The relationship between nurses' moral competency and missed nursing care: a descriptive-correlational study.

BACKGROUND: When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses. METHODS: This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey. ETHICAL CONSIDERATION: This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences. RESULTS: The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC. CONCLUSION: The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.

Evaluation of cross-cultural adaptation and validation of the Persian version of the critical thinking disposition scale: methodological study.

INTRODUCTION: Assessing critical thinking disposition is crucial in nursing education to foster analytical skills essential for effective healthcare practice. This study aimed to evaluate the cross-cultural adaptation and validation of the Persian version of the Critical Thinking Disposition Scale among Iranian nursing students. METHOD: A total of 390 nursing students (mean age = 21.74 (2.1) years; 64% female) participated in the study. Face and content validity were established through feedback from nursing students and expert specialists, respectively. Construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA was used to explore the number of factors and the items that were loading on them. The CFA was used to confirmed the fidnings of the EFA on the same sample. Convergent and discriminant validity were examined, along with reliability through internal consistency and test-retest reliability. RESULTS: EFA revealed a two-factor structure, comprising "Critical Openness" and "Reflective Skepticism," explaining 55% of the total variance. CFA confirmed the model's fit (χ² = 117.37, df = 43, χ²/df = 2.73, p < 0.001; RMSEA = 0.067; CFI = 0.95; TLI = 0.93, SRMR = 0.041). Convergent and discriminant validity were supported, with significant factor loadings (p < 0.001) ranging from 0.61 to 0.77. The CTDS exhibited strong internal consistency (α = 0.87) and excellent test-retest reliability (ICC = 0.96). CONCLUSION: The validation of the CTDS in Persian language settings provides a reliable tool for assessing critical thinking disposition among Iranian nursing students. The two-factor structure aligns with previous research, reflecting students' propensity towards critical openness and reflective skepticism. The study's findings underscore the importance of nurturing critical thinking skills in nursing education.

Moral reckoning among nurses: A directed qualitative content analysis.

BACKGROUND: When nurses face ethical challenges, they attempt to accept responsibility for their actions and start moral reckoning. Moral reckoning is the personal evaluation of one's behaviors or others' behaviors during ethically challenging situations. RESEARCH AIM: This study aimed at exploring the concept of moral reckoning and its stages among Iranian nurses using Nathaniel's moral reckoning Theory. RESEARCH DESIGN: This descriptive qualitative study was conducted in 2022 using directed content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Eighteen nurses were purposively recruited from three teaching hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Data were collected via in-depth semi-structured interviews which lasted 50 minutes on average and were concurrently analyzed via the three-step directed content analysis method proposed by Elo and Kyngas. ETHICAL CONSIDERATIONS: This study earned the ethical approval of the Ethics Committee of Golestan University of Medical Sciences, Gorgan, Iran (code: IR.GOUMS.REC.1400.171). FINDINGS: During data analysis, 157 final codes were developed and categorized into 23 subcategories, 10 categories, and four themes. The themes of the study are ease (with the two categories of becoming and interacting), upset (with the two categories of mental upset and behavioral upset), resolution (with the two categories of making a stand and giving up), and reflection (with the four categories of remembering, telling the story, examining conflicts, and living with consequences). CONCLUSION: Ethically challenging situations alter the ease stage of moral reckoning among nurses, cause them mental and behavioral upset, and thereby, require them to make stand or give up. Then, they continuously examine events in their mind and finally, live with the positive and negative consequences of the events.

Cytotoxicity properties of plant-mediated synthesized K-doped ZnO nanostructures.

In this study, potassium-doped zinc oxide nanoparticles (K-doped ZnO NPs) were green-synthesized using pine pollen extracts based on bioethics principles. The synthesized NPs were analyzed using X-ray diffraction (XRD), inductively coupled plasma atomic emission spectroscopy (ICP-AES), scanning electron microscopy (SEM), energy-dispersive X-ray analysis (EDXA), and transmission electron microscopy (TEM). The cytotoxicity of these nanoparticles (NPs) on normal macrophage cells and cancer cell lines was evaluated. In the same concentrations of K-doped ZnO and pure ZnO NPs, K-doped ZnO NPs demonstrated higher toxicity. The results confirmed that the doped potassium could increase cytotoxicity. The IC50 of K-doped ZnO NPs, pure ZnO NPs, and the examined control drug were 497 ± 15, 769 ± 12, and 606 ± 19 µg/mL, respectively. Considering the obtained IC50 of K-doped ZnO NPs, they were more toxic to the cancer cell lines and had less cytotoxicity on normal macrophage cells.

