Mohsen Shahriari

Proposing Codes of Ethics for Iranian Nurses: A Mixed Methods Study

The purpose of this study was to develop codes of ethics for Iranian nurses. Researchers used mixed methods in four stages during 2009-2010 to develop a series of ethical codes for Iranian nurses in Isfahan, Iran. 55 ethical codes in 12 categories were extracted and listed as (1) believe in human dignity, (2) respect for patients’ privacy, (3) empathy for patient, (4) autonomy in decision making, (5) accurate and precise nursing care, (6) being conscience, (7) human relationship, (8) professional commitment, (9) promoting justice, (10) preventing harm and/or injury, (11) honesty and confidentiality, and (12) maintaining and promoting professional values. Study findings serve to the global nursing community on the Islamic view of ethics.

Informational needs and related problems of family caregivers of heart failure patients: A qualitative study.

Background: Heart failure is incurable disease and patients often have an ongoing decline once diagnosed. The symptoms of heart failure may impair the ability of patient to perform activities of daily living. As heart failure progresses, patients normally increase their reliance on family caregivers. Aims: This paper explored the informational needs and related problems of family caregivers of heart failure patients as a part of the findings of a study exploring experiences of family caregivers in the caregiving situation. Setting and Design: Using a qualitative design, 19 family caregivers from three educational hospitals in Isfahan, Iran, were recruited. Materials and Methods: Participants were selected by purposive sampling. Data were collected through semi-structured interviews. Interviews were transcribed verbatim and analyzed concurrently. Results: Four major themes were emerged from the analysis of the transcripts: “Lack of care-related knowledge”, “Inaccessibility to responsible source of information”, “Lack of guidance from healthcare team” and “caring with ambiguity due to unpredictable nature of the disease”. Caregivers believed that they did not have the basic knowledge related to disease and medication administration. They received little guidance and support from the health care team on the caregiving roles. They experienced high level of ambiguity and stress in caregiving tasks due to lack of care-related knowledge and unpredictable nature of disease. Conclusion: The care, which was performed by the caregivers of HF patients, is beyond of their knowledge, capabilities, and resources. Nurses and other healthcare providers can use the findings of this study to develop effective educational and supportive programs to facilitate these needs.

Comparative Study of Job Burnout Among Critical Care Nurses With Fixed and Rotating Shift Schedules

Background: Nurses, as health care providers, are insurmountably obliged to the practice of shift work. Literature has reported shift working as one of the inducing factors of burnout. Despite numerous studies in this area, there are inconsistencies on the relationship between shift working and burnout among nurses, especially in those who work in critical care settings. Objectives: The aim of this study was to compare the occupational burnout in critical care nurses with and without fixed shift schedules. Patients and Methods: In this comparative study, 130 nurses with rotating shift schedule and 130 nurses with fixed shift schedule from six university hospitals were selected using stratified random sampling. Maslach burnout inventory was used for data collection. Independent samples t-test, chi-square and one-way ANOVA tests were used to analyze the data. Results: Most of the participants were females (62.7%), aged between 22 - 29 years (38.5%), married (59.2%), and had a bachelor degree (86.9%). The mean score of emotional exhaustion was significantly higher in nurses with fixed shift schedules (P < 0.001). However, no significant difference was found between the mean scores of the two groups in the personal accomplishment and depersonalization subscales (P > 0.05). Moreover, no significant difference was found in burnout mean scores between nurses with fixed morning and fixed night shifts (P > 0.05). The means of the emotional exhaustion subscale were significantly different in nurses with different characteristics (P < 0.05) except the gender and working unit. Conclusions: As a result of this study, it was found that critical care nurses with fixed shift schedules display more burnout in emotional exhaustion dimension, compared to those working with rotating shift schedules.

Ethical values in nurse education perceived by students and educators

Background: Education is considered the first function and mission of the university, and observing educational ethics guarantees the health of the teaching–learning process in the university. Aim: The aim of this study was to explore ethical values in nursing education from the perspective of Iranian nursing students and educators. Research design: This qualitative study was conducted using the Thematic Content Analyses method. The data were collected from seven semi-structured individual interviews and three focus group discussions from July to November 2015. Participants and research context: The participants were faculty educators of nursing and nursing students in Tehran, capital of Iran, who were selected through purposive sampling. They were recruited gradually. Sampling was continued until data saturation when no new codes were extracted. Ethical committee: This study was conducted after obtaining the approval of Shahid Beheshti University of Medical Sciences Ethics Committee, and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process. Findings: Seven major themes emerged: human dignity, constructive human relations, educational justice, competency enhancement, excellence view, wisdom, and commitment and accountability. Conclusion: The results of this study indicated that although many of the values, as universal values, were similar to those of other countries—which can be a reflection of the globalization process in the nursing profession and the presence of humanistic and spiritual approaches at the roots of the discipline, some differences could be found in the content of values due to factors such as the people’s beliefs, culture, and religion. Iranian nursing students and educators revealed a unique and culture-based set of ethical values.

Nurses' commitment to respecting patient dignity

Background: Although respecting human dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing care. Therefore, the present study aimed to investigate nurses’ commitment to respecting patient dignity in hospitals of Isfahan, Iran. Methods: This descriptive-analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from different wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient-nurse relationships, privacy, and independence. All items were scored based on a five-point Likert scale. The collected data were analyzed using descriptive statistics and Chi-square tests. P < 0.05 were considered significant in all analyses. Findings: Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection as moderate/good. Only 6.5% of the subjects rated it as excellent. The majority of the patients (84.4%) believed their independence was maintained. These subjects also approved of taking part in decision-making. Conclusion: According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing authorities and policy makers are thus required to introduce appropriate measures to improve the existing conditions.

