فصلنامه آموزش و اخلاق در پرستاری
سال نهم شماره 3 (پاییز و زمستان 1399)

Due to the increasing number of Covid 19 disease in the world and the prevalence of the second wave of Covid 19 in Iran, we are witnessing the death of many of our compatriots in the countrychr('39')s hospitals every day. Meanwhile, the medical staff of hospitals, especially doctors and nurses, have the most conflicts with patients with Covid 19. Considering the very important issue of moral sensitivity in this period and its effect on the quality of performance of the treatment team, we decided to conduct a study to investigate the level of moral distress in nurses and physicians caring for patients with Covid 19.

Methods and Materials:

This cross-sectional descriptive study was performed in 1399 with available sampling on 103 nurses and physicians working in Peymaniyeh Hospital in Jahrom. Data collection tools in this study included the Demographic Information Questionnaire and the Corelli Moral Distress Questionnaire. Data analysis was performed using SPSS software version 21 and descriptive and inferential statistical tests at a significant level of p <0.05.

In this study, 103 nurses and physicians involved with patients with Covid 19 participated. The mean severity and recurrence of moral distress were 47.98± 17.69 and 47.82± 16.78, respectively. A higher score indicates the severity and recurrence of higher moral distress. The level of severity and recurrence of moral distress was low in the majority of caregivers. The severity and recurrence of moral distress in clinicians was higher than nurses and general practitioners, but there was no significant relationship between job and severity and recurrence of moral distress (p-value <0.05).

The results of this study showed that the level of moral distress in the present study is very low. Since the consequences of moral distress can affect the quality of nurseschr('39') occupational therapy in the health system, so the serious attention of managers to use training programs related to ethical issues with the aim of identifying the symptoms of moral distress and the factors affecting it. It also seems necessary to do more research to identify other dimensions of moral distress in other medical centers.

One of the important dimensions of nursing care and the key role of a nurse in delivering health services is patient education. Despite the great benefits of educating the patient for its negligible costs, implementation of this important issue faces some health centers. This study aimed to explain the challenges of patient education from nurses' point of view.

  The present study was a qualitative study with a contraceptive content analysis approach on nurses working in East Gilan hospitals in 2019. Sampling method, purposeful and data gathering method were semi-structured interviews with open-ended questions and continued to reach information saturation. To carry out the data analysis process, the proposed steps of Granneheim and Lundman were used and the validity and robustness of the research was based on Guba and Lincoln criteria.

The results of 21 interviews consisted of four main categories and 17 subcategories: management barriers (neglect of teaching, distance between colleagues, uncoordinated physicians), inadequate organizational context (inadequate nursing staff, in time constraints, insecure, inadequate equipment, border Educational barriers), patient / patient barriers (knowledge weakness, accompanying anxiety, cultural barriers, shaky beliefs, unconscious beliefs) and barriers of perceived personnel (distrust of relationship, diminutive motivation, hard language, difficult understanding).

The results of the study have shown that the challenges of patient education are affected by various factors, among which managerial and personnel barriers are more noticeable. Therefore, in order to improve the situation of patient education, it is necessary to align managers in this field and increase the level of communication skills of nurses.

Patient response to trauma problems is influenced by individualchr('39')s cultural and spiritual background. This highlights the importance of spiritual and human care; nurses pay less attention to it. Watsonchr('39')s theory of human care states that human existence should not be treated as an object of care, and that care is a spiritual ideal that is intertwined with their mind, spirit, and body involved and effective.

The purpose of this case report is to apply nursing care based on the theory of human care on adolescent anxiety and hopelessness with fracture trauma and burns.
Methods and Materials:This case study of nursing care was based on Watsonchr('39')s human care model and Caritas care process on a patient with burn trauma and fracture. Data gathering method was qualitative method using semi-structured interview. Care of the client was performed according to Watsonchr('39')s human care model in two phases: First phase. Interview based on Watsonchr('39')s human care model with the patient to identify care needs and problems second phase. Implement interventions based on the classification of identified needs and problems based on the ten care factors and caritas care processes and receive feedback.

