فصلنامه آموزش و اخلاق در پرستاری
سال دهم شماره 3 (پاییز و زمستان 1400)

With the proliferation of ethical issues in nursing care and the placement of people in situations where lack of reasoning power confuses them, there is a need for more and more research on the ethical evolution of nurses.  The aim of this study was to investigate the level of moral development of nurses working in Golestan Medical Center in Ahvaz and the effect of retraining courses (by providing periodic seminars and posters) on the growth rate of moral development of nurses. 

This study was performed by quasi-experimental method. The study population was all nurses working in specialized and sub-specialized teaching-medical Golestan hospital in Ahvaz. In this study, 73 nurses were calculated according to the same article and according to 4 units, there was a significant difference between trained and untrained scores. According to the conditions of entry, they entered the study and completed the Kelberg Moral Development Questionnaire before and after the intervention. Admission requirements were a bachelor's degree in nursing and at least one year of work experience.The Kelberg Ethics Development Questionnaire consists of two parts: demographic information and the nursing riddle test. The nursing riddle test includes 6 scenarios of infants with severe abnormalities, compulsory medication, adult demand for death, familiarization of a new nurse, medication error, and patients in the later stages of the disease. Our intervention, which included holding a seminar on ethics in three time intervals with an interval of 3 months and installing the poster "Ethical codes in nursing" in different parts of the hospital in this time interval in dimensions (60×90) and with colored shapes. Questionnaire was completed before and after the intervention by nurses having the conditions of entry.  The results were compared and reviewed after collecting data through SPSS software and using descriptive statistics and calculating means and percentage and frequency. 

In the demographic information section, other than the place of service, other variables were not related to moral evolution. In the moral decision section, which is the first question of the questionnaire for each scenario. Increased moral decision making after training in the infant scenario with severe anomalies, compulsory medication, familiarization of new and adult nurses with severe disease in the final stages were statistically significant. (P<0.001) Comparison of the mean total score of moral thinking of nurses before and after training showed that the difference between the mean score of moral thinking in each scenario was statistically significant and the total score of moral thinking of participants was (P<0.001) and it has increased.

This study showed that holding retraining courses and installing posters has an effective role in improving the moral development of nurses.

The   experiences of  learners in the educational system is not limited to  explicit   curriculum and other factors in the form of hidden curriculum play a significant role to shaping students' learning. Due to the lack of comprehensive tools for its study in the medical sciences, the purpose of this study is to construct and validate the tools  in  hidden  curriculum  in medical education

This study is a qualitative study  as  a  hybrid approach. This study was conducted in two phases of design and validation of a questionnaire to study the hidden dimensions of the curriculum in medical education in 2020 at Jahrom University of Medical Sciences. In the design phase, a three-phase hybrid study was used (review of previous study / field research and final conclusion). In the second part,  validation indicators, validity, and reliability of were extracted. Face and content validity assessed by  8 expert professors and a student group with 20 people and its reliability with a group of 104 people. Construct validity by Exploratory Factor Analysis led to the confirmation of tool items.

 The results of the first part (hybrid study) led to the identification of 5  Dimensions. These areas included (teacher-student interactions, teachers' professional characteristics, the architecture of the educational environment and its rules, interactions and communication in the educational environment, and methods of evaluation and obtaining feedback). In the second stage, which was the validation phase, the validity (content, face, construct and reliability of the questionnaire were examined. All parts mentioned above were appropriate. These tools maybe use to assess hidden curriculum in medical education.

 According to the results, Due to the lack of specific tools in medical education, this tool can be used by medical education researchers.

During the study period, students should achieve an appropriate level of moral development and make the right moral decisions by starting the clinical work. The aim of this study was done to determine the level of moral development of nursing students and the effective factors on it.

This descriptive-analytical study was conducted in 2017 on 188 nursing students of Ardabil University of Medical Sciences. Sampling was performed by convenience sampling method. The Kelberg Moral Evolution Questionnaire with 95% reliability, was used to collect data. This questionnaire includes 6 scenarios on the subject of infants with severe anomalies, drug coercion, adults' demand for death, introduction of a new nurse and the patients in the late stages of the disease. Data were analyzed using SPSS software version 18 and descriptive and analytical statistical tests.