Vital role of cultural and religious context on suicidal behavior

I N A RECENT issue of Psychiatry and Clinical Neurosciences, Russell et al. well described cultural influences on suicide in Japan. Cultural factors, such as the custom of respectable suicide, can influence the suicide rate. It is important to know the cultural and religious context of different areas in a multiethnic society. The impact of culture on suicide is challenging. Culture influences suicide and suicidal methods. There are different

Comparison of the effects of enteral feeding through the bolus and continuous methods on blood sugar and prealbumin levels in ICU inpatients

Background: Appropriate nutritional support is effective on achievement of expected outcomes in intensive care unit (ICU) patients. Although several studies have suggested different conclusions about the effectiveness of tube feeding methods, there is no specific program of nutritional support for patients who have been hospitalized. There is a possibility for complications due to an inadequate nutrition. The aim of our study is to compare the effects of enteral feeding through the bolus and continuous methods on blood sugar and prealbumin level among the ICU inpatients. Materials and Methods: Fifty subjects were selected by convenient sampling from April to Aug 2013 in the ICU wards of Alzahra Hospital, Isfahan, Iran, and randomly assigned to study and control groups in this clinical trial. The subjects in the study group received infusion pump feeding while the control group received bolus feeding for 72 h. Blood sugar was checked for every 4 h for 72 h and the prealbumin level was assessed on the first and the fourth day in two groups. Results: In the study group, the mean blood sugar significantly decreased on the fourth day, compared with the first (P = 0.03, F = 3.85) and third (P = 0.01, F = 3.15) day. In the control group, the mean blood sugar increased from the first day. It was significantly higher in the control group on the second day (P = 0.02, F = 3.55), compared with the study group. In the study group, there was a significant difference in the mean prealbumin before and after intervention (P = 0.048, t = 1.97), but no significant difference was observed in the control group. There was a significant difference between two groups after intervention (P = 0.04, t = 2.05). Conclusion: The obtained results showed that supportive nutrition through a continuous method had an effect on critical patients’ blood sugar control and made a better nutritional status for these patients through an increase of prealbumin level. Positive effects of this feeding method can result in appropriate outcomes for patients’ recovery and reduce the complications.

How Is Developing the Sense of Belonging in Iranian Adolescent Girls? A Qualitative Study

BACKGROUND: Communicating with adolescents is associated with many challenges for parents and healthcare providers. AIM: This qualitative study was conducted for exploring the sense of belonging in Iranian adolescent girls. METHODS: In this study, deep semi-structured interviews were carried out with 27 adolescent girls, 10 experts, and 10 parents. Purposeful sampling was used and continued until data saturation. The data were coded and categorised through a conventional content analysis method by MAXQDA 10. RESULTS: Three main categories were obtained from the analysis of the participants’ descriptions: “family; a haven of tranquillity”, “dominated by peers”, and “concerns about differences in gender socialization”. According to our results, most of the girls achieved calmness through being emotionally accepted by their families. But this sense of belonging and tranquillity was shaken by their peers’ showing off, in a way that adolescent girls were always struggling to gain acceptance among their peers. Also for fear of being rejected by their peers’ group, they sometimes began to make friends with the opposite sex. Meanwhile, traditional attitudes towards gender roles and adolescent girls’ feelings about their lower social participation as compared to that of boys had also led to their concern about differences in gender socialization and a lower sense of community belonging among some adolescent girls. CONCLUSION: Adequate parental education and the proper management of girls’ interactions with the family and society can play an important role in the development of a sense of belonging among adolescent girls.

The relationship between ethical conflict and nurses’ personal and organisational characteristics:

Introduction: Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict. Aim: The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses. Methods: This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0). Ethical considerations: All participants were informed about the study’s aim and were assured that participation in and withdrawal from the study would be voluntary. Findings: The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was “working with professionally incompetent nurses or nurse assistants.” Married nurses, nurses with official employment, nurses with master’s degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager’s conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict. Conclusion: Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses’ exposure to ethical conflict.

Effects of an ethical empowerment program on critical care nurses’ ethical decision-making:

Background: Nurses require empowerment if they are to make ethical decisions. Ethical empowerment has always been one of the main concerns in nurse training programs. Research aim: The present study was conducted to determine the effect of an ethical empowerment program on critical care nurses’ ethical decision-making. Research design: This is a clinical trial study with two groups and pre and post design. Participants and research context: In this study, 60 nurses working in Intensive Care Unit were selected through random sampling and then divided into a control and an experimental group after filling out the Moral Sensitivity Questionnaire. Both groups completed the questionnaire again immediately and 2 months after the ethical empowerment workshop had been held for the experimental group. The collected data were analyzed in SPSS-16 using descriptive and inferential statistics. Ethical considerations: The goals of the study were explained to the participants and then a written informed consent was received from them. Findings: The results showed no significant differences between the two groups in terms of their ethical sensitivity scores at the beginning of the study; however, immediately and 2 months after the intervention, the mean score increased significantly in the experimental group. Moreover, the scores obtained 2 months after the workshop increased compared to the pre-intervention scores but showed a drop compared to the scores reported immediately after the workshop. Discussion: The ethical empowerment program, given to the critical care nurses in this study, improved their ethical sensitivity in making decisions significantly over time. Despite the extensive methods, available for teaching nursing ethics, the ethical empowerment program, adopted in this study, had long-lasting effects in terms of ameliorating the process of ethical decision-making in clinical situations. Conclusion: The ethical empowerment of nurses requires the adoption and application of proper methods and patterns of complying with nursing ethics.