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1.  Ethical challenges of researchers in qualitative studies: the necessity to develop a specific guideline 
Considering the nature of qualitative studies, the interaction between researchers and participants can be ethically challenging for the former, as they are personally involved in different stages of the study. Therefore, formulation of specific ethical guidelines in this respect seems to be essential. The present paper aimed to discuss the necessity to develop explicit guidelines for conducting qualitative studies with regard to the researchers’ role. For this purpose, a literature review was carried out in domestic and international databases by related keywords.
Health care providers who carry out qualitative research have an immense responsibility. As there is no statistical analysis in qualitative studies, the researcher has to both evaluate what he or she observes and to interpret it. Providing researchers with the necessary skills and applying stringent supervision can lead to better extraction of reliable information from qualitative studies. This article presents a debate in order to illustrate how researchers could cover the ethical challenges of qualitative studies and provide applicable and trustworthy outcomes.
Researchers face ethical challenges in all stages of the study, from designing to reporting. These include anonymity, confidentiality, informed consent, researchers’ potential impact on the participants and vice versa. It seems of paramount importance that health care providers, educators and clinicians be well informed of all the different aspects of their roles when acting as qualitative researchers. Hence, these adroit roles need to be well defined, and the use of practical guidelines and protocols in all stages of qualitative studies should be encouraged.
PMCID: PMC4263394  PMID: 25512833
qualitative research; ethical challenges; researcher’s role; guideline
2.  Education and implementing evidence-based nursing practice for diabetic patients 
Background:
Foot ulceration is one of the most common complications associated with diabetes that needs to be managed. In Iran, prevalence of diabetes foot ulcer is 3%. According to studies, evidence-based nursing (EBN) is an effective alternative to facilitate clinical decision making in patient care and may lead to quality improvement in nursing practice. The aims of this study are to assess the effects of EBN education on the knowledge, attitude, and practice of nurses who take care of patient with diabetes foot ulcer.
Materials and Methods:
A quasi-experimental study (based on IOWA model as a framework to improve nursing practice) was conducted using a before-and-after design. All of nurses (consisted of 19 baccalaureate nurses) who are working in an endocrinology ward were chosen and taught using EBN approach through different workshops. Before and after educational intervention, the data about nurses’ knowledge, attitude, and practice were gathered by questionnaire and then compared. The nurses’ performance in patient care was evaluated in 3 months by one checklist. The data were analyzed using descriptive and inferential statistics.
Results:
There were statistically significant differences in knowledge, attitude, and practice of nurses before and after intervention (P = 0.001). The nurses’ performance in caring for patient with diabetes foot ulcer, based on clinical guideline, showed the improvement in clinical practice.
Conclusion:
Education of EBN can improve the nurse's knowledge and attitude to EBN, and be used as a basis on which to influence the professional practice of nursing.
PMCID: PMC3748547  PMID: 23983764
Clinical nursing; diabetes foot ulcer; evidence-based nursing practice; IOWA model of evidence based practice; Iran
3.  Ambiguity in knowledge transfer: The role of theory-practice gap 
BACKGROUND:
In spite of much literature written about the theory-practice gap in the international nursing journals, there is evidence that indicates this subject has not been probed comprehensively since nursing education was transferred to universities in Iran. In the recent years, the public and the government have criticized Iranian nurses because of poor quality of patient care. Although this subject has been lamented by some researchers, there is no comprehensive work on how this gap resulted. In the process of a larger study on “nursing knowledge translation to practice”, of one PhD thesis, this process was explored.
METHODS:
Using grounded theory analysis, indepth interviews were undertaken with a purposive sample of 29 nurses, with different levels of experience, from the school of nursing in Tehran University of Medical Sciences in 2006 from January to August. Data were analyzed using the constant comparative method.
RESULTS:
Three main themes emerging from this study included clinical behavior structure, paradoxical knowledge and practice, and divergent nursing organization.
CONCLUSIONS:
It seems that nursing education with some praxis and paradoxes in the realm of nursing knowledge and practice, along with divergent organizational structure have decreased nurses’ ability in applying their professional knowledge and skills in order to bridge the gap between theory and practice. Moreover, in spite of increased academic input into nursing education, clinical behaviors of both education and practice settings was perceived as “traditional routine-based”.
PMCID: PMC3093182  PMID: 21589789
Iran; nursing; qualitative research; nursing theory; knowledge
4.  A meta-synthesis study of literature review and systematic review published in nurse prescribing 
Background: Prescribing represents a new aspect of practice for nurses. To make qualitative results more accessible to clinicians, researchers, and policy makers, individuals are urged to synthesize findings from related studies. Therefore this study aimed to aggregate and interpret existing literature review and systematic studies to obtain new insights on nurse prescription.
Methods: This was a qualitative meta synthesis study using Walsh and Downe process. In order to obtain data all Digital National Library of Medicine's databases, search engines and several related sites were used. Full texts with "review and nurs* prescri* " words in the title or abstract in English language and published without any time limitation were considered. After eliminating duplicate and irrelevant studies, 11 texts were selected. Data analysis was conducted using qualitative content analysis. Multiple codes were compared based on the differences and similarities and divided to the categories and themes.