In this study, 32 nursing students (17.02%) were at the pre-customary level, 61 nursing students (32.44%) at the customary level, 81 nursing students (43.08%) at the post-customary level and 14 nursing students (7.44 %) were at the level of clinical considerations. Also, the mean score of moral thinking of the participants in the study was 42.55 ± 5.54 and the mean score of clinical considerations was 20.06 ± 3.83.

The present study showed that despite the presence of more than half of the students were in customary and post customary levels, a considerable number of them were still at low levels of moral development. Therefore, nursing administrators should pay more attention to the moral education of nursing students.

Ethical principles will be an effective factor in improving good quality of nursing care and adherence to these ethical principles may be influenced by their aggression and the job motivation of nurses. The purpose of this study was to the assessment of the relationship between observance of ethics with job motivation and aggression in nurses working in Ahvaz educational hospitals in 2019.

This is a descriptive-analytical study in which 257 nurses working in Ahvaz hospitals were selected by available sampling. Data gathering tools included demographic information questionnaire, nurses' view of professional ethics, AGQ standard aggression questionnaire, and Herzberg job motivation standard questionnaire. Correlation Pearson and Multiple regression coefficients tests with using SPSS-22 software conducted to analyze the relationship between morality with aggression and job motivation.

Out of 257 nurses, 84.4% were female and 15.6% were male. Mean and standard deviation were ethical principles (120.5 ± 10.86), aggression (89.96 ± 12.04), and job motivation (78.58 ± 14.28). The results of the Pearson test showed that there was a significant and inverse correlation between ethics and aggression (r = -0.35, p <0.001). Also, there was no significant relationship between ethics and job motivation (r = -0.108, p >0.084).

 The results showed the role and importance of aggression in predicting the ethical principles of nurses. They need to be made to teach aggression management skills as well as increase job motivation. It is suggested that policymakers pay attention to these variables in designing programs to the promotion of the ethical principles of nurses.

The lack of a uniform and agreed program in medical ethics education has led to the neglect of many essential features to provide a practical medical ethics course. The role of the students in self-assessment and the construction of the knowledge they need is necessary through methods that enable rethinking performance. Therefore, this study aimed to investigate the students' experience of comprehensive ethics education based on a case-based study method based on a combined learning approach in a phenomenological study. 

In this qualitative study with a phenomenological approach, 70 medical students participated in the physiopathology course who had passed the medical ethics course. The data collection tool was a semi-structured interview in the individual and focus groups on students' experience of the intervention and its impact on learning. They were analyzed using conventional content analysis. The accuracy and stability of the data were assessed using the proposed Lincoln and Guba criteria.

The result of data analysis was the derivation of three themes and eight sub-themes. They included: Operational training (content application level, training in practice, cognitive overload), Challenge training (inconsistency in practice, ambiguity challenge), Contradiction in practice (role models, objective training, experience).

The present study results showed that this method of education in practice could provide the basis for examining the challenges of medical ethics and resolving ethical contradictions in the clinical environment in students' minds. Therefore, using this method in teaching medical ethics is recommended.

The professional competence of health personnel depends on adherence to the principles of professional ethics, and given the importance that the issue of professional ethics in natural disasters becomes more important, Therefore this study was conducted to investigate the ethical challenges of health care system personnel in natural disasters.                                                     

This qualitative study was conducted with a conventional content analysis approach. Participants were 38 employees of Lorestan University of Medical Sciences who were present at the Lorestan 1398 flood incident for at least two days to provide relief and willingness to participate in the study. Data were analyzed using in-depth semi-structured face-to-face interviews with the aim of understanding non-verbal evidence. The interview guide was used to focus on the content of the interview.

