فهرست مطالب

نشریه پرستاری ایران
پیاپی 124 (تیر 1399)

  • تاریخ انتشار: 1399/04/10
  • تعداد عناوین: 8
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  • فاطمه بارکزایی، علی نویدیان، نسرین رضایی* صفحات 1-12
    زمینه و هدف

    با وجود پیشرفت هایی که در زمینه مراقبت با کیفیت در بخش های ویژه نوزادان انجام شده است، نیازهای روانی مادران آنها کمتر مورد توجه قرار گرفته است. مادرانی که نوزاد نارس آنها در بخش های ویژه نوزادان بستری می شوند با انواعی از مشکلات روانشناختی همچون افسردگی روبه رو می شوند. امروزه شناسایی و ارایه برنامه مداخله زود هنگام برای پیشگیری و کاهش این شرایط به یکی از اولویت های خدمات بهداشتی در جهان تبدیل شده است. لذا این مطالعه با هدف تعیین تاثیر برنامه آموزش شادکامی فوردایس بر افسردگی مادران نوزادان نارس بستری در بخش مراقبت های ویژه نوزادان مراکز درمانی شهر زاهدان انجام شد.

    روش بررسی

    این مطالعه نیمه تجربی در بهار و تابستان سال 1398 بر روی 80 مادر نوزاد نارس بستری در بخش مراقبت ویژه نوزادان در شهر زاهدان انجام شد. نمونه گیری به شیوه در دسترس انجام شد و نمونه ها در دو گروه مداخله (40 نفر) و کنترل (40 نفر) قرار گرفتند. قبل از مطالعه از مادران خواسته شد که فرم اطلاعات فردی و پرسشنامه افسردگی بک را تکمیل نمایند. مادران گروه مداخله در گروه های 5-4 نفره برنامه آموزش شادکامی فوردایس (Fordyce) را طی شش جلسه به صورت یک روز درمیان در مدت زمان 60 -45 دقیقه دریافت کردند. پس از گذشت یک ماه از مداخله مجددا پرسشنامه تکمیل شد. داده ها به وسیله نرم افزار SPSSنسخه 16 و به کمک آزمون های آماری مورد تجزیه و تحلیل قرار گرفتند.

    یافته ها: 

    نتایج نشان داد میانگین نمره افسردگی مادران نوزادان نارس بستری در بخش ویژه نوزادان دو گروه پس از آموزش شادکامی فوردایس تفاوت آماری معنی دار دارد (0001/0=P) و این بدان معنی است که اجرای آموزش شادکامی فوردایس در گروه مداخله توانسته باعث کاهش میانگین نمره افسردگی مادران شود. میانگین نمره افسردگی مادران نوزادان در گروه مداخله قبل از آموزش شادکامی از 81/5 ± 72/23 به 17/3 ± 47/11 پس از آن کاهش یافت و در گروه کنترل از 58/10 ± 82/21 قبل از مداخله به 62/3 ± 90/23 پس از آن افزایش یافت.

    نتیجه گیری کلی: 

    نتایج مطالعه حاضر نشان داد آموزش مبتنی بر شادکامی فوردایس می تواند افسردگی مادران نوزادان نارس بستری در بخش مراقبت های ویژه نوزادان را کاهش دهد. بنابراین می توان این برنامه آموزشی را در کنار برنامه های خانواده محور در مراکز درمانی به اجرا در آورد و ضروری است برنامه هایی همچون آموزش شادکامی فوردایس جهت حفظ و ارتقاء سلامت روان مادران مد نظر قرار گیرد.

    کلیدواژگان: افسردگی، شناختی رفتاری، مادران، نوزاد نارس
  • مریم عیدی، طاهره نجفی قزلجه *، شیما حقانی صفحات 13-26
    زمینه و هدف

    ادراک بیماری می تواند بر سلامت روان فرد و نحوه برخورد بیماران با بیماری تاثیر می گذارد و بدین ترتیب رفتارهای خودمراقبتی و کیفیت زندگی را تحت تاثیر قرار دهد. هدف از این مطالعه پیش بینی رفتارهای خودمراقبتی و کیفیت زندگی براساس درک از بیماری افراد با نارسایی قلبی بود.

    روش بررسی

    این مطالعه مقطعی از نوع همبستگی پیش بین از دی ماه 1396 تا اردیبهشت 1397 بر روی 150 بیمار مبتلا به نارسایی قلب که به روش مستمر انتخاب شدند انجام گردید. داده ها به صورت خود گزارش دهی با استفاده از پرسشنامه اروپایی رفتارهای مراقبت از خود در بیماران نارسایی، پرسشنامه کوتاه درک از بیماری و پرسشنامه زندگی با نارسایی قلبی مینه سوتا جمع آوری شدند. جهت تحلیل داده ها از ضریب همبستگی پیرسون، آزمون آنالیز واریانس، کای اسکویر، تی مستقل و ضریب تعیین در نرم افزارSPSS  نسخه 16 استفاده شد.  

    یافته ها: 

    براساس نتایج، میانگین نمرات درک از بیماری با HF برابر با 86/7 ± 42/59 بود. میانگین رفتارهای خودمراقبتی 79/7 ± 24/36 (با بیشینه و کمینه 15-53) بدست آمد که نشاندهنده خودمراقبتی در سطح متوسط بیماران است. کمترین و بیشترین نمره کیفیت زندگی به ترتیب برابر با 0 و 97 با میانگین 84/16 ± 53/59 (بالاتر از میانه نمره ابزار) بود بدین معنا که کیفیت زندگی واحدهای مورد پژوهش در سطح ضعیف قرار داشت. بر اساس نتایج 12 درصد از تغییرات رفتارهای خودمراقبتی و 42 درصد از تغییرات نمره کیفیت زندگی تحت تاثیر درک از بیماری براساس مشخصات جمعیت شناختی تبیین شده اند.

    نتیجه گیری کلی:

     با توجه به یافته ها، درک از بیماری پیش بینی کننده کیفیت زندگی و رفتارهای خودمراقبتی است. کارکنان سلامت مخصوصا پرستاران که در ارتباط بیشتری با بیماران هستند می توانند با آموزش بیماران در جهت بهبود ادراک بیماران تلاش نمایند تا در نهایت خودمراقبتی و کیفیت زندگی آنها افزایش یابد.

    کلیدواژگان: درک از بیماری، رفتارهای خودمراقبتی، کیفیت زندگی، نارسایی قلبی
  • مهدی شهرکی* صفحات 27-40
    زمینه و هدف

    نسبت بهینه و مناسب پرستار برای داشتن یک نظام سلامت کارا ضروری است به طوری که کمبود پرستار علاوه بر کاهش کیفیت مراقبت های سلامت منجر به آثار سوء بر ویژگی های جسمی و روحی پرستاران می گردد. از طرفی مازاد عرضه پرستار نیز منجر به هزینه بالای ارایه خدمات درمانی و اتلاف منابع می شود. هدف این مطالعه تعیین عوامل موثر بر نیاز به نیروی کار پرستاری، پیش بینی تعداد پرستار مورد نیاز و همچنین مازاد یا کمبود پرستار در بیمارستان های دولتی ایران برای سال های 1404 -1397 بود.

    روش بررسی

    مطالعه حاضر تحلیلی است که برای تعیین تعداد پرستار موردنیاز، ابتدا تابع تقاضای پرستار بر اساس مهم ترین عوامل تاثیرگذار با روش خودرگرسیون با وقفه توزیعی Autoregressive Distributed Lag (ARDL) و برای سال های 96 -1373 برآورد شد و سپس با استفاده از نتایج به دست آمده، تعداد پرستار مورد نیاز برای سال های 1404 -1397 پیش بینی شد. داده های موردنیاز مطالعه از نوع سری زمانی سالانه بودند که برای سال های 96 -1373 جمع آوری شدند. داده های تولید ناخالص داخلی سرانه، نسبت پرداخت از جیب برای مخارج سلامت به کل مخارج سلامت، نسبت افراد بالای 65 سال به افراد 65 -14 سال از پایگاه داده ای بانک جهانی و داده های تعداد پرستار و تخت بیمارستان از سالنامه های آماری سال های مختلف مرکز آمار ایران استخراج شدند. برآورد مدل ها و آزمون های موردنیاز در نرم افزار Eviews 10 صورت گرفت.