Case Study:

This study reports the case of a 17-year-old adolescent with trauma of the 3rd and 2.5 th burns on the palms, fingers and wrists and from 5 fractures of the palms and fingers 3 and 4. Having a psychological problem during treatment, such as misery, loneliness, misery. In this study, Watsonchr('39')s theory of human care was used to identify and solve the patientchr('39')s problem, so that follow-up care and educational interviews were conducted based on the classification of needs and psychological problems based on ten care factors.

This study demonstrated the application of Watsonchr('39')s theory in difficult and anxious events. The improvement in the condition of the adolescent with trauma was based on the patientchr('39')s expression of feelings of improvement during the care interview process.

The patient safety culture is one of the most important aspects of the quality of clinical care. The results of the study showed that patient safety was observed in undesirable treatment centers. Understanding effective methods in promoting this component is an organizational priority. The aim of this study was to Survey of Effectiveness, Professional Ethics Training in the Attitude of Clinical Management Nurses to the Patient Safety Culture.

Quasi-experimental study was performed using pre-test and post-test and control group in 2016. The sample consisted of 30 clinical management nurses working in Shahid Sayyad Shirazi Hospital in Gorgan. Sampling method was available as a randomization with each group. The nurses were divided into two experimental groups (training of professional ethics of care with a patient safety culture approach) and control (without any intervention). Training was offered in 8 of the Protocol for 8-6 hours training each interval every 5 to 7 days through workshop. The study tool included demographic information and a standard hospital scanning scale in the patient safety culture (HSOPS). Data were analyzed by SPSS software version 16, descriptive statistics, and Kolmogrov-Smirnov, Chi-square, independent t-test and paired t-test at a significant level of p <0.05.

total of participants were 17 female (56.7%). The mean age of the nurses was 39.5 ± 6.7 years. Before the start of the workshop, the mean safety culture of the patient in the intervention group was 50.6 ± 3.5 and the control group was 48.9 ± 5.9. After providing the training, a significant difference (p = 0.012) in the mean score of the experimental group (139.2 ± 13.7) was compared to the control group (53.5 ± 3.09). The results of paired t-test were shown in the intervention group the mean safety culture after the intervention increased (139.2 ± 13.7) significantly (t = 21.29, p = 0.0001) compared to the pre-intervention (50.6 ± 3.5) however, there was no significant difference in the control group (t = 0.970, p = 0.1).

This study showed career ethics training was effective in enhancing nurseschr('39') attitudes towards levels to patient safety culture. Therefore, it is recommended that intervention with an emphasis on teaching ethics as an effective method in educational programs promoting nurseschr('39') safety culture.

Ethical conflict is one of the problems of intensive care unit nurses that can occur for various reasons and have many consequences. Given the negative effects of ethical conflict and its impact on nurseschr('39') professional and ethical practices,it is important to identify factors associated with them that contribute to increasing the intensity and frequency of conflict. The purpose of this study was to determine the relationship between exposure to ethical conflicts with demographic characteristics and perceptions of the environment in nurses working in intensive care units.

This cross-sectional study was performed on251 nurses working in public hospitals affiliated to Ahvaz University of Medical Sciences. Samples were selected through census method and data were collected using demographic questionnaires, Nursing Questionnaire-Critical Care Version Ethical Conflict ،Perceptions of the clinical setting questionnaire. Statistical analysis was performed by SPSS 22 using ANOVA, independent t-test, Pearson correlation coefficient, and chi-square.

The findings indicated that there was a inverse correlation between ethical conflicts and age with (P<0.05)(r= -0 .129), intensive ward (P<0.05), experience (r= -0. 131) (P<0.05).Gender, shift،bioethics coueses had no significant relationship with ethical conflict (p> 0.05). the level of moral conflict in the private sector was moderate.

Nurses have a significant ethical conflict in the care.Nurses dont have a good perception of the environment and this exacerbates the conflict and has a negative impact on their career.The level and severity of ethical conflict in nurses is at a moderate level,recommended to investigate the frequency and severity of exposure to ethical conflict for intensive care unit nurses.

