Is there any relationship between nurses' perceived organizational justice, moral sensitivity, moral courage, moral distress and burnout?

AIM: The present study is an attempt to investigate the relationship between Corley's model variables in mental health nurses. BACKGROUND: Based on Corley's model, burnout and moral distress in nurses are, in retrospect, the consequences of the interplay of organizational and individual factors such as perceived organizational justice, moral sensitivity, and moral courage. The relationship between two variables or three variables of Corley's moral distress model has been investigated, but the test of Corley's moral distress model with more variables has not been done. Therefore, this research was proposed with the aim of investigating the relationship between the variables of moral courage and moral sensitivity (as characteristics of nurses), perceived organizational justice (as an antecedent), moral distress, and job burnout (as consequences of moral distress). METHODS: The study was conducted as a descriptive correlational study involving 500 nurses working in the mental health wards of hospitals. Data collection was conducted using perceived organizational justice scale, moral sensitivity scale, moral courage scale, moral distress scale, and burnout inventory. RESULTS: The results showed a significant relationship between perceived organizational justice, moral sensitivity, moral courage, and moral distress (< 0.05). Moreover, perceived organizational justice and moral distress had an inverse relationship. Moral sensitivity and moral courage had a direct relationship with moral distress (< 0.05). Furthermore, the results showed inadequate model fitness. CONCLUSIONS: This study adds to the existing knowledge about the experiences of mental health nurses and their interactions with both organizational and individual factors. It highlights that the connections between perceived organizational justice, moral sensitivity, moral courage, moral distress, and burnout are intricate and multifaceted. As we deepen our understanding of these relationships, it opens the door for the development of interventions and strategies to enhance nurses' well-being and the quality of care they deliver in mental health settings. Moreover, future research and ongoing refinement and expansion of Corley's model will be crucial in addressing the complex challenges within the healthcare sector.

Community-based nursing: a concept analysis with Walker and Avant's approach.

BACKGROUND: Community-based nursing in recent years has received much attention from nursing schools in different countries as a suitable solution in response to existing and future problems and challenges, but there is yet no comprehensive and correct understanding of this concept and considering its importance, the present study was conducted to the aim of analyzing the concept of community-based nursing. METHODS: Concept analysis was done using Walker and Avant's 8-step approach. Nursing dictionary, Persian dictionary, research articles, journals and conferences articles, dissertations, thesis, books, and other sources related to the concept of research were investigated through search engines and available databases using the keywords of nursing, community-based, concept analysis and Walker and Avant from 1990 to 2023. Finally, 54 articles related to the concept were reviewed and analyzed. RESULTS: The results showed that community-based nursing has attributes such as individual-oriented/ family-oriented/ community-oriented, social partnership with the communities and stakeholders, social justice, and group and interprofessional cooperation, the community as the main activity setting, providing services based on cultural diversity, providing services according to the context, conditions and community needs, caring for individuals and families with health problems throughout life, responding to the community needs, community-based experiences and facing real-life issues in the context of community, using a problem-based and service-based approach, providing context-based care and considering factors affecting health. In this regard, borderline and related cases (community health nursing, community-oriented nursing, population-based nursing, and public health nursing) were also presented to clarify the concept. Antecedents of community-based nursing included: determining the position of community-based nursing, making infrastructure and structure, the partnership between university, hospital and community, identifying all settings, the presence of educators proficient in education, survey of community needs, having knowledge, communication and community-based skills, expanding the role of the nurse, stakeholders' attitude towards community-oriented nursing and management and financial support. Consequences of community-based nursing included: competence development in nurses, solving community-based nursing challenges, meeting the health needs of individuals, families and communities, social justice, and increasing access to health care services. CONCLUSION: The results of this study can provide an objective and understandable image of the use of community-based nurses and their education in practice. Conducting more quantitative and qualitative studies about community-based nursing is also recommended.

Psychometric evaluation of the Persian version of the Hospital Survey on Patient Safety Culture Questionnaire (HSOPSC) in neonatal intensive care units: a methodological study.

