Moral distress in Iranian nurses' experiences

AbstractBackground & Aim:Ethics is an integral part of nursing practice. Nurses and other professionalcaregivers are increasingly recognizing the issue of moral distress. The aim of this study is todescribe Iranian nurses' experiences in moral distress.Materials and Method: In this study the qualitative phenomenological approach was used. 11nurses from teaching hospitals of Hamadan University of Medical Sciences participated in thestudy. The data were collected by in-depth interviews. Transcripts were analysed by constantcomparative contant analysis.Result:The results sorted into 4 content areas: individual characteristics of team care (includingknowledge, ability, experience, responsibility and…), mental-affective reactions (including faulty,defensive reactions, lack of motivation and…), laws and officials (including, limitation of laws andcontradictory of laws with ethics, religion, knowledge and ability) and circumstances of workplace(including physical circumstances, manpower, facilities and equipments).Conclusion:It is necessary that nurses become familiar with ethical problems, nursing code ofethics and promote the skills for encounter to moral distress.Key words:Ethics, Moral distress, Nursing practice, Experience, PhenomenologyCorresponding Author:Parkhideh Hasani, Faculty Lecturer, Department of Anesthesiology,Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences,Tehran, IranEmail: [email protected] REFERENCES- Forum. 17 (1) 33–48.- - - - - - - - - - - - - - - - - - - edition. Philadelphia: Lippincott.- Wilkinson JM (1987). Moral distress in nursing practice: Experience and effect. Nursing Forum. 23(1) 16-29.Streubert HJ Carpenter DR (2007). Qualitative Research in Nursing Advancing the Humanistic Imperative. 3rdVan Manen M (2001). Researching Lived Experience. Action Sensitive Pedagogy 3rd edition. Ontario: Althouse Press.Silen Marit et al (2008). Workplace distress and ethical dilemmas in neuroscience nursing. Journal of NeuroscienceNursing. 40(4) 222-231.Pijl-Zieber EM et al (2008). Moral distress: An emerging problem for nurses in long-term care. Quality in Ageing andOlder Adults. 9(2) 39- 48.Oskouie F pairovi H (2005). [Qualitative Research in Nursing]. 1st edition. Tehran: Iran University of MedicalSciences Press. (Persian).Oberle k Hughes D (2001). Doctors and nurses perceptions of ethical problems in end-of-life decisions. Journal ofAdvanced Nursing. 33(6) 707-715.Nathaniel A (2002). Ethics and human rights. The American Nurses Association Issues Update. 1(2) 3-8.Mitchell GJ (2002). Policy, procedure and routine: Masters of moral influence. Nursing Science Quarterly. 14(2) 109-114McVicar A (2003). Workplace stress in nursing: A Literature review. Journal of Advanced Nursing. 44(6) 633-642.Mauleon AL Palo Bengtsson L Ekman SL (2005). Anaesthesia care of older patients as experienced by nurseanaesthetists. Nursing Ethics. 12(3) 263–272.Herting A et al (2004). Downsizing and reorganization: Demands, challenges and ambiguity for registered nurses.Journal of Advanced Nursing. 45(2) 145-154.Jameton A (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWONN’s Clinical Issuesin Prenatal and Women Health Nursing. 4(4) 542-551.Gutierrez KM (2005). Critical care nurses’ perceptions of and responses to moral distress. Dimensions of CriticalCare Nursing. 24(5) 229–241.Chitty Kay K Beth BP (2007). Professional Nursing Concepts.Challenge. Saunders ElsevierEbrahimi H et al (2007). [Stress: Major reaction of nurses to the context of ethical decision making]. Journal of IranUniversity of Medical Sciences. 14(54) 7-15 (Persian).Cronqvist A Lutzen K Nystrom M (2006). Nurses’ lived experience of moral stress support in the intensive carecontext. Journal of Nursing Management. 14(5) 405-413.Corley M et al (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing. 33(2)250-256.Corley M (2002). Moral distress: A proposed theory and research agenda. Nursing Ethics. 9 (6) 636-650.Canadian Nursing Association (2002). Code of ethics for registered nurses. Ottawa: Author. [On line].http://www.nurses.ab.ca/Carna-Admin/Uploads/CNAcodeofEthics.pdfCanadian Nurses Association (2003). Ethics in Practice for Registered Nurses. [On line]. http://www2.cnaaiic.ca/CNA/documents/pdf/publication/Ethics_in_Practice.Austin W et al (2005). Moral distress in healthcare practice: the situation of nurses. Health care ethics committee   

Exploring the Process of Spiritual Health of the Elderly Living in Nursing Homes: A Grounded Theory Study

