فصلنامه آموزش و اخلاق در پرستاری
سال نهم شماره 1 (بهار و تابستان 1399)

Moral distress is a serious problem for health care professionalsall over the world; it has detrimental effects for patients, nurses and organizations. Nurses in ICUs experience more moral distress due to their daily dealing with ethical problems and the stressful atmosphere. The purpose of this study was to conduct an integrated review and a combination of existing studies on moral distress in Intensive Care Unit nurses.

In the literature review from 2000 to 2019, various databases including SID, Irandoc, Google Scholar, PubMed, Medline, Scopus, Cochrane Library, and ScienceDirect were searched with keywords of moral distress, nursing, Intensive Care Units. The modified version of Cooper's five-stage integrated review by Whittemore and Knalf was used for this purpose.

Results were presented in four sections on theeffects and sources of moral distress on nurses in Intensive Care Units, their psychological reactions, and how they deal with moral distress.

Based on a review of the literature, we can say that moral distress can never be completely eliminated, but its causes and effects can be mitigated.As this phenomenon is more common among nurses in intensive care units due to its challenging environment, ethical distress should be identified in nurses and prevention or treatment strategies should be considered

Nurseschr('39') ethical distress means acting in contradiction with their ethical beliefs, which today has become one of the challenges of health systems because it has devastating effects on nurses and can lead them to abandon their jobs. Therefore, these factors should be considered together. The purpose of this study was to determine the relationship between ethical distress and willingness to leave their work among nurses working in Jahrom University of Medical Sciences in 2016.

This descriptive cross-sectional study was performed on nurses working in hospitals affiliated to Jahrom University of Medical Sciences in 2016. All nurses working in hospitals affiliated to Jahrom University of Medical Sciences were enrolled. Data collection tools included three demographic information questionnaires, Corleychr('39')s ethical distress questionnaire and nurseschr('39') willingness to remain in the Nursing profession. Data were analyzed using SPSS software version 21 and descriptive and inferential statistical tests.

The mean age of the participants was 28±5.4 years. Nurseschr('39') willingness to leave the service was 1.04±1.03 and ethical distress severity score was 0.72.±2.44%. Spearman test results showed that there was no significant relationship between tendency to quit work and moral distress in severity (p-value> 0.337) and repetition (p-value>0.444). Mann-Whitney test showed that there was no significant relationship between gender variables with variables of desire to quit, severity of moral distress and repetition of moral distress (p-value>0.05). The results of Kruskal-Wallis test showed that there was no significant relationship between educational level, service sector and type of employment with variables of tendency to quit, severity of moral distress and repetition of moral distress (p-value> 0.05).

The results of the present study showed that there was no significant relationship between mean moral distress in two dimensions of severity and repetition with the intention to quit nurses. Although the ethical distress reported in this study is moderate, this lack of relevance cannot be taken into account, but sometimes nurses have to be reluctant to quit due to lack of work and difficult economic conditions. Therefore, it is recommended that appropriate measures be taken to reduce the stressors due to the existing conditions.

Endangering patient safety by delaying the care provided by members of the treatment team can cause irrecoverable harm to the patient. In this study, a case has been presented with the ethical challenge of delay in patient care.

The patient was a middle-aged man suffering from Penetrating trauma to the nerve and tendon of the fingers hand with extensive bleeding by electric milling. He referred to the emergency department. The only Services performed for him included; wound dressing, without inject tetanus vaccine and antibiotics and providing necessary training. The client was referred personally to a hospital in Tehran after 24 hours. Eventually, the patient underwent surgery after 42 hours of fasting due to overcrowding of patients. As a result, the patient involved in complications due to delayed nerve and tendon surgery.

In this report, patient safety was compromised with delay in treatment. This risk was due to the lack on time visits by specialist physicians, delayed surgical complications and prolonged fasting, failure to comply with physician orders (antibiotics and tetanus vaccine) despite payment by the patient, lack of transfer information and training Sufficient to support the patient in making a personal decision to leave the hospital.

