The Effect of Spiritual Group Therapy on the Quality of Life and Empowerment of Women with Breast Cancer: A Randomized Clinical Trial in Iran.

This randomized clinical trial was carried out on 74 women with breast cancer between May 2015 and April 2016 in the south of Iran. The patients were selected using a simple sampling method and randomly divided into an intervention (n = 30) and a control (n = 37) group. Five spiritual therapy sessions were conducted for the intervention group. Each session lasted one hour. The quality of life and empowerment of the patients were measured before and one month after the intervention. To collect data, four instruments were used, including a demographic information form, the European Organization for Research and Treatment of Cancer QOL questionnaire Cancer-30 (EORTC QLQ C-30), EORTC QLQ Breast-23 (EORTC QLQ-BR23), and the Cancer Empowerment Questionnaire (CEQ). After the intervention, a difference was observed between the groups concerning the mean score of general health (P = 0.016) and emotional function (P = 0.029), but there was no significant difference between the groups concerning the mean score of empowerment (P = 0.62). Thus, it appears that spiritual group therapy can improve the quality of life of this group of patients.IRCT registration number: IRCT 2014050417546N2.

Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting.

BACKGROUND: The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings. METHODS: This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1. RESULTS: The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96. CONCLUSIONS: The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.

Reliability and validity of the Persian version of 5-D itching scale among patients with chronic kidney disease.

BACKGROUND: Hemodialysis is considered a major therapeutic method for patients with chronic kidney disease. Pruritus is a common complaint of hemodialysis patients. The 5-D pruritus scale is amongst the most common tools to evaluate several dimensions of itch. Psychometric properties of the 5-D scale have not been evaluated in Persian speaking population with hemodialysis; hence, the objective of this study was to assess reliability and validity of the Persian version of the scale. METHODS: Ninety hemodialysis patients (men: 50, women: 40, mean age: 54.4 years) participated in this cross-sectional study. The final Persian version of 5-D scale was given to the participants. Tests Compared: One-third of the participants completed the scale twice within 3-7 days apart to evaluate test- retest reliability. Other psychometric properties including internal consistency, absolute reliability, convergent, discriminative and construct validity, floor/ceiling effects were also evaluated. RESULTS: The Persian 5-D scale has strong test-retest reliability (ICC= 0.98) and internal consistency (Cronbach's alpha= 0.99). Standard error of measurement and minimal detectable change were 0.33 and 0.91, respectively. Regarding convergent validity, the scale had moderate correlation with numeric rating scale (r =0.67) and quality of life questionnaire related to itch (r = 0.59). Exploratory factor analysis revealed two factors within the scale. No floor or ceiling effect was found for the scale. CONCLUSION: The Persian version of 5-D the itching scale is a brief instrument with acceptable reliability and validity. Therefore, the scale could be used by experts, nurses, and other health service providers to evaluate pruritus among Persian speaking hemodialysis patients.

Empowering health volunteer's through participatory action research in a comprehensive healthcare center.

BACKGROUND: Health volunteers act as the link between the society and the healthcare system and are a symbol of people's participation in the health maintenance and promotion. Despite the important role of health volunteers in the health system, it seems that they experience several problems. The aim of this study was empowering health volunteers through an action research. METHODS: This participatory action research was conducted through two continuous cycles of reflection and acting for change over 20 months, in a comprehensive health center in Southern of Fars province in Iran. Participants included 25 health volunteers; two instructors and an academic researcher as facilitator. In the first cycle the participants discovered the challenges of health volunteers, prioritized them, designed an action plan, and implemented it. At the end of this cycle, evaluation was done with the participants' cooperation. The second cycle began with reflecting on the results of the first cycle and then after designing and implementing second action plan, final evaluation was done. RESULTS: Qualitative content analysis in the first phase led to the emergence of four categories, including role confusion, inadequate volunteer training, deficits in attracting and keeping volunteers, and being unfamiliar to the public. After the implementation of the action plan the participants learned through reflection and immersing in action. Finally, quantitative and qualitative data showed improvement of knowledge and performance, satisfaction, effectiveness of programs and improvement in volunteer's competence. CONCLUSIONS: Clarification of volunteers' roles, supporting volunteers to improve their knowledge and skills with coherent planning based on their educational needs, are appropriate management plans to attract and retain volunteers. By presenting their services to the society, they will be empowered and motivated to continue.

