Development and psychometric testing of a questionnaire for assessment of medical science educators' adherence to ethical principles in virtual education: exploratory sequential mixed methods study.

BACKGROUND: Principles of ethics are among the pillars of the teaching-learning system. Evaluation of educators' adherence to principles of ethics in virtual education requires the use of reliable instruments. This study was carried out to develop and test the psychometric properties of a questionnaire for assessment of medical science educators' adherence to principles of ethics in virtual education. METHODS: This is an exploratory sequential mixed methods study conducted in two parts. In the first stage (the qualitative phase), we used conventional content analysis to establish the concept of ethical principles in virtual education. Thus, 21 semi-structured, in-depth interviews were conducted with 21 medical science professors on a face-to-face basis from March 2022 to November 2022. Subsequently, we developed the items of the questionnaire based on a review of literature and semi-structured in-depth interviews. In the second stage (the quantitative phase), psychometric features of the questionnaire were evaluated using COSMIN criteria (face validity, content validity, construct validity and internal consistency). RESULTS: Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 300 medical science professors, who were selected using convenience sampling. The results of exploratory factor analysis yielded a factor loading of the 20 items of the questionnaire to range between 0.79 and 0.98, all the values being significant. The three factors of adherence to the principles of copyright, adherence to educational principles, and justice in evaluation, which were addressed by the instrument, were verified by satisfactory values. The confirmatory factor analysis (CFA) fitted the data well (χ2/df = 13), RMSEA = 0.01, CFI = 0.96, NFI = 0.97, and TLI = 0.99. The total interclass correlation (ICC) of the questionnaire was estimated to be 0.90. Moreover, the reliability of the instrument measured in terms of internal consistency was estimated 0.98. CONCLUSION: The findings of the study indicated that the questionnaire we developed for evaluation of adherence to ethical principles of in virtual education was valid and reliable enough. Therefore, the managers in the education system can employ this instrument to assess medical science educators' adherence to principles of ethics in virtual education.

Effect of Spirituality-Based Palliative Care on Pain, Nausea, Vomiting, and the Quality of Life in Women with Colon Cancer: A Clinical Trial in Southern Iran.

This randomized controlled clinical trial aimed to examine the effect of spirituality-based palliative care on pain, nausea, vomiting, and the quality of life in 80 Iranian colon cancer inpatients from January to June 2020 in southern Iran. Patients were randomly assigned to an intervention group and a control group. The intervention group took part in four 120-min sessions while the control group received standard care. Pain, nausea, vomiting, and quality of life were assessed before the intervention and one month after the intervention. Data were analyzed using paired t-test and independent t-test. Between-groups differences analysis showed a significant difference in the quality of life scores, pain score, as well as nausea and vomiting scores following the one-month intervention. In conclusion, this group spirituality-based palliative care intervention might be beneficial in improving quality of life and reducing symptoms.

Effect of the Implementation of Interdisciplinary Discharge Planning on Treatment Adherence and Readmission in Patients Undergoing Coronary Artery Angioplasty.

OBJECTIVES: To determine the effect of interdisciplinary discharge planning on treatment adherence and readmission in the patients undergoing coronary artery angioplasty in the south of Iran in 2020. METHODS: This experimental study had an intervention group and a control group with pre-test and post-test. 70 patients participated in the study who were randomly divided into the groups (intervention group (n=35) and control group (n=35)). In the intervention group, discharge planning was performed based on an interdisciplinary approach. Treatment adherence before, immediately, and one month after the intervention was evaluated with a 10-question survey scored from 1 to 5 (maximum score = 50), as well as readmission three months after the discharge was examined in both groups. RESULTS: Before the intervention, there was no statistically significant difference between the intervention and the control groups in the treatment adherence score (18.22 versus 17.37; p=0.84) but immediately and one month after the intervention statistically significant differences between the groups were showed (21.51 versus 46.14 and 23.28 versus 43.12, respectively; p<0.001). Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. CONCLUSIONS: The implementation of interdisciplinary discharge planning had positive effects on treatment adherence and readmission rate in patients undergoing coronary artery angioplasty; therefore, it is suggested that health care system managers make the necessary plans to institutionalize this new educational approach for other patients discharge planning.