    یافته ها:

     تعداد پرستاران بیمارستان های دولتی به ازای هزار نفر در سال 1373 برابر با 207/0 بود که در سال 1396 به 12/1 رسید که میانگین آن طی سال های 96 -1373 برابر با 26/0 ± 55/0 بود. لگاریتم طبیعی تولید ناخالص داخلی سرانه طی این دوره روند صعودی داشت و میانگین آن برابر با 13/0 ± 63/9 دلار به ازای هر نفر بود. همچنین میانگین نسبت افراد بالای 65 سال به افراد 65 -14 سال در این دوره برابر با 5/0 ± 33/7 و میانگین پرداخت از جیب برای مخارج سلامت به کل مخارج سلامت برابر با 36/6 ± 53/53 بود. نتایج نشان داد مقدار پیش بینی تقاضای پرستار بیشتر از مقدار پیش بینی عرضه پرستار طی سال های 1404 -1397 بود همچنین میانگین پیش بینی عرضه و تقاضای پرستار طی این دوره به ترتیب برابر با 1622/1 و 3254/1 پرستار به ازای 1000 نفر بود که به میزان 17/0 کمبود پرستار به ازای 1000 وجود داشت.

    نتیجه گیری کلی:

     تولید ناخالص داخلی و نسبت افراد بالای 65 سال به افراد 65 -14 تاثیر مثبت و نسبت پرداخت از جیب برای مخارج سلامت به کل مخارج سلامت تاثیر منفی بر تقاضای پرستار داشتند. همچنین تا سال 1404 با کمبود پرستار مواجه خواهیم بود لذا سیاست ها و برنامه هایی برای کاهش این کمبود ضروری است که در این راستا افزایش تولید ناخالص داخلی و نرخ استخدامی، مشوق های قوی و قراردادهای استخدامی انعطاف پذیرجهت جلوگیری از بازنشستگی زودهنگام پرستاران پیشنهاد می شود.

    کلیدواژگان: پرستار، منابع سلامت، نیروی کار سلامت، پیش بینی
  • سید محمدجواد موسوی نیا، عبدالزهرا نعامی*، نسرین ارشدی، کیومرث بشلیده صفحات 41-57
    زمینه و هدف

    تعارض میان کار و خانواده به عنوان موضوعی اصلی که هم کارکنان و کارفرمایان و هم خانواده آنان را متاثر می سازد، با مشکلات برجسته ای در حوزه خانوادگی مانند خشنودی خانوادگی، کیفیت روابط زوجین و کیفیت فرزندپروری همراه است. پژوهش حاضر با هدف تعیین نقش بهزیستی کارکنان، در کاهش اثر تعارض کار- خانواده بر خشنودی خانوادگی، کیفیت روابط زوجین و کیفیت فرزندپروری پرستاران انجام شد.

    روش بررسی

    مطالعه حاضر به صورت پیمایشی و از نوع همبستگی در بیمارستان های دولتی شهر اهواز بر روی 223 پرستار که به روش نمونه گیری چندمرحله ای انتخاب شده بودند، از شهریور تا آبان 1398انجام گردید. جهت جمع آوری داده ها، از پرسشنامه های تعارض کار- خانواده Carlson  و همکاران، پرسشنامه خشنودی خانوادگی Aryee و همکاران، پرسشنامه کیفیت روابط زوجین Chonody و همکاران، مقیاس فرزندپروری Arnold و همکاران، مقیاس بهزیستی کارکنان Zheng و همکاران، استفاده شد. تحلیل داده ها از طریق آمار توصیفی و استنباطی (همبستگی پیرسون و رگرسیون سلسه مراتبی) و با استفاده از نرم افزار SPSS نسخه 16 انجام گرفت.

    یافته ها: 

    نتایج نشان داد که افزودن تعامل تعارض کار- خانواده و بهزیستی کارکنان به معادله رگرسیون در گام دوم، به تبیین 631/0 درصد از واریانس خشنودی خانوادگی با 044/0 درصد واریانس انحصاری افزوده (227/0 = β و 01/0< P)، و تبیین 685/0 درصد از واریانس کیفیت روابط زوجین با 022/0 درصد واریانس انحصاری افزوده (160/0 = β و 01/0< P)، و تبیین 671/0 درصد از واریانس کیفیت فرزندپروری با 048/0 درصد واریانس انحصاری افزوده (237/0- = β و 01/0< P) منجر شد. علاوه بر این نتایج نشان داد که افزودن تعامل تعارض خانواده- کار و بهزیستی کارکنان به معادله رگرسیون در گام دوم، به تبیین 626/0 درصد از واریانس خشنودی خانوادگی با 036/0 درصد واریانس انحصاری افزوده (213/0 = β و 01/0< P)، و تبیین 685/0 درصد از واریانس کیفیت روابط زوجین با 016/0 درصد واریانس انحصاری افزوده (142/0 = β و 01/0< P)، و تبیین 654/0 درصد از واریانس کیفیت فرزندپروری با 032/0 درصد واریانس انحصاری افزوده (200/0- = β و 01/0< P) منجر شد. همچنین ضریب رگرسیون مربوط به تعامل این متغیرها نشان داد که اثر تعاملی تعارض کار- خانواده و بهزیستی کارکنان و همچنین اثر تعاملی تعارض خانواده- کار و بهزیستی کارکنان از لحاظ آماری معنی داراست.

    نتیجه گیری کلی: 

    نتایج حاکی از آن است که تعارض کار- خانواده و همچنین تعارض خانواده- کار نقش معنی داری در کاهش خشنودی خانوادگی، کیفیت روابط زوجین و کیفیت فرزندپروری پرستاران داشتند. بعلاوه در رابطه با نقش تعدیل کننده بهزیستی کارکنان، نتایج نشان داد که این متغیر می تواند تاثیرات منفی تعارضات تجربه شده میان حوزه های کار و خانواده را بر خشنودی خانوادگی، کیفیت روابط زوجین و کیفیت فرزندپروری تعدیل کند.

    کلیدواژگان: تعارض کار- خانواده، خشنودی خانوادگی، کیفیت روابط زوجین، کیفیت فرزندپروری، بهزیستی کارکنان
  • مرجان مردانی حموله، نعیمه سید فاطمی، آمنه اسلامی*، شیما حقانی صفحات 58-69
    زمینه و هدف

    توجه به مهارت شایستگی مراقبت معنوی پرستاران، می تواند ارزشمند باشد زیرا به نظر می رسد پرستاران با بهره گیری از این مهارت در محیط پیچیده بالین، قادر می گردند که مراقبت های بهتری به بیماران خود ارایه دهند. واقع امر آن است که شایستگی مراقبت معنوی، یکی از مفاهیم مطرح در خلق مراقبت های پرستاری استاندارد برای بیماران است. بر این اساس، هدف مطالعه حاضر، تعیین شایستگی مراقبت معنوی پرستاران شاغل در بیمارستان های آموزشی وابسته به دانشگاه علوم پزشکی البرز بود.

    روش بررسی

    در این پژوهش توصیفی- مقطعی، 200 پرستار شاغل در بیمارستان های آموزشی وابسته به دانشگاه علوم پزشکی البرز شامل بیمارستان های کمالی، شریعتی، امام حسین، مدنی و رجایی در سال 1398 طی چهار ماه به شیوه نمونه گیری در دسترس، مشارکت نمودند. ابزار گردآوری داده ها، ابزار روا و پایا شده شایستگی مراقبت معنوی بود. داده ها با استفاده از آزمون های آماری تی مستقل و آنالیز واریانس تحت نرم افزار SPSS نسخه 16، تحلیل شدند.

    یافته ها:

     نتایج مطالعه حاضر گویای آن بود که نمره کلی شایستگی مراقبت معنوی پرستاران 69/14 ± 21/54 می باشد که با توجه به میانه ابزار یعنی 81، این یافته نشان می دهد که نمره کلی شایستگی مراقبت معنوی پرستاران از میانه ابزار کمتر شده است. سایر یافته های پژوهش، حاکی از آن بود که از میان مشخصات فردی پرستاران، شایستگی مراقبت معنوی با سمت سازمانی (005/0=p) و سابقه کار پرستاری (003/0=P) ارتباط معنی دار آماری داشت. به طوری که شایستگی مراقبت معنوی پرستاران به طور معنی داری بهتر از سرپرستاران بود. افزون بر آن، شایستگی مراقبت معنوی پرستاران دارای سابقه کار پرستاری با محدوده 1-5 سال، نسبت به سایرین در وضعیت بهتری بود.

    نتیجه گیری کلی:

     با توجه به این که طبق یافته های مطالعه حاضر، شایستگی مراقبت معنوی پرستاران در وضعیت مطلوبی قرار نداشت، باید فرصتی فراهم نمود تا دانش آنان در این زمینه ارتقاء یابد. در واقع، نتایج حاصل از این مطالعه می تواند اطلاعات پایه ای جهت انجام مطالعات بعدی و همچنین جهت انجام مطالعات مداخله ای را در این زمینه فراهم سازد.