Nursing professional practice environment and its relationship with nursing outcomes in intensive care units: a test of the structural equation model.

INTRODUCTION: Burnout, intention to leave and ultimately shortage of skilled nurses are associated with poor practice environments; however, in Iran comprehensive data are unavailable. The aim of this study was to investigate the relationships between the nursing professional practice environment with nurses' burnout and intention to leave in intensive care units, using structural equation modelling analysis. METHODS: This cross-sectional, multi-centred study was conducted among 320 nurses in twenty ICUs of five teaching hospitals affiliated with Shiraz University of Medical Sciences from September 2018 to June 2019. Valid measurement instruments including Nursing Professional Practice Environment Questionnaire (NPPEQ), Maslach Burnout Inventory (MBI) and Anticipated Turnover Scale (ATS) were used for data collection. RESULTS: Goodness-of-fit statistics confirmed a model with burnout dimensions in mediating positions between nursing professional practice environment dimensions and intention to leave, explaining 86.4% of the variation. CONCLUSION: The results confirmed a theoretical model with structural the relationships among the nursing professional practice environment, burnout and intention to leave in nurses working in ICUs. In this model, burnout had a strong direct positive effect on intention to leave. The results can provide guidance for various stakeholders, such as health policymakers and nurse managers attempting to improve the quality of nurses' workplace, by drawing their attention to various factors influencing the retention of technically trained nurses in the critical care units.

Improving nurses' knowledge, attitude, and performance in relation to ethical codes through group reflection strategy.

BACKGROUND: The most basic responsibility of nurses that even precedes their therapeutic role is respect for professional ethics in providing clinical care. The present study was conducted to determine the effect of group reflection on the knowledge, attitude and performance of nurses in relation to ethical codes. METHODS: The present blinded, before-after, educational trial was conducted on 86 nurses working at a general hospital in the south of Iran who were randomly divided into a intervention (n = 44) and a control (n = 42) group. Data were collected before and after the intervention using three tools, including a knowledge test, an attitude rating scale and a performance questionnaire. In the intervention group, the intervention given consisted of four sessions of group reflection, and the control group received a single lecture on ethical codes. RESULTS: The mean changes in the nurses' score of knowledge after the intervention compared to before differed significantly in both intervention and control groups (P < 0.001), but there was no significant difference between the two groups in terms of the mean changes in the score of knowledge (2.73 ± 3.45 in intervention group vs. 2.57 ± 3.36 in control group, P = 0.83). Although the mean score of attitude differed significantly between the intervention and control groups in the posttest (34.7 ± 8.44 in intervention group vs. 29.95 ± 9.09 in control group, P < 0.014), the two groups were not significantly different in terms of the mean changes in the score of attitude in relation to ethical codes before and after the intervention (P < 0.14). Moreover, the two groups were significantly different in terms of the mean changes in the scores of performance in the two stages (9.07 ± 16.84 in intervention group vs. 0.67 ± 20.01 in control group, P < 0.001). CONCLUSION: Group reflection can improve the knowledge, attitude and performance of nurses in relation to ethical codes. Although lectures can help improve nurses' knowledge and attitude in this area, they have no significant effects on their performance. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (No: IRCT2016070317546N6, registration date: 10 October 2016), https://www.irct.ir/trial/16112.

Challenges Associated With Patient Transfer From Postanesthesia Care Unit to Surgical Unit in Iran: A Mixed-Method Study.