BACKGROUND፡ Spiritual health is one of the important dimensions of the elderly’s health, which plays an important role in other dimensions of their health. This study aimed to explain the process of spiritual health of the elderly living in nursing homes.METHODS: This grounded theory study was conducted in 4 nursing homes in the city of Arak Iran between October 2019 and September 2020. The participants were 24 elderly people living in nursing homes, two health care providers, one nurse and one family member, first selected through purposive sampling andthen, through theoretical sampling. The data were collected through semi-structured interviews and field notes. All the interviews were transcribed verbatim and analyzed based on Strauss and Corbin approach (2008).RESULTS: Six main categories were identified, including helplessness, inefficient supportive environment, spiritual distress, seeking support, relative improvement of spiritual health and factors affecting spiritual health, each of which explains a part of the whole process of spiritual health of the elderly living in nursing homes.CONCLUSION: Supporting the elderly living in nursing homes is necessary in order to meet their spiritual needs and preserve and promote their spiritual health

Factors Predicting the standard precautions for infection control pre-hospital emergency staff of Hamadan based on the Health Belief Model

Background and Objective: Standard precautions are a set of basic strategies for preventing occupational exposure in pre-hospital emergency staff. The aim of this study was to determine the predictive factors for controlling infection based on the health belief model. Materials and Methods: In a descriptive-analytic study, 84 pre-hospital emergency staff members were selected through the census sampling method in Hamadan, Iran, 2017. Data collection tool was a self-report questionnaire including sections on demographic information, awareness, health belief model constructs, and practice. To analyze the data, independent t-test, Pearson correlation coefficient, and linear regression were run in SPSS, version 21. Results: The mean age of the subjects was 31.64±7.63 years. The level of awareness about the standard precautions for infection control was poor (mean: 46.85±15.13), while the practice level was moderate (mean: 55.16±12.73). There was a significant relationship between practice and the constructs of perceived benefits, cues to action, perceived sensitivity, and perceived self efficacy (P<0.05). Further, perceived benefits was significantly association with awareness (P=0.009). However, the results of linear regression analysis were not significant (P>0.05). Conclusion: Observance of the standard precautions for controlling infection among pre-hospital emergency staff can be improved by reinforcing the constructs of perceived benefits, perceived susceptibility, perceived selfefficacy, and cues to action

Requirements for Effective Evaluation in Nursing Education: a Qualitative Study

Introduction: There are many studies about evaluation in nursing education and its problems in Iran, but no study has been reported on the requirements for effective evaluation. This study aimed to explore academic managers' perceptions about requirements for effective evaluation in nursing education in Iran. Methods: This qualitative study was performed in year 2010. Semistructured individual interviews were arranged for 21 academic nursing managers and experts. The interviews were tape-recorded and transcribed verbatim. The transcriptions were analyzed using content analysis method. Results: Requirements for effective evaluation emerged in three categories and each category included some themes: input issues (infrastructure requirements, consideration of appropriate evaluation policies and approaches, revision of evaluation tools, consideration of students admission criteria, continuous assessment of students, teachers’ competence, comprehensive evaluation of curricula) process issues (standardization of objectives, revision of evaluation tools, establishment of follow-up committees, improvement of evaluators’ conditions, consideration of stakeholders’ expectations, and improvement in evaluation of theoretical and clinical training), and output issues (effective evaluation of students’ academic achievement, maintaining contact with alumni, alumni competence, continuing education for alumni, academic progress of alumni, awareness of occupational situation, work licensure, and graduates’ impact on society). Conclusion: There are numerous requirements for making nursing evaluations effective. Providing these requirements in the three categories of educational inputs, processes and outputs may improve the effectiveness of current evaluations.Also further studies are essential to design an efficient evaluation system for nursing education

The Effect of Education Based on BASNEF Model on Introduction of Complementary Feeding

Introduction: The mother has a significant role in introducing food to her child. In present study, the effect of complementary feeding introduction based on BASNEF model on the practice of primiparous mothers was investigated. Methods: This was a two groups pre&post test and quasi experimental study carried out on 160 primiparous mothers with 5 months children referred to healthcare centers in Hamadan. Mothers were put into two groups. At first both groups completed a questionnaire which was based on BASNEF model. Then the intervention group was instructed during four sessions (60 min) based on BASNEF model. Two months later, data was collected via questionnaires and a mother performance checklist in two groups again. Data were analyzed by SPSS18 software through Chi-square and Mann-Whitney. Results: Before the intervention, there was no significant difference in the mean scores of BASNEF structures in the two groups (P>0.05), but after the intervention a significant difference was observed in the mean scores (P.0.05). Supplementary feeding time of the intervention and the control groups was 5.88±0.49 and 6.14± 0.35 months respectively. The mean scores of supplementary feeding performance of two groups of mothers, had significant differences (P <0.001). Conclusion: BASNEF MODEL can be an efficient tool for increasing knowledge, attitude, enabling factors, subjective norms, intention and performance of introduction of complementary feeding of mothers; so we suggest health education programs instead of applying traditional instructions

The corollation on general health and Spiritual health ofnursing studentsin Universityof Hamedan Medical Sciences in 2016