    کلیدواژگان: شایستگی مراقبت معنوی، پرستار، مراقبت پرستاری
  • آلیس خاچیان، محمدرضا زارعی، حمید حقانی، فاطمه خانی* صفحات 70-81
    زمینه و هدف

    جامعه ایرانی به لحاظ تاریخی دارای بافت چند قومیتی، فرهنگی، زبانی و مذهبی بوده، که این امر در میان مراجعین نظام خدمات سلامت نیز به چشم می خورد. با توجه به اهمیت مراقبت، به عنوان مهم ترین جزء اقدامات پرستاری و از سویی وجود تفاوت های فرهنگی در کشور ایران، و این که بیماران از شهرهای مختلف کشور با فرهنگ های متفاوت به مراکز درمانی در شهرهای بزرگ از جمله تهران مراجعه می کنند و پرستاران باید در برنامه ریزی مراقبت پرستاری اطلاعات ضروری در مورد وضعیت فرهنگی، اجتماعی و قومیتی بیمار به عنوان بخشی از حرفه پرستاری داشته باشند، ضروری به نظر رسید که پژوهشی با هدف تعیین ارتباط شایستگی فرهنگی پرستاران با رفتارهای مراقبتی آن ها در مراکز آموزشی درمانی وابسته به دانشگاه علوم پزشکی ایران در سال 1398 انجام شود.

    روش بررسی

    این مطالعه مقطعی از نوع همبستگی با مشارکت 200 پرستار شاغل در مراکز آموزشی درمانی وابسته به دانشگاه علوم پزشکی ایران در شهر تهران که به صورت چند مرحله ای خوشه ای انتخاب شدند، انجام شد. جمع آوری داده ها با استفاده از پرسشنامه شایستگی فرهنگی Perng و Watson و پرسشنامه رفتارهای مراقبتی CBI-42 از ابتدای آبان ماه تا آخر دی ماه 1398 انجام شد. داده ها پس از جمع آوری، با استفاده از نرم افزار SPSS نسخه 16 با آزمون تی مستقل، ANOVA و ضریب همبستگی پیرسون مورد تحلیل آماری قرار گرفتند.

    یافته ها: 

    میانگین نمره شایستگی فرهنگی پرستاران 02/15 ± 27/66 و میانگین نمره رفتارهای مراقبتی پرستاران 43/0 ± 28 /5 بود. بیشترین نمره میانگین شایستگی فرهنگی مربوط به بعد حساسیت فرهنگی (50/60) وکمترین نمره میانگین مربوط به بعد دانش فرهنگی (25/56) بود. کمترین نمره میانگین رفتارهای مراقبتی مربوط به بعد احترام قایل شدن برای دیگری (09/5) و بیشترین نمره میانگین مربوط به بعد دانش و مهارت حرفه ای (43/5) بود. به طور کلی بین شایستگی فرهنگی پرستاران مورد پژوهش و رفتارهای مراقبتی آن ها ارتباط معنی دار ضعیفی وجود داشت. همچنین بین تمامی ابعاد رفتارهای مراقبتی و شایستگی فرهنگی به غیر از دانش و مهارت و حساسیت فرهنگی (058/0=P) ارتباط معنی دار آماری مشاهده شد (05/0>P). همچنین یافته ها نشان داد که افرادی که در بخش اورژانس کار می کنند سطح شایستگی فرهنگی بالاتری دارند و افراد متاهل دارای سطح بالاتر رفتارهای مراقبتی هستند.

    نتیجه گیری کلی: 

    نتایج مطالعه حاضر نشان داد که بین شایستگی فرهنگی پرستاران و رفتارهای مراقبتی آنها ارتباط معنی دار ضعیفی وجود دارد. پیشنهاد می شود با تقویت آنها از طریق آموزش های آکادمیک و ضمن خدمت باعث بهبود ارایه مراقبت های پرستاری به مددجویان شد.

    کلیدواژگان: شایستگی فرهنگی، رفتارهای مراقبتی، پرستاران
  • فاطمه دولت شاد، علی ماهر*، سید مجتبی حسینی، امین عقیلی صفحات 82-91
    زمینه و هدف

    استرس شغلی به طور منفی با کیفیت مراقبت ها ارتباط دارد و منجر به افزایش بروز حوادث اشتباه و خطا خواهد شد. از طرفی با توجه به ماهیت کار پرستاران و احتمال بروز خطا، تمایل به تجربه ی احساس گناه پاتوژن یا مرضی، ممکن است به سلامت آنان آسیب برساند. این مطالعه با هدف تعیین ارتباط بین استرس شغلی با احساس گناه در پرستاران بیمارستان کودکان مفید تهران انجام شد.

    روش بررسی

    پژوهش حاضر به صورت توصیفی کاربردی در تابستان سال 1397 بر روی 141 پرستار که با روش نمونه گیری تصادفی ساده انتخاب شدند انجام گردید. ابزار گردآوری داده ها شامل سه بخش مشخصات جمعیت شناختی پرستاران، پرسشنامه استرس شغلی اسیپو (Osipow) و پرسشنامه احساس گناه مراقب CGQ (Caregiver Guilt questionnaire) بود. برای تحلیل داده ها از نرم افزار SPSS نسخه 16 و آمار توصیفی و استنباطی استفاده گردید.

    یافته ها: 

    میانگین و انحراف معیار احساس گناه 64/0 ± 93/3 و استرس شغلی 51/0 ± 29/4 بدست آمد. نتایج مطالعه نشان داد بیشتر پرستاران (5/69 درصد) در محدوده استرس شدید و با احساس گناه شدید (4/55 درصد) قرار داشتند. همبستگی مثبت و معنی داری بین استرس شغلی و ابعاد آن با احساس گناه و ابعاد آن در میان پرستاران وجود داشت (05/0>P).

    نتیجه گیری کلی: 

    بر اساس نتایج با توجه به رابطه معنی داری که بین استرس شغلی و احساس گناه وجود داشت، به کارگیری تکنیک های کاهش استرس شغلی در بین پرستاران بیمارستان های کودکان اهمیت بسزایی دارد. لازم است سیاست گذاران سیستم بهداشتی درمانی، در راستای کاهش استرس شغلی پرستاران با استفاده از عواملی همانند کم کردن ساعات کاری، حذف نوبت های کاری های متوالی، افزودن خدمات رفاهی، بهبود شرایط محیط فیزیکی کار و غیره اقدام نمایند.

    کلیدواژگان: احساس گناه، استرس شغلی، پرستار، بیمارستان
  • محمدرضا شیخی چمان* صفحات 92-103
    زمینه و هدف

    در سازمان‌های ارایه‌دهنده مراقبت‌های بهداشتی و درمانی، بهبود فرهنگ ایمنی بیمار به عنوان یکی از عوامل مهم در راستای کاهش حوادث ناخواسته و ارتقای ایمنی بیمار شناخته شده است. هدف از مطالعه حاضر تعیین وضعیت فرهنگ ایمنی بیمار از دیدگاه پرستاران بیمارستان‌های منتخب دانشگاه علوم پزشکی تهران بود.

    روش بررسی

    مطالعه حاضر یک پژوهش مقطعی بود که در نیمه دوم سال 1398 و در میان هفت بیمارستان آموزشی- درمانی منتخب وابسته به دانشگاه علوم پزشکی تهران با حجم نمونه 295 نفر انجام شد. مشارکت‌کنندگان با روش نمونه‌گیری تصادفی ساده انتخاب شده و ابزار گردآوری داده‌ها نیز پرسشنامه استاندارد فرهنگ ایمنی بود. در نهایت داده‌ها توسط آمار توصیفی (تعداد، درصد، میانگین، انحراف معیار) و تحلیلی (آزمون تی‌مستقل، آنالیز واریانس یک‌طرفه) و در سطح معنی‌داری کمتر از 05/0 به وسیله نرم‌افزار SPSS نسخه 16 تحلیل گردید.

    یافته‌ها:

     از 295 پرسشنامه توزیع‌شده، تعداد 260 پرسشنامه (8/89 درصد) بازگردانده شد. نمره کلی فرهنگ ایمنی بیمار در مطالعه حاضر 06/3 با انحراف معیار 40/0 بود که از بین ابعاد آن، بیشترین میانگین مربوط به بعد یادگیری سازمانی (74/0 ± 45/3) و کمترین میانگین به ابعاد تبادلات و انتقال اطلاعات (86/0 ± 45/2) تعلق داشت. بر اساس نتایج بخش تحلیلی پژوهش نیز بین وضعیت فرهنگ ایمنی با ویژگی‌های جمعیت شناختی و سازمانی پرستاران ارتباط آماری معنی‌داری وجود نداشت (05/0>p).

