The Necessity of Nursing Prescription from the Perspectives of Nursing Policymakers

Introduction: Presently, in many countries, certain groups of nurses are allowed to prescribe medicine. Despite the increasing attention of the world to nursing prescription and emphasis of the World Health Organization (WHO) on its implementation in regional countries, a review of literature indicated that there is no evidence of nursing prescription in Iran. Thus, this study aimed to assess the necessity of nursing prescription from the perspective of the Iranian nursing policymakers. Method: This descriptive qualitative study was performed through interviews with 14 nursing policymakers. The participants were selected through purposive sampling method. Semi-structured interviews were used to collect data. Interviews were conducted after coordination with participants and in their workplace. All interviews were recorded using a digital voice recorder. Interviews were simultaneously transcribed verbatim and analyzed using conventional content analysis through inductive approach. The coding was performed using MAXQDA software. To achieve the accuracy and reliability of the data, the Lincoln and Guba authenticity criteria were used. Results: Analysis of the recorded interviews resulted in the extraction of the 3 main categories of "the right to health and individual’s requirements", "the current situation of the clinical setting", and "nursing prescription outcomes". Conclusion: The views and perspectives of nursing policymakers indicated that due individuals’ right to health and need for health care services, and also the positive outcomes that may result from nursing prescription, the necessity of its implementation is felt. However, there are challenges to its implementation that require the relevant authorities' efforts to resolve them. Keywords: Drug prescription, Nursing policymakers, Qualitative research

Quality in Grounded Theory Studies

Introduction: The quality of qualitative research is an important issue for clinicians and researchers that use research in order to deliver high quality care. Gaining quality in qualitative research, such as grounded theory, is not an accident and is achieved by abiding a set of circumstances. The aim of this study was to identify the most important criteria in assessing the quality of grounded theory studies. Method: This is a review study done by an extensive review of literature in the form of electronic and printed materials. This paper therefore, has reviewed 10 related books and 11 related papers. Results: The result of literature review showed that compliance to methodological principles of research is the key element in achieving quality in grounded theory studies. Paying attention to dynamic research process, theoretical sampling, theoretical sensitivity, constant comparison, theoretical saturation, methodological fitness, and linking research and body of knowledge are important factors in achieving quality in grounded theory. Conclusion: Quality in grounded theory is an important issue in qualitative research. Grounded theory researchers must have a thorough understanding of methods used in research. Moreover, they must try to improve the quality of grounded theory studies by considering ontological and epistemological assumptions. Keywords: Quality, Grounded theory, Nursing researc

Developing and Testing a Spiritual Care Questionnaire in the Iranian Context

Abstract As most research exploring nurses’ perceptions on the topic of spiritual care was conducted in Western countries, these findings may not be applicable in Iran because of cultural and health system differences. Therefore, a new survey instrument was developed for the Iranian context. The study was conducted in two steps: (1) development and validation of items for perception scale and (2) distribution of the questionnaire among nursing students to determine scale reliability and construct validity. The preliminary scale consisted of 50 items designed to measure the participants’ perception of spiritual care. Construct validity of the scale was examined on the remaining 33 items. On interpretation of the items, the following four components were identified: (1) meeting patient as a being in meaning and hope, (2) meeting patient as a being in relationship, (3) meeting patient as a religious being, and (4) meeting patients as a being with autonomy. The results in this paper showed that preserving dignity in the nurses’ practice meant getting involved in interpersonal caring relationships, with respect for the involved peoples’ religious beliefs and their autonomy. Proper education and professionally led supervision with reflection on past and recent experiences may develop student nurses’ and nurses’ perceptions as well as their attitudes toward spiritual care and to achieve a realistic view of the profession

Meaning of Spiritual Care

Spiritual care is an essential component in nursing practice and strongly influenced by the sociocultural context. This article aimed to elucidate the meaning of nurses’ experiences of giving spiritual care in southeast of Iran. A phenomenological hermeneutic approach influenced by Ricoeur was used. Eleven staff nurses who were currently working in the 3 major hospitals under the umbrella of the Kerman University of Medical Sciences were interviewed. The meaning of spiritual care was comprehensively understood as meeting patient as a unique being. This can be divided into 3 themes: meeting patient as a being in relationship, meeting patient as a cultural being, and meeting patient as a religious being. The results in this study suggest that education about spirituality and spiritual care should be included in the continuous and in-service education of registered nurses. Spiritual and cultural assessment criteria should be included in this education to improve the provision of holistic care. KEY WORDS: Iran, nurse, phenomenology, spiritual care Holist Nurs Pract 2013;27(4):199–20

Prognostic Factors for Survival at 6-Month Follow-up of Hospitalized Patients with Decompensated Congestive Heart Failure

