Mojtaba Vaismoradi

Smoking among male medical sciences students in Semnan, Islamic Republic of Iran.

We determined the prevalence of smoking among 320 male medical sciences students (174 studying for a medical degree, 95 a bachelor degree and 51 a associate degree) in Semnan, Islamic Republic of Iran. A self-administrated, anonymous questionnaire was used. The prevalence of smoking was 14.4%; 45.6% of the smokers started smoking between the ages of 18 and 20 years, 43.5% starting at university. There was no significant difference in the prevalence between students undertaking different college degrees and also those having different types of accommodation. However the smoking behaviour of friends and family was significantly correlated with smoking in the students. Smoking amongst medical sciences students, who will become the health professionals of the future, needs to be addressed.

Iranian nursing students’ comprehension and experiences regarding evaluation process: a thematic analysis study

Scand J Caring Sci; 2011; 25; 151–159 Iranian nursing students’ comprehension and experiences regarding evaluation process: a thematic analysis study In this study, a qualitative design based on a thematic analysis approach was employed to explore the comprehension and experiences of Iranian nursing students regarding evaluation process in both classroom and clinical setting. After utilising purposeful sampling to choose 13 bachelor’s degree nursing students, semi-structured interviews were held for data gathering. During the data analysis, three main themes emerged: ‘definition of evaluation process’, ‘unfair evaluation’ and ‘ideal evaluation’. The second theme consisted of two sub-themes: ‘problematic process’ and ‘unexpected outcome’. Our study findings showed a gap between what Iranian nursing students depicted as a fair and equitable evaluation and what they experienced during their academic career. There is a need to bring a change to process of evaluation to increase the feeling of fairness and justice regarding evaluation among nursing students. The findings can be helpful for international nurse instructors to be exposed to the unheard perspectives of nursing students and reconsider the weaknesses of evaluation process conducted by them.

A qualitative study on Iranian nurses’ experiences and perspectives on how to provide safe care in clinical practice

Nurses are the healthcare providers who are well positioned to strengthen patient safety through providing safe care in clinical practice. The purpose of this study was to explore and describe the experiences and perspectives of Iranian nurses in relation to how to provide safe care in clinical practice. A qualitative design by using a content analysis approach was applied for the data gathering and analysis. After employing a purposive sampling to choose 16 bachelor’s degree nurses working in the medical and surgical wards of a referral teaching hospital in an urban area of Iran, semi-structured interviews were conducted to collect data. During the data analysis, three main themes emerged: ‘providing safe care as the patient’s right’, with the subthemes: ‘feeling a personal commitment’ and ‘incorporating patients’ feelings of safety into providing safe care’, ‘encouraging reciprocal accountability in healthcare professionals’ and ‘leadership commitment to safe care’. The findings suggest that educators should provide more information during nurses’ education to focus on the moral duty to provide safe care. In addition, the provision of safe care needs the commitment and collaboration of all healthcare professionals, as well as the leadership of nursing for removing obstacles to nurses’ efforts to making the healthcare system safer.

Patient safety is not just about medication errors.

I have read your Commentary entitled‘Signposting the causes of medication errors’ (2011) published in the last issue of International Nursing Review. Surely, it will improve international knowledge on the important subject of patient safety. However, I find it necessary to make the following comments on the Commentary. In the Commentary, you stated ‘with the precise number and types of errors available . . .’. It is believed that it is impossible to gather data on the exact or precise numbers and types of errors. According to Kingestone et al. (2004), the prevalence of nursing disclosure for errors (and ‘near misses’) tends to be under-reported by nurses who are widely acknowledged as a group that reports incidents more significantly than other health professionals, including medical practitioners. In this regard, some errors are reported because they have had a large impact on patients’ well-being or they have even resulted in patients’ death; therefore, no study can claim that it has presented a precise number of errors. In addition, you mentioned that ‘. . . we know little as to their causes,and this study (Joolaee et al.2011) offers compelling insights’. First of all, from the methodological perspective, the study of Joolaee et al. (2011) has not mentioned how many hospitals have been selected for the data gathering. In this study, in the data gathering zone, Tehran, there are three medical sciences universities, which all hospitals in Tehran are affiliated. Each university supervises a couple of hospitals in the different geographical locations of the city. It should be noted that the context and know-how of the hospitals are very diverse. The hospitals under the supervision of each university provide services to people with different social classes and have different workloads and staffing patterns. If the results would have been expected to be generalized to all hospitals in Tehran, the authors should have been selected one hospital, at least, from each medical sciences university for the data gathering. The authors have not done so, and their data cannot be generalized to other health-care settings in Tehran. Moreover, based on my experiences in the Iranian healthcare system, there are differences in the working conditions of nurses working in the hospitals affiliated to the mentioned universities in Tehran. For example, in hospitals affiliated to Beheshti University, there are better working conditions for nurses and a more standard nurse–patient ration. Therefore, the working conditions of nurses in the hospitals may not be considered equal. Furthermore, you stated that we need to reflect on the causes of medication errors, and the Joolaee et al. study (2011) offers compelling insights. This study has only focused on medication errors, not other kinds of errors. Surely, the presented causes would be applicable to the causes of medication errors rather than other kinds of error. My PhD dissertation subject is about patient safety entitled ‘exploration of the process and the development of a theoretical model of safe nursing care within the Iranian health care system’. Based on my country’s culture and context, the concept of safety encompasses other kinds of errors, and there are many other kinds of errors missed in the international literature. Medication errors form a very small part of the errors (Vaismoradi et al. 2011a,b). In this regard, those papers that consider all causes of nursing errors without prejudgment and direction to the medication ones are preferred.Moreover, such a paper and the relationship between working conditions (management practices, providing a suitable environment with the requisite supply of resources and infrastructure and increasing nurses’ knowledge) and nursing practice errors have been presented before (Anoosheh et al. 2008), and it is not something specifically mentioned in the Joolaee et al.’s study. I am afraid you missed to cite it. It clearly covers the causes of all sorts of nursing practice errors with a strong methodology. Finally, I am concerned that with such commentaries concentrating and emphasising on medication errors, we miss the main parts of patient safety and just think that ‘medication errors are equal to patient safety’. I apologize for the lengthy letter. Thank you for your consideration and the commentary. With my warmest regards,