    نتیجه‌گیری کلی: 

    در این مطالعه نمره کلی فرهنگ ایمنی بیمار در حد متوسط بود. عواملی از قبیل حمایت مدیران از مقوله ایمنی بیمار در بیمارستان، کار تیمی درون واحدهای سازمانی، ارتباطات و ارایه بازخورد در مورد خطاها و تسهیل تبادل و انتقال اطلاعات در سازمان‌های مراقب سلامت در راستای افزایش ایمنی گیرندگان خدمات ضروری می باشد. همچنین ارتقای روابط و کار تیمی بیشتر درون واحدهای بیمارستانی و ایجاد محیط غیرتنبیهی به منظور گزارش بیشتر حوادث نیز می‌تواند در این راستا مثمرثمر واقع گردد.

    کلیدواژگان: بیمارستان، پرستاران، فرهنگ ایمنی بیمار، تهران
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  • F. Barekzaei, A .Navidian, N. Rezaee* Pages 1-12
    Background & Aims

    The birth of a premature and sick infant leads to a severe psychological crisis for the parents. The birth of an infant is associated with numerous changes in the family function in terms of lifestyle, leisure, and relations of the family members. When an infant is born in need of medical care, these changes are intensified, and the family members experience increased mental pressure. Premature delivery and admission of the neonate adversely affects the emotional state of the mother, and one of the psychological reactions perceived by these mothers is the onset of depressive symptoms. Depressed mothers are faced with several challenges in the care of an inpatient infant, which are considered a risk factor for the deterioration of their mental health and dysfunction. Despite the advances in the quality care in neonatal intensive care units (NICUs) for infants, the psychological needs of their mothers have received less attention. The mothers of the premature infants admitted to NICUs experience various psychological issues (e.g., depression). These issues along with the physical complications of childbirth cause these women not to pay attention to their physical and mental health. Today, the identification and provision of early interventions to prevent and reduce these issues have become a priority of healthcare services in the world. The present study aimed to assess the effect of Fordyce happiness training on the depression of the mothers of the premature infants admitted to the NICUs of the medical centers in Zahedan, Iran.

    Materials & Methods

    This quasi-experimental study was conducted in the spring and summer of 2019 on 80 mothers of the premature infants admitted to the NICUs of Zahedan. The subjects were selected via convenience sampling and divided into two groups of intervention (n=40) and control (n=40). For sampling, the researcher initially referred to the NICUs and identified the mothers of the admitted premature infants. After explaining the research objectives and obtaining written consent, the mothers who met the inclusion criteria were enrolled. The mothers of the control group were enrolled first, followed by the mothers of the intervention group in order to prevent the transfer of information in the groups. Prior to the study, the mothers were asked to complete the demographic information form and Beck depression inventory. The mothers of the intervention group received Fordyce happiness training in groups of 4-5 for six sessions every other day (45-60 minutes). Fordyce happiness training is a program designed to increase the happiness of community members, which consists of 14 cognitive and behavioral elements. In the present study, some of the components of Fordyce happiness training that were appropriate for the sample population were presented and discussed based on examples and experiences. One month after the intervention, the questionnaire was completed again. The control group received no other training than the routine educational program of the hospital, as well as the posttest simultaneous with the intervention group. Data analysis was performed in SPSS version 16 using statistical tests.

    Results

    The minimum and maximum age of the mothers in the intervention and control groups was 15 and 31 years and 18 and 35 years, respectively. Most of the deliveries in the intervention group were natural (65%), and in the control group, the mode of delivery was equal in both groups (50%). No significant differences were observed in most of the variables between the groups, while the age of the mothers was significantly different between the groups. The analysis of covariance was used for the confounding effect of age, and the results of the analysis of covariance to adjust the effect of the pretest scores and age variable indicated a significant difference in the mean score of depression in the mothers of the preterm infants admitted to the NICU between the groups after Fordyce happiness training (P=0.0001). Therefore, the implementation of Fordyce happiness training in the intervention group could reduce the mean score of depression in the mothers. The mean score of maternal depression in the intervention group decreased from 23.72±5.81 before the intervention to 11.47±3.17 after the intervention. In the control group, the score increased from 21.82±10.58 before the intervention to 23.90±3.62 after the intervention. However, the results of independent t-test indicated that the mean score of maternal depression before intervention had no significant difference between the study groups (P=0.32), while it was considered significant after the happiness training in both the intervention and control groups (P=0.0001).

    Conclusion

    According to the results, Fordyce happiness training could reduce depression in the mothers of the premature infants admitted to the NICU. Although the experience of childbirth is pleasant for the mother, giving birth to a premature infant and the admission of the infant could be an unpleasant experience, adversely affecting the emotional state and of the mother and giving rise to depressive symptoms. In order to maintain and promote the mental health of mothers, in addition to the care of the premature infant in medical centers, the health of the mother of the infant should also be considered. Fordyce happiness training could positively influence the reduction of depression in these mothers. Fordyce happiness training is a type of cognitive-behavioral intervention, which is used to reduce depression. This intervention enables the individual to find a more positive mindset in controlling distressing emotions and thoughts, which in turn enhances the cognition of patients by reducing depression. The reduction of depressive symptoms improves the performance of individuals in responsibilities and duties. The mothers who overcome their issues in this regard are able to participate in the care of the neonate during admission. Therefore, this training program could be implemented alongside family-oriented programs in medical centers, and it is essential to consider programs such as Fordyce happiness training to maintain and promote maternal mental health.

    Keywords: Depression, Cognitive-Behavioral, Mothers, Premature Infant
  • M. Eydi*, T. Najafi Ghezeljeh, SH .Haghani Pages 13-26
    Background & Aims

    Heart failure (HF) is a disorder that is caused by the inability of the heart to pump blood properly due to the disorders in the structure or function of the heart. Quality of life (QOL) is lower in patients with HF compared to the general population and patients with other chronic diseases. For optimal QOL, it is necessary to change behaviors and follow treatment regimens throughout the period of self-care. The impact of any chronic and long-term condition on the patients and their ability to optimize self-care could be attributed to several factors, such as the understanding of the condition and its nature, impact of the condition on the ability of the patient to perform daily activities, beliefs and expectations, patientchr('39')s involvement in self-care, and support. Disease perception could affect the mental health of the patients and management of the disease, thereby affecting their self-care behaviors and QOL. The present study aimed to predict the self-care behaviors and QOL based on the disease perception of patients with HF.

    Materials & Methods

    This cross-sectional was conducted with a predictive correlational design during January 2017-May 2016 on 150 patients with HF, who were selected via continuous sampling based on the inclusion criteria of the confirmed diagnosis of HF by a physician and a minimum of six months past the disease, age of more than 18 years, and ability to communicate and literacy to complete the questionnaires. Data were collected in a self-report manner using the European HF self-care behavior scale, a brief illness perception questionnaire, and Minnesota living with heart failure questionnaires. The European HF self-care behavior scale consists of 12 items, and the responses are scored based on a five-point Likert scale (Completely=1, Not at All=5) within the score range of 12-60. The lower scores in this questionnaire show the better self-care behavior of individuals and vice versa. The brief illness perception questionnaire has eight items, which were prepared based on the modified version of the questionnaire. The items are scored within the range of 0-10, and the score obtained from the eight items is within the range of 0-80, which is the highest score indicating the patientchr('39')s understanding of the high risk of the disease. The Minnesota living with heart failure questionnaires has 21 items that are scored based on a six-point Likert scale (0-5), and the total score is within the range of 0-105, and the higher scores show the lower QOL of the patient. Data analysis was performed in SPSS version 16 using Pearsonchr('39')s correlation-coefficient, the analysis of variance (ANOVA), Chi-square, independent t-test, and regression analysis.