BACKGROUND: A valid and reliable tool compatible with the culture is needed to evaluate the safety culture as one of the vital and promotional components in improving the quality of safety and health care. This study aimed to investigate the psychometric properties of the Persian version of the "Hospital Survey on Patient Safety Culture (HSOPSC)" in physicians and nurses working in Neonatal Intensive Care Units. METHODS: In this methodological research, the qualitative face, content validity, and construct validity were performed by Confirmatory Factor Analysis to the psychometric evaluation of the HSOPSC questionnaire. Based on convenience sampling and the inclusion criteria, 360 individuals completed the questionnaire. Internal consistency and stability were measured. Data analysis was performed using SPSS 21 and LISREL. RESULTS: In examining the construct validity, fit indices were not appropriate for the 12-dimension model of the Persian version. According to T-value, six heterogeneous items and a dimension were omitted. The 11-dimension model with 36 items showed an appropriate fit with the data. Cronbach's alpha was evaluated at 0.79, and the stability was 0.82 (p˂0.001). CONCLUSION: The Persian version of HSOPSC with 11 dimensions and 36 items has favorable validity and reliability and can be used in NICUs.

Explaining of existing challenges of community-based undergraduate nursing education in Iran: a qualitative study.

BACKGROUND: The education of nursing students should be such that the health needs of the community are met, but in Iran, due to some problems, students do not receive such education. Therefore, the present study was conducted to explain the existing challenges of community-based undergraduate nursing education in Iran. METHODS: Ten individual semi-structured interviews were conducted with the faculty members and nursing specialists in this qualitative study. Eight focus group interviews were conducted to the nurses and nursing students using a purpose-based sampling method in 2022. The interviews were recorded and transcribed and then content analysis was done by the Lundman and Granheim method. RESULTS: Five themes were obtained from the analysis of participants' responses, which include "weakness in community-based nursing education and curriculum", "treatment-oriented health system and education", "defect in the infrastructure and basic structures of community-based nursing education", "weakness in the implementation of community-based nursing education" and "weakness in the stakeholder engagement and cooperation of interested organizations". CONCLUSION: Interviews with the participants provided a vision of the challenges of community-based nursing education so that the reviewers of the undergraduate nursing curriculum in the ministry and nursing schools, educators, policymakers and nursing managers can use the results of the present study to improve the quality of education and the effective use of nursing students in responding to the community's needs and provide a proper context for improving students' learning.

Prevalence and predicors of COVID-centred obsessive compulsive disorder among Iranian COVID-19 recovered individuals: a Bayesian analysis.

BACKGROUND: The evidence on the psychological consequences of coronavirus 2019 mainly relates to general psychiatric problems, and a few studies have reported the incidence and predictors of obsessive-compulsive disorder. OBJECTIVE: To determine the prevalence of obsessive-compulsive disorder (OCD) and its predictors in Iranian COVID - 19 recovered individuals at 3-6 months, 6-12 months, and 12-18 months after recovery. METHOD: In this cross-sectional analytical study, 300 participants were randomly selected based on the inclusion criteria from three hospitals in three different regions of Tehran, Iran, and were assessed by the Clinical Demographic Information Questionnaire, the Obsessive Compulsive Inventory-Revised (OCI-R), the Depression, Anxiety and Stress Scale 21 (DASS21), The Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). The obtained data were analyzed with SPSS version 26. RESULTS: The results showed that the mean score of OCD is 30.58 ± 15.22, with a prevalence of 71% (n = 213). Female gender (BF = 0.50, p = 0.01), sleep disturbance (BF = 0.02, p = 0.001), PTSD (BF = 0.009, p = 0.0001), depression (BF = 0.0001, p = 0.0001), and stress (BF = 0.0001, p = 0.001) are the strongest predictors of the presence of OCD in recovered COVID - 19 individuals. CONCLUSION: OCD-like symptoms was observed in the majority of COVID - 19 recovered individuals with mild to moderate severity. In addition, the stated prevalence, severity, and significance varied according to sociodemographic and health inequalities.

Theoretical definition of nurse-conscious mechanically ventilated patient communication: a scoping review with qualitative content analysis.

Providing critical nursing care for conscious mechanically ventilated patients is mediated via effective communication. This study aimed to identify and map the antecedents, attributes, consequences, and definition of nurse-conscious mechanically ventilated patient communication (N-CMVPC). This scoping review was conducted by searching the Cochrane Library and the CINAHL, EMBASE, PubMed, Web of Science, and Scopus databases, between 2001 and 2021. The keywords queried included "nurses," "mechanically ventilated patients," "mechanical ventilation," "intubated patients," "communication," "interaction," "relationships," "nurse-patient communication," "nurse-patient relations," "intensive care units," and "critical care." Studies related to communication with healthcare personnel or family members were excluded. The results indicated that N-CMVPC manifests as a set of attributes in communication experiences, emotions, methods, and behaviors of the nurse and the patient and is classified into three main themes, nurse communication, patient communication, and quantitative-qualitative aspects. N-CMVPC is a complex, multidimensional, and multi-factor concept. It is often nurse-controlled and can express itself as questions, sentences, or commands in the context of experiences, feelings, and positive or negative behaviors involving the nurse and the patient.

