: PMC4263382  PMID: 25512837
nurses patients relationship; bad news; qualitative research
6.  Family and the Risky Behaviors of High School Students 
Background:
Family plays an important role in helping adolescent acquiring skills or strengthening their characters.
Objectives:
We aimed to evaluate the influences of family factors, risky and protective, on adolescent health-risk behavior (HRB).
Patients and Methods:
In this cross-sectional study, students of high schools in Kerman, Iran at all levels participated, during November 2011 till December 2011. The research sample included 1024 students (588 females and 436 males) aged 15 to 19 years. A CTC (Communities That Care Youth Survey) questionnaire was designed in order to collect the profile of the students’ risky behaviors. Stratified cluster sampling method was used to collect the data.
Results:
Using logistic regression, 7 variables enrolled; 4 of them were risk factors and 3 were protective factors. The risk factors were age, (linear effect, ORa = 1.20, P = 0.001), boys versus girls (ORa = 2.33, P = 0.001), family history of antisocial behavior (ORa = 2.29, P = 0.001), and parental attitudes favorable toward antisocial behavior (ORa = 1.72, P = 0.03). And, protective factors were family religiosity (ORa = 0.65, P = 0.001), father education (linear effect, ORa = 0.48, P = 0.001), and family attachment (ORa = 0.78, P = 0.001).
Conclusions:
Our findings showed that family has a very significant role in protecting students against risky behaviors. The education level of the father, family religiosity, and attachment were the most important factors.
doi:10.5812/ircmj.15931
PMCID: PMC4270667  PMID: 25558380
Parents; Risk; Health; Behaviors; Adolescent
7.  Factors Affecting the Nurse-Patients’ Family Communication in Intensive Care Unit of Kerman: a Qualitative Study 
Journal of Caring Sciences  2014;3(1):67-82.
Introduction: The communication between nurses and patients' families impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU.
Methods: This study is a qualitative study with content analysis. Participants were eight registered nurses and ten of patients’ families. Patients were admitted to the ICU of two large university hospitals in Kerman, Iran. We used non-structured interviews for data collection. All interviews were transcribed verbatim with a simultaneous, constant comparative analysis of the audio tapes.
Results: According to data analysis, facilitative factors between nurses and families' communication consisted of spiritual care, emotional support, Participation, notification and consultation and barriers that were misunderstandings regarding treatment, job and patient difficulties.
Conclusion: The findings led into the recognition of the important barriers and facilitators in communication between ICU team and the family of the patients. By identification of the barriers and facilitators of communication, establishing new rules and using creative methods in education and establishing the communication of ICU team especially using patient-based approach we can have effective communication.
doi:10.5681/jcs.2014.008
PMCID: PMC4134163  PMID: 25276750
Communication; Nurses; Family; Intensive Care Units; Qualitative Research
8.  The relationship between moral distress, professional stress, and intent to stay in the nursing profession 
Moral distress and professional stress are common problems that can have adverse effects on nurses, patients, and the healthcare system as a whole. Thus, this cross-sectional study aims to examine the relationship between moral distress, professional stress, and intent to stay in the nursing profession. Two hundred and twenty full-time nurses employed at teaching hospitals in the eastern regions of Iran were studied. A 52-item questionnaire based on Corley’s Moral Distress Scale, Wolfgang’s Health Professions Stress Inventory and Nedd Questionnaire on Intent to Stay in the Profession was used in the study. Additionally, demographic details of the study population were collected. No significant correlation was observed between the intensity and frequency of moral distress, professional stress, and intent to stay in the profession among nurses (P > 0.05). There was a significant correlation between moral distress, professional stress, and age, number of years in service and work setting (P < 0.05). Given the important effect of moral distress and professional stress on nurses, in addition to the educational programs for familiarization of nurses with these concepts, it is recommended that strategies be formulated by the healthcare system to increase nurses’ ability to combat their adverse effects.
PMCID: PMC4263391  PMID: 25512824
moral distress; professional stress; intent to stay; nursing profession; nursing ethics
9.  Living in a misty marsh: A qualitative study on the experiences of self-care suffering of patients with thalassemia 
Background:
Thalassemia major is the most common hereditary anemia in Iran. Thalassemia major patients require lifelong care and suffer much pain during self-care. Knowledge of the nature, meaning, and impact of suffering from the perspective of patients is needed to determine which interventions are helpful. This study was designed to understand the experience of suffering in patients with thalassemia.
Materials and Methods:
This was a qualitative study conducted with content analysis method. In the present study, 21 patients with thalassemia were selected by purposive sampling. The research was performed at Kerman Samen Alhojaj Medical Center, Iran, in 2013. Data collection method was conducting unstructured interviews using open-ended questions and field notes. In addition, data were analyzed using qualitative content analysis and conventional approach.
Results:
Data analysis resulted in the emergence of the four central categories of physical exhaustion, mental and spiritual restlessness, society's behaviors and beliefs, and surviving a hard life, which were the suffering themes of the patients.
Conclusions:
Results showed that thalassemia in the physical, psychological, social, and spiritual aspects is very stressful for patients. Moreover, culture plays an important role in the patients’ experience of suffering. Results of this study can help nurses improve nursing care to alleviate suffering based on these experiences.
PMCID: PMC4402994  PMID: 25949257
Qualitative research; suffering; self-care; thalassemia
10.  The Relationship between Students’ Bonding to School and Multiple Health Risk Behaviors among High School Students in South-East of Iran 
Iranian Journal of Public Health  2014;43(2):185-192.
Abstract
Background
School is the first social institution which affects adolescents’ lives, and it determines their opportunities, life quality and behavior. Thus, the aim of this study was to determine the relationship between students’ bonds with their school and multiple health risk behaviors amongst high school students in Kerman City, Iran.
Methods
In this cross-sectional study, high school students of all levels participated during November and December 2001 in Kerman. The research sample included 1024 students (588 females and 436 males) aged 15 to 19 years. A CTC (Communities That Care Youth Survey) questionnaire was designed based ona standard questionnaire in order to collect a profile of students’ risk behaviors. A multi-stage cluster sampling method was used to collect the data.
Results
In the final multivariate logistic regression, two variables including; age, (ORa=1.15, P=0.02) and male gender (ORa=2.14, P=0.001) had a significant positive association with multiple health risk behaviors (MHRB). School commitment (ORa=0.38, P=0.001) and school rewards for involvement (ORa=0.80, P=0.21), had a significant negative association with MHRB.
Conclusion
Our results quantified the pivotal role of schools in shaping the risky behavior of students. It seems that school may minimize the risky behaviors by creating a strong link, and improving the effective communications with students.
PMCID: PMC4450686  PMID: 26060742
Students’ bonding; Health risk behaviors; High school students
11.  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
12.  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
13.  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
14.  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
15.  Barriers of Referral System to Health Care Provision in Rural Societies in Iran 
Journal of Caring Sciences  2013;2(3):229-236.
Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran.
Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients) were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis.
Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found.
Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential.
doi:10.5681/jcs.2013.028
PMCID: PMC4134155  PMID: 25276731
Health care; Rural communities; Referral
16.  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
17.  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
18.  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
19.  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
20.  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
21.  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
22.  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
23.  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
24.  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
25.  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

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