In this study, 38 medical staff of Lorestan province participated in the study. 66% of the participants were women and 44% were men. 37% were married and 63% were single, with a mean age of 42 years. The data were analyzed with 58 initial codes in 15categories and five main themes. The results of data analysis were divided into the following five concepts: Injustice extracted from classes such as inadequate distribution of resources and locations, crisis management deficits resulting from classes such as lack of coordination in service delivery, lack of pre-accident planning, and so on. Delays in the provision of services resulting from classes such as delays in receiving medication and medical services. Responsibility and conscience:  These two concepts were extracted simultaneously with classes such as empathy, compassion and kindness, self-sacrifice, hospitality, humanity, and difficulty in enduring heartbreaking scenes.                                                                                                                          

The crystallization of manifestations of national determination and jihadi will, donations, public presence, empathy and kindness, the beauty of religion and culture in times of national crises are among the strengths obtained in this study. Despite the positives, there were challenges such as inconsistencies between aid centers, lack of adequate planning and training of staff, inequality in the distribution of services and facilities, delays in service delivery, and injustice. It seems that the root of these problems is the lack of scientific planning before, during and after the crisis, the lack of coordination of the responsible bodies during the crisis and the basic problems in the infrastructure. It is suggested that in order to reduce the problems, more studies be done in the field of rooting out the problems and how to eliminate the mentioned shortcomings.

Satisfaction is one of the characteristics of hospital effectiveness and it is necessary to achieve it by respecting patients' rights. Due to the need for nurses to be aware of the Patient Bill of Rights, this study was conducted with the aim of systematically reviewing the level of nurses' awareness of the Patient Bill of Rights in studies conducted in Iran.

This is a systematic review. The quality of the articles was evaluated using the STROBE standard checklist. To review the preliminary studies of articles in Persian language databases; SID, Iranmedex, Magiran and English language databases Science Direct, PubMed and Scopus and Google Scholar search engine from January 2000 to January 2020. In order to access the full text of articles from Persian keywords; Patient rights, knowledge, nurses and their combination and the English keywords Patient, Awareness, Patient`s Right in Iran were used.

In the initial stage of research search, 569 studies were reviewed. The researchers then reviewed the searched articles and 553 studies were deleted due to not being relevant to the subject and duplication and lack of access to the full article. Finally, 16 studies were used to write this study. The highest level of patients 'awareness of the Charter of Patients' Rights was about privacy and the right to receive good health services. In most of the studies, there was only a significant relationship between work experience and nurses' knowledge. However, in most studies, there was no significant relationship between gender, age, marital status and level of education with nurses' knowledge.

The results of this study showed that the level of nurses' knowledge about the Charter of Patients' Rights is favorable in most studies and also there is a significant relationship between age and nurses' level of knowledge. Therefore, the implementation of respect for patients' rights in health centers, especially for hospital nurses seems to be essential. Therefore, it is necessary to pay attention to this issue of hospital administrators and provide measures to implement it as well as possible.

 The handover process is an essential part of advanced health care. Considering ethical principles in this process by nurses is essential. This study was conducted to improve ethics in nursing handover.

Current study was done through action research over a period of 19 months. Participants were 12 nurses, 2 nurses' aid, a head-nurse, and an academic researcher as a facilitator. First, challenges of nursing handover in the context were discovered by the facilitator and participants. Then, in 2 reflective sessions action plan was designed and prioritizing of plans and empowering the participants were done. The action plan was implemented and immersion in practice was performed. At the end of the first cycle, the primary assessment was done. The second cycle started with a reflection on results and learned lessons. Also, group reflection sessions were done. Then new action plan was designed and carried out in practice. Finally, evaluation was done by the facilitator and participants. Data gathering was done through triangulation and summative content analysis was done simultaneously.

qualitative and quantitative analysis of data before the study revealed that nursing handover was not ethical, while nursing reports at the end of the second cycle were changed to a more ethical process, and judgments were not heard. The emphasis of the reports was on nursing care and the whole aspects of the children and their families. The mean of stated judgments in nursing reports compared with the chi-square test was different in all stages.

Nursing handover relates to ethical and legal issues closely and there is essential for nurses to know them. Iran is a Muslim country and according to religious principles, it is sin to backbite and label. The religious principle could provide a valuable guide about nursing ethics according to Iranian religion and culture. Hence, it is necessary to introduce nursing codes of ethics in handover according to our religion and cultural context.

Improper administration of chemotherapy drugs has many risks for nurses and adherence to standards prevents irreparable harm. This study was conducted to compare the effect of training chemotherapy service management standards by booklet and cellphone application on nurses' awareness and adherence.