Patient safety culture in neonatal intensive care units: A qualitative content analysis.

Background: Safety culture, as an important and influential component of neonatal safety, can lay the ground for the provision of professional and quality care by creating a positive insight among workers. The present study aimed to explain the concept of safety culture and its dimensions from the perspective of the nurses and the physicians working in neonatal intensive care units (NICUs). Methods: This qualitative directed content analysis study was carried out with 24 NICU physicians and nurses working in Tehran, Iran. These multicenter participants were selected through purposive sampling with maximum diversity in terms of demographic characteristics. The data was collected through in-depth semi-structured interviews and was analyzed using the deductive approach. The COREQ checklist was used for the comprehensive report of this study. Results: The concept of patient safety culture in NICUs included achieving professional development, constructive interactions, organizational supportive climate, management's commitment to neonatal safety, planning and implementation of neonatal developmental care, which are extracted from 5 main categories, 10 generic categories and 21 sub-categories. Conclusion: The dimensions of safety culture include procedures that, if promoted, could improve neonatal safety, reducing harm to neonates' health while expending less financial and human resources. Gaining knowledge of the status of these dimensions in wards and hospitals can give a purposeful direction to promote neonate health and policymaking.

Nursing students' experience of incivility behaviours and its correlation with their nursing professional values: A cross-sectional descriptive study.

AIMS: The purpose of this study was to determine the relationship between experienced incivility behaviours and professional values in the clinical setting and also the factors influencing incivility and professional values. DESIGN: Cross-sectional descriptive study. METHODS: Data gathering tools used in the study includes demographic characteristics, incivility behaviour and nursing professional values. Data were analysed using IBM SPSS version 21. RESULTS: The findings showed that incivility behaviours had a statistically significant negative correlation with professional values (r = -.150, p = .003), so that the level of incivility behaviours experienced by students was low (1.76 out of 5). This was while the level of professional values was moderate to high among students (3.72 out of 5). Due to the negative and statistically significant correlation between incivility behaviours experienced by students and nursing professional values, it is necessary that the officials of teaching hospitals inform nurses about incivility behaviours. Considering the negative and statistically significant correlation, it can be concluded that the reduction in nurses' incivility behaviours as patterns of the nursing profession causes nursing students to better acquire and internalize nursing professional values in the clinical setting. Nurse educators should also try to communicate with nursing administrators to exchange information about nurses' civil and incivility behaviours perceived by students.

Effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses: a randomized controlled trial.

BACKGROUND: Witnessing or experiencing of incivility affected the nurses' perception of the ethical climate and quality of their work life. The aim of this study was to investigate the effectiveness of educational intervention and cognitive rehearsal on perceived incivility among emergency nurses. METHOD: This study was conducted as a randomized controlled parallel group clinical trial. Eighty emergency nurses participated in this study and were randomly assigned to intervention and control groups during December 2019-March 2020. Cognitive rehearsal program (include of definitions of incivility, ten common incivilities and appropriate practice methods for responding to each and role-plays) was delivered in five two-hour sessions over three weeks on different working days and shifts. The control group received only written information about what incivility is and how to deal with it before the implementation of intervention and one month after the completion of the training sessions, the demographic information form and the incivility scale were completed by the nurses. RESULTS: The results showed that there was a significant effect on overall incivility, general incivility, and supervisor incivility between the intervention and control groups. However, these significant reductions were seen in control group who received only written education. There were no significant differences in nurse's incivility towards other nurses, physician incivility, and patient/visitor incivility between the two groups. CONCLUSION: The cognitive rehearsal program did not decrease perceived incivility among emergency department nurses in the short term. TRIAL REGISTRATION: Our research was registered on clinicaltrials.gov. REGISTRATION NUMBER: IRCT20200714048104N1 , first registration 16/07/2020.

Developing and validating the nursing presence scale for hospitalized patients.