Resident-nurse communication involves the interaction between them to achieve a common therapeutic goal, namely to improve patient status. Proper communication has been identified as the most important attribute for people working in primary health care. The purpose of this study was to determine the attitudes of nurses and residents towards professional communication.

This study was a descriptive-analytical study in 2019. Sampling was made of available participants, including 200 nurses and residents of an educational hospital. Data were collected using two valid and reliable questionnaires included two professional communication questionnaires from the perspective of nurse and physician. Data were analyzed using descriptive statistics (frequency distribution, mean and standard deviation) and inferential statistics (t-test and ANOVA) and SPSS16   software.

From the nurseschr('39') viewpoint, the level of professional communication about timely informing residents about patient care issues, with a mean of 4.62 and from the residentschr('39') viewpoint, the effect of good professional communication with nurses on the improvement of patient status, with a mean of 4.72 more there were other items. 70% of nurses and 83% of residents admitted that their professional relationship was good. There was a significant difference between the viewpoints of nurses with different employment status (p = 0.046) and the viewpoints of different educational departments in the field of professional communication. (P =0.001)

Overall, professional communication from the viewpoint of residents and nurses is at a good level. However, measures such as interprofessional education and communication skills for the treatment team need to be considered in order to increase the effectiveness of health care delivery and improve the efficiency of the health care system, as well as to familiarize people with the impact of learning professional communication skills.

Self-control, as the foundation of individual beliefs, plays a key role in various areas of human life, especially the progress and academic performance of students. The aim of this study was to determine the relationship between self-control and academic performance of medical interns in Shahid Beheshti Hospital of Kashan University of Medical Sciences in 2019.

This descriptive cross-sectional study was performed with the participation of 100 medical clerkships and available sampling. Data collection tool was a self-regulatory questionnaire of Tangney model and to evaluate academic performance, the average of clerkships was examined. Data were analyzed using t-test and Pearson correlation test and SPSS16 statistical software. (P≤0.05).

There was a significant relationship between self-control and its components and the academic performance of clerkships . (p=0.020) Among female clerkships, a significant relationship between self-control and academic performance was reported. (p=0.003) Also, in single clerkships, there is a significant relationship between total self-control score and academic performance, and with increasing self-control score, their academic performance rate also increases significantly. (P=0.021)

The results showed that with increasing the total score of self-control and its components in medical clerkships, the score of academic performance also increases significantly. Since the academic achievement of medical students is related to public health, it is desirable that universities provide training to increase studentschr('39') self-control.

Goal orientation is one of the factors influencing academic achievement and behavior. It can also explain the relationship between the university student’s beliefs about academic achievement, engagement, and continuity in performing a learning task.

In this descriptive cross-sectional study, 135 Midwifery students of Shahid Sadoughi University of Medical Sciences included .The data collection tool was the educational goal orientation questionnaire of Buffard et al. along with 20 questions in three dimensions of mastery, functional, and avoidance orientation. The studentschr('39') average marks were the criterion for academic achievement. The data were analyzed using linear regression and one-way ANOVA.

Based on the results of the study, the mean and standard deviation of the mastery orientation  was23.68± 4.33, the functional orientation 27.65 ± 5.36, and the avoidance orientation was 25.14 ± 4.91. The total goal orientation score was 76.47 ± 12.73. The linear regression results showed a significant relationship between performance orientation and avoidance with academic achievement. According to one-way ANOVA, there was a significant relationship between the age difference and the year of  entering the university with different orientations. Moreover, the results of independent t-test showed that there was a significant relationship between marital status and employment status with different orientations.

Based on the results of the study, it is recommended to plan for the further academic achievement in accordance with their interest in order to improve the academic achievement of midwifery students, while identifying their orientation in early semesters of the university.

Nursing is the human profession that is inherently associated with ethical issues that is effective in spreading their moral intelligence. They also play a major role in the quality of service delivery, so job satisfaction and efficiency increase and enhance health services.