Abstract:BACKGROUND: The prevalence of Congestive Heart Failure (CHF) is increasing in recent years. Factors associated with mortality in CHF patients are important to be determined in order to select therapeutic modality by physicians. The purpose of the current study was to declare predictors of 6-months survival in patients hospitalized for decompensated CHF in Isfahan.METHODS: A cohort of 301 hospitalized patients with decompensated CHF were recruited in this study. The diagnosis of CHF was based on previous hospitalizations and Framingham criteria for heart failure (HF). Information regarding past history, accompanying diseases such as cerebrovascular accidents (CVA), chronic obstructive pulmonary diseases (COPD), clinical data, medications and echocardiography were obtained by a cardiologist. Patients were followed for their survival for 6 months by telephone calls. Kaplan-Meier method was used for uni variate survival analysis and Cox proportional hazard model was used for multivariate analysis.RESULTS: Mean age of patients was 71.9 &plusmn; 12.2 years and 59.8% was male. During 6-months follow-up 138 (45.8%) patients died. Mean survival was 119.2 &plusmn; 4.4 days (Mean &plusmn; SEM). Significant prognostic factors for 6 months survival were high education level (HR = 0.74, CI 95% 0.59&mdash;0.93), COPD (HR = 1.91, CI 95% 1.2&mdash;3.04), CVA (HR = 1.69, CI 95% 1.03&mdash;2.78), Angiotensin Converting enzyme (ACE) inhibitors use (HR = 0.44, CI 95% 0.3&mdash;0.66) and Diuretics (HR = 0.63, CI 95% 0.41-0.96).CONCLUSION: Six-month survival of hospitalized decompensated CHF patients in Iran is not favorable. Many factors particularly accompanying diseases and medications affected the patient&rsquo;s 6-months survival.Keywords: Heart failure, Survival,&nbsp; Mortality.</p

Back on the Road to Life: Iranian Patients’ Experience of Heart Transplantation

Introduction: Heart transplantation is a standard treatment for end-stage cardiac disease. In addition to inducing physical changes and improving the quality of life, it causes unique mental and psychological changes in transplant recipients. Therefore, this study sought to explain and interpret the experience of heart transplant recipients in Iran. Methods: Using a qualitative content analysis approach, this study was performed on 13 heart transplant recipients in Tehran. The data were collected through observation and semi-structured interviews. The participants were selected using purposive sampling, and the interviews continued until data saturation. After obtaining informed consent, interviews were recorded, transcribed, and analyzed using conventional and concurrent content analysis. Results: The analysis of the data revealed two stages experienced by heart transplant recipients. The transition stage was categorized into two concepts of "emotional turmoil" and "feeling of duality". The emotional turmoil was subcategorized into feeling guilty, alienation with the new heart, and gratitude. Besides, the "feeling of duality" was subdivided into personality change and lifestyle changes. The stabilization stage was conceptualized into “self-acceptance” which was subcategorized into three concepts of the acceptance of the new heart, feeling of unity with the donor, and normalization. Conclusion: Adaptation to the new heart is a multistage process in heart transplant recipients. Based on the insights from this study, it can be concluded that healthcare professionals need to improve their knowledge of post-transplant changes, recipients’ feelings, and their adaptation strategies. They are also advised to address the physical needs and mental concerns of transplant recipients

Association between R353Q polymorphism for coagulative factor VII and severity of coronary artery disease in Iranian population

Background: Recent research has supported the central role of coagulative factors in advancing atherosclerosis and causing coronary artery disease (CAD). The present study, for the first time, aimed to clarify the relationship between R353Q polymorphism for factor VII and the occurrence and severity of CAD in a large sample of Iranian population.Methods: Nine hundred and nineteen consecutive patients with suspected CAD, who candidated for coronary angiography in the Tehran Heart Center between January 2006 and March 2007, were examined. The number of diseased coronary vessels was determined, and the severity of CAD was assessed by the Gensini score. Genotyping was done via the PCR-RFLP method.Results: The frequency of Q and R alleles was 74.1% and 25.9% in the patients with CADand 75.2% and 24.8% in those without CAD, with an insignificant difference (p = 0.625). The frequency of Q allele in the patients with single-vessel, two-vessel, and three-vessel diseases was 72.8%, 71.5%, and 76.4%, respectively; the difference was also insignificant (p = 0.379). No relationship was observed between the distribution of the genotypes and the number of the involved coronary vessels. The average of the Gensini score was 43.39 ± 46.18 in the patients with QQ genotype, 38.87 ± 42.89 in those with QR genotype, and 55.61 ± 53.80 in the ones with RR genotype, with the difference not constituting any statistical significance (p = 0.084).Conclusions: The results suggest no association between R353Q polymorphism for factor VII and the presence or progression of CAD in the Iranian population