AIM: We developed and psychometrically tested the Nursing Presence Scale. BACKGROUND: Nursing presence is a foundation for professional nursing practice; therefore, it is critical to measure this concept. INTRODUCTION: This instrument development study was designed to generate an itemized scale and psychometric testing using a sample of Iranian patients. METHODS: Based on both a concept development and literature review, and finally face and content validity 44-item draft scale was generated. During November 2018-2019, 774 patients were surveyed. Exploratory and confirmatory factor analyses were used to evaluate the scale's construct validity; concurrent and predictive reliability of the nursing presence scale were also evaluated. We also examine the weighting to scale items. RESULTS: The analyses yielded a 36-item, 4-factor scale that adequately fit the data. Cronbach's alpha coefficient for the whole instrument was 0.94. The intra class correlation coefficient was 0.91. Nursing Presence Scale scores were positively correlated with Revised Humane Caring Scale and predicted 25% of missed nursing care. CONCLUSION: This 36-item has good reliability and validity, making it useful for measuring the current condition of nursing presence. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Measuring the frequency of nursing presence allows for data-driven planning and upgrading the inpatient care services.

A comparative study of patient safety in the intensive care units.

AIM: This study aimed to assess patient-safety principles in ICUs. DESIGN: This is a descriptive-comparative study. METHODS: The research environment includes ICUs of hospitals affiliated to the two universities of medical sciences in Tehran. Sampling was done by census using Time and Event Sampling methods. Research instrument was "Patient Safety Principles Checklist". Data analysis was performed using SPSS-20 and descriptive-inferential statistics with a significance level of 0.05. RESULTS: There is no significant difference (p-value = .15) in the level of observance of patient-safety principles in two university-affiliated hospitals A (133.26 ± 9.14) and B (128.16 ± 18.01). Evaluation of the mean scores obtained in each dimension and in each of the ICUs was showed that only in dimension No.3 the difference was significant (F[68,2] = 5.20, p-value = .008) and in the AICUs (16.13 ± 1.8) (p-value = .04), it was significantly lower than other ICUs. Identifying risk factors for the patient's immunity reduces the side effects of patient care.

Challenges in Access to Support Resources for Diabetic Patients: A Qualitative Study in Deprived Areas of Iran.

OBJECTIVES: This study aimed to identify the perceptions of challenges in access to diabetes-related support resources among patients with type 2 diabetes and their family caregivers. METHODS: This qualitative study was conducted with 18 patients with type 2 diabetes and nine of their family caregivers, using the conventional content analysis method, in 2020 in Lorestan Province, Iran. The participants were selected through purposive sampling and the process continued until the data was saturated. Thirty semi-structured interviews, carried out from February to April 2020, were used to collect the data; they were analyzed using Graneheim and Lundman's content analysis (2004). RESULTS: The study showed two main categories of structural challenges (subcategories: shortage of skilled professionals and defects in executive processes) and destructive inefficiencies (subcategories: service bottlenecks, uncertain support, and irresponsibility of medical team), indicating the dimensions of the participants' perceptions of barriers to support. DISCUSSION: The findings of the study showed that barriers relating to the structure and function of healthcare organizations were among the most important challenges perceived by patients with diabetes when pursuing their care. However, there may be other barriers that have not been addressed due to the lack of support resources in deprived areas and the lack of awareness of patients.

Effect of community-based education on undergraduate nursing students' skills: a systematic review.

BACKGROUND: Community-based education, as an effective approach to strengthen nurses' skills in response to society's problems and needs has increased in nursing education programs. The aim of this study was to review the effect of community-based education on nursing students' skills. METHODS: For this systematic review, ProQuest, EMBASE, Scopus, PubMed/ MEDLINE, Cochran Library, Web of Science, CINAHL and Google Scholar were searched up to February 2021. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Seventeen studies were included in this systematic review. Inclusion criteria included articles published in English and were original articles. RESULTS: In all studies, undergraduate nursing students' skills were improved by participation in a community-based education program. Community-based education enhances professional skills, communication skills, self-confidence, knowledge and awareness, and critical thinking skills and teamwork skills in undergraduate nursing students. CONCLUSIONS: Community-based education should be used as an effective and practical method of training capable nurses to meet the changing needs of society, to improve nurses 'skills and empower them to address problems in society.

The effect of peer support on quality of life among type 2 diabetic patients in deprived areas in Iran: A randomized clinical trial.