    Results

    The mean score of the illness perception was 59.42±7.86, the mean score of self-care behaviors was 36.24±7.79 (moderate), and the mean score of QOL was 59.53±16.84 (poor). A significant, direct, and weak correlation was observed between the illness perception and self-care behaviors (P<0.001; r=0.26). In addition, self-care was the only predictor of illness perception, and illness perception and QOL had a direct, significant correlation (r=0.48; P<0.001). The results of multiple linear regression analysis showed that illness perception, adequate income, education level, number of hospitalizations, and classification of HF were the predictors of QOL. The mean score of the illness perception was 59.42±7.86, and the mean score of self-care behaviors was 36.24±7.79 (maximum: 53, minimum: 15), which indicated the moderate self-care of the patients. The minimum and maximum scores of QOL were zero and 97, respectively with the mean score of 59.53±16.84, which indicated the poor QOL of the research units. A weak, significant correlation was observed between the illness perception and self-care of the patients (r=0.26; P<0.001), so that with the increased score of illness perception, the self-care scores of the patients increased. In the results of the multiple linear regression analysis indicated that the only self-care could predict self-care (P=0.046), so that with the increased score of illness perception by one point, the self-care scores of the patients increased by 0.15 units. Therefore, when the patient is threatened to perceive their disease, their self-care becomes weaker (Table 2). In addition, the correlation between the two variables of illness perception and QOL was direct and significant (P<0.001; r=0.48). As the scores of disease perception increased, the QOL of the patients was higher, so that the more the patient perceives the threat of the disease, the poorer their QOL becomes. The results of multiple linear regression analysis indicated that per one unit of increase in the perception of the disease, the QOL score increased by 0.33, which shows the deterioration of the QOL. The QOL in those with sufficient income was lower by 0.14 compared to those with insufficient income. Furthermore, the QOL score of those with an undergraduate degree (below diploma) was lower by 0.22 compared to those with higher education. The patients without the history of hospitalization had higher QOL scores by 0.31 compared to those with 5-10 hospitalizations, indicating the better QOL. In addition, the QOL score of the patients with HF class II was lower by 0.29 units and 0.16 units in those with HF class III compared to those with HF class IV, which indicated their better QOL.

    Conclusion

    According to the results, illness perception predicts QOL and self-care behaviors. In this study, patients with HF, which is a common chronic disease, were examined. In these patients, the perception and cognition that a person is affected by other factors of his disease affects the perception of their physical needs, followed by their activities and the behaviors that influence self-care and meeting needs. However, it should be noted that in addition to illness perception, other factors play a key role in the self-care of patients with HF, which must be investigated in the future studies. The healthcare professionals (especially nurses) who are more in contact with patients could improve the patientschr('39') perceptions through education to increase their self-care and QOL. The patients with poor illness perception had more negative self-care behaviors. The healthcare professionals (especially nurses) who are more in contact with patients could improve the patientschr('39') perceptions through education to increase their self-care. The results showed that poor illness perception was associated with the lower QOL. Therefore, it is suggested that interventions such as counseling and follow-up programs be considered to improve the understanding of diseases, so that QOL could be enhanced. Research must be focused on the effectiveness of these interventions. Considering the association between illness perception and self-care behaviors in the HF patients and the predictive role of disease perception (especially for QOL), nursing managers could provide facilities for planning and implementing the necessary measures to improve the patientchr('39')s understanding of HF upon admission and referral to medical centers or the proper conditions should be provided for the implementation of counseling and follow-up sessions in the management of the patients at home.

    Keywords: Heart Failure, Illness Perception, Self-care Behaviors, Quality of Life
  • M Shahraki* Pages 27-40
    Background & Aims

    The optimal and appropriate ratio of nurses is essential to an efficient healthcare system. In addition to decreasing the quality of health care, the shortage of nursing staff adversely affects the physical and mental characteristics of nurses. On the other hand, the supply surplus of nurses leads to high costs of medical service provision and waste of resources. In case of the surplus or shortage of nurses that could lead to the inefficiency of the healthcare system, adopting appropriate policies and proper planning to maintain equilibrium in the supply and demand of nurses are paramount. The present study aimed to evaluate the influential factors in the demand of nurses, predict the number of the required nurses, and determine the surplus or shortage of nurses in the public hospitals in Iran during 2018- 2025.

    Materials & Methods

    This analytical study aimed to determine the required nurses and the surplus/shortage of nurses in the hospitals affiliated to Iran University of Medical Sciences during 2018- 2025. To determine the number of the required nurses, the nurse demand function was initially estimated based on the most important influential factors using the autoregressive distributed lag (ARDL) method during 1994- 2017. The obtained results were used to predict the number of the required nurses during 2018- 2025. Before the estimation of the model, the stationary of the variables had to be ensured, for which the augmented Dickey-Fuller (ADF) test was used. The nurse short-term demand function was defined by selecting the optimal lags based on the Schwarz criterion (SIC) in the ARDL method, as follows:
    natural logarithm of the number of nurses per 1,000 population;
    natural logarithm of the number of nurses per 1,000 population with a one-time lag;
    natural logarithm of the number of nurses per 1,000 population with a two-time lag;
    natural logarithm of the gross domestic product (GDP) per capita based on the purchasing power parity;
    the ratio of people aged more than 65 years to those aged 14-65 years;
    the ratio of the out-of-pocket payments for health expenditures to the total health expenditures;
    the ratio of the out-of-pocket payments for health expenditures to the total health expenditures with a one-time lag;
    the number of hospital beds per 1,000 population;
    the coefficients of the model variables
    To estimate the long-term demand function of nurses, the presence of long-term correlations had to be ensured, for which the F-test was used. If the F statistic value was higher than the critical value of the upper bound, the null hypothesis that there is no long-term correlation would be rejected, and if the F statistic value was less than the lower bound, the null hypothesis could not be rejected. Finally, if the F statistic value was between the two bounds, the result would be uncertain. To determine the surplus or shortage of nurses during 2018- 2025, the difference between the predicted values of the supply and demand of nurses was used. To predict the supply of nurses, the autoregressive integrated moving average (ARIMA) method was used based on the Box-Jenkins methodology in four steps of identification, estimation, diagnostic checking, and forecasting. The required data were the annual time series that were collected for the period of 1994- 2017. In addition, data on the GDP per capita, ratio of the out-of-pocket payments for health expenditures to the total health expenditures, and ratio of the people aged more than 65 years to those aged 14- 65 years were obtained from the World Bank databases, and the data on the number of nurses and hospital beds were extracted from the statistical yearbooks of the Statistics Center of Iran. The required models and tests were estimated in the EViews software version 10.

    Results

    The number of the nurses in the public hospitals per 1,000 population in 1994 was 0/207, while it was 1.12 in 2016 with the mean of 0/55±0/26 during this period. The natural logarithm of the GDP per capita during this period had an upward trend, with the mean value of 9/63 ± 0/13 per person. In addition, the mean ratio of the people aged more than 65 years to those aged 14- 65 years in this period was 7/33 ± 0/5, and the mean of the out-of-pocket payment for health expenditures to the total health expenditures was 53/53 ± 6/36. Before estimating the nurse demand function, the stationary of the variables had to be ensured using the ADF test, and the results showed that all the variables were non-stationary at the level, while they were stationary at the first difference. After determining the stationary of the variables, the short-term demand function of nurses was estimated using the ARDL method, and the results of the short-term nurse demand function indicated that the natural logarithmic coefficient of the number of nurses per 1,000 population with a one-time lag was 0/46 (i.e., 1% increase in the demand of this year would increase the demand of the next year by 0/46%). On the other hand, the natural logarithmic coefficient of GDP per capita was equal to 0/874. The coefficients of the ratio of the people aged more than 65 years to those aged 14- 65 years and the ratio of the out-of-pocket payments for health expenditures to the total health expenditures in the previous year were 0/37 and -0/015, respectively. To estimate the long-term demand function, the presence of a long-term correlation was initially evaluated using the F-test, and the nurse long-term demand function was estimated using the ARDL method. The F statistic value was 9/38, which was higher than the upper bound value at the significance of 5%; therefore, the null hypothesis regarding the lack of a long-term correlation was rejected. Furthermore, the obtained results indicated that the coefficients of the natural logarithmic of GDP per capita, ratio of the people aged more than 65 years to those aged 14- 65 years, and ratio of the out-of-pocket payments for health expenditures to the total health expenditures were 1/77, 0/76, and -0/0332, respectively. To determine the surplus or shortage of nurses during 2018- 2025, the difference between the predicted values for the supply and demand of nurses was used, and the obtained results showed that the predicted value of nurse demand was higher than the predicted value of nurse supply during 2018- 2025. In addition, the mean predicted values of the supply and demand of nurses during this period were 1/1622 and 1/3254 nurses per 1,000 population, respectively, which indicated the shortage of nurses by 0/17 per 1,000 population.

    Conclusion

    According to the results, the GDP and ratio of the people aged more than 65 years to those aged 14-65 years had a positive impact on the nurse demand, while the ratio of the out-of-pocket payments for health expenditures to the total health expenditures had a negative impact on this variable. Furthermore, a shortage of nurses is expected by 2025, and there is an urgent need for effective policies and proper planning to control this issue. In this regard, increased GDP and employment rates, strong incentives, and flexible employment contracts are proposed to prevent the early retirement of nurses.