Effect of the Implementation of Interdisciplinary Discharge Planning on Treatment Adherence and Readmission in Patients Undergoing Coronary Artery Angioplasty / Efecto de la implementación de la planificación interdisciplinaria del alta en la adherencia al tratamiento y el reingreso en pacientes sometidos a angioplastia de la arteria coronaria / Efeito da implantação do planejamento de alta interdisciplinar na adesão ao tratamento e readmissão em pacientes submetidos à angioplastia coronariana

Objective. To determine the effect of interdisciplinary discharge planning on treatment adherence and readmission in the patients undergoing coronary artery angioplasty in the south of Iran in 2020. Methods. This experimental study had an intervention group and a control group with pre-test and post-test. 70 patients participated in the study who were randomly divided into the groups (intervention group (n=35) and control group (n=35)). In the intervention group, discharge planning was performed based on an interdisciplinary approach. Treatment adherence before, immediately, and one month after the intervention was evaluated with a 10-question survey scored from 1 to 5 (maximum score = 50), as well as readmission three months after the discharge was examined in both groups. Results. Before the intervention, there was no statistically significant difference between the intervention and the control groups in the treatment adherence score (18.22 versus 17.37; p=0.84) but immediately and one month after the intervention statistically significant differences between the groups were showed (21.51 versus 46.14 and 23.28 versus 43.12, respectively; p<0.001). Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Conclusion. The implementation of interdisciplinary discharge planning had positive effects on treatment adherence and readmission rate in patients undergoing coronary artery angioplasty; therefore, it is suggested that health care system managers make the necessary plans to institutionalize this new educational approach for other patients discharge planning

Objetivo. Determinar el efecto de la planificación interdisciplinaria del alta en la adherencia al tratamiento y el reingreso en los pacientes sometidos a angioplastia de la arteria coronaria en el sur de Irán en 2020. Métodos. Este estudio experimental contó con un grupo de intervención y un grupo de control con evaluación pre-test y post-test. Participaron en el estudio 70 pacientes que se dividieron aleatoriamente en los grupos. En el grupo de intervención, la planificación del alta se realizó sobre la base de un enfoque interdisciplinario. En ambos grupos se examinó la adherencia al tratamiento antes, inmediatamente y un mes después de la intervención con una encuesta de 10 preguntas puntuadas de 1 a 5 (máximo puntaje = 50), así como el reingreso hasta tres meses después del alta. Resultados. Antes de la intervención, no hubo diferencias estadísticamente significativas entre el grupo de intervención y el de control en la puntuación de la adherencia al tratamiento (18.22 versus 17.37; p=0.84), pero inmediatamente y un mes después de la intervención los grupos mostraron una diferencia estadísticamente significativa (21.51 versus 46.14 y 23.28 versus. 43.12, respectivamente; p<0.001). A los tres meses del alta, la tasa de reingreso fue del 11.4% en el grupo de control, mientras que no se registró ningún reingreso en el grupo de intervención. Conclusión. La aplicación de la planificación interdisciplinaria del alta tuvo efectos positivos la adherencia del tratamiento y la tasa de reingreso en los pacientes sometidos a angioplastia de las arterias coronarias; por lo tanto, se sugiere que los gestores del sistema sanitario hagan los planes necesarios para institucionalizar este nuevo enfoque educativo para la planificación del alta de otros pacientes

Objetivo. Determinar o efeito do planejamento de alta interdisciplinar na adesão ao tratamento e readmissão em pacientes submetidos à angioplastia de artéria coronária no sul do Irã em 2020. Métodos. Este estudo experimental contou com um grupo intervenção e um grupo controle com avaliação pré-teste e pós-teste. Participaram do estudo 70 pacientes que foram divididos aleatoriamente em grupos. No grupo intervenção, o planejamento da alta foi realizado com base na abordagem interdisciplinar. Em ambos os grupos, a adesão ao tratamento foi examinada antes, imediatamente e um mês após a intervenção com um questionário de 10 questões pontuadas de 1 a 5 (pontuação máxima = 50), bem como a readmissão até três meses após a alta. Resultados. Antes da intervenção, não houve diferenças estatisticamente significativas entre os grupos intervenção e controle na pontuação de adesão ao tratamento (18.22 vr. 17.37; p = 0.84), mas imediatamente e um mês após a intervenção os grupos apresentaram diferença estatisticamente significativa (21.51 vr. 46.14 e 23.28 vr. 43.12, respectivamente; p <0.001). Aos três meses após a alta, a taxa de readmissão foi de 11.4% no grupo de controle, enquanto nenhuma readmissão foi registrada no grupo de intervenção. Conclusão. A aplicação do planejamento de alta interdisciplinar teve efeitos positivos na adesão ao tratamento e na taxa de readmissão em pacientes submetidos à angioplastia de artéria coronária; portanto, sugere-se que os gestores do sistema de saúde façam os planos necessários para institucionalizar essa nova abordagem educativa para o planejamento da alta de outros pacientes

Examining the association between opium use, cigarette smoking and alcohol consumption with the liver enzyme levels in a population-based study: Fasa Persian cohort data.