Failure to maintain patient safety has irrecoverable consequences for patients and the service delivery system. As a result, the solution is to nurse managers; planning in-service education to the staff for increase professional knowledge, commitment, responsibility, accountability, ethical sensitivity and recognition of ethical challenges to prevent delays in patient treatment.

Empowerment of employees is a new technique that it is used by managers to increase productivity by increasing employeeschr('39') commitment to the organization and vice versa. This is a valuable method that make balance between full control of management and the freedom of action the employees. Organizational commitment is an attitude about employee loyalty to the organization and as a continuous process creats from the participation of individuals in organizational decisions and attention to the success, development and welfare of the organization. Considering the important role of nurses in the health care system this, this study was performed to investigate the relationship between empowerment and organizational commitment in medical- educational Center martyr Sayyad Shirazi.

This research is a descriptive - Analytical sectional that was done in 2018. Subjects in this study included 180 nurses in medical- educational Center martyr Sayyad Shirazi that were selected by field method. The instruments were psychological empowerment questionnaire Spreaderchr('39')s (1995) and Organizational Commitment Questionnaire by Allen & Meyer (2000) that was completed by nurses. For analysing the data were used 16 SSPS software. Descriptive and Analytical statistics (Spearman).

The results of this study showed that there is a significant relationship between psychological empowerment and organizational commitment (p=0.000, p=0.619). Findings of organizational commitment showed that nurses were at the desired level and have the highest commitment rate was related to normative commitment. The results of psychological empowerment showed that most of the nurses had high empowerment (mean 64/972) and in all dimensions of psychological empowerment were in the High Capability level and the highest mean was related to the dimension of trust.

Endeavor to improve empowerment can be considered as a valuable strategy to improve organizational commitment and encouraging and significant methods should be used. Individuals should feel the freedom, power, motivation and respect of the organizationchr('39')s atmosphere to Increase organizational commitment and commitment.

Physicianschr('39') profession activities are mainly centered on clinics and the focus of medical education is on improving the quality of ambulatory education. Improving ambulatory education helps develop studentschr('39') communication skills, professional attitudes, and empathy in addition to enhancing clinical skills. This study was performed to evaluate the ambulatory education program based on the participant-oriented evaluation model in 2018.

This cross-sectional study was performed with the participation of 111 residents, interns, faculty and non-faculty physicians at the Kashan Shahid Beheshti Hospital. Participants chr('39')viewpoints were collected using the ambulatory education quality assessment questionnaire including three domains of quality of educational services, physical area and environment of the clinic, and learnerschr('39') feedback on the status of the clinic, whose reliability was calculated using the internal consistency index (r = 0.95). Descriptive and inferential statistics were used for data analysis.

The majority of interns (84.5%) and assistants (45.4%) were negative about the quality of ambulatory education, while the majority of the faculty members (66.7%) and physicianschr('39') views (38.5%) were positive. Most of the participantschr('39') view was aligned that the environmental situation was inappropriate. In general, there were differences in the views of the participants in terms of quality in the three areas of the ambulatory education program.

Participantschr('39') general view of the current status of ambulatory education was particularly negative for learners, which could be due to the lack of independent activity, active supervision of teachers, prescription training and differential diagnostics, and poor environmental area.

Being in a position to use white lies is the most experimental challenge for the treatment team. The definitions of expediency in using white lies vary from person to person. Understanding these definitions is an effective step in providing patients with the right treatment. The aim of this study was to review the research conducted on the use of white lies to examine patient care.

In this narrative review, by  using the keywords of  White lies, Care and Truth Telling for search in international and Persian database like MEDLINE, Cochrane Library, PsychINFO, SID, Magiran, Google scholar, PubMed, ProQuest and Scopus was designed by “Tittle search method” without time limiting. The articles which were not consistent with the purpose of study and were case report or letter to editor articles were excluded. Out of 3114 searched articles, 12 were selected. To extract data, all the final articles, included in the process of study, were extracted from a pre-made checklist.