تبیین زیبایی‌شناسی اخلاق‌مدار از دیدگاه مدیران پرستاری

Background and Aim: Aesthetic leadership is a leadership style closely intertwined with ethical leadership. This style is values-based and focused on promoting ethical behaviors, with a strong ethical goal centered on values of justice and fairness. This study aimed to explore ethical aesthetics from the perspective of nursing managers at Tehran University of Medical Sciences. Methods: This descriptive qualitative study used a customary content analysis with the approach of Graneheim and Lundman. The study population included the leadership and management team of hospitals affiliated with Tehran University of Medical Sciences. Data collection was done through semi-structured, face-to-face interviews. The sampling method was purposive snowball sampling and participants were selected until data saturation was reached. A total of 28 interviews were conducted with matrons, supervisors and head nurses. Ethical Considerations: The study was approved by the ethics committee. Ethical considerations such as obtaining informed consent, voluntary participation, explaining the research objectives and ensuring confidentiality were adhered to. Results: After analysis, three main categories and sub-categories were identified. The main categories included aesthetic ethical thinking (self-discipline, absence the sense of superiority, respect in work, empathy and understanding of others, altruism, having a clear conscience, attention to human dignity, adherence to professional ethics principles), aesthetic ethical behavior (efforts to uphold employee rights, ethical judgments, ethical disciplinary methods, appreciation and recognition of staff efforts, adherence to justice, patience, forgiveness, altruism in behavior) and aesthetic ethical speech (respectful communication, courage in speech, fairness in speech, preservation of human dignity in speech, honesty and truthfulness in speech, respecting individuals' privacy in speech). Conclusion: The aesthetics of ethics is an internalized ethical inclination that leads to actions (speech and behavior) grounded in human aesthetic values, goodness, benefit and truth. This research can strengthen the theoretical foundation of aesthetic leadership and complement the model of aesthetic nursing leadership within the healthcare system. It also contributes to the objectification and clarification of the concept of beauty and the sublime beauty of ethics in organizational life and nursing leadership and management in the Iranian healthcare system.زمینه و هدف: رهبری زیباشناخت‌گرا یکی از سبک‌های رهبریست که با سبک رهبری اخلاقی عجین است. این سبک، ارزش‌مدار و معطوف به بروز رفتار‌های اخلاقی و به عنوان یک سبک رهبری با هدف اخلاقی قوی حول ارزش‌های عدالت، انصاف در نظر گرفته می‌شود و مروج اهداف اخلاقی می‌باشد. این مطالعه با هدف تبیین زیبایی‌شناسی اخلاق‌مدار از دیدگاه مدیران پرستاری در دانشگاه علوم پزشکی تهران انجام شده است. روش: مطالعه حاضر، مطالعه كیفی با روش تحلیل محتوی مرسوم با رویکرد Graneheim و Lundman است. جامعه پژوهش شامل تیم رهبری و مدیریت بیمارستان‌های دانشگاه علوم پزشکی تهران بود و جمع‌آوری داده‌‌ها، به صورت مصاحبه فردیِ عمیق نیمه‌ساختارمند و چهره به چهره انجام شد. روش نمونه‌گیری، هدفمند و گلوله برفی بوده است و تعداد مشارکت‌کنندگان تا اشباع داده‌‌ها انتخاب شدند و در مجموع 28 مصاحبه با مترون، سوپروایزر، سرپرستار انجام شد. ملاحظات اخلاقی: این مطالعه توسط کمیته اخلاق تأیید شده است. ملاحظات اخلاقی نظیر تکمیل فرم رضایت آگاهانه کتبی، مشارکت داوطلبانه، توضیح اهداف تحقیق و اطمینان در مورد محرمانه‌بودن اطلاعات رعایت گردید. یافته‌‌ها: پس از تحلیل، سه طبقه اصلی و زیرطبقات شناسایی گردید. محوریت طبقات اصلی حاصل از تحلیل نهایی عبارت از تفکر زیباشناخت اخلاق‌مدار (خودآیینی‌داشتن، احساس تفوق و ریاست‌نداشتن، اعتقاد به احترام در کار، تلاش برای مفاهمه و درک افراد، خیرخواهی برای دیگران، داشتن وجدان بیدار، توجه داشتن به کرامت انسانی، پایبندبودن به اصول اخلاق حرفه‌ای)، رفتار زیباشناخت اخلاق‌مدار (تلاش برای احقاق حقوق کارکنان، قضاوت اخلاق‌مدارانه، استفاده از روش‌های تنبیهی اخلاق‌مدارانه، قدردانی و دیدن زحمات کارکنان، رعایت‌کردن عدالت، صبوربودن، گذشت‌داشتن، خیرخواهی در رفتار)، گفتار زیباشناخت اخلاق‌مدار (رعایت احترام در گفتار، شجاعت‌داشتن در گفتار، انصاف‌داشتن در گفتار، حفظ کرامت انسانی در گفتار، صداقت و راستگویی در کلام، رعایت حریم افراد در کلام) می‌باشد. نتیجه‌گیری: زیبایی‌شناسی اخلاق‌مدار نوعی گرایش اخلاقی درونی شده است که به کنش (گفتار و رفتار) با ارزش‌های زیباشناسانه انسانی، خیر، سودمندی و حقیقت منجر خواهد شد. این پژوهش، می‌تواند سبب تحکیم مبانی نظری رهبری زیباشناخت‌گرا گردد و تکمیل‌کننده مدل رهبری پرستاری زیباشناخت‌گرا در نظام مراقبت سلامت می‌باشد. همچنین به عینی‌سازی و تبیین مفهوم زیبایی و والایی زیبایی اخلاق در زیست سازمانی و رهبری و مدیریت پرستاری در نظام مراقبت سلامت ایران کمک می‌کند