OBJECTIVES: Opium use, cigarette smoking, and alcohol consumption are serious health problems in many countries including Iran. The present study aimed to examine the association between the opium use, cigarette smoking and alcohol consumption with liver enzyme levels in Southern Iran. This analytical cross-sectional study was conducted in 2020. The entire population of the Fasa Persian cohort study in the southern region of Iran was selected as the sample. Accordingly, 10,145 people participated in the study. RESULTS: Results indicated that there was a significant relationship between cigarette smoking and alcohol consumption with liver enzymes (AST, ALT, and ALP). There was also a significant relationship between inhaled opium and liver enzymes, but oral opium revealed no significant relationship with the activity of liver enzymes. Accordingly, policymakers of the health care system are recommended to hold educational programs to improve the health literacy level of the society and take effective preventative strategies in reducing the use of these substances.

Development and psychometric evaluation of a reflection on clinical practice questionnaire for nursing students.

BACKGROUND: Reflection on clinical practice is the core of education for nursing students. Evaluating reflection on clinical experiences requires a tool which accurately measures reflection skills. The present study aims to develop and test the psychometric properties of a tool for measuring nursing students' reflection on clinical practice. METHODS: Based on a mix-method exploratory approach, the study was carried out in two stages: in the first stage (the qualitative phase), the concept of reflection on clinical practice was established. In the second stage (the quantitative phase), the psychometric properties of the developed scale were evaluated. RESULTS: Based on the results of the exploratory factor analysis and the verification process, the final version of the scale came to consist of 36 items and 6 dimensions. The dimensions were: professional competence, internal sources of motivation, challenging situational clinical setting, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. Overall, 6 factors accounted for 62.79% of the variances. The factor loadings of the items ranged between 0.62 and 0.94, all of which were significant. The total intraclass correlation (ICC) of the scale was found to be 0.94. Also, evaluation of the reliability of the scale as measured through internal homogeneity yielded a total Cronbach's alpha of 0.90. CONCLUSION: The findings show that the developed scale for evaluation of nursing students' reflection on clinical practice possesses satisfactory validity and reliability, and nursing professors can use this instrument to assess students' reflection skills.

Exploring senior managers' perceptions of the COVID-19 Crisis in Iran: a qualitative content analysis study.

BACKGROUND: Identification of the experience of senior managers in tackling biological crises can be a roadmap for future crisis management planning. The aim of the present study was to investigate the experiences of senior managers during the COVID-19 crisis. METHODS: This is a descriptive qualitative research. Data were collected using in-depth and semi-structured individual interviews. Accordingly, 20 senior managers of medical universities with experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. Data were collected from February 2020 to May 2021. For data analysis, qualitative content analytical approach was used. RESULTS: According to the results, 4 main themes and 10 sub-themes were obtained; they included dealing with issues and challenges in the face of COVID-19 disease (Structural challenges, Cultural challenges, Educational challenges, COVID-19 complexity); individual and managerial competencies (Individual competencies, Managerial competencies); comprehensive, accountable, and efficient management (Comprehensive and accountable management, efficient management); and professional and organizational self-efficacy (Professional self-efficacy, organizational self-efficacy) were obtained. CONCLUSIONS: In the present study, a number of senior managers' experiences in the COVID-19 crisis management were identified. Managers and policymakers of the health system are suggested to use the results of the present study to effectively manage the crisis and improve crisis management in various health-related areas by providing an effective cultural and organizational context.

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis.

BACKGROUND: Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel. METHODS: The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis. RESULTS: The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues. CONCLUSION: The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel's professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel's clinical decision-making skill.

Faculty retention in regional medical schools in Iran: a qualitative content analysis.