PURPOSE: This study aimed to explore the entire spectrum of challenges associated with the process of patient transfer from the postanesthesia care unit (PACU) to the surgical unit. DESIGN: The study employed a mixed-method design with concurrent triangulation approach. METHODS: The study was conducted during July-December 2018 at three teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. A total of 23 health-care providers involved with the patient transfer process from the PACU and surgical unit were recruited. Data were collected using quantitative and qualitative approaches. The quantitative study included 25 structured observations. The qualitative study included 12 unstructured observations, individual semistructured in-depth interviews (n = 13), and focused group sessions (n = 3). Data were managed using MAXQDA.10 software and analyzed using SPSS software (version 22.0). FINDINGS: Based on qualitative data, 4 main categories and 14 subcategories were extracted. The main categories were "Multifarious Activities of Nurses", "Insufficient Organizational Resources", "Task-oriented Approach", and "Deficient Professional Performance". Results showed that 51% of patient-specific information, 64% of anesthesia information, and 74% of surgical information was not transferred during patient handoffs. CONCLUSIONS: Insufficient organizational resources and deficient professional performance were identified as the main challenges associated with the transfer process of postoperative patients. Our findings provide a better understanding of these challenges and encourage health policymakers and planners to resolve these issues to promote patient safety during handoffs.

Translation and Psychometric Assessment of the Postoperative Handover Assessment Tool.

PURPOSE: The objective of the present study was to translate and validate the Postoperative Handover Assessment Tool (PoHAT) in the Persian language. DESIGN: The study used a descriptive, mixed-method design. METHODS: The present descriptive, mixed-method study was conducted in 2018 at Shahid Rajaee Hospital and Shiraz Nursing and Midwifery School, Shiraz University of Medical Sciences (Shiraz, Iran), to evaluate the psychometric properties of the Persian version of the PoHAT. The original version of PoHAT was translated into the Persian language and then back-translated for comparison. The face validity (qualitative), content validity (qualitative and quantitative), construct validity (experimental intervention method), and reliability (inter-rater reliability, internal consistency) of the Persian version of the PoHAT were assessed. Data were analyzed using SPSS software, version 22. P values less than 0.05 were considered statistically significant. FINDINGS: The content validity ratio of all the 34 items of the Persian version of the PoHAT ranged between 0.66 and 1. The content validity index for all items was within the acceptable range (between 0.92 and 1). The result of construct validity, using the experimental intervention method, showed a significant difference between before and after intervention (P < .05). The correlation coefficient for inter-rater reliability of all subscales (information, tasks, teamwork) and the total checklist was 0.89, 0.80, 0.94, and 0.85, respectively; the coefficient was significant for all subscales (P < .001). CONCLUSIONS: The validity and reliability of the 34-item Persian version of the PoHAT were confirmed. The application of the PoHAT to assess the process and quality of postoperative handover in Iran and other Persian-speaking countries is recommended.

[Factors affecting nursing students' professional self-concept in Iran: a qualitative study]. / Fattori che influenzano il concetto di sé professionale degli studenti infermieri in Iran: uno studio qualitativo.

INTRODUCTION: Professional self-concept is a contextualized multidimensional concept that describes the subjective experiences and feelings of nurses with regard to nursing roles. Professional self-concept starts to develop during the academic years. Yet, there is still limited understanding about the factors affecting nursing students' professional self-concept, which is a potential problem. Poor professional self-concept negatively affects nurses' clinical practice, job satisfaction, and retention in the profession. AIM: This study aimed to explore factors affecting Iranian nursing students' professional self- concept from the perspectives of nursing students, nursing instructors, and hospital nurses. METHODS: This exploratory qualitative study was carried out from June 2018 to April 2019. Participants were four hospital nurses, three clinical nursing instructors, and four nursing stu- dents who were purposively selected from the Shiraz University of Medical Sciences, Shiraz, Iran. Data were gathered via in-depth semi-structured interviews and were analyzed via con- ventional content analysis proposed by Graneheim and Lundman. FINDINGS: In total, 610 primary codes were generated and grouped into eleven subthemes and five main themes. The main themes of the study were professional instructors, competent nur- ses, informed choice of nursing profession, difficulties of nursing profession, and congruence between students' personal-professional values and nursing profession. CONCLUSION: Professional self-concept is affected by different personal, educational, envi- ronmental, and social factors. Nursing instructors, hospital managers, and nurse managers can use the findings of this study to support nursing students, promote their professional self-con- cept, and ensure their retention in the profession.