Synthesis characterization of Zn-based MOF and their application in degradation of water contaminants.

Metal-organic frameworks (MOFs) are currently popular porous materials with research and application value in various fields such as medicine and engineering. Aiming at the application of MOFs in photocatalysis, this paper mainly reviews the main synthesis methods of ZnMOFs and the latest research progress of Zn MOF-based photocatalysts to degrade organic pollutants in water, such as organic dyes. This nanomaterial is being used to treat wastewater and has proven to be very efficient because of its exceptionally large surface area and porous nature. The results show that Zn-MOFs are capable of high degradation of the above pollutants and over 90% of degradation was observed in publications. In addition, the reusability percentage was examined and studies showed that the Zn-MOF nanostructure has very good stability and can continue to degrade a high percentage of pollutants after several cycles. This review focuses on Zn-MOFs and their composites. First, the methods of synthesis and characterization of these compounds are given. Finally, the application of these composites in the process of photocatalytic degradation of dye pollutants such as methylene blue, methyl orange, crystal violet, rhodamine B, etc. is explained.

Magnetic cobalt oxide nanosheets: green synthesis and in vitro cytotoxicity.

Cobalt oxide nanoparticles were prepared via green chemistry route and fully characterized by Field Emission Scanning Electron Microscope (FESEM), Energy-dispersive X-ray spectroscopy (EDAX), X-ray diffraction (XRD), High-resolution transmission electron microscopy (HRTEM) and Transmission electron microscopy (TEM) analyses; the CoO and Co3O4 nanoparticles, in sheet-shaped cobalt oxide form, ensued simultaneously in one step. The varying concentrations of NPs were analyzed via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test on the cancer cell line (U87) which revealed that with increasing concentration of cobalt oxide nanoparticles, the survival rate of U87 tumor cells decreases; IC50 of nanoparticles being ~ 55 µg/ml-1.

CeO2 foam-like nanostructure: biosynthesis and their efficient removal of hazardous dye.

In this study, CeO2 (cerium oxide) nanoparticles were synthesized using Pinus halepensis pollen and were characterized by field emission scanning electron microscopy (FESEM), powder X-ray diffraction (PXRD) and Raman spectroscopy. The results showed that the ensuing CeO2 nanostructures, ranging in size from 5 to 25 nm, had high porosity. Synthesized CeO2 showed the effective catalytic activity towards the photocatalytic removal of dyes. In this work, the photocatalytic activity to removal dye (methyl violet 2B), in the absence of UV radiation, using cerium dioxide nanoparticles (CeO2-NP) was determined. In this research, four main factors such as effect on color, concentration and pH were examined and maximum %R was obtained about was 97% in 75 min in presence of 50 mg of hydrogen peroxide.

Leishmanicidal activities of biosynthesized BaCO3 (witherite) nanoparticles and their biocompatibility with macrophages.

The aim of this study was cost-effective and greener synthesis of barium carbonate (BaCO3 or witherite) nanoparticles with economic importance, and to evaluate their therapeutic potentials and biocompatibility with immune cells. Barium carbonate nanoparticles were biosynthesized using black elderberry extract in one step with non-toxic precursors and simple laboratory conditions; their morphologies and specific structures were analyzed using field emission scanning electron microscopy with energy dispersive X-ray spectroscopy (FESEM-EDX). The therapeutic capabilities of these nanoparticles on the immune cells of murine macrophages J774 and promastigotes Leishmania tropica were evaluated. BaCO3 nanoparticles with IC50 = 46.6 µg/mL were more effective than negative control and glucantium (positive control) in reducing promastigotes (P < 0.01). Additionally, these nanoparticles with a high value of cytotoxicity concentration 50% (CC50) were less toxic to macrophage cells than glucantime; however, they were significantly different at high concentrations compared to the negative control.

Recommendations for spiritual care in cancer patients: a clinical practice guideline for oncology nurses in Iran.

