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.

Psychometric validation of the Persian version of the ethical awareness scale for nurses working in Iranian intensive care units.

AIM: The purpose of this study was to translate and validate the ethical awareness scale for nurses working in Iranian intensive care units. DESIGN: A cross-sectional psychometric study. METHODS: The study was conducted in Oct 2020 to Sep 2021, involving the participation of 200 ICU nurses. The process included translation of the original version of the ethical awareness scale into Persian, following the World Health Organization guideline, for use in Iran. The translated version was then evaluated for reliability, face validity, content validity ratio, content validity index, convergent validity and construct validity. RESULTS: The initial reliability of the scale was established. In qualitative face validity, a few items changed slightly and all items were retained in the quantitative face validity assessment. Based on Lawshe's values, three items were removed from the scale during CVR assessment. All items exhibited acceptable CVI scores. Convergent validity was established with an average variance extracted greater than 0.5. The fit indices, such as CFI = 0.94, GFI = 0.94, RMSEA = 0.01, AGFI = 0.97 and CMIN/DF = 2.99, supported the structural model of the scale. The fit indices for the structural model of the scale were all within acceptable ranges, suggesting that the model fit the data well. Its reliability was confirmed through the test-retest method, with Cronbach's alpha = 0.84 and McDonald's omega coefficient >0.8. CONCLUSION: The findings of this study indicate the Persian version of the ethical awareness scale for Iran (EAS-IR) is comparable in content to the original version, demonstrating its validity and reliability for assessing ethical awareness among Iranian nurses in ICUs. The scale can be a valuable resource for measuring ethical awareness in the Iranian healthcare context and may contribute to improving ethical practices and decision-making in ICU settings. PATIENT OR PUBLIC CONTRIBUTION: In this project, no patient or public contribution was necessary, because it was not applied to our work.

Psychometric properties of Fagerström Tolerance Questionnaire among Turkmen Nass (Naswar) users.

BACKGROUND: Smokeless tobacco (SLT) products are gaining popularity around the globe, particularly in Asia, Africa, and the Middle East. Among these products, Nass (aka Naswar) is popular among the Turkmen ethnicity in Iran. Although several studies reported nicotine dependence (ND) among SLT users, psychometric instruments have never been utilized to specifically measure ND among Nass users. Therefore, in this study, we aimed to evaluate the reliability and validity of the Fagerström Tolerance Questionnaire (FTQ) among Turkmen Nass users. METHODS: A cross-sectional, descriptive study was conducted in June-December 2018 among 411 Turkmen adults who currently (past 30 days) used Nass. Two bilinguals (Persian English) individuals translated and back-translated the FTQ-SLT, which maintained both the questionnaire's accuracy and cultural sensitivity. Construct validity was assessed using exploratory and confirmatory factor analysis. RESULTS: The mean age and standard deviation for initiating Nass were 22.5 ± 11.81 years. Exploratory and confirmatory factor analysis indicated a single-factor solution with 8-items that captured several important ND components. Using Nass frequently, soon after waking, when sick, and experiencing a craving were some of the main components. Subgroups comparison revealed that higher scores occurred among those who were married, had Nass user(s) in their immediate family, and consumed bulk form of Turkmen Nass directly without using a tissue. CONCLUSION: Our findings show that the FTQ- SLT is a fairly reliable and valid scale to measure ND among Turkmen Nass users and warrants further testing to accommodate cross-cultural differences in other populations.

The Relationship Between Compassion Fatigue and Nursing Care Quality in Intensive Care Units: A Correlational Study in Northeast of Iran.

Intensive care unit (ICU) nurses are repetitively exposed to traumatic situations and stressful events, which can lead to compassion fatigue (CF). Compassion fatigue can negatively affect the nurses' emotional and physical health and job satisfaction. The aim of this study was to evaluate the relationship between CF and nursing care quality in ICU. This descriptive-correlational study was conducted on 46 ICU nurses and 138 ICU patients, in 2 referral hospitals in Gorgan, Northeast of Iran in 2020. Participants were selected using stratified random sampling. Data were collected using CF and nursing care quality questionnaires. The results of this study showed that most nurses were women (n = 31, 67.4%), with mean age of 28.58 ± 4.80 years. The mean patients' age was 49.22 ± 22.01 years and 87 (63%) of them were male. The severity of CF in most ICU nurses (54.3%) was moderate, with a mean score of 86.21 ± 16.78. Among of the subscales, psychosomatic score was higher than the rest of subscales (0.53 ± 0.26). Nursing care quality was at the optimal level (91.3%) with the mean score of 81.51 ± 9.93. The highest scores of nursing care were related to subscale of medications, intake, and output (0.92 ± 0.23). In this study, there was a weak and inverse relationship between CF and nursing care quality (r = -0.28; P = .058). The results of this study indicate a weak, nonsignificant inverse relationship between CF and nursing care quality in ICU.