Effectiveness of Standardized Patient in Abdominal Physical Examination Education: A Randomized, Controlled Trial.

INTRODUCTION: Simulation and virtual technologies currently are used to enhance basic and advanced nursing skills. Information on the use of simulation methods in the Iranian nursing education system, particularly regarding standardized patients (SP), is scarce. Hence, the present study aimed to evaluate the effect of using SP on the performance of Iranian nursing students in the physical examination of the abdomen. In addition, the SP method was compared with the purely lecture-based education method. METHODS: The present study was of a pre-test/post-test design carried out at the School of Nursing and Midwifery, Kazerun Islamic Azad University (Kazerun, Iran) during 2014. Third-year nursing students were recruited and assigned to either a control or an intervention group. The study was conducted in three phases: pre-test knowledge evaluation, training sessions, and post-test/recall test evaluation of objective structured clinical examination (OSCE). Data were analyzed using the SPSS software (version 16.0). A total of 87 students were included in our analysis. RESULTS: All participants were female with a mean age of 21.99±1.73 years. The mean pre-test score of the control and intervention groups were 4.98±2.17 and 5.35±1.77, respectively. No significant difference was observed between the groups regarding the OSCE overall scores (P>0.05). However, there was a significant difference between the mean pre-test and post-test scores in each group (P<0.05). Compared to the control group, the difference in the mean pre-test and post-test scores was higher in the intervention group (4.98±2.17 and 14.43±3.93 in control group vs. 5.35±1.77 and 15.39±3.2 in intervention group, respectively). Furthermore, there was no statistically significant difference between the groups in terms of the post-test and recall test scores. CONCLUSION: Our study demonstrates the SP method is an effective tool for learning to perform the physical examination of the abdomen as compared to the purely lecture-based educational method. The present pilot study could be extended to cover training on the physical examination of other human organs.

Causes of medical errors and its under-reporting amongst pediatric nurses in Iran: a qualitative study.

OBJECTIVES: To explore the causes of medical errors (ME) and under-reporting amongst pediatric nurses at an Iranian teaching hospital. DESIGN: A qualitative study, based on individual, in-depth, semi-structured interviews and content analysis approach. SETTINGS: The study was conducted at the Pediatric Department of the largest tertiary general and teaching hospital in Shiraz, southern Iran. PARTICIPANTS: The study population was all pediatrics nurses who work at Pediatric Department and they had been trained on ME, as well as methods to report them through the hospital's ME reporting system. Purposive sampling was used by selecting key informants until data saturation was achieved and no more new information was obtained. Finally, 18 pediatric nurses were interviewed. MAIN OUTCOME MEASURE(S): Pediatrics nurses' views on the causes of ME and under-reporting. RESULTS: We found five main factors causing ME and under-reporting: personal factors, workplace factors, managerial factors, work culture and error reporting system. These factors were further classified into proximal and distal factors. Proximal factors had direct relationship with ME and distal factors were contextual factors. CONCLUSION: Causes of ME and under-reporting amongst pediatric nurses are complex and intertwined. Both proximal and distal factors need to be simultaneously addressed using context-specific approaches. Further research on other groups of healthcare workers and using a quantitative approach will be beneficial to elucidate the most appropriate interventions.

Presence: the cornerstone of spiritual needs among hospitalised patients.