BACKGROUND: In spite of the necessity of implementing spiritual care practices for cancer patients, there is no clear process in this regard in palliative care programs of the health system of countries. The present study was designed with the aim of developing a clinical practice guideline of spiritual care in cancer patients for oncology nurses in the current context. METHODS: This is a multi-method study which was conducted in five stages within the framework of the National Institute for Health and Care Excellence (NICE) guideline. A research committee consisting of four focal and 16 secondary members was formed. The stages included determining the scope of the study, developing guideline (a qualitative study and a systematic review, triangulation of the data, and producing a preliminary draft), consultation stage (validation of the guideline in three rounds of the Delphi study), as well as revision and publication stages. RESULTS: The clinical guideline of spiritual care with 84 evidence-based recommendations was developed in three main areas, including the human resources, care settings, and the process of spiritual care. CONCLUSIONS: We are hoping by applying this clinical guideline in oncology settings to move towards an integrated spiritual care plan for cancer patients in the context of our health system. Healthcare organizations should support to form spiritual care teams under supervision of the oncology nurses with qualified healthcare providers and a trained clergy. Through holistic care, they can constantly examine the spiritual needs of cancer patients alongside their other needs by focusing on the phases of the nursing process.

Is there a relationship between moral competencies and the formation of professional identity among nursing students?

BACKGROUND: Moral competencies are essential for nursing work. Professional identity is a set of values and beliefs that a person has about her/his job, which includes moral values as well. The development of moral competencies and formation of professional identity in nursing students occurs mainly during their college years. The aim of this study was to investigate the relationship between moral competencies and the formation of professional identity among nursing students. METHODS: This study was designed as a descriptive-correlational study. The study population was consisted of nursing students who were enrolled in nursing schools at the time of the study. Two hundred and twenty-one nursing students completed the study tools. The research tools were a demographic questionnaire, Moral Development Scale for Professionals (MDSP), and Professional Identity Scale for Nursing Students (PISNS). RESULTS: The mean (SD) of MDSP and PISNS scores was 45.69 ± 5.90 and 55.61 ± 12.75, respectively. There was a significant statistical relationship between MSDP and PISNS scores (p < 0.05). A significant equation was found (f (2, 218) = 16.68, p < 0.001) with an R2 of 0.113. The MSDP scores increased 0.136 for each score of PISNS, and married students had 2.452 scores higher than single students. CONCLUSIONS: The positive correlation between the formation of professional identity and development of morality in nursing students indicates that by strengthening students' professional values, their moral competencies may develop positively.

Barriers to ethical decision-making for pre-hospital care professionals.

BACKGROUND: Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision. OBJECTIVES: The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel. METHODS: In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were collected by deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach. ETHICAL CONSIDERATIONS: Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality. FINDINGS: The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes. CONCLUSION: Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients' moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them.

Factors affecting spiritual care practices of oncology nurses: a qualitative study.

PURPOSE: Spiritual care is a component of the holistic nursing approach. But in practice, nurses face many challenges during the implementation of spirituality care. Thus, the aim of this study was to explore the barriers and facilitators affecting spiritual care practices by oncology nurses. METHODS: This qualitative study was conducted using a conventional content analysis based on semi-structured interviews with 25 participants, including cancer patients and their family members, oncology nurses, physicians, psychologist, and spiritual researcher-therapists. RESULTS: The results showed that the two main themes of the study, "spiritual competency" and "spiritual inefficiency" in healthcare organization, were two major factors in implementing spiritual care practices for cancer patients by oncology nurses. CONCLUSIONS: The findings of this study emphasize the necessity of developing coherent spiritual care programs in hospitals and removing administrative barriers. Teaching spiritual care in nursing courses at schools and continuing education programs for training of healthcare team members are necessary. Likewise, forming a spiritual care team with oncology nurses at the center and defining their members' roles and responsibilities are essential. Hospital managers can also make fruitful steps by establishing a monitoring system and identifying the needs and barriers for spiritual care in oncology settings.

Professional Values of Nurses and Nursing Students: a comparative study.

