فصلنامه آموزش و اخلاق در پرستاری
سال هفتم شماره 3 (پاییز و زمستان 1397)

Nurses are exposed to a lot of tension due to their sensitive job, which can lead to aggressive and violent behavior among them. Anger is a complex emotion in human being, which is considered a normal response to unwanted situation or behavior. However, it could turn to destructive aggression if it gets out of control. Moral intelligence can be considered as a fundamental criterion for human behavior to guide him what is right or wrong. The present study aims to investigate the relationship between moral intelligence and anger in nurses. This is a descriptive correlational research that is carried out through a sampling of 140 nurses in the Social Security Organization hospitals in Gonbad and Gorgan. Two questionnaires including Lennick & Kiel Moral Intelligence Test and AGQ aggression Test were used for data collection. The data analysis was performed using statistical software SPSS16, implementing descriptive statistics (tables, mean, and standard deviation) and inferential statistics (Pearson product-moment correlation coefficient, independent T-test and analysis of variance). The measures of 148/1 ± 18/7 for the moral intelligence and 68/5 ± 13/3 for the aggression indicated a statistically meaningful relationship in a way that the increase in one (moral intelligence) caused a decrease in another (aggression) rate. There was no meaningful relationship between moral intelligence and aggression with demographic characteristics. The results showed that by improving and enhancing ethical intelligence, the level of anger in nurses can be reduced. Hence, through planning and holding courses and workshops on ethical and communication issues, hospital authorities and supervisors can increase the intelligence and ethical attitude of nurses and prevent conflict between nurses and patients and colleagues.

Clinical education is a major part of nursing education without which training effective and qualified nurses is a far-fetched goal. So this study was done with the aim of identifying stressful factors in clinical education from vantage point of Ferdows Paramedic School students. This cross-sectional study was done in the first semester of 2014 -15. Of 137 undergraduate nursing and operating room students, a total of 107 students entered the study based on convenience sampling methods. Data collecting instrument was a questionnaire with two sections including: demographic and standard questionnaire, clinical education stressors (with content validity and reliability of 0.85). The average scores were calculated for each of the five domains of stressors (including interpersonal communication, humiliating experiences, educational environment, clinical experiences, and unpleasant emotions) (scores range from 1 to 5). Data were analyzed using SPSS software (version 16). Results showed that the most stressful factors in the practice from the students’ point of view, in order of intensity, included stress from unpleasant feelings, humiliating experiences, clinical practice and interpersonal relationships. The mean score of the questionnaire was 31.3 ± 13.2 and most grades were in the range of 28 to 54 (moderate). In clinical education processes, students of various medical sciences are exposed to many stressful factors. Identifying these factors can play an important role in decreasing their stress levels. Considering that unpleasant feelings were the most stressful factor in the study, it is necessary to draw attention to this issue, explain its various dimensions and provide solutions in this regard.

Ethics has always played a significant role in nursing training settings. For many years, the training method has been one of the most serious challenges faced by nursing professionals. The purpose of this study was to compare teaching the principles of nursing ethics in two methods based on problem solving and conventional education. This experimental study has been conducted on 140 undergraduate nursing students using random sampling, who were divided into intervention group (72 subjects) and control group (70 subjects). The data were collected using a researcher-made three-part tool, the first part of which was demographic information, the second part measured the students' ability, and the last part explored the students’ satisfaction. Data analysis has been done by SPSS16 and using descriptive statistics and T-test. The scores of moral nursing discrimination abilities in the problem-based learning group are higher than those of the control group. Moreover, the results of the pre-test and post-test show that there is a significant difference between the results of the pretest and the post-test for both groups. According to the study results, the satisfaction level in the intervention group is larger than that of the control group. The problem-based learning method influences ethical performance and traditional teaching methods on how students learn and observe ethical principles. Therefore, in educational planning, the problem-based learning method can be used as the main learning method and the traditional teaching method as a secondary learning method.

During the development of nursing profession, nurses have encountered such terms as wholeness and holism. Considering the fact that these issues were introduced into theories and practices with different approaches, they differed from context to context and period to period. The purpose of this study was to clarify the concept of holism in nurses' philosophical views and to investigate possible relevant factors in its institutionalization. This is a narrative review study that was done in 2014 by exploring databases such as Pubmed, Elsevier, Ovid, Google Scholar, SID and Iranmedex and using Holistic, Holistic Nursing and Holistic Approach in nursing and their English equals keywords. 41 articles were found and after studying their abstracts, 20 articles were selected for review. The concept of holism refers to this fact that the maximum of wellbeing and health occurs when all of the human being's inseparable features are balanced and in harmony with each other. Delivering holistic care to clients serves to retrieve their awareness, power and self-care responsibility and has a critical role in developing nurses' professional position and increasing their authority and professional self-confidence. Holistic practice in nursing leads to the improvement of clients' lifestyle and satisfaction. In today's challenging condition, the officials' close attention in education and management is needed to consider influencing factors in establishing a holistic overview in nurses and removing barriers to practicing it.

Effective communication skill, along with other clinical skills, is one ‎of the essential needs for students of different disciplines of medical science. According to studies, ‎also this matter that students how learn to communicate with other people can help them be ‎effective in educational quality. Due to the lack of study on this subject, this study aimed to ‎investigate the relationship between students 'communication skills with their course satisfaction in ‎Ardabil University of Medical Sciences.‎ All midwifery and operating room students of Ardabil University of ‎Medical Sciences were entered into this analytical study. Data collection was performed through ‎demographic questionnaire, Queen Dom communication skill and course satisfaction surveys. Data ‎were analyzed by the SPSS18 software using descriptive and analytical statistics methods including ‎t-test and Pearson and Spearman correlation coefficient.‎ In this study, 98 people of operating room students and 89 people of midwifery students ‎participated, which 38.5% of them were male and 61.5% of them were female. The average age of ‎students was 21.07±1.68 years. Total mean of communication skills was 115±8 and course ‎satisfaction was 58±11. Also, a significant relationship was found between student’s ‎communication skill and their course satisfaction (p≤0.001, r=0.42).‎ In view of the direct relationship between students 'communication skills with their ‎course satisfaction, to increase student’s satisfaction with their course, taking steps to improve ‎students' communication skills is essential.‎

Health is recognized as one of the prerequisites for social welfare systems. Insurance coverage changes the behavior of the consumer (patient) and the provider (doctor) of the medical services, which is considered a moral hazard. This study was conducted with the aim of addressing the concept of moral hazard and its types and consequences in health insurance marketing.

This is a review article that its related articles have been selected from published literature in national and international databases. The database of English texts includes Pubmed, Science direct, Scopus and the Google Scholar search engine and Persian texts including Magiran, Sid, Irandoc, Iranmedex and Medlib. Articles were searched between the years of 2009 and 2018. Finally, among the articles founded, 52 related articles were selected, which studied moral hazard in health insurance system.

Moral hazards are caused by the change in service providers and consumer behavior as a result of being insured due to the presence of a third-party payer. The third-party is another agent or company, such as insurance, which covers the cost of patients and therefore the consumer and service provider are not motivated to reduce received services. In moral hazard, people with higher insurance coverage, make less efforts to prevent (ex-ante moral hazard), and with the onset of illness, they use more and better health care services (Ex-post moral hazard). The moral hazard of the consumer is the most significant form of moral hazard.

Moral hazards have negative consequences, such as reducing the welfare and increasing costs in the health system. It is essential to investigate and recognize the effects of moral hazard and its control in order to prevent undesirable outcomes and misallocation of resources. To control consumer moral hazard, one can use franchise, especially for highly elastic services.