نشریه پرستاری ایران
پیاپی 121 (دی 1398)

Medication errors commonly occur in clinical nursing. The present study aimed to determine the causes of medication errors, their lack of report, and their frequency in intensive care units (ICUs).

This cross-sectional, descriptive study was conducted on 300 nurses engaged in the ICUs and critical care units of three teaching hospitals affiliated to Qom University of Medical Sciences in Qom, Iran in 2019. The participants were selected via census sampling. Data were collected using a demographic form and medication error questionnaire with confirmed reliability and validity. Data analysis was performed in SPSS version 21 using descriptive and inferential statistics (analysis of variance and independent t-test).

Systemic errors (mean score: 4.1±1.2) and pharmacy errors (mean score: 2.5±1.1) were the most and least important causes of medication errors, respectively. In addition, management errors (mean score: 3.8±1) and disagreement regarding the definition of medication errors (mean score: 2.6±1.1) were the most and least significant causes of the non-reporting of medication errors, respectively. On the other hand, intravenous errors (22.56%) had higher frequency compared to non-intravenous errors (21.89%). Among the demographic variables, the analysis of variance indicated significant associations between age (P=0.029) and job experience in the current ward (P=0.007) with medication errors.

According to the results, reducing the incidence of medication error by nurses requires the provision of proper conditions to minimize systemic errors in hospitals. Furthermore, nursing managers must facilitate error reporting for nurses, while meticulously monitoring the administration of drugs by nurses, especially in the case of intravenous medications.

The estimation and analysis of the education costs of students helps with the better decision-making of managers and policymakers by providing information on the performance of the involved units. The present study aimed to assess the education costs of the nursing and midwifery students in the autonomous hospitals affiliated to Iran University of Medical Sciences.

This descriptive, cross-sectional study was conducted to calculate the direct education costs of nursing and midwifery students in various levels from the perspective of hospitals in the academic year 2018-2019. The selected hospitals included Firoozgar, Hazrat Rasoul, Akbarabadi, Ali Asghar, Firoozabadi, Hasheminejad, Shohada-e Haft-e Tir, Lolagar, Motahhari, Iran Psychiatry, and Shafa Yahiaian. The real and direct costing approach was applied in the sttudy. After identifying the cost headings and structured interviews with the educational department managers, educational supervisors, clinical and financial managers, faculty members, and students (n=20), the share of the students in each cost heading was determined based on work study and time study. The study tools in the first and second stages were the interview guide and checklist, respectively.

The highest per capita cost of undergraduate education was observed in midwifery Bachelor of Science at Akbarabadi Hospital (1,125,926), and the lowest per capita cost was observed in postgraduate psychiatric nursing at Ali Asghar Hospital (46,154). In addition, the most important cost headline for the education of these students was the costs of consumables.

Due to the high costs of educating students, transparency should be promoted in educational processes through the implementation of brainstorming sessions among the heads of departments, directors of nursing and midwifery schools, hospital educational authorities, and students in order to properly manage the costs of education.

Today, attention to the clinical competence of nurses is increasingly important as clinical competence seems to be influenced by several factors, such as the ability of critical thinking. The present study aimed to evaluate the association of competence and critical thinking in the nurses in Imam Khomeini Hospital, affiliated to Tehran University of Medical Sciences, Iran.

This cross-sectional, descriptive-correlational study was conducted on 170 nurses employed in Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences in 2019. The participants were selected via proportionate stratified sampling. Data were collected using the competency inventory for registered nurses (CIRN) and Ricketts' critical thinking deposition questionnaire. Data analysis was performed using one-way analysis of variance (ANOVA), independent t-test, Pearson's and Spearman's correlation-coefficients, Mann-Whitney U test, and Kruskal-Wallis test.