BACKGROUND: The process of learning the professional values is started from the student's entering to the university and to the workplace. This study compared the importance of professional values from the perspectives of nurses and nursing students. METHODS: This descriptive-analytical study was conducted on 250 nurses and 100 nursing students. Data were collected using the Nursing Professional Values Scale-Revised. RESULTS: According to the findings, the mean scores of nurses (3.68 ± 0.16) and nursing students' (3.86 ± 0.17) perspective toward professional values were at an important level. Furthermore, the students' perspective toward the professional values' importance was significantly more favorable than those of nurses. The highest mean scores of professional values in the two groups were related to the caring and justice domains. Both groups considered activism and professionalism as the least important domains among the others. CONCLUSIONS: As the findings suggest, we need to pay more attention to values training, especially professionalism and activism, during undergraduate education for preparing the nurses to work in today's complex healthcare context. It is necessary to conduct more comprehensive studies for exploring the gap between theory and practice in different cultures and contexts.

Cockroach wings-promoted safe and greener synthesis of silver nanoparticles and their insecticidal activity.

Simpler and biocompatible greener approaches for the assembly of nanoparticles (NPs) have been the focus lately which have minimum environmental damage and often entails the use of natural biomolecules to synthesize NPs. Such greener synthesis of nanoparticles has capitalized on the use of microbes, fungi, and plants using biological resources. In this study, Periplaneta americana (American cockroach) wings' extract (chitin-rich) is studied as a novel biomaterial for the first time to synthesize silver NPs (less than 50 nm); chitin is the second most abundant polymer after cellulose on earth. The physicochemical properties of these NPs were analyzed using UV-visible spectroscopy, X-ray diffraction, and transmission electron microscopy (TEM). The insecticidal effect of ensuing NPs was examined on the mortality of Aphis gossypii under laboratory conditions; 48 h after treatments of A. gossypii with silver NPs (100 µg/ml), the mortality rate in treated aphids was about 40% (an average), while an average percentage of losses in the control sample was about 10%. These results indicate the lethal effect of green-synthesized silver NPs on A. gossypii, in vitro. Greener synthesis of silver nanoparticles using American cockroach wings and their insecticidal activities.

Nickel-Doped Cerium Oxide Nanoparticles: Green Synthesis Using Stevia and Protective Effect against Harmful Ultraviolet Rays.

Nanoparticles of cerium oxide CeO2 are important nanomaterials with remarkable properties for use in both industrial and non-industrial fields. In a general way, doping of oxide nanometric with transition metals improves the properties of nanoparticles. In this study, nickel- doped cerium oxide nanoparticles were synthesized from Stevia rebaudiana extract. Both doped and non-doped nanoparticles were characterized by X-ray diffraction, Field Emission Scanning Electron Microscopy, Energy Dispersive X-ray, Raman spectroscopy, and Vibrating-Sample Magnetometry analysis. According to X-ray diffraction, Raman and Energy Dispersive X-ray crystalline and single phase of CeO2 and Ni doped CeO2 nanoparticles exhibiting fluorite structure with F2g mode were synthesized. Field Emission Scanning Electron Microscopy shows that CeO2 and Ni doped nanoparticles have spherical shape and sizes ranging of 8 to 10 nm. Ni doping of CeO2 results in an increasing of magnetic properties. The enhancement of ultraviolet protector character via Ni doping of CeO2 is also discussed.

The importance of professional values from nursing students' perspective.

BACKGROUND: Professional values of nursing students may be changed considerably by curricula. This highlights the importance of the integration of professional values into nursing students' curricula. The present study aimed to investigate the importance of professional values from nursing students' perspective. METHODS: This cross-sectional study was conducted at the Kerman University of Medical Sciences, Iran. Data were gathered by using a two-section questionnaire consisting of demographic data and Nursing Professional Values Scale-Revised (NPVS-R). By using the stratified random sampling method, 100 nursing students were included in the study. RESULTS: Results showed that the mean score of the students' professional values was at high level of importance (101.79 ± 12.42). The most important values identified by the students were "maintaining confidentiality of patients" and "safeguarding patients' right to privacy". The values with less importance to the students were "participating in public policy decisions affecting distribution of resources" and "participating in peer review". The professional value score had a statistically significant relationship with the students' grade point average (P < 0.05). CONCLUSIONS: In light of the low importance of some values for nursing students, additional strategies may be necessary to comprehensively institutionalize professional values in nursing students.