    Keywords: Nurses, Health Resources, Health Workforce, Predictions
  • SMJ .Mousavinia, A. Naami*, N. Arshadi, K .Beshlideh Pages 41-57
    Background & Aims

    Today, work-family conflict is considered as one of the most important issues in the world of work, which is increasing rapidly and is not limited to one organization, and all organizations must pay special attention to this phenomenon in order to maintain their human resources as the most important competitive advantage. Nurses are no exception due to the high work requirements on the one hand and family issues on the other hand. People in the nursing profession usually work in different and sometimes irregular work shifts, and their work may be associated with stress and difficulties and affect nurses psychologically. In the meantime, the situation can be more difficult for married nurses, as they may become involved in work-family conflicts. The conflict between work and family as a major issue affecting both employees and employers and their families is accompanied by prominent family problems such as family satisfaction, couple relationship quality, and parenting quality. Therefore, industrial and organizational psychologists have focused their research on finding moderating variables to reduce such adverse effects. Therefore, the present study aimed to investigate the role of Wellbeing at Work in reducing the effect of work-family conflict on family satisfaction, couple relationship quality and parenting quality of nurses.

    Materia & Methods

    The present study was a correlational survey. The research community consisted of married nurses with children of govermental Ahvaz city hospitals, among which 240 were selected as sample members in a multi - step sampling method. Thus, among the Governmental hospitals in Ahvaz, four hospitals were randomly selected and 5 wards were randomly selected from each hospital and 12 people from each ward were selected by simple random method as constituent members in The present study was considered. The data collection period was three months (from September to November 2019). Among the distributed questionnaires, 231 questionnaires were returned, of which 223 were fully completed and usable, and 8 questionnaires were incompletely completed and excluded from the analysis process. Criteria for inclusion in the study included marriage, having children, willingness and informed consent to participate in the research and complete answers to all questions of self-report questionnaires. Incomplete completion of the questionnaires was the exit criterion. Carlson et al. (2000) Work-Family Conflict, Aryee et al. (1999) Family Satisfaction, Chonody et al. (2016) Couple Relationship Quality, Arnol et al. (1993) Parenting scale, Zheng et al. (2015) Employee well‐being Scale were used for data collecting. Data analysis was performed using SPSS-16 software through descriptive statistics (mean, standard deviation, minimum and maximum) and inferential statistics (Pearson correlation and hierarchical regression).

    Results

    The results of Pearson correlation coefficient showed that between work-family conflict and family satisfaction (r = -0/256, P <0/01), and Couple Relationship Quality (r = -0/274, P <0/01), and parenting quality ( r = 0/171, P <0/01), as well as between family-work conflict and family satisfaction (r = -0/273, P <0/01), and Couple Relationship Quality (r = -0/301, P <0/01), and Parenting quality (r = 0/165, P <0/01), there was a negative and significant relationship. Also, the results of hierarchical regression showed that adding the interaction of work-family conflict and Employeechr('39')s well-being to the regression equation in the second step, explained 0/631% of the variance of family satisfaction with 0/044% exclusive variance (𝜷= 0/227, P<0/01), and explained 0/685% of the variance of  the Couple Relationship Quality  increased by 0/022% of the exclusive variance (𝜷= 0/ 160, P<0/01), and the explanation of 0/671% of the variance of the parenting quality increased by 0/048% of the exclusive variance(𝜷= -0/237, P<0/01). Furthermore, the results of hierarchical regression showed that adding the interaction of family-work conflict and Employeechr('39')s well-being to the regression equation in the second step, explained 0/626% of the variance of family satisfaction with 0/036% exclusive variance (𝜷= 0/213, P<0/01), and explained 0/685% of the variance of  the Couple Relationship Quality increased by 0/016% of the exclusive variance (𝜷= 0/142, P<0/01), and the explanation of 0/654% of the variance of the parenting quality increased by 0/032% of the exclusive variance(𝜷= -0/200, P<0/01). Also, the regression coefficient related to the interaction of these variables showed that the interactive effect of work-family conflict and Employeechr('39')s well-being and also the interactive effect of family-work conflict and Employeechr('39')s well-being are statistically significant. Significance of this interaction means that the relationship between work-family conflict as well as family-work conflict with family satisfaction, the quality of couple relationship and the quality of parenting at high and low levels of Employeechr('39')s well-being are different. Therefore, it can be said that Employeechr('39')s well-being affects the relationship between work-family conflict and also family-work conflict with family satisfaction, the quality of couple relationship and the quality of parenting.

    Conclusion

    The results indicate that work-family conflict as well as family-work conflict had a significant role in reducing family satisfaction, the quality of couple relationships and the quality of parenting in nurses. In explaining these findings, we can refer to the theory of spillover. Accordingly, onechr('39')s experiences in one area (work or life) leak into another. In addition, according to the theory of role, work and family are each separate areas and each area tries to spend more time and attention in society. Reducing time spent with family members due to attendance at work jeopardizes happiness and a sense of intimacy between them (time-based work-family conflict).On the other hand, not being on time at work due to family issues causes problems for the person in the organization (time-based family- work conflict). In addition, spending a lot of time, effort and attention in the workplace reduces a personchr('39')s energy to take care of the family (exhaustion-based work-family conflict). Conversely, spending too much time, effort, and attention on the family reduces a personchr('39')s energy to take on job responsibilities (exhaustion-based family- work conflict). The employee may also become so engrossed in the pursuit of resources in the workplace that he or she sees the home environment as an organization (behavior-based work-family conflict). Conversely, one may assimilate to onechr('39')s family roles to the extent that one performs appropriate behaviors with the family domain in the workenvironment (behavior-based family-work conflict). All of these factors can have a negative effect on family outcomes. In addition, regarding the moderating role of Employeechr('39')s well-being, the results of regression analysis showed that this variable can moderate the negative effects of conflicts between work and family on family satisfaction, the quality of couple relationships and the quality of parenting. To explaining these findings, it can be said that work-family conflict is described as an incompatibility between work and family roles, which arises from the incompatible pressure of family and job roles. In other words, when a person plays two or more roles that are incompatible with each other, he / she experiences role conflict. Everyone is affected by work and family issues, regardless of demographic characteristics, socioeconomic status or family structure. On the other hand, as stated in the definition of Employeechr('39')s well-being, Employeechr('39')s well-being in the form of experiences such as job satisfaction, job enthusiasm, independence, competence, self-acceptance, purposefulness, personal growth, positive relationships with others , And the absence of negative experiences such as anxiety, stress and depression in the workplace. In addition to providing the necessities of life, the job is directly related to the psychological well-being of the individual and also paves the way for the satisfaction of many of his/her immaterial needs. People who experience positive well-being believe that they have positive feelings and pleasant experiences. Positive psychological well-being is characterized by the perception of efficient personal characteristics and successes, proper interaction with the world, and social cohesion and positive progress over time. Positive well-being includes satisfaction with life and energy and positive mood. This positive feeling acts as a buffer and allows people to be less affected by the negative effects of conflicts between work and family, And make better decisions to avoid the negative impact of these conflicts on different areas of their lives.

    Keywords: Work-Family Conflict, Family Satisfaction, Couple Relationship Quality, Parenting Quality, Employees' Wellbeing
  • M .Mardani Hamooleh, N .Seyedfatemi, A. Eslami*, SH. Haghani Pages 58-69
    Background & Aims

    Spiritual care is to help the individuals with challenged beliefs, values, purpose, and meaning of life, which occurs when patients are faced with severe diseases. Under such circumstances, nursing care is focused on the provision of spiritual care. Accordingly, spiritual care has been emphasized and acknowledged in the nursing profession, so that the provision such care could reduce physical pain, induce mental relief, reduce depression and anxiety, accelerate recovery, increase hope, and enhance the communication of the patient and nurse. From a deeper perspective, the provision of spiritual care by nurses to patients promotes the personal growth of the nurses. Meanwhile, attention to the spiritual care competency skills of nurses could be valuable as it seems that nurses are able to provide better care to patients by using these skills in the complex clinical setting. In fact, the competence in spiritual care is a concept involved in creating standard nursing care for patients, which encompasses a set of skills used in the nursing profession with a special status in the nursing process, as well as components such as the communication between the nurse and patient, availability to the patient, active listening, showing empathy and sympathy to value the life of the patients and give hope to the patient, facilitating spiritual skills for the patients with special beliefs, helping patients to create a calm atmosphere, and referring patients to specialists in spirituality. Although some studies have been focused on the phenomenon under study in some regions of the country, the emergence of this phenomenon in the field of nursing ethics requires these studies to highlight the need for further research regarding this concept in order to bridge the gap in the nursing knowledge in the other regions of the country, so that the obtained results could be compared. The present study aimed to evaluate the spiritual care competency of the nurses employed at the teaching hospitals affiliated to Alborz University of Medical Sciences, Iran.