The mean total score of competence in the nurses was 169.74±16.04 (out of 220), which indicated  high clinical competence based on the scoring instrument. The mean total score of the critical thinking of the nurses was 124.75±12.27 (out of 165), which indicated the high critical thinking ability of the participants. A significant, positive correlation was observed between the total mean score of competence and critical thinking (r=0.64; P<0.0001). However, no significant associations were observed between the demographic variables with nursing competence, while the critical thinking ability of the nurses in critical care wards was significantly higher compared to those employed in general wards (P=0.008).

According to the results, nurses with better critical thinking abilities have higher clinical competence and could provide independent, effective nursing care. Therefore, the improvement of critical thinking in nurses could promote their clinical competence.

Moral distress in the nursing profession leads to adverse complications in the workplace. Nurses experiencing moral distress may show symptoms such as confusion, fear, anxiety, and powerlessness, which lead to job dissatisfaction and failure. The present study aimed to assess the correlation between moral distress and demographic characteristics of the critical care nurses in selected teaching hospitals in Tehran, Iran.

This cross-sectional, descriptive-correlational study was conducted on 200 nurses engaged in the critical care units of selected teaching hospitals in Tehran. The participants were selected via proportionate stratified sampling. Data were collected using the Corley questionnaire, and data analysis was performed in SPSS version 16.

The mean frequency of moral distress was 48.96 ± 18.21, which was close to the mean score of the instrument (49). The mean intensity of moral distress was 52.04 ± 18.43, which was higher than the mean score of the instrument (49). In addition, a significant correlation was observed between the frequency of moral distress and department of work (P=0.014). The frequency of moral distress was significantly lower in the ICU-OH compared to the CCU (P=0.040) and ICU (P=0.018), while the difference between ICU and CCU was not significant in this regard. A significant association was also observed between the severity of moral distress and the ward of employment (P=0.030). Moreover, the severity of moral distress was significantly lower in the ICU-OH compared to the CCU (P=0.005) and ICU (P=0.008), while no significant difference was observed between the CCU and ICU. No significant correlations were denoted between moral distress and other demographic characteristics.

According to the results, moral distress in the critical care nurses was moderate, which could adversely affect patient care and health of other staff. Therefore, it is recommended that nursing managers and authorities adopt proper strategies for the reduction of moral distress in critical care nurses.

Health literacy is defined as the capacity of an individual to acquire, interpret, and comprehend basic information and health services, which largely influences health-related decision-making. Asthma is a prevalent chronic disease, which adversely affects the quality of life the patients. The present study aimed to investigate the correlation of health literacy with the quality of life of the asthmatic patients referring to the clinics affiliated to Shahid Sadoughi University of Medical Sciences in Yazd, Iran in 2018.

This descriptive-correlational study was conducted on 300 patients with asthma, who were selected via simple random sampling. Data were collected using the questionnaires of demographic characteristics, quality of life, and health literacy, which completed in a self-report manner. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics.

The majority of the patients were female (52.3%) and married (87.3%), with the mean age of 43.9±11.08 years. The majority of the patients (73.3%) used the option of asking physicians and healthcare providers to receive the necessary information regarding their disease. The mean score of health literacy was 100.78±28.55, and the highest and lowest scores belonged to the components of evaluation (68.5) and accessibility (55.36), respectively. In addition, the health literacy of the majority of the subjects (45%) was inadequate. The mean score of the quality of life was 46.91±5.32, with the highest and lowest mean scores observed in the concerns about health (17.41±2.88) and physical dimensions (10.66±2.88), respectively. However, no significant correlations were observed between the health literacy and its components and various dimensions of the quality of life (P>0.05).

According to the results, the level of health literacy and quality of life of the asthmatic patients were not favorable, and no significant correlations were observed between health literacy and its components with the dimensions of the quality of life. Therefore, studies are required to investigate the mediating factors that may affect these variables. Furthermore, the development of comprehensive programs, simple and understandable educational materials, and effective psychological interventions could enhance the health literacy skills and quality of life of asthmatic patients.

Dysmenorrhea and premenstrual syndrome (PMS) are common disorders in women, which affect different aspects of life. The present study aimed to evaluate the effectiveness of the combination of cinnamon and ginger with walking and stretching exercises on dysmenorrhea and PMS.