Psychometric Properties of the 'Patients' Perspective of the Quality of Palliative Care Scale'.

Objectives: Palliative care is a basic human right for all patients suffering from progressive and excruciating pain, limitations in daily activities as well as requiring constant care. The development of palliative care is always associated with the physical, psychological, social and spiritual care quality level and requires continuous evaluation by the care-receiving patients. This study aimed to determine the psychometric properties of the patients' perspective of the quality of palliative care scale. Materials and Methods: This methodological study was conducted on 500 patients with chronic diseases admitted to the hospitals affiliated in Golestan University of Medical Sciences, between 2019 and 2020. Participants were selected through stratified sampling through proportional allocation as well as considering the bed occupancy rate in the two referral hospitals of the university. According to Wild approach, we translated the original version of the scale the patients' perspectives of the quality of the palliative care scale with 35 items and eight subscales. Using exploratory and confirmatory factor analysis, the psychometric properties of the scale (i.e., initial reliability and face, content, convergent and construct validities) were assessed. The reliability of the scale was calculated by applying Cronbach's alpha coefficient, McDonald's omega coefficient and the Intraclass correlation coefficient (ICC). SPSS-16 and AMOS-24 software programs were used to analyse the data. Results: Three items were omitted after assessing the initial reliability of the translated version of the perspectives of the quality of the palliative care scale using adjusted Cronbach's alpha. The qualitative face validity and impact score of the remaining items of the scale were confirmed by the target group. Meanwhile, a panel of experts confirmed the content validity ratio and content validity index. Convergent validity was approved by calculating the average variance extracted >0.5. Performing EFA led to the extraction of 7 subscales with 32 items. CFA and goodness of fit indices such as GFI = 0.98, CFI = 0.91, RMSEA = 0.048 and GFI = 0.97 confirmed the construct model by omitting three items. Hence, the Persian version of the patient's perspective of the quality of palliative care scale was finalised, including seven subscales with 29 items. ICC of >0.7 represented good reliability. Moreover, Cronbach's alpha and McDonald's omega coefficient confirmed the internal consistency of the scale. Conclusion: Based on the findings of this study, the Persian version of the patients' perspective of the quality of palliative care scale is introduced as a valid and reliable scale. It can accurately indicate and predict the meticulous quality of such care in hospitalised patients and can be used in the cure and care assessments in the health system.

Knowledge and Attitude of Iranian Medical University Students about Organ Donation and Transplantation: A Cross-Sectional Study.

BACKGROUND: Medical professionals' knowledge of and attitudes toward organ donation and transplantation have positive impact on donation rates. The aim of this study was to determine the knowledge and attitude of medical university students in Iran about organ donation and transplantation. METHODS: This cross-sectional study was carried out on 1078 undergraduate students in Golestan University of Medical Sciences, Gorgan, Iran, from January to June 2019. All eligible students were recruited using convenient sampling. Data were gathered using knowledge and attitude toward organ donation and transplantation questionnaire. The higher scores of both subscales, the knowledge subscale (range from 0 to 13) and the attitude subscale (range from 13 to 65), indicate the better knowledge and attitude toward organ donation and transplantation. RESULTS: The mean age of students was 22.24±5.16 years. Finding showed that the mean score of students' knowledge and attitude toward organ donation and organ transplantation were 8.48±1.71 and 48.55±8.11 respectively. Also, the mean score of students' knowledges in females (P<0.001), married (P=0.001) and who had organ donation card (P<0.001) was significantly higher. Nearly all of the students had heard about organ donation (98.3%) and organ transplantation (98.4%). Majority of them pointed that their source of information about organ donation and transplantation was television (TV) program (47.1%). Most of the students (73.8%) reported that they agree to donate their organs but most of them (67.5%) did not know how to obtain organ donation card and only 9.6% of them had the organ donor card as a volunteer donor. CONCLUSION: According to finding, despite the awareness and favorable attitude about organ donation and transplantation among medical students, the number of registered donors was low. In addition to promoting college students' awareness about organ donation for increasing registered donors, it is needed to aware and pursue lay people through social media.