BACKGROUND: An important part of the spiritual needs of patients is 'presence'. The increased demand for holistic care has led to increased attention on 'presence' and its quality. AIMS AND OBJECTIVE: Given the importance of understanding the phenomenon of presence in order to promote the spirituality dimension among hospitalised patients, this study aimed to describe the lived experience of hospitalised patients in the context of presence. RESEARCH METHODS: This was a descriptive phenomenological qualitative study carried out on 12 admitted patients in general hospital settings. The data were collected through individual and semi-structured interviews. The Colaizzi method was used for analysing and interpreting the data, while the criteria of the Guba and Lincoln method were used to ensure the trustworthiness of these data. RESULTS: The experience of hospitalised patients concerning 'presence' appeared in the form of three main themes: 'multidimensional connection', 'receiving support' and 'dignity'. During hospitalisation, patients need to experience effective connection with the transcendent and individuals, and receive various types of comprehensive support, such that their and others' dignity is preserved. Patients considered that 'presence' was beyond 'being' and able to provide them with comfort. CONCLUSIONS: Patients' need is very important in the field of presence. In the social and religious context of Iran, in which both supernatural and human aspects of presence are emphasised, it seems that healthcare teams, health authorities and policymakers must provide an appropriate supportive environment in terms of providing a healing presence in its different dimensions.

Hospitalized adolescents' perception of dignity: A qualitative study.

BACKGROUND: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents' recovery. However, many studies have been conducted on exploring the concept of the patients' dignity from the adult patients and fewer studies still have explored the dignity of young people. OBJECTIVE: This study explores the hospitalized adolescents' perception about dignity. RESEARCH DESIGN: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents' dignity. PARTICIPANTS AND RESEARCH CONTEXT: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). ETHICAL CONSIDERATIONS: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. FINDINGS: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. DISCUSSION AND CONCLUSION: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent's identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses.

Impediments to the formation of intensive care nurses' professional identify.

BACKGROUND: Nurses face challenges regarding professional identify. Being unaware of these challenges and not owning positive professional identify leads to a lack of self-confidence. Thus, nurses face problems in interpersonal communication and lose their attachment to their profession. Few studies have engaged with impediments to forming positive professional identity in relation to intensive care nurses. OBJECTIVE: The purpose of this study is to investigate the impediments to forming positive professional identity in nurses working in intensive care unit. RESEARCH DESIGN: In this study, the conventional content analysis method was used in order to obtain the impediments to forming positive professional identities in nurses. Data were collected through 15 semi-structured interviews and 2 focus group interviews from March 2015 to June 2016. Purposive sampling was used and participants were recruited until data saturation was reached; they were then analyzed using the conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT: In total, 24 intensive care unit nurses from one hospital in Northern Iran were selected through purposive sampling. ETHICAL CONSIDERATION: This study was approved by the Ethics Committee of Shiraz University of Medical Sciences. FINDINGS: Four main themes of professional identity challenges were extracted from the analysis of the data: neglect of professional status of nursing; distrust of nursing knowledge; unprofessional performance; and low professional attraction. DISCUSSION AND CONCLUSION: Nurses stated that the neglect of the professional status of nursing and distrust of nursing knowledge have always been a hindrance in forming a positive professional identity. They also mentioned that unprofessional performance and low professional attraction are the other influencing factors in this regard. Thus, detecting these factors can guide nurses and their managers towards creating positive professional identity, and as a result, will improve their job satisfaction, professional advancement, and durability.

Patients' perception of dignity in Iranian general hospital settings.

BACKGROUND: Dignified care is one of the main objectives of holistic care. Furthermore, paying attention to dignity as one of the fundamental rights of patients is extremely important. However, in many cases, the dignity of hospitalized patients is not considered. Dignity is an abstract concept, and comprehensive studies of the dignity of Iranian patients hospitalized in general hospital settings are limited. OBJECTIVE: The aim of this study was to explore the concept of dignity from the perspective of patients hospitalized in general hospital settings in Iran. RESEARCH DESIGN: This study takes a qualitative approach. Data were gathered using individual, semi-structured interviews. Qualitative content analysis was the method used to analyse and interpret the data. The criteria suggested by Guba and Lincoln were used ensure the trustworthiness of the study. PARTICIPANTS AND RESEARCH CONTEXT: A total of 14 hospitalized patients in general hospital settings in Shiraz participated in this study. ETHICAL CONSIDERATIONS: The Research Ethics Committee of the Shiraz University of Medical Sciences approved the protocol of the study and the ethical principles were followed throughout. FINDINGS: The findings of this study revealed four main themes - 'respectful atmosphere', 'patient privacy', 'preservation of authority' and 'receiving attention' - and 10 categories. DISCUSSION: Patients need to be hospitalized in a respectable environment in which their privacy is preserved and paid attention, providing them with sufficient authority in terms of medical decisions and their life-related issues. The dignity of hospitalized patients will be preserved under these conditions. CONCLUSION: Patients hospitalized in general hospital settings need to retain their dignity. This can contribute to the optimal therapeutic outcomes for them. Therefore, it is suggested that a cultural, professional and institutional background, in which all components of the patient's dignity are protected and emphasized, should be provided.