    Materials & Methods

    This descriptive, cross-sectional study was conducted on 200 nurses employed at the teaching hospitals affiliated to Alborz University of Medical Sciences (Kamali, Shariati, Imam Hossein, Madani, and Rajaei hospitals) in 2019 during four months. The subjects were selected via convenience sampling. Data were collected using demographic questionnaires containing data on the age, gender, marital status, education level, work experience, average working hours per month, ward of employment, employment status, work shifts, and organizational position. In addition, the valid and reliable tool of spiritual care competency was used for data collection. To assess the content validity, the tool was provided to five faculty members of the School of Nursing and Midwifery of Iran University of Medical Sciences, and their corrective comments were applied to the tools. The reliability was also evaluated using the retest method. For this purpose, the instruments were provided to 15 individuals, who were identical to the research samples but not included in the sample population, at two-week intervals twice, and the Pearsonchr('39')s correlation-coefficient obtained from the two tests was calculated to be 0.86. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent t-test and analysis of variance). To comply with ethical considerations, the researcher obtained the ethics code from Iran University of Medical Sciences, followed by the letter of recommendation, and made the required arrangements with the management of the selected hospitals. In addition, informed consent was obtained from the participants for enrollment, and they were justified about the research procedures, while also ensured that participation in the study was completely voluntary. In addition, the participants were assured of the confidentiality and anonymity of the data.

    Results

    The majority of the nurses were aged 20-30 years (57%), female (81%), and married (70%). In addition, the majority of the participants were nurse (96%), had a BSc (94.5%), and worked in rotational shifts (89%). The total mean score of the spiritual care competency of the nurses was 54.21±14.69; considering the median of the instrument (=81), this finding indicated that the total score of spiritual care competency of the nurses was lower than the median. Among the demographic characteristics of the nurses, spiritual care competency was significantly correlated with the organizational position (P=0.005) and nursing work experience (P=0.003), and the spiritual care competency of the nurses was significantly higher compared to the head nurses. In addition, the spiritual care competency of the nurses with the work experience of 1-5 years was higher compared to the others. 

    Conclusion

    According to the results, the spiritual care competency of the nurses did not have a favorable status. Therefore, proper opportunities should be provided to promote their knowledge in this regard. In fact, the results of this study could lay the groundwork for further investigations and interventional studies in this regard. In other words, the recognition of the spiritual care competency of nurses in general and in terms of various dimensions in particular is an important step toward its promotion, resulting in the expansion of the views of nurses toward this concept. It seems that through spiritual care competency, nurses will be able to provide more comprehensive nursing care to patients. As such, nursing managers must take the necessary measures to enhance the spiritual care competency of nurses, among the most important of which are the implementation of educational workshops based on the concepts of spirituality and spiritual care for nurses, so that they could achieve spiritual care competency more efficiently in their profession. One of the limitations of this study was the emotional state of the sample while completing the research instruments, which could not be controlled by the researcher. Furthermore, the subjects were selected via convenience sampling, and the non-probability of the sampling method may restrict the generalizability of the findings.

    Keywords: Spiritual Care Competency, Nurse, Nursing Care
  • A .Khachian, MR .Zarei, H .Haghani, F .Khani* Pages 70-81
    Background & Aims

    Culture is a behavioral pattern that grows over time as a mental consequence through social and religious structures and artistic manifestations. Culture encompasses the values, beliefs, and norms of a particular group, which are learned and shared to guide thinking, decision-making, and actions in modeling approaches. Historically, the Iranian community has a multi-ethnic, cultural, linguistic, and religious context, which is also observed among the clients of the healthcare system. With the integration of the global economy, the number of the clients from various cultural backgrounds and characteristics of health, cultural activities, health needs, and expectations has also increased in all industrialized countries. In addition, the growth of international exchanges and number of manpower transfers and migration, the need for nursing with cultural knowledge has been created. A culturally qualified nurse has acquired a strong foundation in cultural attitudes, cultural knowledge, and cultural skills. Nurses are often equipped with all the influential factors in cultural competence to provide care to a wide variety of patients with diverse cultural backgrounds. Therefore, such nurses are able to assess the cultural needs of the clients, plan an appropriate care program, and provide skilled cultural care under any circumstances. Care is the foundation of the nursing profession and considered an important component of the quality health care that meets the health needs of patients. The care behaviors of nurses encompass all their actions, cognitions, feelings, thoughts, perceptions, movements, gestures, looks, and actions by which the client is cared for, and these behaviors must be ethical. The differences in the care behaviors of nurses from one institution to another or one country to another have led nursing researchers to investigate the influential factors in the motivations and determinants of care behaviors. In addition, the process of nursing care provision is influenced by the conditions of their work environment and community culture. Given the importance of care as the most important component of nursing practices, the cultural differences in Iran, and the facts that patients from different cities with different cultures refer to medical centers in large cities (including Tehran) due to the lack of adequate medical facilities and nurses should have the necessary information about the cultural, social, and ethnic status of patients as part of the nursing profession for the planning of nursing care, the present study aimed to assess the correlation between the cultural competence of nurses and their care behaviors in the teaching medical centers affiliated to Iran University of Medical Sciences in 2019.

    Materials & Methods

    This cross-sectional, correlational study was performed with the participation of the nurses working in the teaching medical centers affiliated to Iran University of Medical Sciences in Tehran, Iran. In total, 200 nurses were selected via multistage cluster sampling. At the first stage, the medical centers were divided into two categories of general and specialized, and in the next stage, three centers were selected from among the general medical centers, and three centers were selected from among the specialized centers randomly. The sample size of treatment center was divided by the proportion of the nurses, and based on random allocation in each treatment center, the samples were selected from the nurses. Data were collected using a self-report demographic form, the cultural competence questionnaire by Perng and Watson, and the caring behaviors inventory (CBI-42) in a self-report manner during November 2019-January 2020. Data analysis was performed in SPSS version 16. To achieve the specific goals and accurate responses to the research questions, we used descriptive statistics (tables), central indicators (mean), dispersion indices (standard deviation), and inferential statistics (independent t-test, ANOVA, and Pearsonchr('39')s correlation-coefficient). The significance level was set at P<0.05, and it was assumed that due to the sufficient sample size, the study population had normal distribution.

    Results

    The mean score of the cultural competence of the nurses was 66.27 ± 15.02, and the mean score of the care behaviors of the nurses was 5.28 ± 0.43. The highest mean score of cultural competence belonged to the cultural sensitivity dimension (60.50), and the lowest mean score belonged to the cultural knowledge dimension (56.25). The lowest mean score of the care behaviors belonged to the dimension of respecting others (5.09), and the highest mean score was observed in the dimension of professional knowledge and skills (5.43). In general, a weak, significant correlation was observed between the cultural competence of the nurses and their care behaviors. In addition, significant correlations were observed between all the dimensions of the care behaviors and cultural competence (P<0.05), except for the dimensions of cultural knowledge, skills, and sensitivity (P=0.058). The findings also indicated that the emergency department nurses had higher cultural competence, and the married nurses had better care behaviors.

    Conclusion

    Cultural competence is a major foundation of clinical nursing, and more attention to cultural competence plays a pivotal role in better and more competent patient care. According to the results, the cultural competence level of the nurses had a weak, significant correlation with their care behaviors. Therefore, it could be concluded that enhancement in one of these factors leads to the improvement of the other. Considering that each of these factors is an important component of nursing care, their improvement through academic and in-service training could enhance the provision of nursing care to the patients, while also facilitating the relationship of nurses with patients.

    Keywords: Cultural Competence, Care Behaviors, Nurses
  • F. Dolatshad, A. Maher*, SM .Hosseini, A. Aghili Pages 82-91
    Background & Aims

    Occupational stress is inherent to all jobs, while it becomes more important in the jobs that involve humans. Evidence and studies suggest that the nursing profession is among the most stressful jobs. Considering the consequences of occupational stress on employeeschr('39') mental health, the feeling of mental health is widely affected by the perceptions of individuals toward events and occupational stressors. Stress diminishes attention, concentration, decision-making skills, and judgment and is also negatively correlated with the quality of care. In addition, stress leads to the increased incidence of mistakes and errors. Given the nature of the nursing profession, tendency to feeling the guilt of pathogen or diseases may adversely affect their health. In the occupations such as nursing in which the responsibility of the life and welfare of others is undertaken by nurses, guilt could be acute and significant, especially when several issues appear. However, few studies have been focused on the impact of guilt feelings on the wellbeing of nurses. Various studies have reported positive, significant correlations between guilt feelings and depression, anxiety, and stress. Therefore, the recognition and focus on solving the occupational issues of nursing staff as a great spectrum of healthcare providers are inherent to the national macro health planning. Stress, occupational stress, and their consequences on the physical, mental, and professional life of the nurses in healthcare organizations are among the issues that affect the goals and performance of these organizations. Therefore, obtaining more information about occupational stress, communications, and other related variables (e.g., guilt feelings) has attracted the attention of researchers.

