Explaining ethical challenges and practical solutions from a nursing managements' perspective: A phenomenological study.

Introduction and Objective: Ethical practice is a vital aspect of nursing interventions. Complying with the ethical aspects of the intervention procedure in a stressful nursing environment is not easy and nurse managers always face ethical challenges which are in conflict with their personal values and norms. Identifying and solving these challenges improves the efficiency and effectiveness of nursing care activities. Therefore, this research was done to explain the ethical challenges of nurse managers and practical solutions from their perspective. Material and Method: It is a qualitative study that was carried out based on the phenomenological method in 2022. The participants of this study were 20 nurse managers of Arak hospitals who were selected by purposive sampling until data saturation. The data were collected through semi-structured interviews for 30 to 90 minutes. Data collection was carried out with the participant's consent, using a digital recording device and verbatim transcription, and then it was analyzed using Van Manen's six-step hermeneutic phenomenological approach. Findings: The results of this study could provide a clear picture of ethical challenges and their practical solutions from the nurse managers' perspective in the form of four themes of managerial ethical challenges which include challenges facing physicians, organizations, employees, managers, and three themes for practical solutions, including organizational solutions, interpersonal solutions, and educational solutions which were manifested. Conclusion: Nurse managers are always faced with ethical challenges in their daily activities. To deal with these challenges, they must be familiar with the rules and principles of professional ethics, practical standards, and laws related to patients' rights. Ethical principles and awareness of the ethical decision-making process are useful and effective in having capable and ethical nurses who provide competent care. To deal with ethical challenges, it is suggested to consider self-care strategies and structural and specialized support in each center, which will ultimately lead to the improvement of service quality and the promotion of ethics in care-treatment environments.

Does moral sensitivity contribute to patient satisfaction? A cross-sectional survey in educational hospitals.

Introduction: Our study aims to assess interactions between the moral sensitivity of physicians and the satisfaction of patients. Methods: This is a cross-sectional study. Data were collected by a standard questionnaire of the physicians' moral sensitivity about decision-making and a researcher-made patient satisfaction questionnaire. The physicians were selected through the census method, and patients were selected using quota sampling to equal the selection of each physician from each work shift. All information was analyzed by SPSS statistical software version 23. Results: The mean score for physicians' moral sensitivity was 91.6 ± 0.63 which shows a high level of moral sensitivity. The average patient satisfaction was 61.97 ± 3.55 out of the total score (23-115) which shows a moderate level of satisfaction with the highest scores in the domain of "professionalism" and the lowest scores were related to the domain of "Technical Quality of Care". Conclusion: For improving patient satisfaction, adopting appropriate strategies like performing the periodic evaluation of this phenomenon and providing some codified training in this regard are required to increase the level of moral sensitivity of physicians and provide high-quality care.

Understanding lived experiences of nurse managers about managerial ethics.

INTRODUCTION: Expressions of Managerial ethics as a clinical phenomenon in Nursing Ethics as expressed by nurse managers were investigated. A coherence could be detected between the concepts and phenomena of Managerial ethics and nurse managers as a context. BACKGROUND: Managerial ethics as a new approach has emerged in the perspective and by prioritizing ethics in the organization has provided the basis for creating and promoting individual and organizational effectiveness. Managers' and staff's adherence to professional ethics helps hospitals to achieve their intended goals. AIM: The present study aimed to explain nurse managers' experience of managerial ethics. RESEARCH DESIGN: This qualitative study was conducted based on a phenomenological design in 2022. PARTICIPANTS AND RESEARCH CONTEXT: The participants included 20 nurse managers working in hospitals in Arak, Iran. They were selected by the purposive sampling method which continued until data saturation. Data were collected through semi-structured individual interviews (30-90 min); subsequently, the obtained results were analyzed using the Van Manen six-step approach. ETHICAL CONSIDERATIONS: The confidentiality and the right of participants to take part or withdraw from the study were observed during this research. RESULTS: The results of the present study were able to demonstrate nurse managers' lived experience of managerial ethics in the form of five themes of professional ethics, people-oriented management, professional empowerment, excellencism, and patient-centered care. CONCLUSIONS: As evidenced by the obtained results, nurse managers held a positive view of managerial ethics. They were striving to strongly adhere to ethical principles in nursing management since they contribute greatly to the improved quality of nursing services in care and health settings. Therefore, appropriate policy-making and planning for managerial ethics training are indispensable for all nurses and nursing students.

Evaluating Measles Incidence Rates Using Machine Learning and Time Series Methods in the Center of Iran, 1997-2020.