BACKGROUND AND PURPOSE: Recruitment and retention of competent faculty members are important in maintaining and improving the quality of education and research performance of universities. The aim of the present study was to find out the faculty members' views, experiences, and attitudes to identify the reasons for faculty attrition and retention in regional medical schools in Iran. METHODS: In this qualitative study, we used a content analysis method. The participants included 12 faculty members who had been transferred to type I universities, four faculty members who had applied for transfer, four with more than 10 years of experience and working in the type 3 universities with no intention to be transferred. Data were collected using semi-structured interviews, which were conducted either face-to-face or via phone calls. The interview was developed for this study (Supplementary file). To measure the trustworthiness of the data, we evaluated four components of credibility, transferability, dependability, and conformability, as proposed by Lincoln and Guba. RESULTS: The findings were classified into three categories and 14 subcategories. The first category was "retention facilitators" including four subcategories of facilitated communication, proximity to major universities, gaining experience, and support by authorities. The second category was "retention threats" including six subcategories of social infrastructure, individual dimension, occupation dimension, economic dimension, sense of respect, and executive management. The third category was "retention strategies" which included four subcategories of recruitment and promotion processes, inter-university collaboration with type I universities, facilitation of the scientific growth, and fulfilment of the safety needs. CONCLUSION: Several factors play a role in the faculty members' retention in regional medical schools in Iran. Authorities can create a more positive environment by devising a suitable reward system, supporting academic activities, and increasing the level of faculty autonomy practically to develop a sense of belonging among them and reduce the intention to be transferred among their human resources.

The Effectiveness of Teaching Nursing Ethics via Scenarios and Group Discussion in Nurses' Adherence to Ethical Codes and Patients' Satisfaction with Nurses' Performance.

BACKGROUND: There are shortcomings in nurses' adherence to ethical principles in practice. The present study aims to investigate the effectiveness of teaching nursing ethics via scenario-based learning and group discussion in nurses' adherence to codes of ethics and patients' satisfaction with nurses' performance. METHODS: Using a quasiexperimental design, the present study employed questionnaires which measure nurses' compliance with nursing codes of ethics and patients' satisfaction with nursing care before, immediately after, and one month after intervention. The collected data were analyzed using the independent t-test, ANOVA, and chi-square test in SPSS v.22. The level of significance was set at p < 0.05. The nurses (n = 80) and patients (n = 160) from various units of two university hospitals in the south-west of Iran participated in the present study. RESULTS: The pretest mean scores of the intervention and control groups in patient rights and patients' satisfaction with nursing care were not significantly different (p=0.07, p=0.21). Yet, there were statistically significant differences between the groups' mean scores as calculated immediately after (p < 0.001, p < 0.001) and one month after intervention (p < 0.001, p < 0.001). CONCLUSION: Employment of new approaches to teach nursing ethical principles improves compliance with nursing ethical codes and patients' satisfaction with nurses' performance.

Effect of Acupressure on Preoperative Cesarean Section Anxiety.

Anxiety is a common preoperative problem in cesarean section candidates. Nonpharmacologic anxiety control has been demonstrated to be more suitable in pregnant women. The current study was a randomized, single-blind clinical trial which evaluated the effect of acupressure on preoperative C-section anxiety. In this study, 60 patients facing surgery were randomly divided into two groups of 30 patients each. Those patients in the intervention group received simultaneous acupressure at the Yintang and HE-7 acupoints for 5 minutes before surgery, and patients in the control group received intervention at a sham acupoint. The anxiety level of patients was preoperatively assessed twice using the Spielberger's State-Trait Anxiety Inventory. The mean anxiety scores of the two groups were shown to be insignificantly different before the intervention (p = 0.859), whereas a significant difference between the mean anxiety scores of the two groups was observed after the intervention (p = 0.001), suggesting that acupressure reduced the anxiety of patients before surgery.

Exploring the perception of nursing students about consequences of reflection in clinical settings.

BACKGROUND: Reflection on practical experiences is a key element that enables students to recognize their own strengths and weaknesses and develop nursing skills. Whilst reflection may enhance students' learning in practice, there is little evidence about nursing students' perception of the consequences of reflection in clinical settings. OBJECTIVE: This study aimed to explore Iranian nursing students' perception regarding the consequences of reflection during clinical practices. METHODS: This qualitative study was conducted by a conventional content analysis approach in two nursing schools at Shiraz and Fasa Universities of Medical Sciences in Iran. Data were collected through in-depth semi-structured interviews during 2015-2016, from 20 students selected by purposive sampling. All the interviews were tape-recorded, transcribed verbatim, and analyzed by content analysis method. Rigor of this study was approved by member check and external audit. RESULTS: Two categories emerged from the data analysis, including movement toward professionalism and self-actualization of emotions. The former consisted of three subcategories of function modification, sharing experiences and generalizing experiences. The latter consisted of two subcategories of inner satisfaction and peace of mind. CONCLUSION: The results indicated that nursing students' reflection in clinical settings is effective in personal and professional levels. Reflection in a personal level led to positive emotions that increased the quality of care in patients. Accordingly, nursing educators need to create a nurturing climate as well as supporting reflective behaviors of nursing students.