    Materials & Methods

    This descriptive, applied research was conducted in the summer of 2018 at Mofid Childrenchr('39')s Hospital in Tehran, Iran. The sample population consisted of all the employed nurses of the hospital (n=260), and 141 nurses were selected via simple random sampling using the name lists by drawing lots as the samples and enrolled in the study. No inclusion and exclusion criteria were defined for sample selection. After obtaining the required permit, explaining the research objectives to the subjects, and obtaining oral informed consent, the questionnaires were distributed and completed in the presence of the researcher. All the items of the questionnaires were completed by the participants without attrition. The data collection tool consisted of three sections, including the demographic characteristics of female nurses (ward of employment, education level, employment status, work shifts, age, marital status, and work experience), Osipow job stress questionnaire, and the caregiver guilt questionnaire (CGQ). Osipow job stress questionnaire has been developed to measure the stressors in the workplace (especially in hospital and healthcare settings) with 60 items and six dimensions, including heavy workload (professional role workload), incompetence (role dichotomy), incompatibility (role duality), role range, sense of responsibility, and physical problems. The items of the questionnaire were scored based on a five-point Likert scale. The total score of each female nurse was calculated within the range of 60-300 and classified into four levels of below the natural level, natural level, medium level, and severe level. The CGQ had five dimensions and 22 items regarding the feelings of guilt about the mistakes of the care receiver, challenges and failures of care, self-care, neglect of other relatives, and negative feelings toward others. The questionnaire items were scored based on a five-point Likert scale. The total score of each nurse was calculated by summing up the scores within the range of 22-110. The degree of guilt was categorized as low, moderate, and high. The internal consistency of the questionnaires was also confirmed, with the Cronbachchr('39')s alpha estimated at 89% and 88%, respectively. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics.

    Results

    Statistical analysis was performed on 141 returned, intact questionnaires. The mean age of the nurses was 33 ± 7.03 years, and their mean work experience was 7.56 ± 5.21 years. The mean score of guilt feelings was 3.93 ± 0.64, and the mean score of occupational stress was 4.29 ± 0.51. According to the findings, the majority of the nurses (69.5%) had severe stress and severe guilt feelings (55.4%). In addition, positive, significant correlations were observed between occupational stress and its dimensions with guilt feelings and its dimensions among the nurses (P<0.05).

    Conclusion

    According to the results, occupational stress and guilt feelings were significantly correlated in the nurses, which could be due to work challenges, high stress of patient care, burnout, and guilt for the death of patients. The results of this study are consistent with the previous studies and theories regarding the impact of occupational stress on guilt feelings. Given the critical role of nursing staff in patients care and prevention of mortality, healthcare policymakers could take action to reduce the occupational stress of nurses by decreasing their working hours, eliminating continuous work shifts, increasing welfare services, and improving the conditions of the physical workplace. It is also suggested that nursing managers take measures considering factors such as the lack of emotional readiness, problems between colleagues, working schedules of nurses, and interactions with patients and their companions in order to reduce occupational stress and guilt feelings in nurses. Regarding the significant correlation between occupational stress and guilt, the application of job stress reduction techniques among the nurses of childrenchr('39')s hospitals is of paramount importance theoretically and operationally. Furthermore, the performance of nurses should be assessed in an environment with no stress and burnout, and the nurses with these issues must receive treatment immediately after they are identified, so that no harm would be done to their colleagues, family, and patients. The results of this study could be incorporated into nursing services (especially pediatric nursing) to attract the attention of the related authorities for awareness regarding the disruptive factors of mental health in nurses.

    Keywords: Guilt Feeling, Occupational Stress, Nurse, Hospital
  • MR. Sheikhy Chaman * Pages 92-103
    Background & Aims

    Quality of care is an important issue in the health system of every country, especially in healthcare centers. The quality of care services encompasses various elements, one of the most pivotal of which is patient safety. Studies have indicated the inadequacy of safety in patient care. Due to the high incidence of medical errors, it is essential to recognize the patient safety culture in the health sector in order to change and modify the existing culture in accordance with recent developments. Safety experts consider the patient safety culture as an inherent element in the promotion of the safety and quality of patient care, and the World Health Organization (WHO) has emphasized on this issue as well. Culture could be defined as the beliefs and values of individuals, which are manifested in their behaviors. The patient safety culture constantly seeks to minimize the adverse events caused by the care provision process in patients, while also indicating the priority of patient safety from the perspective of healthcare employees and their organization. Assessing the current culture could be the starting point for the development of an appropriate safety culture using proper instrument, so that hospital officials would become aware of the status of the patient safety culture and find solutions to improve the culture. The present study aimed to evaluate the patient safety culture among the nurses employed in the selected hospitals affiliated to Tehran University of Medical Sciences, Iran.

    Materials & Methods

    This cross-sectional study was conducted in the late 2019 at seven selected teaching hospitals affiliated to Tehran University of Medical Sciences. Nurses with the minimum clinical experience of one year were enrolled, and those with incomplete questionnaires were excluded from the study. The participants were selected via simple random sampling by the researcher with the cooperation of the nursing manager of each hospital using the random number table. The sample size was determined to be 295 using the Cochranchr('39')s formula, and the share of each hospital was 40-45 nurses. The data collection instrument consisted of two sections; the first section contained the demographic and organizational variables of the nurses, and the second section was the hospital survey on patient safety culture (HSPSC). The HSPSC had 12 dimensions of organizational learning, feedback and communication about error, teamwork within units, supervisor/manager expectations and actions promoting patient safety, frequency of event reporting, non-punitive response to error, staffing, teamwork across units, overall perception of patient safety, communication openness, management support for patient safety, and information exchange and transmission. The HSPSC has been used frequently to evaluate the patient safety culture across the world, and its final version has been translated into Persian by Iranian researchers, the validity and reliability of which have been confirmed. After referring to the research environment and making the necessary arrangements with the hospital officials, the researcher received the permit to enter the wards. In addition, informed consent was obtained from the eligible nurses, and the participants were allowed to withdraw from the research at any stage. Data analysis was performed in SPSS version 16 using descriptive statistics (number, percentage, mean, and standard deviation) and analytical statistics (independent t-test and one-way ANOVA) at the significance level of less than 0.05.

    Results

    Out of 295 distributed questionnaires, 260 (89.8%) were returned. According to the results of descriptive analysis, the mean age of the nurses was 34.14 ± 8.27 years, and the majority were female and married. The mean clinical experience of the participants was 9.98 ± 7.35 years. In addition, the majority of the nurses had a BSc and were employed in general wards. The mean total score of the patient safety culture was 3.06 ± 0.40, with the highest mean scores observed in the dimensions of organizational learning (3.45 ± 0.74), feedback and communication about error (3.44 ± 0.82), and teamwork within units (3.42±0.88). On the other hand, the lowest mean scores belonged to the dimensions of information exchange and transmission (2.45 ± 0.86), management support for patient safety (2.62 ± 0.65), and communication openness (2.87 ± 0.73). The analytical results indicated no significant correlations between the patient safety culture status and demographic and organizational characteristics of the nurses (P>0.05).

    Conclusion

    According to the results, the total score of the patient safety culture was moderate in this study. Among various dimensions of the patient safety culture, the highest and lowest mean scores belonged to the dimensions of organizational learning and information exchange and transmission, respectively. Therefore, it could be concluded that enhancing the safety of care service recipients in health care organizations is influenced by several factors, such as managerschr('39') support for the patient safety culture in hospitals, nurseschr('39') recognition of the patient safety culture, teamwork within organizational units, feedback and communication about errors, staff-related issues, and facilitating information exchange and transmission. Furthermore, promoting interactions, more teamwork within hospital units, and creating a non-punitive environment in order to report more events could be effective in this regard. It is also recommended that the quality improvement unit of hospitals provide appropriate training courses to familiarize nurses with the patient safety culture, implement exams during these courses, and use the feedback to enhance the quality of new and similar training courses. Since this study was only conducted at the hospitals affiliated to Tehran University of Medical Sciences, the results should be generalized to other healthcare centers with caution. For further investigations in this regard, it is suggested that studies be focused on the governmental and non-governmental hospitals of other provinces and larger sample sizes from the perspective of other healthcare employees.

    Keywords: Hospital, Nurses, Patient Safety Culture, Tehran