The effect of education through conceptual mapping on critical thinking of nursing students.

OBJECTIVE: To determine the effect of conceptual mapping on nursing students' critical thinking. METHODS: The quasi-experimental case-control study was conducted from April 2015 to October 2016 at the University of Medical Sciences, Shiraz, Iran, and comprised students of Fatemeh-Zahra School of Nursing and Midwifery, Shiraz. The students were randomly assigned to intervention and control groups. Baseline data was collected using a two-part questionnaire, including demographic items and California Critical Thinking Skills Test. Both groups underwent 24 six-hour training sessions 3 times a week. The intervention and control groups were trained by conceptual map and integration methods, respectively. Post-intervention data was collected using the same questionnaire and was analysed using SPSS 13. RESULTS: Of the 81 subjects, 41(50.6%) were in the intervention group and 40(49.4%) in the control group. The mean age was 25.12}3.71 years in the intervention group and 25.5}4.10 years in the control group (p>0.05). At baseline, there was no significant difference between the mean critical thinking scores of the two groups (p=0.781). Postintervention values increased in both groups, but the mean critical score was significantly higher in the intervention group (p<0.0001). CONCLUSIONS: Concept mapping was found to be an effective approach for improving students' critical thinking skills.

Spiritual Health: A Concept Analysis.

Spiritual health has attracted a lot of attention in health-related and nursing sciences and numerous researches. Yet, this concept has remained complex and ambiguous, and there is no consensus in this regard. This ambiguity can be challenging for holistic nursing; therefore, clarification of the concept is required for development of nursing knowledge. The present study aimed to explore the concept of spiritual health in health-related and nursing literature. Walker and Avant (Strategies for theory construction in nursing, Appleton & Lange, Norwalk, 1995) concept analysis method was used in this study. The results were categorized as antecedents, attributes, and outcomes of spiritual health. The critical attributes extracted for spiritual health included transcendence, purposefulness and meaningfulness, faithfulness, harmonious interconnectedness, integrative power, multidimensionality, and holistic being. Besides, the antecedents of spiritual health included capability and potentiality for transcendence, and spiritual awareness. Finally, well-being and moral development were the outcomes of spiritual health. Spiritual health is one of the basic aspects of health and providing a clear theoretical definition can result in a common understanding of this concept for nurses. Clarifying this concept would also be useful for provision of spiritual care interventions and development of nursing theories.

Evaluating the Effectiveness of a Continuing Education Program for Prevention of Occupational Exposure to Needle Stick Injuries in Nursing Staff Based on Kirkpatrick's Model.

BACKGROUND: Nurses are the most vulnerable group that are faced with occupational injuries caused by exposure to needle stick injuries. This study evaluated the effectiveness of a continuing education program about the prevention of occupational exposure to needle stick injuries in the nursing staff, based on the Kirkpatrick model. METHODS: In this study, 120 nurses were selected in the experimental and control groups. A continuing education program for experimental group was performed. After the education program, its effectiveness has been evaluated across four levels (Reaction, Learning, Behavior, Results) of the Kirkpatrick model. Data analysis was conducted using Pearson's correlation coefficient, chi-square test, paired t-test, independent samples t-test, and descriptive statistics. The data were analyzed using the SPSS statistical software (V. 22). RESULTS: The mean score for knowledge in the experimental group improved significantly from 8.32 ± 2.17 to 13.98 ± 1.2 (p < 0.05). The experimental group of 24 nurses (40%) were exposed to needle stick injury before education, but this number was reduced to 9 (15%) after intervention. The chi-square test showed a significant difference (P = 0.013). However in the experimental group, 15 nurses (25%) were exposed to blood and body fluids before intervention, but again it was reduced to 6 (10%) after education. The chi-square test showed a significant difference (P = 0.002). CONCLUSION: The results from the execution of continuing education program showed that through designing training programs and raising awareness in nursing personnel, we can reduce occupation exposure to needle stick injuries.