A comparative study of the perceptions of family members patients hospitalized in intensive and cardiac care units (CCU and ICU) in regard to the importance of family needs in Golestan University of Medical Sciences 2020.

INTRODUCTION: Intensive care units (ICUs) cause double stress and tension in hospitalized patients' family members. Improving care quality in these wards requires estimating the importance of the families' needs by the nurses. Therefore, the present research was designed to determine and compare the perceptions of family members of the patients hospitalized in the ICUs and cardiac care units (CCUs) about the importance of family needs and their relationship with some factors in the Golestan University of Medical Sciences, 2020. METHODS: This was a descriptive-analytical study. Eighty-eight companions of the patients admitted in the ICU and 88 companions of the patients admitted in the CCU were studied by stratified sampling, proportional, and then, available allocation. To analyze the data, Mann-Whitney, Kruskal-Wallis, and multivariate analysis of variance in the SPSS 18 statistical software were used (the significance level was 0.05). RESULTS: The results revealed that in both the ICUs, the variable "the family relationship of hospitalized patients' companions" and their needs was found to be significantly different in general. This difference in all dimensions was related to the relationship between the spouse and the patient. Generally, there was no significant difference between the gender of the patient's companion and the importance of family needs in the CCU ward, but this difference was significant in general and in all dimensions in the ICU ward so that the importance of all the needs was more in the female companions. CONCLUSION: This study proved that the need in the "confidence" dimension is the most important need of the family of patients admitted to the two wards (CCU) and (ICU).

The Experiences of Family Members of COVID-19 Patients in Iran: A Qualitative Study.

Background: Being diagnosed with coronavirus disease-19 (COVID-19) usually causes emotional stress for patients and their families. Understanding the challenges faced by family members of COVID-19 patients is necessary to provide holistic family centered care to support patients and families on their journey to recovery from COVID-19. The aim of this study was to explore the experiences of Iranian family members of COVID-19 patients. Methods: This qualitative study was performed using the conventional content analysis approach in 2020 in Gorgan, northeastern Iran. Using a purposive sampling 15 family members of inpatient and outpatient COVID-19 patients who were involved in caring of their patients were selected. Data were collected using in-depth and semi-structured interviews and were analyzed by Graneheim and Lundman's content analysis method with the support of MAXQDA software. Results: Family members' experiences of COVID-19 patients were categorized into two main themes, four category and 10 subcategories. One of the main themes was "psychosocial distress", with two categories of "uncertainty of the disease" and "perceived psychosocial burdens". Another main theme was "adaptation strategies", with the two sub-categories including "adaptative care" and "trusting God". Conclusion: The results of this study provide a broad range of context-specific challenges faced by family members of Covid-19 patients. It is essential for healthcare providers to be aware of the complex psychological and social conditions of families of Covid-19 patients. Hence, healthcare managers and policymakers should implement preventive and supportive programs at all levels in hospitals and community and provide supportive strategies to reduce or eliminate their challenges.

Factors affecting supportive needs in hemodialysis patients: A literature review.

BACKGROUND: Explaining the factors affecting supportive needs of patients under hemodialysis seems to be essential to supply their needs. Also, it can help healthcare providers to make favorite decisions about care planning to improve the patients' quality of life. OBJECTIVE: This study was conducted to determine the factors affecting supportive needs in hemodialysis patients using a literature review. METHODS: This literature review was carried out in PubMed, MEDLINE, SCOPUS, SID, Magiran, and Iranmedex. Data based were searched from 2000 to 2018 using the keywords of "Need", "Supportive Need", and "Hemodialysis". In a total of 239 full texts of published articles, 12 such relevant articles were selected. RESULTS: The finding showed that the factors affecting the supportive need of patients can be categorised into two: internal and external factors. Internal factors consist of patient-related factors, disease-related factors, and treatment-related factors. External factors consist of personal living circumstances, health system-related factors and socioeconomic factors. CONCLUSION: By explaining the factors affecting supportive need in hemodialysis patients, it may help clinicians and researchers to identify the patients' need, developing an appropriate questionnaire, and implementing suitable intervention. As a result, it can improve their quality of life.

The effects of teaching methods of palliative care on life pattern of old women with chronic pain.

