Nurses' Experiences of Practical Challenges Associated with Nurses' Prescription: A Qualitative Study.

Background: Because nurse prescription has numerous benefits for the health systems, in many countries around the world, nurses are given the right to prescribe medication. In Iran, the role of nurses in prescription drugs is not well understood, and nurses face various challenges in this regard. Materials and Methods: A qualitative content analysis methodology based on the Graneheim and Lundman model was used. Thirteen nurses working in medical wards of hospitals affiliated with the Tehran University of Medical Science were selected to participate in this study by purposeful sampling. Participants were interviewed via telephone using a semi-structured tool. After thirteen interviews, data saturation was reached. Data collection was undertaken between April 2020 and April 2021. Results: The results of this study are summarized in one theme, four categories, and ten subcategories. The theme extracted from the data analysis was "the practical challenges of nurse prescription," which included four main categories: structure challenges, personnel-related barriers, interprofessional separation, and society's attitudes. Conclusions: The results of this study explain the barriers and practical challenges of nurse prescription in Iran. Identifying these challenges and barriers provides the necessary evidence for policymakers to remove and adjust these challenges and barriers. Moreover, the elimination of identified challenges will help nurses better perform their new roles and develop the nursing scope and profession.

Striving to Keep a Clear Conscience by Going Above and Beyond: The Experiences of Intensive Care Unit Nurses.

Working as a nurse in the critical care unit may involve ethical challenges including conflict of conscience. Literature provides very limited knowledge about intensive care unit (ICU) nurses' perception of conscience. Considering the influence of culture on the perception of conscience, it is important to study it in diverse contexts. This study aims were to explore the meaning of conscience and the impact of conscience on nurses' practice in the ICU. A qualitative research approach was used to answer the research question, and qualitative content analysis guided the study. A total of 17 interviews were conducted with ICU nurses. Data were collected through semistructured tools by using videoconferencing and face-to-face interviews. Data analysis resulted in the formation of 2 main categories and 7 subcategories. The main categories included understanding the conscience and unlimited efforts in caretaking as the path to a clear conscience. The category of understanding the conscience includes 3 subcategories of conscience as an intrinsic asset and internal observer, dynamicity of conscience, and conscience as the cornerstone of morality. Also, the category of unlimited efforts in caretaking as the path to a clear conscience consists of 4 subcategories including giving full attention to the patient, putting oneself in another's shoes, taking responsibility, and working beyond the job description. Conscience plays an essential role in providing the ethical care among ICU nurses. The ICU nurses felt that they need to go above and beyond to keep their conscience clear. Nurses expressed the importance of following the call of conscience at their workplace, which demanded unlimited efforts to achieve a clear conscience.

Psychometric evaluation of the Persian version of the perception of conscience questionnaire in Iranian nurses.

Conscience is defined as the cornerstone of ethics and is considered a valuable asset. There is, however, little evidence about how Iranian nurses perceive conscience. The purpose of this study was to psychometrically evaluate the Persian version of the Perception of Conscience Questionnaire (PCQ) in Iranian nurses. In this cross-sectional and descriptive study, a psychometric evaluation of the PCQ was conducted on Iranian nurses in 2022. A total of 300 nurses participated in this study to validate the PCQ. At first, the initial translation and determination of face validity was done, and content validity was assessed using the Content Validity Index and Content Validity Ratio. Reliability was determined by intra-class correlation coefficient and Cronbach's alpha coefficient. The construct validity of the PCQ was determined by exploratory factor analysis, which led to the extraction of five factors of warning signal, valuable asset, spiritual power, burden and conscience outcomes from the initial 14 factors of the questionnaire. Reliability of the whole questionnaire was calculated to be 0.80 using Cronbach's alpha. While an intra-class correlation coefficient of 0.58 indicated average stability, the five-factor construct of the PCQ showed good validity and reliability. Therefore, our findings proved that this tool is suitable for assessing Iranian nurses' perception of conscience.

Intensive care unit nurses' conflict of conscience: Walking the Razor's edge.

The study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. A qualitative approach guided the study, which was undertaken between April 2020 and April 2021. A total of 15 registered nurses working in intensive care units were recruited through purposive sampling. Individual semistructured interviews were conducted. The data were analyzed using a qualitative content analysis. The analysis revealed two themes: "conflict of conscience in relation to the structure" and "conflict of conscience based on context." Conflict of conscience in relation to the structure consisted of two categories: conflict of interest and conflict of conscience and law. Conflict of conscience based on context consisted of two categories: care dilemmas and arbitrary behaviors with end-stage patients. A variety of factors were accompanied by a conflict of conscience for nurses in intensive care units. Given that conflict of conscience has negative consequences for the health and quality of nursing care, health care managers need to tailor strategies to reduce the negative consequences considering the findings of the study.