Nurses' adherence to ethical codes: The viewpoints of patients, nurses, and managers.

BACKGROUND: Ethical codes are guidelines that orient nurses and ensure that their decisions are in accordance with the values of the professional system. These codes show that there is a connection among values, patients' rights, and nurses' duties. OBJECTIVES: This study aimed to compare the viewpoints of patients, nurses, and nurse managers regarding the extent to which clinical ethical codes are observed. RESEARCH DESIGN: In this descriptive-comparative study, data were collected using three questionnaires based on Iranian nurses' ethical codes with a focus on clinical care. The reliability of the questionnaire was verified by test-retest method (r = 0.9). The patients were interviewed by the researcher, but nurses and managers completed the questionnaires themselves. After all, the data were analyzed using the SPSS statistical software (v 15). PARTICIPANTS AND RESEARCH CONTEXT: In all, 100 patients, 100 nurses, and 30 managers from internal and surgical wards of two major hospitals in Shiraz, Iran, participated in 2014. ETHICAL CONSIDERATIONS: This research was approved by the Ethics Committee of Shiraz University of Medical Sciences. All the participants signed written informed consents. FINDINGS: According to the results, 70% of the patients, 86% of the nurses, and 53.3% of the nurse managers rated nurses' adherence to ethical codes as satisfactory. The mean scores (standard deviation) of the level of adherence to ethical codes were 38.44 (6.91) in the patients, 41.08 (4.82) in the nurses, and 37.83 (6.98) in the nurse managers. The results of analysis of variance revealed a significant difference between the attitudes of the nurses and the other two groups (p = 0.001). DISCUSSION: Nurses' adherence to ethical codes was satisfactory in all three groups. Accordingly, our findings agree with the results of some national and international studies, although there are still controversies in this regard. CONCLUSION: Although the nurses rated their performance in certain fields more satisfactory compared to the patients and managers, all the three groups agreed that clinical ethical codes were properly observed in the internal and surgical wards. Nurses can improve the quality of care by considering the viewpoints of patients and managers about their ethical performance.

The effect of need-based spiritual/religious intervention on spiritual well-being and anxiety of elderly people.

Anxiety and spiritual distress are the most common problems among the patients admitted in intensive care units. The elderly are more vulnerable to this problem due to impairment of their adaptation mechanisms. Hence, helping to reduce anxiety is one of the most effective nursing interventions. Therefore, this study aimed at investigating the effect of need-based spiritual/religious interventions on spiritual well-being (SWB) and anxiety of the elderly admitted to coronary care unit (CCU). This quasi-experimental study with pre- and posttest control group design was conducted on 66 patients admitted to CCU of Imam Reza hospital in Lar, southern Iran, in 2014. After obtaining informed consents, the data were collected using the Spielberger State-Trait Anxiety Inventory, the SWB Scale, and a demographic questionnaire. The questionnaires were completed through interviewing the patients before and after the intervention. The participants of the intervention group underwent 60- to 90-minute sessions of spiritual and religious need-based interventions for 3 consecutive days. The results showed a significant increase in the mean scores of SWB in the intervention group after the intervention (P = .001). Also, a significant decrease was found in mean scores of trait and state anxiety in the intervention group in comparing to control group (P < .001). Moreover, a significant correlation was observed between the mean scores of SWB and state and trait anxiety. Spiritual/religious interventions could enhance SWB and reduce anxiety in the elderly admitted to CCU.