'Development and psychometric evaluation of the safety feeling scale in adult patients at hospital: Exploratory sequential mixed method'.

AIM AND OBJECTIVES: This study aimed to develop and examine psychometric properties of the safety feeling scale (SFS) in adult patients to assess their sense of safety during a hospital stay. DESIGN: Mixed methods design. A SQUIRE checklist was used. METHODS: This is a study with two phases of scale development and evaluation of the psychometric properties of the scale. In the first phase, the concept of 'safety feeling' was analysed using a hybrid model. Thus, a systematic review and then a qualitative study with hospitalized patients (n = 31) were conducted by conventional content analysis. In the psychometric phase, factorial validity, reliability, feasibility, and responsiveness of the scale were evaluated by different tests in various samples. RESULTS: After integrating the results of the systematic review and qualitative study, a scale item pool with 84 items was developed. In the psychometric phase, 12 items with four factors were specified; 'effective care,' 'confidence in the healthcare team,' 'emotional enrichment' and 'hygienic facilities,' explaining 51% of the total variance of the scale. They were confirmed by confirmatory factor analysis. Internal consistency and stability of the scale were satisfactory. Feasibility and responsiveness were also acceptable.

Nurses' experiences of the ethical values of home care nursing: A qualitative study.

Objective: Considering the importance of out-of-hospital services, the emergence of home care nursing, and the need for an ethical framework in nursing practice, the present study aimed to explore the nurses' experience of ethical values of home care nursing. Methods: The data of the study was collected using face-to-face individual interviews. Through purposive sampling, 20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed. They shared their experiences of the ethical values of home care nursing. Then, the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method. Results: In the present study, 416 codes were extracted. Merging these codes based on the similarity, seven main themes, and 16 sub-themes were extracted. The themes included perception of the professional identity, respect for the client's autonomy, respecting privacy, establishing human interaction, maintaining mutual safety, observance of justice, and cultural-religious competence. The sub-themes included responsibility, development of professional and inter-professional interactions, maintaining the professional status at home, providing the holistic artistic care, patient's privacy, nurse's privacy, and maintaining the confidentiality of information, respect for the client's choice, honestly informing, empathetic interaction, adjusting the power positions, client's safety, nurse's safety, establishing justice, respect for the religious beliefs at home and cultural sensitivity. Conclusion: The participants stated that due to entering the patient's privacy in the home care cases, the ethical values such as perception of the professional identity, privacy, family interactions' management, mutual security, and cultural-religious competence became doubly important compared to the hospital caring.

The expansion of the role of nurse prescribing in intensive care units in the healthcare system of Iran: a qualitative content analysis.

Intensive Care Unit (ICU) nurses prescribe medication for patients in many countries. However, there is still no evidence on the legitimacy of nurse prescribing roles in the healthcare system of Iran. This qualitative study with 30 experts was conducted to explore the experiences regarding the expanding role of prescribing medication by the ICU nurses. Data were collected through 31 individual semi-structured interviews and analyzed using the conventional content analysis method by MAXQDA 10. One major theme, "applicability of prescribing medication by ICU nurses", together with three sub-themes of "facilitators", "potential risks of nurse prescribing" and "the professional pathway", emerged. The use of successful global experiences, patient-oriented healthcare system policies, current culture and positive professional position of nurses, physician shortage, and high capacity of ICU nurses appeared as facilitators to perform the new role in our context. For the expansion of the new role, different professional pathways such as discussion with physicians and special groups with conflicts of interests, training qualified nurses in this area, and gradual development were proposed by the participants. The next step of the research is to prepare a set of standards for the prescription of medication by the ICU nurses in our context.

Explaining the process of dealing with nursing errors in the emergency department: A grounded theory study.

BACKGROUND: Errors are among the factors threatening patient safety. It is essential to understand how to deal with nursing errors in the emergency department. Thus, the present study aimed to explain the process of dealing with nursing errors in the emergency department. METHOD: This qualitative study adopted Corbin and Strauss's (2008) grounded theory method. The data were collected by in-depth semi-structured interviews and field notes. Eighteen nurses, two doctors, and one patient companion participated in this study. The research setting was the emergency departments of five teaching hospitals in down tone of Tehran, Iran. The participants were selected by purposive sampling at first, and then by theoretical sampling. RESULTS: Following the data analysis, four main categories of "reality shock", "formulating a situational response", "reactive measure", and "progress or regress" were extracted. The data analysis showed that "formulating a situational response" is the core category of the process of dealing with errors among nurses in the study emergency departments. The first step in the process of dealing with errors in ED was the reality shock, then nurses entered the stage of formulating a situational response, after that they entered the stage of "reactive measure" and finally they entered the stage of progress or regress. DISCUSSION AND CONCLUSION: After an error occurs in the emergency department, nurses experience four stages during the process of dealing with nursing errors. When dealing with an error, nurses think about protecting the patients. However, some contextual factors direct the nurses towards protecting themselves rather than the patient. The decision-makers in the healthcare system can modify these contextual factors, provide in-service training, develop anonymous reporting systems, and establish a positive support environment, thus directing the nurses towards supporting the patients (in addition to trying to protect oneself).