Ethical decision-making based on field assessment: The experiences of prehospital personnel.

INTRODUCTION: Due to the stressful nature of prehospital emergency providers' duties, as well as difficulties such as distance to information resources and insufficient time to analyze situations, ethical decision-making in prehospital services is a daily challenge. OBJECTIVES: This study aimed to describe the experiences of Iranian prehospital emergency personnel in the field of ethical decision-making. METHODS: The data were collected by semi-structured interviews (n = 15) in Iran and analyzed using the content analysis approach. ETHICAL CONSIDERATIONS: This study was conducted in accordance with the principles of research ethics and national rules and regulations relating to informed consent and confidentiality. RESULTS: The results obtained were categorized into three main categories that included "assessment of the scene atmosphere, assessment of patients' condition and their family, and predicting outcomes of decision-making." The central category was "field assessment," which demonstrated the strategy of ethical decision-making by prehospital providers when facing ethical conflicts. CONCLUSION: Although findings showed that the majority of prehospital providers make ethical decisions based on the patients' benefit, they also consider consequences of their decisions in dealing with personal and professional threats. This article identifies and describes a number of ethical values of prehospital providers and discusses how the values may be considered by paramedics when facing ethical conflicts.

Changes in ethical attitudes of clinical laboratory professionals after teaching them ethics using three different methods.

Background: Ethical attitudes and personal values play a significant role in clinical decision-making; however, they have been given limited attention by professionals in laboratory medicine. Studies suggest that individual attitudes are not static and that professionals learn ethical attitudes through a variety of formal and informal learning methods. This study was conducted to investigate changes in the attitudes of clinical laboratory professionals after teaching them ethics and to compare the results among the 3 groups. Methods: Four topics were selected in the field of medical laboratory ethics as teaching materials. A questionnaire including 22 items was designed and validated. Teaching sessions for the 3 study groups were held. All 65 clinical laboratory participants completed the questionnaire before and after the classes. Paired t test and ANOVA were used to assess differences among groups. Results: Significant differences were found in the mean scores of ethical attitudes before and after the educational intervention among the lecture-based teaching group (p=0.016), problem-based learning group (p=0.001), and all participants (p=0.004). However, no significant difference was found between the mean scores before and after the intervention in role-playing group (p=0.623). Conclusion: Teaching by lecturing and problem-based learning was more effective to change ethical attitude of the laboratory professionals than the role-playing method. Thus, we suggest the implementation of teaching ethics using these methods to improve the ethical attitude of clinical laboratory professionals.

The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses.

BACKGROUND: The safety culture has recently attracted the attention of healthcare organizations. Considering the importance of the roles of nurses with regard to patient safety, their knowledge and experiences of the challenges that influence patient safety culture can facilitate the development and implementation of better strategies. The aim of this study was to explore the nurses' experiences of the challenges influencing the implementation and integration of safety culture in healthcare. METHODS: A qualitative study with deep and semi-structured individual interviews was carried out using a purposive sampling method to select 23 nurses from four hospitals affiliated with a large medical university in Southeast Iran. Data were analysed using the conventional content analysis of Lundman and Graneheim. RESULTS: Data analysis reflected the main theme of the study, "A long way ahead of safety culture". This theme includes four categories: 1) inadequate organizational infrastructure, 2) insufficient leadership effectiveness, 3) inadequate efforts to keep pace with national and international standards, and 4) overshadowed values of team participation. CONCLUSION: While practical strategies for creating a safety culture may seem simple, their implementation is not necessarily easy. There are several challenges ahead for cultivating an effective and positive safety culture in healthcare organizations. To keep pace with international standards, healthcare managers must employ modern methods of management in order to overcome the challenges faced by the institutionalization of safety culture and to make a difference in the healthcare system.

Experiences of pre-hospital emergency medical personnel in ethical decision-making: a qualitative study.

BACKGROUND: Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service (EMS) personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to deal with every day, ethical decision-making (EDM) has become an inevitable challenge. METHODS: The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. RESULTS: The process of data analysis resulted in the emergence of 3 main categories "respecting client's values", "performing tasks within the professional manner", "personal characteristic", and the emergence of eight (8) sub-categories signifying participants' experiences with regard to EDM. CONCLUSION: According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client's values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties.