فصلنامه آموزش و اخلاق در پرستاری
سال سوم شماره 1 (بهار 1393)

Gaining patient satisfaction is one of the major goals of medical health care organizations. This study aimed at assessing reasons for discharging patients for getting services for patients. This is a cross-sectional and analytic study which used convenience sampling to study 96 patients in Gachsaran Rajayi Hospital who were discharged with their own consent from April to September 2013. The data collection tool consisted of a checklist including 3 parts: personal، environmental and staff related factors. Data were analyzed using SPSS 20. 0. The most frequent discharges took place in pediatric section. Tendency to continue treatment at home with regard to environmental problems and discontent with physical space was the most frequent personal factor for patient discharge. Physician unavailability counted as the most prevalent element among staff related factor for patient discharge with their consent. The most frequent discharges took place in pediatric section. It highlights parents’ sensitivity and calls for further attention to health care services in this area. Statistical rates highlight the necessity of improving medical services and accommodations in order to enhance health workers’ interaction with patients.

Realization of educational equity is one of the main goals in educational systems. But how can we provide educational equity in medical science universities? This article was aimed at explaining the challenges of educational equity faced with medical science universities in order to present solutions for enhancing the present condition. Method and material: This is an initial review study performed on 48 relavant English and Persian articles and books which were obtained in three steps from databases including PubMed, SID, Iran Medex, Elsevier and ProQuest. Keywords including equity, educational equity, and equity in medical education were used according to the National Library of Medicine to search material. This article introduces educational equity and then, proposes practical solutions which can be used by the government, educational system, university, and students in order to develop educational equity in medical sciences. Establishing educational equity in medical science universities entails to set up indices for educational equity and then, undertake required evaluations.

Spinal anesthesia is caused by the injection of anesthetic in the subarachnoid space. The major reason patients refuse to apply this method is the back pain after operation and the main reason is the lack of satisfaction after spinal anesthesia. This study was conducted with the aim of increase patient satisfaction after spinal anesthesia. This clinical trial study was conducted on 283 patients operated through spinal anesthesia. These patients were categorized into two groups of control and experimental by block randomization. The subjects in the experimental group were instructed by the experts equally by pre-prepared plans in the case of this anesthetic technique; a video clip was presented to them regarding patient satisfaction already recorded. Demographic characteristics, spinal anesthesia, and surgery were collected by experts who were unaware of the sort of the experimental and control groups. Then, the rate of patients’ satisfaction after spinal anesthesia and the incidence and severity back pain was recorded in the forms 24 and 48 hours and seven days later based on VAS scale. Regarding back pain incidence in three times, a significant decrease was observed in the experimental group (the first 24 h P= 0.007, 48 h and 7 days later P= 0.001, respectively). A significant decrease in back pain severity in three levels was observed (the first 24 and 48 h P<0.001 and 7 days later P= 0.003 respectively). Satisfaction rate in the experimental group than in the control group had a significant increase in three times(In all three time P<0.001). It seems that education and positive empathy effective on reduce the incidence and severity of back pain which leads to increased satisfaction from spinal anesthesia.

An important issue of nursing in the provision of care is to achieve the desirable quality of services in order to gain the satisfaction of patients. The aim of this study is to consider the views of patients regarding the observance of codes of professional ethics in the domain of clinical services by nurses working in hospitals affiliated to Jahrom University of Medical Sciences. In this descriptive-analytical study, 210 patients admitted in different hospitals of Jahrom University of Medical Sciences were selected using randomized quota sampling.The data gathering tool consisted of a valid, reliable (r=0/84) questionnaire including two sections of demographic information and 7 specific questions related to clinical services with 5-point Likert scale. Data analysis was performed by descriptive and analytic statistics via SPSS. The mean of observance of codes of professional ethics by nurses in the domain of clinical services through the perspective of patients was 20/68±5/33 (out of total 28). Findings of the research indicated no significant or meaningful relationship between the patients’ demographic data (age, sex, marital status, place of residence, education and occupation) and the characteristics of hospitalization (hospital and ward-inpatient, history of hospitalization and length of stay) in one hand, and the observance of codes of professional ethics for nurses on the other. With respect to the acceptable level of the observance of codes of professional ethic by nurses in the area of clinical services and according to the data collected from patients, it seems necessary that hospital authorities have to direct their efforts towards keeping and promoting the present situation.

Evidence-based nursing guidelines are important tools in improving the quality of nursing clinical work. One of the most important indicators in the assessment of care quality provided for patients is the quality of nursing care standards. This study attempts to trace the influence of the implementation of such guidelines on the quality of standards of nursing care provided for patients with severe coronary syndrome admitted to CCU. This clinical trial before and later was performed in Hazrat Fatima hospital in Kerman city during 2012 and 2013. Interventions included training CCU nurses in the evidence-based nursing guidelines, and to put the same guidelines based on the nursing process into enforcement for patients admitted to coronary care unit. Before and after intervention, the quality of nursing care was measured via ANA questionnaire and through observation and review of documentation from records of 90 patients admitted to the coronary care unit. Data collected were analyzed by using SPSS version 19, and descriptive statistics which included mean and standard deviation; and inferential statistics which included paired T-test, Chi-square and Fisher’s exact test. At all stages of the nursing process, the comparison of mean scores before and after training revealed meaningful statistic differences. The mean scores of registered nursing diagnosis, planning, implementation and evaluation process before the intervention, was respectively 2/28 (0/62), 1/75 (1/04), 9/3 (1/4) and 3/8 (1/6) and after intervention, respectively 3/88 (0/31), 5/7 (0/52), 15/13 (1), 8/6 (0/6) and p<0/001. The implementation of evidence-based nursing guidelines improved the quality of nursing care. So that, the Hospital officials and health care centers are recommended to put training of evidence-based nursing guidelines on the agenda.

The purpose of this paper is to introduce and recognize academic practices and skills and strategies to manage anger from the perspective of religious training to doctors and nurses. This study was done in the form of reviewing the literature, namely the use of professional nursing and medical articles and Islamic sources including both Shiite and Sunni and the application of Islamic sciences software such as: (Erfan 2 – JamiAhadith 3.5 – JamiTafasir 2). According to religious sources and aphorisms quoted by imams and religious scholars for anger control and prevention of extremism in it, at least two major recommendations have been expressed: One is "patience" means tolerance and other "appease the wrath" which is in fact the same as anger control. Numerous other approaches were mentioned in religious texts, and some of them have theoretical and cognitive aspects. Some also have practical and behavioral aspects, each of these are mechanisms to subdue the rebellious soul. This paper presents six theoretical approaches and seven practical strategies from the perspective of Islamic ethics. Islam has not merely expressed a general content about anger management. Instead, it provides practical solutions. Firstly, because of the priority of these teachings over modern psychology and Secondly, due to the trust of doctors and nurses Muslim community in religious teachings, studying this issue in the perspective of religious teachings increases the possibility of their accentuation and application by them.

Nursing student's attitudes concerning euthanasia may affect their future performance. The present study was conducted with the aim of investigating the attitudes of nurse practitioner students in relation to euthanasia. Method and Material: 80 nurse practitioner students studying in Islamic Azad University of Shahrekord Branch in 1392 constituted the descriptive-analytical type of this study and the data relating to their attitude have been collected using Euthanasia Attitude Scale (EAS). The 20-point scale has been classified in four dimensions including "moral considerations, practical considerations, honoring the life and naturalistic beliefs". The data were statistically analyzed in the SPSS 15 statistical software using descriptive statistics (mean ± SD) and the chi-square test, Pearson correlation, independent t-test and ANOVA. Results showed that the score of subject's attitudes toward euthanasia was 0/54±2/92 (within a score range of 5-1), and totally of 47.5 percent (38 persons) had negative attitude towards euthanasia,3.8 percent (3%) had neutral attitude and 8/48 percent (n = 39) had positive attitude. Moreover, among the studied demographic variables, only age had a statistically significant association with it, to the extent that the student’s positive attitudes toward euthanasia increased as they got older (P <0/035, r =0/236). The results of this study suggest that many nursing senior students in Iran lack a positive attitude towards euthanasia (51/3%). However, the number of people supporting this phenomenon is not small (48/8%), so that, the officials and staff of nursing education programs should focus more attention to this issue.

The cornerstone of nursing care, competent for today society and the future world; is trained nurses who are qualified professional ethics. Due to the weakness of professional ethics, the issue as a first step in solving problems and providing solutions is necessary. This study aimed to determine barriers to observe professional ethics in the practice of nurse care from nurse managers’ viewpoints in year 2013. Method and Material: This descriptive cross-sectional study was conducted on a census sample of nurse managers (nursing and midwifery services managers, supervisors and head nurses) working in government and non-government. The number of 96 sample with loss was determined.To collect data, a standard questionnaire consisting of two sections, demographics and three categories of barriers to compliance with professional ethics standards, including “managerial”, “environmental” and “individual care-giving” obstacles. Data using statistical software and descriptive statistics (frequency, percentage frequency, mean and standard deviation) were analyzed. Most responders agreed to the barrier role of environmental (0/77±3/73), managerial (0/8±3/71) and individual care-giving (0/69±3/62) items in meeting ethical standards in practice. The most important barriers were lack of staff (1/1±4/22) regarding management area, biologic changes in night shifts (0/89±3/97) considering environmental area, and failure in fulfillment of basic needs such as sufficient income or enough break-time for nursing staffs (1/17±3/87). Environmental areas were the most important barriers of compliance with professional ethics. Managers of health care organizations through periodic surveys of professional ethics and obstacles; determine the current status and comply with that provide and enforce premier Solutions about removing barriers including the elimination of workplace Issues.