Investigating the relationship between the ethical atmosphere of the hospital and the ethical behavior of Iranian nurses.

BACKGROUND: The ethical guidelines and ethical atmosphere of the hospital affect the quality of nursing care. Improving the health of patients in most cases depends on the observance of ethical points and ethical behaviors by nurses. The aim of this study was to determine the effect of hospital ethics and ethical training guidelines on improving the quality of nursing care and nurses' professional ethics. MATERIALS AND METHODS: This is a descriptive-analytical study. This study was performed by multi-stage relative cluster sampling on 260 qualified nurses in 2014. Data were collected using the Hospital Ethical Climate Questionnaire and the Judgments about Nursing Decisions Questionnaire and analyzed using SPSS software version 19. RESULTS: The results showed that nurses' perceptions of the ethical climate of hospitals were relatively positive. The ethical behavior of nurses was moderate and good. Nurses' perception of the ethical climate scores was not related to the ideal ethical behavior of nurses (r = 0.11, P = 0.86). The ethical climate perceptions of nurses were related to real workplace ethical behavior score (r = 0.188, P = 0.002). The results also showed that ethical guidelines can improve the quality of nursing care. CONCLUSION: Considering the results of this study, it seems that holding nursing ethics training programs can be a big step toward promoting the professional behavior of nurses and the observance of professional ethics by nurses.

Role of judgment in promoting nurses' decisions and ethical behavior.

BACKGROUND: Ethical decision-making and behavior of nurses are major factors, which can effect on the quality of nursing care. It seems that there is a correlation between demographic variables and ethical decision-making and moral behaviors of nurses. Promoting patients' health is one of the issues related to nurses' ethical behaviors. The aim of this study was to determine the role of judgment in promoting nurses' decisions and ethical behavior. MATERIALS AND METHODS: This was a descriptive, cross-sectional study in which 260 nurses were selected based on the inclusion criteria. Sampling method was available. The data collection tool was the Hospital Ethics Committee Survey Questionnaire. Data were analyzed by SPSS software version 20. RESULTS: In this study, judgments and ethical behaviors of nurses were evaluated at the moderate and good level. Gender, marriage status, education level, and nursing position were effective in judgments and ethical behavior of nurses. Age, job experience, and participation in the ethics workshop had no significant effect on ethical behavior and moral judgment. The mean score of moral belief of nurses participating in this study was 181.56 ± 17.60, and their mean moral practice in the real environment was 168.5 ± 17.77. CONCLUSION: The judgment competencies in ethical situation of nurses should be promoted to a higher level. It seems that more advanced educational methods are needed to achieve this goal. The findings from this study show the necessity of nurses' ability to improve their behavior and moral judgment. It also shows that nurses need more reinforcement based on the demographic variables.

Development and validation of the Iranian version of the Patient Privacy and Confidentiality Scale.

The aim of this study was to develop and psychometrically validate the Iranian scale of patient privacy and confidentiality. This methodological study was conducted in two stages: first, a conventional content analysis was used to qualitatively identify concepts of privacy and confidentiality. Then, the face validity, content validity, and construct validity were assessed. Internal consistency coefficient and total consistency were checked. KMO and Bartlett's test were used to examine thequestionnaire for factor analysis. EFA identified seven factors that accounted for 55.25% of the total variance in the questionnaire score. The total Cronbach's α coefficient was 0.84 for the whole instrument. The Spearman reliability coefficient of the instrument was 0.91 using the test-retest method.The final Iranian version of the Patient Privacy and Confidentiality Scale can be used as a valid and reliable instrument to measure the rate of observation of patient privacy and confidentiality.

Cancer patients' perspectives on dignity in care.

BACKGROUND: Since "dignity" is one of the fundamental rights of every patient, consideration for patients' dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran. RESEARCH OBJECTIVE: This study aimed to evaluate the perception of Iranian cancer patients on human dignity. RESEARCH DESIGN: A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method. PARTICIPANTS AND RESEARCH CONTEXT:  This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018. ETHICAL CONSIDERATIONS: The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study. FINDINGS: Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the "personal space and privacy," "respect for human values," and "moral support." DISCUSSION: The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity. CONCLUSION: Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.

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.

Inter-professional ethical values in Iranian aged care: a qualitative study.

Aim Ethical values are the basis of the behaviour and performance of professional care staff. This study aimed to identify inter-professional ethical values in aged care. Methods This qualitative thematic content analysis study was conducted in Khorramabad, Iran, from September 2018 to June 2109, and 36 core members of the aged care team (including 24 nurses, 5 physicians, 3 physiotherapists, and 4 social workers) were selected through the purposive sampling method and interviewed in depth. The data were analysed using the directed content analysis and the method of Zhang and Wildemuth. Results Four main themes of providing professional care, preserving the integrity of the aged, observing the dignity of the aged, establishing human relationship, along with 21 subthemes were extracted as ethical values in aged care. Conclusion The results of this study indicate that providing ethical aged care is influenced by the specific conditions of this age group. In addition to general ethical values such as providing professional care, providing ethical aged care is based on ethical values such as promoting social interaction, promoting peace and comfort, preserving and promoting independence, and autonomy in aged care. Promoting collaborative care and paying more attention to the human dimensions of communication and interaction were other emphasized values.