In a quasi-experimental study in 2020, 75 available nurses of oncology and chemotherapy departments were selected. Samples were randomly assigned to three groups. Data collection tools were demographic questionnaires and Ahmadi standardized questionnaire for assessing awareness and adherence. The samples participated in the pre-test by completing the questionnaires. One group was trained in chemotherapy standards with a cellphone app. The other group received the training through a booklet. The control group did not receive any training. 15 days later, the questionnaires were completed again and post-test was taken. Data were analyzed by descriptive statistics (number, percentage, mean, standard deviation) and inferential tests (one-way analysis of variance, post hoc LSD, paired t-test, Chi-square, Kruskal-Wallis).

Before the intervention, the mean score of awareness and adherence to chemotherapy standards was not significantly different between groups (P> 0.05); But after the intervention, the mean scores of nurses' adherence in the cellphone aining group were higher than the other two groups (P <0.001). The mean score of nurses' awareness in the two intervention groups was higher than the control group (P <0.001).

Nurses need specialized and supplementary training to increase awareness of chemotherapy standards. Due to their busy schedule, the mobile application provides quick access to information, which, following these principles, is preferable to teaching with a booklet.

The present study was a cross-sectional study that was performed on all students using the census method. Out of 716 visits, 248 students were observed and after fulfilling the inclusion and exclusion criteria, 225 people participated in the sampling. Due to the epidemic of corona virus, it was designed electronically using the Serqual questionnaire and the samples were filled. Mann-Whitney, Kruskal Wallis and Bonferroni tests were used for the variables. Data analysis was performed using SPSS 22.

The present study was a cross-sectional study that was performed on all students using the census method. Out of 716 visits, 248 students were observed and after fulfilling the inclusion and exclusion criteria, 225 people participated in the sampling. Due to the epidemic of corona virus, it was designed electronically using the Serqual questionnaire and the samples were filled. Mann-Whitney, Kruskal Wallis and Bonferroni tests were used for the variables. Data analysis was performed using SPSS 22.

The highest mean of students' perception was the confidence dimension (2.97 ± 0.79) and the lowest was the tangible dimension (2.72 ± 0.93( The highest average expectation is related to the tangible dimension (3.97 ± 0.88) and the lowest average is related to the guarantee dimension (3.67 ± 0.75( The highest mean gap is related to the guarantee dimension (1.24 ± 1.25) and the lowest is related to the tangible dimension (-0.91 ± 1.03(.

The findings of the present study showed that students' expectations from the services received in five dimensions of the quality of educational services were not fully met. Due to the current situation and crisis, a high and new step can be taken in educating students by raising the quality of virtual education

Following the coronavirus pandemic, various crises have occurred in different parts of the world. The educational system has encountered myriads of problems at all levels. What is certain is that in addition to the the complex educational and professional difficulties that students often encounter regarding the negative effects of the Corona crisis, the social effect of the pandemic on education is not an exception. The new period with the emergence of the post-corona period is the knowledge-based age, which makes a profound change in teaching and learning by emphasizing the present context. It can be stated that teaching and learning will continue in a new context and will mark the knowledge-based age with the need to use the resources to develop it. The age which has been adopted with new opportunities can be called the age of knowledge and ability, and it will provide the path of personal and scientific growth by teaching the foundation and transcendent wisdom.

Arterial blood gas interpretation is necessary to train nurses in intensive care units. Use new teaching methods to increase the knowledge and skills of nursing students training is recommended for durability. So this study aimed to compare the amount of learning through workshop and mobile phone, in interpretation the arterial blood gases in nursing students at Iranshahr.

This was a quasi-experimental, educational intervention study that compared two methods impact on learning to interpret the arterial blood gas test. A workshop was held for 53 students of Azad University and 30 students of the Faculty of Nursing received the necessary training via mobile phone and electronic booklet sharing. The questionnaire was completed before and after the training in both groups. Analysis of information were performed with SPSS 19, descriptive and analytical statistics.

In this study, both methods were associated with increased scores but in a group with cell phone average student learning score (16.47±4.04) significantly was more than workshop (13.42±8.1) and that difference was statistically significant (P<0.05).

Today, mobile phones are easily available, on the other hand, use this tool can cover a large number of learners .It is recommended as an alternative method or use other training supplements for educational purposes.