Background: Nursing students as nursing personnel in the future, play an important role in the spiritual and physical of persens. Attention to public health and spiritual health, especially in nursing students that often dealing with poor clients, is essential. . This study aims to determine The corollation on general health and Spiritual health ofnursing studentsin Universityof Hamedan Medical Sciences. Materials & Methods: In this descriptive – correlation study, 258 nursing students were selected with classified sampling. Data were collected by general health questionnaire and spiritual health questionnaire. Data were analyzed by using SPSS/16 software, descriptive and inferential statistics. Finding: The average of age students was 21/57±3/17 and 89/1 percent female and 10.9 percent were male gender. The mean (SD) score of Public Health was 39/27 (3/10) and (SD) score of spiritual health was 97/10 (13/40). significant relationship between Structures spiritual health and general health were observed (p<0/05). Conclusions: Spiritual health and public health is closely together and Is expected to promote spiritual well-being is improved public health nursing students. Attention to spiritual health in addition to physical, mental and social can improve the health of this important grou

The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women

Background: Changes in lifestyle and eating habits have put women at risk of obesity and overweight more than ever. This aim of this study was to investigate the effect of Pender’s Health Promotion Model (HPM) to improve the nutritional behavior of overweight and obese women admitted to Fatemiyeh Hospital clinics in Hamadan, west Iran in 2015. Methods: n this quasi-experimental study, 108 eligible women were selected and randomly assigned to two groups: one experimental and one control. Data were gathered using three questionnaires: demographics, Pender’s HPM constructs, and nutritional behavior. The questionnaires were filled out by both groups as pre-test and two months later. A Pender’s HPM-based intervention was conducted for the experimental group. The data were analyzed by paired and independent t-tests, ANCOVA, and Spearmans’ correlation coefficient in SPSS/16. The level of significance was considered to be <0.05. Results: The mean score of nutritional behavior was 41.75±3.28 and 42.36±3.69 before the intervention and 79.09±5.27 and 49.72±9.49 after it in the experimental and control groups, respectively. The difference was significant only between before and after the intervention in the experimental group (P<0.001). Furthermore, the mean scores of the following variables were significantly different between before and after the intervention in the experimental group: nutritional behavior, perceived benefits, perceived self-efficacy, commitment to action, interpersonal and situational influences, behavior-related affect, and perceived barriers (P<0.001). Conclusion: The results showed that Pender’s HPM-based training improved nutritional behavior and some constructs of the model. Therefore, this educative model can be used by healthcare providers to improve the nutritional and other health promoting behaviors

The Effect of Peer Education on Health Promotion Behaviors of Nursing Students in Hamadan University of Medical Sciences

Introduction: Practicing health promotion behaviours is one of the best ways to maintain health. Modification of health promoting behaviors is essential for students and peer education can be an effective way. Therefore, the present study was conducted to evaluate the effect of peer education on nursing students' health promoting behaviors. Methods: In this quasi-experimental study , 80 nursing and midwifery students were selected by  covenience sampling method in 2016-2017. Data gathering tool was Pender Health Promotion Standard Questionnaire. Before education, health promoting behaviors were examined. Then, the first and second semester nursing students were educated in a 4 sessions (each session was 1.5-hour), with lecture and peer education methods, respectively. Two months after education, post-test was done. The data were analyzed using statistical test by SPSS 16 Results: There were no significant differences between the two groups in terms of the mean score of health promotion behaviors (P=0.29) and their related dimensions including spiritual growth (P=0.776), responsibility (P=0.44), interpersonal relationships (P=0.556), stress management (P=0.238), exercise (P=0.704), and nutrition (P=0.06) before education. However, after education, the mean score of health promotion behaviors and their dimensions in the lecture group had a statistically significant increase compared to that of  peer education group (P <0.001). Conclusion: The effectiveness of health promoting behaviors education in lecture group was more than peer group

The Effect of Post-discharge Telephone Training and Follow-up on Self-care Behaviors of Myocardial Infarction Patients

Background and purpose: Patients with myocardial infarction need to receive care and self-care ability. The aim of this study was to determine the effect of post-discharge education and follow-up on self-care behaviors of patients with myocardial infarction. Materials and Methods: In this quasi-experimental study, 116 patients with myocardial infarction were selected by convenience sampling method and randomly assigned to the two groups of control (n = 58) and intervention (n = 58). In the intervention group, a face-to-face training session was held first. Then telephone follow-up with training immediately after discharge, twice a week in the first month and once a week in the second month with the intervention group. The standard questionnaire of self-care behaviors in patients with myocardial infarction was used to collect information. SPSS software version 23 and descriptive statistics and Fisherchr('39')s independent and accurate t-tests were used to analyze the data. Results: The mean score of self-care in the intervention group in one month and two months after training compared to discharge time was 35.29 and 44.10 units, respectively. The results of LSD post hoc test showed that these differences were statistically significant (p <0.001). Using chi-square test, a statistically significant difference was observed between the frequency distribution of patients in the control and intervention groups in one month and two months after the intervention in terms of self-care. Conclusion: Due to its availability, the use of telephone follow-up can be used as a method to follow the training provided to patients