فصلنامه مدیریت پرستاری
سال چهارم شماره 4 (پیاپی 16، زمستان 1394)

The importance of preserving life, maintaining patients’ health as well as supporting fair and ethical functions of health care worker call for determining legislations that clarify terms, responsibilities and obligations of physicians and nurses. Within the former Iran Penal Code physician was known as the absolute guarantor, contrary to the presumption of innocence. The new Penal Code (1392-2013) has allocated 4 material (158, 495, 496, and 497) to set up rules governing the work of physicians and nurses and their responsibilities. The absolute physician’s responsibilities have been degraded in the new Penal Code. For example, the clause 1 of Article 496, which is discussed in this article, nurse is recognized as the absolute guarantor in the case of patient harm resulting from physician errors that was done by informed nurses. Mandate expressed in the clause 1 of Article 496, may cause tensions, dereliction of medical orders by nurses, serious complications for patient's health and lead to job insecurity nursing profession. In this article, we discussed about clause 1 of Article 496 to understand it and recommend solutions for the future.

Employee learning and development are as an important key in the dynamics and effectiveness of any organization. Nurses as a great source of organizational knowledge and knowledge transfer can play a major role in the process of organizational learning. That would be facilitate by nurse managers.
Aim: This study was done for assessing relationship between levels of group and individual learning in clinical nurses'' organizational learning in Farabi Hospital in Tehran.
This was descriptive –analytical study that was done in (2013-2014) in Farabi hospital in Tehran. And all of clinical nurses (250) participated. Data gathered by standard questioner that had two domains: individual and group learning levels. Its reliability was (0.911) for individual domain and (0.904) for group domain that estimated by &alpha-Choronbach. All of data analyzed in SPSS19 by statistical descriptive tests.
findings showed that levels of two learning domains in nursing staff were average. So¡ the mean capability in individual learning was (65.78 ± 11.78) and in group learning was (43.56±8.12). Also¡ two domains in organizational learning had direct correlation (r= 0.556) based on Pearson correlation and linear regression showed that 31% learning in individual domain explained by group learning(R Square =0.31).
Nurse managers would be developed organization learning by developing group domain learning because it could be enhanced individual learning domain. So¡ it is suggested to them implement all of the in- service education by group strategies and develop these methods.

In order to reform in health system and downsizing and compensate employment in nursing¡ the 8th government outsourced the nursing services to private companies; but it wasn''t a successful policy in practice. Though study of obstacles could be useful for further activities of nurses.
Aim: Assessing the obstacles of outsourcing in nursing in teaching.
Method & Material: This study took place in 2013¡ which through it the cases was consisted whole nurses of two hospitals from total of three (n=71). Questioner was made of 40 items¡ (0/9) and validity assessed by faculty members and reliability computed by Alpha Cronbach (0. 90). The data was analyzed by SPSS and descriptive statistics and «Manwithney» test.
Nurse''s concern about job safety had the top score (%93). Lack of rules for improvision privatization (%90). prejudice between private session nurses and employees. Lack of planing (%37). Lack of supervision (%32) and execution (%31). Mentioned above¡ are the main factors for prevention of improvision in privatization.
with the obstacles ahead¡ to get matched with the main plicies of country¡ by providing logical concepts¡ must compensate the lack of compensation or it''s abscence for nurses¡ through the process of outsourcement; Specially job safety and ease of cooperation without discrimination of nurses

Shortage of professional nursing staff has become a serious challenge in our country so, retaining committed nurses is a competition between hospital managers and nurse managers.
Aim: This study was done to determine predictors of organizational commitment among nurses.
In this descriptive – correlational study, 400 questionnaires were distributed among nurses employed in 15 hospitals affiliated to Tehran University of Medical Sciences in Tehran, through multi-stage cluster sampling in 2012. Data collecting tools were, Linz’s organizational commitment questionnaire(2003), Alterman’s job satisfaction questionnaire(2007) and Niehoff and Moorman’s organizational justice scale(2005) .In this regard, validity, internal consistency coefficient were approved through content method and confirmed Cronbach’s Alpha, respectively(0.75, 0.77, 0.88). Data were analyzed using SPSS18 software by regression coefficient, stepwise regression and descriptive statistics (&alphaFindings: findings from multiple regression showed that job satisfaction and procedural justice explained 28 and 11 percent (totally 39 percent) of nurse's commitment variance respectively, which was statistically significant (P It is suggest to nurse managers and health-care managers for retaining committed nurses provide conditions for better satisfaction. And they promote organizational justice in nurse's perception by performance appraisal and feedback to nurses fairly in variety situations.