BACKGROUND: Quality of life (QOL) is one of the effective factors in promoting the health of diabetic patients. In recent years, the role of peer support in the optimal management of diabetes has gained increasing attention. However, contradictory results have been reported from the effectiveness of this method. This study aimed to investigate the effect of peer support on the QOL among type 2 diabetic patients in deprived areas. MATERIALS AND METHODS: This study was a randomized clinical trial conducted on 80 patients with T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assigned into two groups of 40 patients. Intervention group received a peer Supportive-educational program for 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventory was used to collect the data. This questionnaire was completed three times at the beginning of the study, immediately after the 3-day training, and after 3 months of peer supportive intervention. The SPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations. RESULTS: There was no significant difference in mean QOL between the two groups before the intervention (P = 0.891) and immediately after the education (P = 0.076). However, after 3 months of intervention, the intervention group showed a significant improvement in mean QOL compared to those in the control group (P < 0.001). CONCLUSION: Peer support program can improve the QOL in type 2 diabetic patients in deprived areas. Therefore, this method can be recommended to improve care and educational programs in these patients.

The of effect of partnership-based education on adherence to the treatment plans in open heart surgery.

BACKGROUND: Adherence to the treatment plans is one of the most effective conducts to prevent and reduce postoperative side effects. Partnership-based education is one of the most efficient ways to shape health behaviors. The aim of the present study was to determine the effect of partnership-based education on adherence to the treatment plans in open heart surgery. MATERIALS AND METHODS: This quasi-experimental study was conducted in 2019-2020 on the patients undergoing open heart surgery in Tehran (Capital of Iran). Sampling was done in one educational hospital. A total of 86 patients and their caregivers participated in the study. Sampling was done nonrandomly by tossing a coin, and patients were allocated into the odd week in the intervention group and the even week in the control group (n = 43 in each group), and data were collected before and after intervention using the Treatment Adherence Questionnaire concerning dietary, physical activity, and medication aspects. The educational intervention was carried out after the pretest analysis in five 20-45 min sessions (two individual and three group educations). Data were analyzed with Chi-square, independent t-test, and paired t-test using SPSS 19 at a significance level of P < 0.05. RESULTS: Patients and caregivers in both groups did not have a significant difference in terms of demographic variables (P > 0. 05). In addition, there was no significant difference in the mean of dietary, physical activity, and medication plans before the intervention in both groups; however, after the intervention, the mean of the three aspects in the intervention group was significantly higher than that of control (P < 0.001). CONCLUSION: Implementing partnership-based education with participation of patients and caregivers is influential in improving patients' adherence to the treatment plans and it is recommended as a clinical dynamic educational strategy.

Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study.

BACKGROUND: Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. METHODS: This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. RESULTS: In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as "age-unfriendly structure," "inefficient care," and "frailty of older adults" could increase the risk of MNC. In addition, factors such as "support capabilities" and "ethical and legal requirements" will moderate MNC. CONCLUSIONS: Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.

The obstacles to nurses being present with patients.

AIM: The aim of the present research was to investigate the obstacles, which prevent nurses being present with patients. BACKGROUND: It is vital for nurses to be able to spend time with patients for an accurate assessment of patients' needs to take place and to allow patients to express their concerns. The factors, which prevent nurses spending time with patients, are still unclear. METHOD: Data were collected using semi-structured interviews with thirty-five participants, including the nurses and physicians from educational hospitals of Tehran. The analysis was performed through the conventional content analysis. To achieve accuracy and trustworthiness of the data, the Lincoln and Guba criteria were used. RESULT: The results of the study can be summarized as: "conflict between human considerations and bureaucratic structure," "failure to meet basic needs," "the personal and interpersonal aspects of caring" and "safety in caring context." CONCLUSION: To ensure high-quality care, it is important to understand more fully the factors that prevent nurses spending time with patients. Interventions are needed to allow nurses to spend more time with the patients. IMPLICATION FOR NURSING MANAGEMENT: Health service managers should consider that the intrinsic motivation of nurses is to care for patients. They can increase the presence of nurses at patients' bedside and improve care quality by creating an attractive working environment, appreciating nurses' values, paying attention to their opinions and establishing professional communication based on mutual respect.

Correlation between Ethical Intelligence, Quality of Work Life and Caring Behaviour of Paediatric Nurses.