This quasi-experimental study was conducted with a pretest-posttest design and a control group on 100 women with PMS in Qaemshahr, Iran in 2019. The patients were selected via convenience sampling and divided into four groups of 25 by drawing lots. The groups included exercise, cinnamon-ginger, combination of exercise and cinnamon-ginger, and control. The exercise training program comprised of stretching exercises and walking three sessions per week for eight weeks. A cinnamon-ginger capsule (500 mg) was administered thrice daily with the onset of pain within the first 72 hours of menstruation for two months. The patients were assessed before and eight weeks after the intervention using the visual analogue scale (VAS) of menstrual pain intensity, PMS screening tool, and PMS daily status. Data analysis was performed using paired t-test, the Mann-Whitney U test, one-way analysis of variance (ANOVA), Kruskal-Wallis test, and Tukey's test.

After eight weeks, the intensity and duration of primary dysmenorrhea and scores of the physical and mental symptoms of PMS significantly decreased in the intervention groups compared to the control group (P<0.05). Furthermore, the effects of the combination therapy on the percentage of the changes in the intensity and duration of primary dysmenorrhea pain and scores of the physical and mental symptoms of PMS were more significant compared to the cinnamon-ginger and exercise groups.

According to the results, the non-pharmacological interventions of walking and stretching exercises, the simultaneous consumption of cinnamon-ginger, and combination therapy could significantly decrease the intensity and duration of primary dysmenorrhea pain and improving the physical and psychological symptoms of PMS. Therefore, these approaches are recommended as safe and effective therapies for the treatment of these disorders.

Job satisfaction plays a key role in the development of organizational exploitation. Emotional intelligence is a set of skills that enhance the ability of an individual to face environmental pressures. Emotional intelligence also affects mental health and wellbeing. Given the importance of this issue in operating room technologists, the present study aimed to investigate the association between emotional intelligence and job satisfaction in operation room technologists.

This cross-sectional, descriptive-correlational study was conducted on all the operating room technologists (n=110) employed in the hospitals in Sanandaj, Iran in 2017, and 10 operating room technologists were excluded due to the work experience of less than one year. Data were collected using a demographic questionnaire, Sibriashring emotional intelligence questionnaire, and Job Satisfaction Spector scale. Data analysis was performed in SPSS version 16 using Pearson's correlation-coefficient, independent t-test, and one-way analysis of variance (ANOVA).

No significant correlation was observed between emotional intelligence and job satisfaction (P>0.05). The mean emotional intelligence was estimated at 112, which indicated the favorable level of this parameter. The mean job satisfaction was 121.5, which showed the level of this parameter to be below average.

According to the results, the job satisfaction level of the operating room technologists was significantly below average. Therefore, it is recommended that the authorities enhance the job satisfaction of these healthcare professional by improving the facilities at the workplace, considering proper promotions, and optimizing the conditions of the work environment.