This descriptive-analytical study was performed on 105 nurses working in Yazd Afshar Hospital in 2017 who were selected by census. Measurement tools included Minnesota Job Satisfaction Questionnaire, Lnick & Kiel Moral Intelligence Questionnaire and demographic profile form. Data were analyzed by SPSS 19 software using descriptive (mean and standard deviation) and inferential tests (Pearson correlation coefficient).

The mean score of moral intelligence and job satisfaction were 73.21± 6.6 and 61.23± 10.05 respectively. The highest mean was for the honesty component (58.09± 5.44) and the lowest mean was for the compassion component (15.01±1.93). There was a significant relationship between job satisfaction and moral intelligence (p=0.001), which showed a significant relationship between job satisfaction and the subscale of honesty, forgiveness and compassion (P< 0.05).There was no significant relationship between job satisfaction and nurses responsibility subscale (P= 0.150).

Nurses with high moral intelligence mean that they are more responsive, compassionate, honest, and forgiving, and are usually more physically emotionally and mentally prepared, which has a wide impact on nurseschr('39') job satisfaction. Gradually the treatment plan will become interesting, challenging, active and creative.

Uncivil behaviors in work environments are a serious threat, lead to shame, and endanger the health of nurses and patients. The aim of this study was study the uncivil behaviors in therapeutic settings from nurseschr('39') viewpoint in educational hospitals of Shahrekord University of Medical Sciences.

This descriptive cross-sectional study was conducted with 219 nurses from educational hospitals affiliated to Shahrekord University of Medical Sciences in 2018. Data were collected through a questionnaire of demographic information and standard questionnaire of Guidroz uncivil nursing behaviors by quota method and then random Sampling. Data were analyzed using SPSS 20 using descriptive statistics and chi square test.

The findings of this study showed that mean score of uncivil behaviors from nursechr('39')s perspective was 14.09±24.10. Most uncivil behavior in nurses interacts with physicians (17.70±5.38) and the lowest in nurses interacting with other nurses (36.17±6.67) was observed.

Although the mean of nursing’s viewpoint about uncivil behavior was not significant in this study. However, due to the destructive effects of such behaviors in clinical settings, adopting strategies to improve the care provided in the clinic and the job satisfaction of nursing staff is essential.

This study aimed to explain the teaching ethics from the viewpoints of Jahrom University of Medical Sciences professors and students as a mixed method .

This is   qualitative- quantitative  study  with mixed  approach .In  quantitative part , 100 students of Jahrom University of Medical Sciences were selected using stratified random sampling method. In the qualitative part, 20 students  and 8 professors participated. The research instrument in the quantitative was  reliable  and valid  questionnaire of professional ethics, consisting of 35 questions in 5 point continuum  . In-depth semi-structured interviews were used in the qualitative section by  Colizzi  analysis   .The results of two parts extracted  and new indicators  and dimension emerged from mixed

In the aspect of  ethic in teaching , the highest mean was related to the personality of the teacher in  related to the recognition of teacher dignity  (3.07±_0.92).   Another high mean od score was  related to interpersonal relationship   with higher score in  ,   genuine interest to students( 3/04 ±_0.92.The qualitative section of the total of 74 codes examined, 3 themes were selected. Themes included individual, social, and professional ethics. with a total of 11 subthemes identified in the qualitative review.

Results from two qualitative and qualitative parts  lead to  emerge questioners items that is comprehensive in content and dimensions than current questionnaire in medical education . This indicator may be used by many researcher in Iran .

The rapid outbreak of Covid-19 has shocked the world. Universities were closed, and most educational, and research activities were suspended. The educational structures of the universities were attacked in hardware and software dimensions. Fear and anxiety were observed in the structure of educational management all over the world. Therefore, in such a situation, the best action is to think. Thinking to answer basic questions such as the role of education and research systems in disasters? How should faculty members perform in different phases of an epidemic? Since always asking the right question is the most important action to change and improve organizations, so in this editorial, basic questions are stated.