The common patient's complaints is the educational role of nurses. So, the health system should be used appropriately and dynamic management model that is aligned with the clinical audit cycle for planning and institutionalizing the educational role of nurses.
Aims: The purpose of this study was to institutionalization the educational role of nurses by Deming management cycle (PDCA) based on the patients satisfaction.
This study was an action research that was done with collaboration between nursing school and two teaching hospitals in Bojnord in one year (2013-2014). At first problem's patient education was identified by (5Whys) technique and then planning for solving those problems based on PDCA started. Based on the PDCA for assessing used forms and tools (eg., patient satisfaction, barrier identification form, SMOG formula and PEMAT). In implementation phase patient satisfaction from the training provided in 5 steps, barriers to patient education from nurse's and student's viewpoint in the 2 steps, patient's literacy levels in 500 patients before change and readability level of educational pamphlets before and after change according to the SMOG formula and PEMAT measured. The next step implemented changes based on past step identified problems and barriers. After change implemented, again patients satisfaction measured in five steps with (200) patients in each steps. Data were analyzed by SPSS 20 software and using statistical tests ANOVA and T-test.
The most important barriers from the nurse's and nurse manager's viewpoint was lack of knowledge of the principles of patient education and from the student's viewpoint was high level of pamphlet' contents. The mean level of patient's literacy (n=500) was (6.72 ± 4.34). Readability level pamphlets had significant difference before and after modification based on the SMOG formula and PEMAT so, the paired t-test was significant (p For changing in clinical education and learning, applying the Deming model suggest to nurse managers and educational managers in nursing, because it has direct effect on student's education and preparing them for adopting educational role in future. Also, clinical learning environments will be enrich that would be promoted faculty staff, clinical nurses competencies and the end improve patients satisfaction.

Quality of patient care is enhanced by effective communication between nurses and patients. One of the most important management practices to improve the quality of nursing care is applying nursing care delivery systems by nurse managers; especially by head nurses effectively.
Aim: This study was done for comparing the effectiveness of primary nursing care and case method on quality of nursepatient interaction in CCU.
Methods and materials: This study was a quasi-experimental study that was done in four CCU in two teaching in Mashhad in 2014. Two units for case method (n=26 patients) and two units for primary nursing (n=33patients) randomly selected. In implementation, at first all of the nurses trained with two nursing care delivery systems by workshops. And then, in primary system allocated (3) patients to primary nurse who was responsible to their discharge. In other shifts sh/he supervised him/her associate nurse. Also, in case method, head nurse allocate (3) patients to nurses in the shift, only they were here. All of the policies established thatwere needed by head nurse mutually. Both of two nursing care delivery systems implemented for (2) months. Data were gathered by standardized questioner QUAL PAC) Quality of patient care) that its reliability was measured by α-Chronbach (0.89). Data were analyzed by SPSS16 and statistical tests such as Mann-Whitney, 2 and others were used. Applying descriptive statistics (mean and standard deviation) and inferential statistics (Pearson moment correlation coefficient and stepwise multiple regression analysis) data were analyzed by SPSS16.
findings showed that there is a significant difference between two group (case method and primary nursing) in quality of interaction between nurses- patients (p In order to effectiveness primary nursing care in promotion in quality of interaction between nurse- patients, it is suggests to nurse managers that they apply its model in CCU.

Medication process has a significant impact in treatment of patients. This process includes four stages: Prescribing, Transcribing, Dispensing and Administration. Medication errors are minatory challenges for patient safety in all countries that can cause serious problems for patients.
Aim: This study has been conducted with the aim of review and classification of the literature related to medication errors and also identification of contributing factors in medication errors.
In the present study a systematic review of the literature related to medication process errors was conducted using the following databases: Embase, Medline, Pubmed. Inclusion criteria were that the studies assessed or discussed the incidence of medication errors and contributory factors to medication errors during the medication treatment process in adults or in children. In this way, literature related to criteria has been investigated and classified in the present study.
In this paper 70 articles have been examined. 17 of them (24%) focused on prescribing errors, 5 of them (7%) focused on transcribing errors, 9 of them (13%) measured dispensing errors, 9 of them (13%) measured administration errors and finally 30 interventional studies assessed actions for reducing medication errors. It has been found that wrong dose, wrong frequency and wrong drug were the most common errors in prescribing stage of studies.
utilization of Computerized Physician Order entry with decision support system was the most action for reducing medication errors. In addition, poor knowledge of medicines was identified as a contributory factor for errors by both doctors (prescribers) and nurses (when administering drugs).