AIMS: The aim of this study is to determine correlation between paediatric nurses' "ethical intelligence" with "quality of work life" and "caring behaviour." DESIGN: Descriptive correlational study. METHODS: Data were collected with EIQ, QWL and CBI. Two hundred and one nurses and 201 caregivers of children hospitalized in a paediatric hospital in Tehran were randomly selected as participants. Data were analysed by SPSS. The data were collected in 2019. RESULTS: Comparison of the subscale "ethical intelligence" with the scale "quality of work life" indicated a significant positive correlation between "honesty" with "job and carrier satisfaction" and "forgiveness" with "job and carrier satisfaction". In addition, findings showed a significant positive correlation between "honesty" and "control at work" and between "accountability" with "home-work interface." There was no significant correlation between "ethical intelligence" and "caring behaviours" and between nurses' "quality of work life" and "caring behaviours." Structural equation modelling showed a correlation between nurses' "ethical intelligence" and "quality of work life."

Psychometrics of the moral distress scale in Iranian mental health nurses.

BACKGROUND: One of the challenges that nurses often face in ethical decision-making situations is moral distress. Moral distress is caused by the conflict between professional and individual values in decision-making situations. Despite its importance, there is no reliable scale in Persian to measure it. Therefore, this study was conducted to validate the moral distress scale in mental health nurses in Iranian culture and Persian language. METHODS: This study was conducted in two parts: Translation and cross-cultural adaptation and psychometric analysis. The translation and cross-cultural adaptation process was conducted based on the Polit approach. Next, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined. This part of the study was a cross-sectional study. In this step, a demographic questionnaire and the Moral Distress Scale were sent to 500 nurses working in selected educational and medical centers in Iran via online questionnaires. Then, the construct validity of the "Moral Distress Scale" was confirmed by confirmatory factor analysis and the reliability of the instrument was examined by studying the internal consistency with Cronbach's alpha and the internal correlation of the AIC. RESULTS: The confirmatory factor analysis showed an acceptable ratio of the expressions in 15 items in three factors: Acquiescence to patients' rights violations (6 items), Unethical conduct by caregivers (5 items), and low staffing (4 items) in the scale. The internal consistency of the instrument with Cronbach's alpha was higher than 7.0. CONCLUSION: The Persian version of moral distress with 15 items of the three factors had validity and reliability. According to the present findings, this scale can be used to study moral distress among nurses working in psychiatric wards. Moral distress leads to burnout, increases risks to patient safety and reduces quality of care. Nurses need to be able to assess and manage moral distress. Therefore, considering the side effects, it is necessary to have a reliable and valid scale that can be studied. Considering that culture has an impact on nurses' moral distress, it is suggested that this instrument be studied in and tested in other languages and cultures.

Translation and validation of caring behaviors inventory among nurses in Iran.

BACKGROUND AND OBJECTIVES: Nurses' caring behaviors, professional activities, and behaviors for the benefit of patients, influence patients' perception of care and satisfaction with the quality of care provided. Caring behaviors of nurses are contextual and various factors such as patients' social structure, lifestyle, culture, and interests, as well as their biographical, social, and physiological characteristics, can influence perceptions of caring behaviors of nurses, as caring behaviors are an interactive and mental process between patients and nurses. This study was conducted to provide a transcultural translation and psychometric analysis of Caring Behaviors Inventory (CBI) among nurses in Iran. METHODOLOGY: Transcultural translation of the 16-item CBI was performed. Then, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined in a cross-sectional study of 509 patients. A demographic questionnaire and the 16-item CBI were sent to enrolled patients via online questionnaires. The reliability of the instrument was assessed by internal consistency using Cronbach's alpha. Then, construct validity of the single factor CBI was assessed using Confirmatory Factor Analysis (CFA). Since one factor CBI was not confirmed, construct validity was examined using Exploratory Factor Analysis (EFA). The final number of factors was confirmed using CFA. RESULTS: The internal consistency of the instrument was good with Cronbach's alpha 0.89. Based on EFA, the CBI were loaded on two factors, eigenvalues >1, no item was removed. The emergent factors were named "Communicating respectfully" and "Professional knowledge and skill". These two factors explained 50.197% of the total variance. Then, CFA showed an acceptable fit for the two factors CBI. CONCLUSION: The results showed that the Persian version of the 16-item CBI had adequate validity and reliability. Accordingly, this instrument can be used to study nurses' caring behaviors.