Investigating Factors Associated with FOBT Screening for Colorectal Cancer Based on the Components of Health Belief Model and Social Support

Introduction: This study aimed to investigate the factors associated with FOBT screening for colorectal cancer based on the components of Health Belief Model and social support in Fasa City, Fars Province, Iran. Materials and Methods: This was a cross-sectional study carried out on 240 subjects in people of Fasa city who had 50 years old and above. The subjects in this study were assigned to two groups of 120 patients. The first group included people over 50 years, who referred to the diagnostic laboratories for doing FOBT, but the second group included people aged 50 years and above who did not refer to a laboratory for doing FOBT and were assessed by questionnaires at home. Data were collected through a questionnaire based on health belief model and perceived social support. Results: The referring group included 61.3 percent women and 38.7 percent men, with a mean age of 65.24 ± 8.01. The non-referring group included 59.7 percent women and 40.3 percent men, with a mean age of 64.21 ±7.53 (p=0.24). In the referring group, 64.2 percent had undergone FOBT in the past year, while in the non-referring group only 12.72percent had done so (p=0.001).The results showed that the referring group obtained higher scores on awareness about CRC and ways to prevent it, and on HBM Model constructs, and social support compared to the non-referring group (p<0.001). In addition, the referring group reported significantly lower Perceived Barriers compared to the non-referring group (p<0.001). Conclusion: The results showed significant differences between the two groups in terms of HBM components and perceived social support for doing FOBT. Therefore, theory-based educational interventions can be used to increase individuals' Perceived Severity, Perceived Susceptibility, and Perceived Benefits and reduce their Perceived Barriers in order to empower and encourage people to perform FOBT.

A Qualitative Inquiry into Nursing Students' Experience of Facilitating Reflection in Clinical Setting.

Background and Aim. Reflection is known as a skill that is central to nursing students' professional development. Due to the importance and the role of reflection in clinical areas of nursing, it is important to know how to achieve it. However, nursing trainers face the challenge of how to help their students to improve reflection in clinical settings. The aim of this study was to investigate the nursing students' experiences of facilitating reflection during clinical practice. This qualitative study was conducted by qualitative content analysis approach. Twenty nursing students during the second to eighth semester of their educational program were selected for participation using purposive sampling. Data were collected through in-depth semistructured interviews. The interview was transcribed verbatim, and qualitative content analysis was used to analyze the data. From the data analysis, four main themes were extracted. Motivation to reflect, complex experiences, efficient trainer, and effective relations were four main themes obtained from study that, in interaction with each other, had facilitating roles in students' reflective process on experiences. The findings revealed that the nursing students' reflection in clinical settings is effective in personal and professional level. Reflection of nursing students depends on motivational and educational factors and these factors increase the quality of care in patients. Furthermore, nursing educators need to create nurturing climate as well as supporting reflective behaviors of nursing students.

The effect of mothers education program based on the precede model on the mean weight in children (6-12 months) at health centers in Shiraz, Fars Province.

BACKGROUND: Growth retardation in children is a result of nutritional ignorance, inappropriate care, and inadequate monitoring of growth monitoring. This study was performed to assess the effect of mothers education program based on the precede model on the mean weight of children (6-12 months) at health centers in Shiraz, Fars Province. METHODS: This quasi experimental study was conducted on 120 mothers (60 in the experimental and 60 in the control group) with single child and exclusively on breast feeding who were cared by health centers in Shiraz, Fars province. The data were gathered through a questionnaire which included demographic characteristics, the components of the precede model (knowledge, attitude, enabling as well as reinforcing factors, and maternal function) and child weight. Educational intervention was performed during 6 sessions each of which lasted for 55 to 60 minutes. The questionnaire was completed by the experiment a land control group before and 4 months after the training program. RESULTS: The results showed that the educational intervention program in the experimental group caused significant increase in the means of knowledge (p<0.001) and attitude scores (p<0.001). This study showed that enabling and reinforcing factors (and training sessions), performance score of mothers as well as weight of children among experimental group were significantly higher than control group (p=0.01). CONCLUSION: The results of this study can be used as a guideline prevents growth retardation in health centers and other related organizations.