Background: Measles is a feverish condition labeled among the most infectious viral illnesses in the globe. Despite the presence of a secure, accessible, affordable and efficient vaccine, measles continues to be a worldwide concern. Methods: This epidemiologic study used machine learning and time series methods to assess factors that placed people at a higher risk of measles. The study contained the measles incidence in Markazi Province, the center of Iran, from Apr 1997 to Feb 2020. In addition to machine learning, zero-inflated negative binomial regression for time series was utilized to assess development of measles over time. Results: The incidence of measles was 14.5% over the recent 24 years and a constant trend of almost zero cases were observed from 2002 to 2020. The order of independent variable importance were recent years, age, vaccination, rhinorrhea, male sex, contact with measles patients, cough, conjunctivitis, ethnic, and fever. Only 7 new cases were forecasted for the next two years. Bagging and random forest were the most accurate classification methods. Conclusion: Even if the numbers of new cases were almost zero during recent years, age and contact were responsible for non-occurrence of measles. October and May are prone to have new cases for 2021 and 2022.

Avicenna and clinical experiences in Canon of Medicine.

Avicenna used his medical knowledge and experience of scientists from different nations to create a new style in medicine. For this reason, his textbook, Canon of Medicine, has been considered a medical reference in all universities worldwide for centuries. In this article, some valuable and interesting diagnostic and therapeutic clinical experiences mentioned in the Canon of Medicine are described in five sections. This research was conducted to review Avicenna's specific clinical observations and interventions in PubMed, Google Scholar, and Scopus databases using the keywords "Avicenna" and "Canon of Medicine". In this article, we presented several examples of diagnostic and therapeutic clinical experiences mentioned in the Canon of Medicine in 5 areas, including semiology, therapeutic strategy, urology, neurology, obstetrics, and gynecology. Canon of Medicine, as a complete medical series containing the medical experiences from different nations and Iranian medical scientists, has influenced the world's medical knowledge for several centuries. Some of Avicenna's clinical and experimental views can be useful from both a historical point of view and new research.

The Effect of E-Learning on Self-Efficacy and Sense of Coherence of Cancer Caregivers: Application of the Bandura and Antonovsky Social Cognitive Theory.

AIM: Cancer is one of the most important chronic diseases which affects caregivers. Therefore, in this study, we decided to increase the self-efficacy and sense of coherence of caregivers by using virtual learning via mobile to increase the power of managing in such situations. METHODS: This study is a clinical trial performed on 60 caregivers of cancer patients. Questionnaires of demographic information, Bandura self-efficacy, and Antonovsky's sense of coherence were completed for both intervention and control groups. Then, for the intervention group, a virtual educational intervention was performed daily for 1 month using the mobile phones, and for the control group, no intervention was performed. RESULTS: The mean score of self-efficacy in the intervention group was (18.09±93.21) before and (135.12±11.14) after the intervention, which was statistically significant (P=0.001). While in the control group, this means was (84.71±18.55) before and (84.75±17.13) after the study, but this difference was not statistically significant (P=0.2). Also, the mean score of sense of coherence in the intervention group was (73.25±7.28) before and (89.11±7.11) after the intervention, which was statistically significant (P=0.001). While in the control group, this means was (76.42±7.45) before and (76.89±7.27) after the study, but this difference was not statistically significant (P=0.31). CONCLUSION: Educational interventions, even virtually, can lead to improved self-efficacy and a sense of coherence in caregivers of cancer patients and can be used as one of the low-cost and effective methods in managing and controlling the disease.

Incidence Trend of Gastrointestinal Cancer in Markazi, in the Center of Iran, Population-Based Cancer Registry Results: 2010-2014.

BACKGROUND: Gastrointestinal cancers are considered as the most common type of cancer among men and the second most common cancer in women after breast cancer in Iran. This study was performed to investigate the epidemiology of gastrointestinal cancer in Markazi Province. METHODS: This is an epidemiological study in which data was gathered from the population-based cancer registry program in the Markazi province of Iran during the years 2010-2014. Data were recorded in Excel software and coded based on ICD-O. All cases out of Markazi provinces were excluded from study, and cases with code C-15-C20 were included in this study. Stata 11 was used to analyze the data. RESULTS: In this study, 2975 new cases of gastrointestinal cancer in Markazi province were included in the analysis. The highest number of cancers was stomach (with 1595 cases), followed by colorectal cancer (980 cases), esophageal cancer (318 cases), and finally small bowl cancer (82 cases). The mean age of gastro-intestinal cancer diagnosis was 65.07 years. The results showed that with increasing age, the incidence of gastro-intestinal cancers increased, and in all sites and both sexes, the highest incidence of gastro-intestinal cancer was in the age group above 70 years. In both sexes, the age specific rate of stomach cancer was higher than other sites (with highest incidence in 2013) followed by colorectal cancer, esophageal cancer, and small bowl cancer. CONCLUSIONS: The results showed similar incidence rate of gastrointestinal cancer in Markazi province to other provinces in Iran. This study found that stomach cancer is the most common cancer in the Markazi province; therefore, identifying effective and preventing factors is necessary.