In the present study, 12 qualitative and descriptive articles were examined. The findings of these articles were presented in two parts: patient expediency and the expediency of the treatment team. The focus of the use of lies to maintain the patientchr('39')s interest in preventing injury to the patient and in the interest of the treatment team was determined by the lack of adequate communication skills.

According to the findings, the use of white lies was to achieve the right position to present the truth. In this regard, providing appropriate guidelines according to the culture of the care platform, therapeutic goal and according to the level of understanding of patients can be used to improve the individual skills of caregivers to provide information. In the field of research, the findings of this study can pave the way for other quantitative and qualitative research on the use of white lies and their consequences.

About half a million women worldwide die annually from complications of pregnancy or lack of midwifery care, 99% of which occur in developing countries. High-quality service often leads to customer satisfaction. Staff play a significant role in improving the quality of care. Given the importance of this issue in improving macroeconomic and international indicators, we decided to review the quality of midwifery care in Iran.

After searching 950 articles with these keywords: quality, care, midwifery and satisfaction in the search engines of Sciencedirect, Iranmedex, SID, Magiran, Google Scholar, Pubmed and IranDoc, about 28 articles were finally selected and the results were filmed.

Studies reported the quality of prenatal care, pregnancy, postpartum and family planning at a moderate level, so that the weakest quality was observed in the fourth stage of labor. Satisfaction of pre-natal services, labor and childbirth, post-partum and family planning was stated at a high and very high level, and the satisfaction with the pre-natal period was higher than the labor.

The quality of midwifery care was at a moderate level and its satisfaction was high. Therefore, high satisfaction does not always mean high quality of service, as motherschr('39') satisfaction may be due to their low expectation. Therefore, in order to evaluate the quality of midwifery services, in addition to obtaining satisfaction, international standards must always be considered.

Today according to the importance of patient rights and autonomy and available educational tools, newly deceased patients are less used for educational purposes. The purpose of this study case report is to present used of new deceased patientchr('39')s teaching of clinical skills to students and to express their ethical challenges.

The patient was a 70-year-old woman with cardiopulmonary arrest. She is referred to the emergency department. The patient dies due to the unsuccessful of her resuscitation operation. Instructor uses patient corpse for training in cardiac massage and intubation of nursing students. In this case, the ethical and educational challenges raised are to include: ignore of patient rights, the patientchr('39')s individual autonomy and obtain informed consent and used of cadaveric as educational tools.

The results showed that due to student guidance by the instructor and her interest in learning in the real environment, the ethical, religious, legal, educational and caring challenges in this case report were ignored.

The relationship between the physicians and nurses involves their engagement in patient care to achieve a therapeutic goal. Professional relationship between physicians and nurses is inevitable. Ethics is essential in all professions. Effective communication between physicians and nurses has been shown to enhance patient care. Effective collaboration between nurses and physicians increases their successfully and satisfaction. The purpose of this study was to the exploration of nurses and physicians experiences of ethical self-care in their professional relationship with each other.

This study is a qualitative research using phenomenology method. Fifteen semi-structured interviews were carried out with 8 nurses and 7 physicians. They described their experiences related to professional communication. The interviews were recorded and transcribed and the data were then analyzed by using the Colaizzi analysis method.

Four themes emerged from data analysis in which influence the nurse-physicians relationship. One of them was perception of ethical self-care in their professional relationship. Professional relationships between physicians and nurses were described based on this theme.

Based on the experience lived by nurses and doctors to understand the professional relationship can be said professional relationship between physicians and nurses is a phenomenon that is understood by the ethical self-care perception and to improve the quality of patient care and nurseschr('39') job satisfaction and doctors is essential.

It is essential to prepare doctoral students in nursing with scientific knowledge in this profession, based on correct and practical curricula; therefore, evaluating the quality of nursing doctoral education and comparing it with robust educational programs in the world is essential. The University of Pennsylvania School of Nursing, of the United States, is ranked No. 1 in the world in 2019. The purpose of this study was to compare the PhD Nursing curriculum of Iran and the University of Pennsylvania School of Nursing.