The effect of peer group education on anxiety, stress, and depression in older adults living in nursing homes.

BACKGROUND: The effects of peer education have been addressed in different populations, but this method of education has not been applied in the elderly population of Iran, and its effect has not been studied. The present study investigated the effects of peer group education on anxiety, stress, and depression of the older adults living in nursing homes. MATERIALS AND METHODS: This research is a quasi-experimental study with an intervention and control group and it was conducted on 70 elderly citizens living in Qom nursing homes in July 2017. For the intervention group, a relaxation and stress reduction program was trained through the peer group. The control group received routine care. Data were collected using a Demographic information questionnaire and Depression Anxiety Stress Scale-21 (DASS-21). Data were collected at the beginning, 10 and 30 days after the intervention. Data analysis was performed using SPSS 19, descriptive statistics, and repeated measure analysis of variance. RESULTS: The results of the study showed no significant difference between any of the demographic variables at the beginning of the study (p > 0.05). The statistical test showed that the effects of time (p < 0.001) and group (p < 0.011) were significant on anxiety, stress, and depression. CONCLUSIONS: The results of this study showed that peer education could decrease anxiety, stress, and depression in the elderly. Therefore, this educational method can be used by nurses to promote various health education programs, e.g., to health promotion and prevent disease especially in the elderly community.

Effect of rosa damascene aromatherapy on anxiety and sleep quality in cardiac patients: A randomized controlled trial.

INTRODUCTION: Anxiety and sleep disorders are the most common disorders of patients admitted to the cardiac care units. The purpose of this study is to investigate the effect of Rosa damascene fragrance on anxiety and sleep quality of hospitalized patients in the cardiac care units. METHODS: In this Randomized clinical trial, 60 patients who had the inclusion criteria were conveniently sampled and randomly allocated to the experimental and control groups. Patients were enrolled in the study 24 h after hospitalization. Those diagnosed with dysrhythmia, ACS, and CHF were included. Patient recruitment lasted from October 2018 to December 2019. In these groups, in addition to the routine care, the intervention was performed for three consecutive nights from 22:00 to 06:00. In the experimental group, patients inhaled five drops of Rosa damascene essence 40% in distilled water, while in the control group, patients inhaled five drops of distilled water as placebo. In both groups, anxiety and sleep quality were examined before and after three consecutive nights using the St. Mary's Hospital Sleep Quality Questionnaire (SMHSQ) and the Spiel Berger State-Trait Anxiety Inventory (STAI) questionnaire. RESULTS: The results of this study showed that the use of Rosa damascene aroma in patients hospitalized in the cardiac care unit significantly reduces anxiety and increases the improvement of sleep quality in the experimental group compared to the control group (P < 0.05). The significance level for anxiety and sleep quality was (P = 0.001). CONCLUSION: Aromatherapy with Rosa damascene reduces anxiety and increases the sleep quality of patients hospitalized in the cardiac care unit. Therefore, along with other treatment measures, Rosa damascene can be used as a complementary method to reduce anxiety and improve sleep quality.

Clarifying the concept of conscience in nurses' ethical performance in Iran: a concept analysis study.

Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses' ethical performance. This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study's conclusions. In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase' results were categorized into three themes: "perception of conscience", "commands of conscience", and "obedience to conscience. The final definition was reached by merging the theoretical and field stages. This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.

The relationship between futile care perception and moral distress among intensive care unit nurses.

Moral distress is among the various types of distress that involves nurses and can lead to multiple complications. It is therefore rather important to identify the factors related to moral distress. The purpose of this study was to examine the relationship between futile care perception and moral distress among intensive care unit (ICU) nurses. This cross-sectional study used a descriptive-correlation method and was conducted on 117 ICU nurses of Qom hospitals in 2016. Data were collected using a 17-item futile care perception questionnaire, and Jameton's moral distress questionnaire containing 30 questions. Data analysis was performed using SPSS 16, descriptive statistics and univariate regression analysis. The results showed that the mean age of the participants was 34.99, and most (about 66.7%) were women. Univariate regression analysis indicated that when ICU nurses' perception of futile care and work experience increased, their moral distress also increased significantly (P = 0.03 and P = 0.02, respectively). It can therefore be concluded that moral distress is associated with futile care and ICU work experience. It seems that some interventions are necessary in future to place nurses in clinical situations involving futile care, and thus reduce their level of moral distress.