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.

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.

Determination of mis-triage in trauma patients: a systematic review.

PURPOSE: Mis-triage including undertriage and overtriage is associated with morbidity and mortality. It is not clear what the extent of mis-triage rates among traumatic patients is. The aim of this study is to determine of mis-triage (undertriage and overtriage) in traumatic patients. METHODS: This study was a systematic review about mis-triage rate among trauma patients. The following electronic databases were searched (Web of Knowledge, Scoups, PubMed, Cochrane library) from conception through February 1, 2018. Search terms included trauma, undertriage, and over-triage. Inclusion criteria were studies which report overtriage or undertriage rate in regard to triage of trauma patients; patients older than 18 years old, English-written papers. Irrelevant papers as well as conference abstract, letter, editorial, thesis and studies on special population were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used to examine review process. RESULTS: Twenty-one papers were included in this study. Sample size ranged from 244 to 550683 trauma patients. Fourteen studies originated from USA. Definition of mis-triage was summarized into four categories: ISS used to define undertriage error, formula for mis-triage (1-sensitivity), need for life-saving emergency intervention and patients triaged to a non-trauma center. Undertriage rate ranged from 1 to 71.9% and overtriage rate ranged from 19 to 79%. CONCLUSIONS: The standardization of mis-triage definitions is vital to estimate true rate of mis-triage among different studies and clarify the role of triage scales. The trauma triage scales need to be further developed to provide more valid and reliable results.

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.

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.

Educational Needs on Palliative Care for Cancer Patients in Iran: A SWOT Analysis.

BACKGROUND: By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder's educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran. METHODS: This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes. RESULT: A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included: "academic education planning", "workforce education", "public awareness", and "patient and caregiver empowerment" that contained our subcategories as follows: "strengths", "weaknesses", "opportunities" and "threats" (SWOT). CONCLUSION: Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced.

Palliative Care Policy Analysis in Iran: A Conceptual Model.

BACKGROUND: Palliative care programs are rapidly evolving for patients with life-threatening illnesses. Increased and earlier access for facilities is a subject of growing importance in health services, policy, and research. AIM: This study was conducted to explain stakeholders' perceptions of the factors affecting the design of such a palliative care system and its policy analysis. METHODOLOGY: Semi-structured in-depth interviews conducted following purposive sampling of the participants. Twenty-two participants were included in the study. The interviews were analyzed using qualitative-directed content analysis based on "policy analysis triangle" framework. RESULTS: The findings showed the impact of four categories, namely context (political, social, and structural feasibility), content (target setting), process (attracting stakeholder participation, the standardization of care, and education management), and actors (the Ministry of Health and Medical Education, health-care providers, and volunteers) in the analysis of the palliative care policies of Iran. CONCLUSION: In the past 6 years, attention to palliative care has increased significantly as a result of the National Cancer Research Network with the support of the Ministry of Health. The success of health system plan requires great attention to its aspects of social, political, and executive feasibility. Careful management by policymakers of different stakeholders is vital to ensure support for any national plan, but this is challenging to achieve.

Iranian nurses' experience of "being a wrongdoer": A phenomenological study.

BACKGROUND: Patient safety, which is a patient's right, can be threatened by nursing errors. Furthermore, nurses' feeling of "being a wrongdoer" in response to nursing errors can influence the quality of care they deliver. RESEARCH OBJECTIVES: To explore the meaning of Iranian nurses' experience of "being a wrongdoer." RESEARCH DESIGN: A phenomenological approach was used to explore nurses' lived experiences. Nurses were recruited purposively to take part in semistructured interviews, and the data collected from these interviews were analyzed using Van Manen's thematic analysis. Participants and research context: Eight nurses working in three private or governmental hospitals in Tehran, Iran. Ethical consideration: The research design was approved in each participating hospital, and all interviews were carried out at a predetermined time in a private place. FINDINGS: Five themes were extracted from the data: "wandering in unpleasant feelings" (with two subthemes: "unpleasant physical feelings" and "unpleasant emotions"), "wandering in the conscience court" (with three subthemes: "being the accused," "being the victim," and "being the judge"), "being arrested in time," "time for change" (with three subthemes: "promoting accountability," "promoting learning," and "strengthening supportive relationships"), and "spiritual exercise." DISCUSSION: Some of our results are supported by the model of self-reconciliation and the recovery trajectory of "second victims" theory. CONCLUSION: The meaning of "being a wrongdoer" has positive and negative aspects. Feelings of wandering provide nurses the opportunity to reflect on and re-embrace the professional and moral responsibility of nursing. Nursing managers can convert their "defeats" into a prelude to learning, increase their accountability, and improve the quality of nursing care.

Ethical values in nurse education perceived by students and educators.

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