Chronic pain is among problems of old people and causes changes in their life pattern and processes. Teaching palliative care can help old people suffering from chronic pain to live an active life. The aim of this research was to determine effects of educating of palliative care on life pattern of elderly women with chronic pain. The present study was a Quasi-experimental design with pre-test and post test was conducted on 30 elderly women suffering from chronic pain in 2018 in Iran. The Questionnaire for evaluating the Pattern of Life with Pain in the elderly was filled before the intervention, group educating of palliative care was carried out using an educational package, and the questionnaire was completed again immediately and one and three months after. The data was analyzed using mean, standard deviations, Fisher's F test, and Greenhouse-Geisser and Bonferroni post-hoc test by employing SPSS- 16. Mean changes before teaching palliative care significantly differed from those of immediately and one and three months after the educational program (p = 0.0), (p = 0.004). There were significant differences between the stages of immediately and one month after the educational program and that of three months after it (p = 0.001), (p = 0.002). Concerning the personal life patterns, there were statistically significant differences between the stage immediately after the educational program and those before the intervention and three months after it (p = 0.005), (p = 0.000). Regarding the social life pattern, only the stage of one month after the educational program significantly differed from that of three months (p = 0.005). Mean growth in life pattern of the old women suffering from chronic pain in the stages after the intervention indicated the importance of and the necessity for palliative care during old age. Moreover, the success of this education three months after the educational program as compared to immediately and one month after it indicates that allocation of sufficient time plays a very important role in transferring information and in teaching methods of palliative care to old people.

The Effect of Computer-based Tests on Nursing Students' Test Anxiety: a Quasi-experimental Study.

BACKGROUND: Test anxiety often leads to poor academic performance. This study aimed to determine the effect of computer-based tests on nursing students' test anxiety. METHODS: This quasi-experimental study was conducted in 2016 on 39 nursing student with anxiety score under 128 on Spielberger's State-Trait Inventory (STAI). They were randomly allocated to computer-based tests (CBT) and paper-based test (PBT) group. Prior to exam, all students completed Sarason's Test Anxiety Scale (TAS). We administered CBT for students in experimental group. Data were analyzed using independent t-test and one-way ANOVA. RESULTS: Students mean test anxiety score was 11.94 and 11.32 in CBT and PBT groups, respectively. 47.4% of students in CBT group and 29.4% of those in PBT group experienced higher test anxiety, while the difference was not significant (p=0.56). CONCLUSIONS: Despite, there was no significant difference between anxiety score of two groups; but students' test anxiety score was higher in CBT group. With the current increase in computer-based assessment, educational administrators must be aware of and plan for the possible unfavorable effects of computer assisted testing, such an anxiety. Future studies are needed to evaluate and compare the effect of different type of student testing such as distance testing or CBTs using new information technologies such as laptop, tablet or mobile phone on students' test anxiety and performance.

Psychometric evaluation of the role strain scale: the persian version.

BACKGROUND: Nursing teachers have difficulties fulfilling multiple roles expectations and balancing the various dimensions of their roles that may lead to role strain. In order to lack of culturally and academically proper scale in Iran to measure role strain in nursing teachers, localizing a foreign scale in this field is necessary. OBJECTIVES: The objective of this study was psychometric evaluation of the Role Strain Scale (RSS) and confirming its structural model in an Iranian population. MATERIALS AND METHODS: The present cross- sectional study was conducted in 2012, comprising 302 nursing teachers from around the country who were selected using stratified- cluster sampling. Psychometric evaluation process of the RSS was carried out by Face, content and constructs validity (confirmatory and exploratory factor analysis). Reliability was examined using test-retest and Cronbach's alpha for internal consistency reliability. RESULTS: In the primary results, in spite of being approved by face and content validity, in Construct validity, fitness indices of original Role Strain Scale showed no satisfactory findings in Iranian data. Therefore, some items from the structural model of original version were extracted by exploratory factor analysis and a five-factor model with 33 items was obtained. These factors were role conflict, role ambiguity, role overload, role incompetence, and role incongruity. New model as Persian version of RSS was confirmed by calculating fitness indices such as GFI = 0.93, AGFI = 0.94, NFI = 0.91, RMSEA = 0.093. Internal consistency reliability for the total scale and subscales were respectively 0.92, and 0.71-0.84. Results from Pearson correlation test indicate a high degree of test-retest reliability (r = 0. 89). ICC was also 0.91. CONCLUSIONS: This reliable and valid scale is academically appropriate for nursing teachers to measure role strain and helps detect and predict a multiplicity of role problems and consequently make educational managers aware of nursing teachers' difficulties while facing with multiple roles and possible future challenges.