Results: The results from the meta synthesis of the 11 studies revealed 8 themes namely: leading countries in prescribing, views, features, infrastructures, benefits, disadvantages, facilitators and barriers of nursing prescription that are discussed in this article. The results led to a schematic model.
Conclusion: Despite the positive view on nurse prescribing, there are still issues such as legal, administrative, weak research and educational deficiencies in academic preparation of nurses that needs more effort in these areas and requires further research.
PMCID: PMC4219909  PMID: 25405142
Nurse prescribing; Meta-synthesis; Review
5.  Nurses’ policy influence: A concept analysis 
Background:
Nurses’ influence on health policy protects the quality of care by access to required recourses and opportunities. This is a new and important concept for nursing; however, research studies on policy influence of nurses in health care sector are lacking a basic conceptual understanding of what this concept represents. The aim of this paper is to clarify the concept of nurses’ policy influence and to propose the definition of this concept, considering the context of Iran.
Materials and Methods:
The eight stages of Walker and Avant approach was used to guide this concept analysis. Various databases and internet engines were searched to find all related information about the concept. Textbooks were also searched manually. English language literature reports published between 1990 and 2012 were reviewed.
Results:
Based on the analysis undertaken, nurses’ policy influence is nurses’ ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses’ job environment and increases patient outcomes. This is a dynamic process situated on a spectrum and is accompanied with nurses’ knowledge, competency, power, and advocacy, and also their ability to change.
Conclusions:
Nurses have individual views on health care issues and influence health care policies in different ways. With a common understanding of nurses’ policy influence as a concept, nurses will recognize the importance of policy making in the health sector and their influence on this process and also on patients’ outcomes.
PMCID: PMC4061635  PMID: 24949073
Advocacy; concept analysis; health policy; influence; Iran; politics; power
6.  Nursing professionalism: An evolutionary concept analysis 
Background:
Professionalism is an important feature of the professional jobs. Dynamic nature and the various interpretations of this term lead to multiple definitions of this concept. The aim of this paper is to identify the core attributes of the nursing professionalism.
Materials and Methods:
We followed Rodgers’ evolutionary method of concept analysis. Texts published in scientific databases about nursing professionalism between 1980 and 2011 were assessed. After applying the selection criteria, the final sample consisting of 4 books and 213 articles was selected, examined, and analyzed in depth. Two experts checked the process of analysis and monitored and reviewed them.
Results:
The analysis showed that nursing professionalism is determined by three attributes of cognitive, attitudinal, and psychomotor. In addition, the most important antecedents concepts were demographic, experiential, educational, environmental, and attitudinal factors.
Conclusion:
Nursing professionalism is an inevitable, complex, varied, and dynamic process. In this study, the importance, scope, and concept of professionalism in nursing, the concept of a beginning for further research and development, and expanding the nursing knowledge are explained and clarified.
PMCID: PMC3917177  PMID: 24554953
Analysis; concept; Iran; nursing; professional
7.  Medication errors of nurses in the emergency department 
Patient safety is one of the main concepts in the field of healthcare provision and a major component of health services quality. One of the important stages in promotion of the safety level of patients is identification of medication errors and their causes. Medical errors such as medication errors are the most prevalent errors that threaten health and are a global problem. Execution of medication orders is an important part of the treatment and care process and is regarded as the main part of the nurses’ performance. The purpose of this study was to explore the medication error reporting rate, error types and their causes among nurses in the emergency department.
In this descriptive study, 94 nurses of the emergency department of Imam Khomeini Hospital Complex were selected based on census in 2010–2011. Data collection tool was a researcher-made questionnaire consisting of two parts: demographic information, and types and causes of medication errors. After confirming content-face validity, reliability of the questionnaire was determined to be 0.91 using Cronbach’s alpha test. Data analyses were performed by descriptive statistics and inferential statistics. SPSS-16 software was used in this study and P values less than 0.05 were considered significant.
The mean age of the nurses was 27.7 ± 3.4 years, and their working experience was 7.3 ± 3.4 years. Of participants 46.8% had committed medication errors in the past year, and the majority (69.04%) had committed the errors only once. Thirty two nurses (72.7%) had not reported medication errors to head nurses or the nursing office. The most prevalent types of medication errors were related to infusion rates (33.3%) and administering two doses of medicine instead of one (23.8%). The most important causes of medication errors were shortage of nurses (47.6%) and lack of sufficient pharmacological information (30.9%).
This study showed that the risk of medication errors among nurses is high and medication errors are a major problem of nursing in the emergency department. We recommend increasing the number of nurses, adjusting the workload of the nursing staff in the emergency department, retraining courses to improve the staff’s pharmacological information, modification of the education process, encouraging nurses to report medical errors and encouraging hospital managers to respond to errors in a constructive manner in order to enhance patient safety
PMCID: PMC3885144  PMID: 24427488
medication errors; nurse; patient safety; emergency department
8.  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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