Associations of demographic, socioeconomic, self-rated health, and metastasis in colorectal cancer in Iran.

Background: Metastasis in Colorectal Cancer (CRC) is important because of the costs imposed on the individual. Self-Rated Health (SRH) can be useful for preventing cancer. Considering the role of Socio-Economic Status (SES) in CRC, our study was conducted to evaluate the relationship between demographic, SES, SRH, and metastasis of this type of cancer in Markazi province, Iran. Methods: This cross-sectional, descriptive study (April to July 2018) was conducted on 411 patients suffering from CRC. These patients were hospitalized in one of the medical centers affiliated to Arak University of Medical Sciences (Arak, Iran), and with non-random sampling (available sampling) they were imported to the study. A reliable and valid questionnaire about levels of SES and SRH was filled by patients. For analyzing the data, Binomial logistic regression and chi-square tests were executed using Stata 11 software. Results: The mean age was 60.01 years. According to the results of this study, as compared with poorest SES patients, the OR estimate of metastasis was 0.80 (95% CI: 0.36, 1.78) among the richest SES patients, in patients with age of >60 years was 9.92 (95% CI: 1.53, 64.39) in comparison with patients with age of <40 years, in male patients was 3.26 (95% CI: 1.76, 6.04) compared with female ones; in divorced/widowed patients was 0.52 (95% CI: 0.11, 2.51) in comparison with single ones; among those with academic level of education was 4.28 (95% CI: 1.49, 12.26) compared with illiterate patients; and compared with poor SRH-age of patients, was 3.78 (95% CI: 2.09, 6.85) among those with good SRH-age. Conclusion: Patient's education and SES are important variables in metastasis and SRH of CRC in Iranian patients. All diagnostic tests and medical possibilities should be available for all individuals with adequate interventions. Patient's education and awareness should also be increased.

Socio-Economic Status Inequity in Self Rated Health in Patients with Breast Cancer.

AIM: We investigate the evaluation of socio-economic status (SES) inequality on self-rated health (SRH) at women with breast cancer. STUDY DESIGN: Cross-sectional study. METHODS: The current study conducted on all 270 breast cancer patients that were admitted to one of the hospitals of Arak University Medical Sciences (Arak, Iran from April to July 2018) by census (using non-random sampling (accessible sampling). SES was calculated by asset-based questionnaire and Principle Component Analysis (PCA) was performed to estimate the families' SES. Concentration Index (C) and Curve (CC) was used to measure SES inequality in SRH. The data were analysed with Stata software. RESULTS: The number of persons with good SRH by the level of SES was 165 (61.1%) and with poor SRH was 105 (38.9%). The number of persons with good SRH in comparison to same-aged people by level of SES was 135 (50%) and with poor SRH was 135 (50%). Concentration index of SRH in all level of SES was 0.061 (SE = 0.03). Also, Concentration index for SRH in comparison to same-aged people at different levels of SES was -0.044 (SE = 0.03). CONCLUSION: The results of this study showed that there is inequality in SRH in a patient with breast cancer of the richest level of SES.

Decomposing Socioeconomic Inequality in Health Literacy in Iran: A Concentration Index Approach.

BACKGROUND: Health literacy is a major factor for health promotion and well-being. In spite of several researches on health literacy, information on the subject of the status of health literacy in Asian countries such as Iran is inadequate. Therefore, this study aimed to assess the inequality of health literacy in an Iranian population and its influencing factors. METHODS: In this cross-sectional study, 736 families were selected by cluster random sampling. A validated questionnaire was used to measure the health literacy of participants. Socioeconomic status (SES) was calculated by asset-based approach, and principal component analysis (PCA) was performed to estimate the families' SES. Concentration index and curve were used to measure SES inequality in health literacy, and after that decomposed into its determinants. The data were analyzed by Stata software. RESULTS: The mean age of the participants was 34.81 years (standard deviation = 5.98 years). The value of concentration index for health literacy equals 0.2292 (95% confidence interval = 0.168-0.283), and this value indicates that there is inequality in distribution of health literacy in Iran and the inequality disfavors the poor. CONCLUSIONS: The results of this study revealed that there is inequality in distribution of health literacy in Iran, and people of higher economic status in Iran enjoy from better health literacy levels.