Sorrow is a natural response to adverse events such as loss and birth of premature or abnormal neonates, which increases the risk of chronic physical diseases, substance abuse, and suicide if prolonged. In addition, sorrow decreases the quality of life of individuals, causing variable degrees of disability in individual and social functions. The components of chronic sorrow in the parents of premature neonates include premature birth, developmental disabilities, Down syndrome, neural tube defects (e.g., meningococcus), and chronic diseases (e.g., cancer). The parents of these neonates experience variable degrees of chronic sorrow, which in turn makes it difficult to care for and interact with the newborn. The birth of a premature neonate is the main challenge in postpartum care. In general, approximately 13 million births lead to premature birth each year. Iran has one of the highest prevalence rates of premature birth across the world, where 5,000 neonates are born daily, 12% of whom are underweight and 10-15% are born premature before 37 weeks of gestation. The birth of a newborn that needs special care causes psychologically special and shocking conditions for the parents, preventing the fulfillment of their true role as a parent. Sorrow occurs when parents find out that their newborn is chr('39')incompletechr('39'). Sorrow encompasses both internal phenomena (e.g., thoughts and feelings) and external phenomena in the form of behaviors related to sorrow (e.g., sadness and crying). One of the main nursing interventions in this regard involves diminishing the problems of the parents whose newborn is hospitalized in the intensive care unit through their empowerment by providing the required knowledge for the better care of admitted premature neonates, which has been highlighted within the context of family-oriented care to increase the quality of life of the neonate and families. In general, the implementation of proper nursing interventions could lead to positive outcomes for parents, reducing issues such as grief, stress, changed parental roles as a major nursing measure for diminishing the problems of the parents whose neonates are admitted to the neonatal intensive care unit. The empowerment of parents occurs by providing the necessary conditions for the interaction and participation of parents in the care of premature neonates. The creating opportunities for parent empowerment (COPE) was designed by Melnyk et al. in 2001 for the parents of premature infants. COPE is a four-stage educational-behavioral intervention based on the self-regulatory and control theories. In addition to the mental support of parents, this program provides the necessary information regarding the complexion and behaviors of premature infants, parental roles, conditions of the intensive care unit, and proper care of the neonates. The present study aimed to assess the effects of the COPE on the chronic sorrow of the parents of the premature neonates admitted to the neonatal intensive care unit (NICU).

This non-randomized clinical trial was conducted with a control group after the approval of the research plan and obtaining the required permit from the Ethics Committee and an introduction letter from Iran University of Medical Sciences at NICUs of Rasoul Akram and Ali Asghar hospitals in Tehran, Iran. Based on the inclusion criteria, 68 parents with premature infants admitted to the NICU were selected via convenience sampling. The stratification of the subjects to two groups was based on a time framework. Initially, the control group was samples, followed by the sampling of the intervention group. Data were collected using a demographic questionnaire and Kendall chronic sorrow instrument with 18 items scored based on a Likert scale, which were collected by the subjects in both groups. In the intervention group, the COPE program (four-stage educational-behavioral intervention) was carried out, and the control group received the routine care of the ward. The trainings and meetings with the parents were performed in groups of 2-4, including the mother and father, in the conference room of the ward with the permission of the head nurse by the researcher and the co-researcher. One month after the launching of the study, the questionnaires were completed again by the subjects via WhatsApp social network. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution tables and numerical indices), followed by inferential statistics using Chi-square, Fisherchr('39')s exact test, independent t-test, and paired t-test for the comparison of the study groups.

No significant differences were observed between the intervention and control groups in terms of age, education level, place of residence, length of the neonatechr('39')s admission, gender of the neonates, and mode of delivery between the intervention and control groups, and the groups were homogenous in this regard at the significance level of 0.05. In addition, the results of independent t-test showed no significant difference between the intervention and control groups in terms of the score of chronic sorrow (P>0.05). After the intervention, the mean score of chronic sorrow in the control and intervention groups was 43.11±8.38 and 32.85±5.45, respectively, which indicated a significant difference in this regard (P<0.001). This finding indicated the effectiveness of the COPE program in decreasing the chronic sorrow of the parents of the premature infants admitted to the NICU.

According to the results, the symptoms of sorrow appeared in the parents in the intervention and control groups upon the admission of the premature neonates to the NICU. Therefore, the parents whose premature infants are admitted to the NICU require proper examination and treatment for the symptoms of sorrow. Our findings confirmed the effectiveness of the COPE program in the alleviation of the sorrow of the parents whose premature neonates were admitted to the NICU. Therefore, it is recommended that this program be implemented as an effective and cost-efficient strategy in NICUs. Furthermore, the use of audio-visual training programs along with routine treatments could positively influence the care of premature infants and reduce the psychological effects on care on the parents. Owing to technological advancement, the easy application of such educational programs could maintain the independence of families and increase the knowledge interaction of parents in the care of the newborn, while decreasing their stress and sorrow.