This study is a descriptive-comparative study. Information on the latest Nursing Doctoral Program is obtained through a computer search on the Internet and an overview of the Iranian Nursing Doctoral Curriculum at the University of Pennsylvania Web site. The model used in the research is the Beredy method, which comprises four main stages of description, interpretation, neighborhood, and comparison.

The program structure of the University of Pennsylvania consists of focused courses and a dissertation that are structurally similar to the mandatory and optional specialty courses of the nursing PhD program in Iran. The overall goal of nursing PhD program in Iran is to train students in the fields of education, research, technology, management and nursing services. The University of Pennsylvaniachr('39')s goal is to specialize in the research, development of nursing scholars to build a research program and advance nursing knowledge. Expectations for these graduates are leadership in universities, health care, government centers and related fields in addition to the research dimension.

It seems that Nursing PhD program in Iran, due to the combination of the two practical and research courses, does not fully define the expectations of our Nursing PhD graduates and needs to be specialized according to its goals.

Many nurses face the challenges of balancing their job and family roles. Today, the corona virus epidemic has become one of the most important causes of concern among the people as well as the World Health Organization. Medical staff are more exposed to work-family conflict due to job conditions such as the number of shifts, hard work and long working hours. The aim of this study was to investigate work-family conflict in nurses and physicians caring for patients with covid 19 in Jahrom city.

This descriptive cross-sectional study was performed in 2020 on 103 nurses and physicians working in hospitals affiliated to Jahrom University of Medical Sciences who were in contact with patients with covid 19. Data collection tools in this study included two questionnaires, demographic information and work-family conflict questionnaire. Data analysis was performed using SPSS software version 21 and descriptive and inferential statistical tests.

16.5% of nurses and physicians had traveled in the corona and 42.2% of them had attended ethics courses. The mean work-family conflict was 52.75 13 13.96. The level of work-family conflict in the majority of people was below average (48.26%). Among the dimensions of work-family conflict, the level of time-based conflict was above average. However, the level of conflict based on behavior and pressure was lower than average.

Work-family conflict in nurses and physicians caring for patients with Covid 19 in Jahrom city is below average. The information obtained from this study can be a basis for starting further studies and conducting training workshops for members of the medical staff.

Considering the influence of technology in all fields of medical sciences and its emergence in the country in this study, we evaluate the experiences of Jahrom University of Medical Sciences students in mobile learning in medical science education and its effective factors in comparison with FRAME model and admission model. TAM technology is a quantitative-qualitative and hybrid study.

The study was conducted in two parts: qualitative and quantitative. In the first or quantitative part, 120 questionnaires based on TAM / FRAME models were distributed randomly among Jahrom medical students from different disciplines and each questionnaire examined the dimensions and factors affecting education and Mobile learning, including the learner and social dimensions, and the interactive dimension of factors that make mobile education useful and easy to use, and perceived barriers, were analyzed using conventional content analysis. In the second or qualitative part, semi-structured and face-to-face interviews were conducted with the viewpoints of Jahrom medical science students on technology acceptance indices with 30 Jahrom medical students from different disciplines who were willing to participate in the project and the results were analyzed by descriptive statistics on different themes and subthemes up to saturation of each theme. Then, by applying the qualitative and quantitative indicators, a new technology acceptance model was obtained from Jahrom medical students.

According to the quantitative method, in TAM questionnaire the highest mean was related to perceived usefulness of technology acceptance with 3.61 and standard deviation ± 0.82 and in FRAME questionnaire the highest mean was related to perceived social dimension of technology acceptance with number. The standard deviation was 4.06 ± 0.76. In the qualitative section, the highest percentage of codecs extracted from student interviews was devoted to the 30% cost reduction theme of the benefits of using e-learning tools. According to the results obtained from both quantitative and qualitative parts, this study can be used as a new model of technology adoption.

The new model obtained from this study can be used by policy makers, designers, and managers of medical education centers to enhance their learning efficiency.