Relationship of Socio Economic Status, Income, and Education with the Survival Rate of Breast Cancer: A Meta-Analysis.

BACKGROUND: Despite our awareness of the significant effect of Social Determinant of Health (SDoH) such as Socio Economic Status (SES), income and education on breast cancer survival, there was a serious lack of information about the effect of different level of these factors on breast cancer survival. So far, no meta-analysis has been conducted with this aim, but this gap was addressed by this meta-analysis. METHODS: Main electronic databases such as PubMed, Web of Science, and Scopus were investigated up to January 2019. Epidemiological studies focusing on the association between SDoH and breast cancer were singled out. Q-test and I2 statistic were used to study the heterogeneity across studies. Begg's and Egger's tests were applied to explore the likelihood of the publication bias. The results were reported as hazard ratio (HR) with 95% confidence intervals (CI) through a random-effects model. RESULTS: We identified 7,653 references and included 25 studies involving 1,497,881 participants. The HR estimate of breast cancer survival was 0.82 (0.67, 0.98) among high level of SES, 0.82 (0.70, 0.94) among high level of income and 0.72 (0.66, 0.78) among academic level of education. CONCLUSION: The SES, income, and education were associated with breast cancer survival, although the association was not very strong. However, there was a significant association between the levels of these factors and breast cancer survival.

Effects of Intravenous and Inhaled Nebulized Lignocaine on the Hemodynamic Response of Endotracheal Intubation Patients: A Randomized Clinical Trial.

BACKGROUND: Endotracheal intubation is one of the most common measures in the Intensive Care Unit (ICU) which plays an important role in airway management of the critically ill patients. AIMS: The study aimed to evaluate the effects of lignocaine spray on hemodynamic response of endotracheal intubation patients. SETTINGS AND DESIGN: This study is a randomized clinical trial on a study population comprising patients admitted to the ICU. SUBJECTS AND METHODS: The patients were divided into three groups using a permuted block randomization. In Group 1, inhaled nebulized lignocaine 4% (75.0 mg/kg) was sprayed around the patients' epiglottis and larynx. In Group 2, intravenous (IV) lignocaine 2% (75.0/mg/kg) was injected. No lignocaine was prescribed for or administered to the control group. One and four minutes after intubation, the patients' hemodynamic and vital signs were measured. STATISTICAL ANALYSIS USED: Data analysis was run using Stata 13 software through repeated measure ANOVA tests. RESULTS: Although the mean arterial blood pressure (MAP) of Group 1 (inhaled nebulized lignocaine) was smaller than that of Group 2 (IV lignocaine), there was no significant difference between the two groups. Both groups' MAPs were significantly different from that of the control group. As for the average number of pulses, a significant difference was observed between the inhaled and IV lignocaine groups; hence, the average number of pulses in Group 1 (inhalation) was lower than that of Group 2 (IV injection). CONCLUSION: As blood pressure is considered to be normal under 140/90 and may not entail any hemodynamic complications, it can be concluded that inhaled nebulized lignocaine can control the hemodynamic changes of intubation more effectively than IV lignocaine.

The Effect of Magnesium Sulfate on Renal Colic Pain Relief; a Randomized Clinical Trial.

INTRODUCTION: Renal colic can be managed by preventing the contraction movements of ureter muscles. By reducing acetylcholine in the nerve terminals, magnesium sulfate could be effective in this regard. The aim of this study is to investigate the effect of magnesium sulfate on acute renal colic pain relief. METHOD: The present study was a double-blind clinical trial in which the patients suffering from acute renal colic were randomly divided into 2 groups of who either received standard protocol (intravenous infusion of 0.1 mg/Kg morphine sulfate, 30 mg of Ketorolac, and 100 ml normal saline as placebo/15 minutes) or standard protocol plus 15 mg/Kg of intravenous magnesium sulfate 50%/100 ml normal saline/15 minutes. Severity of patients' pain was measured by visual analogue scale (VAS) at baseline, and 30 and 60 minutes after infusion. The collected data were analyzed using STATA statistical software. RESULTS: 100 cases were randomly allocated to intervention or control group. The two groups were similar in baseline pain score and demographic characteristics. At 30 and 60 minutes, mean pain score was less in the intervention group compared to the control group. Moreover, the difference between the two groups was statistically significant regarding the additional amount of morphine, suggesting that the intervention group needed less additional morphine than the control group. CONCLUSION: The results of this study showed that Magnesium sulfate can be used as an adjunct drug in treatment of patients suffering from renal colic. It not only alleviates the pain in the patients, but also diminishes the need for pain medications.