Development and validation of the shared governance feasibility instrument in nursing schools in Iran.

ABSTRACT: To develop and validate a shared governance feasibility instrument in schools of nursing in Iran with respect to the nature of the profession and the sociocultural context of the Iranian community. BACKGROUND: Nursing schools are liable to the application of shared governance due to the presence of various expert educational groups within the school that necessitates reciprocal cooperation. Since the concept of shared governance is culture-based and given that no full-fledged study has been conducted on shared governance in Iran, the development of a suitable shared governance feasibility instrument is rendered as mandatory. METHODS: This sequential exploratory mixed-method study consisted of two qualitative and quantitative parts was accomplished 2016-2019. First, the primary items were extracted through an extensive review of the literature, qualitative interviews and underwent psychometric validation using a methodological approach. Face, content, construct validity and reliability of the instrument was established and completed. RESULTS: One hundred fifty items were distilled from the first stage of the study, was reduced to 70 after establishing face, content validity and primary reliability. Exploratory factor analysis resulted in 52 items covering the two factors "shared atmosphere and culture" and "infrastructural prerequisites". These two factors accounted for 78.6% of the total variance of the questionnaire. In calculating the final reliability coefficient of the instrument, Cronbach's alpha and Omega were 0.981 and 0.805, respectively. The results showed an ICC of 0.91 indicating high reliability of the developed instrument with a standard error of measurement (SEM) of 10.43. Finally, the items underwent weighting via scoring by considering item weights due to differences between the two methods. CONCLUSION: "Shared governance feasibility instrument" can provide a new insight into organisational performance for all policy-makers and beneficiaries of higher education. This not only leads to the use of intelligence and capabilities of the beneficiaries, but also aids in faster movement toward achieving organisational goals. IMPLICATIONS FOR NURSING MANAGEMENT: This study and the developed instrument may serve as a guide for the feasibility of implementing shared governance to assess management styles and performance in higher education centers.

Association between ethical leadership, ethical climate and organizational citizenship behavior from nurses' perspective: a descriptive correlational study.

BACKGROUND: Ethical leadership plays an important role in improving the organizational climate and may be have an effect on citizenship behavior. Despite the growing emphasis on ethics in organizations, little attention to has been given this issue. The purpose of this study was to identify ethical leadership, an ethical climate, and their relationship with organizational citizenship behavior from nurses' perspective. METHODS: In this descriptive correlational study, 250 nurses in twelve teaching hospitals in Tehran were selected by multistage sampling during 2016-2017. The data were collected using Ethical Leadership Questionnaire, Hospital Ethical Climate Survey, and Organizational Citizenship Behavior Scale. RESULTS: The findings showed a significant correlation between ethical leadership in managers, organizational citizenship behavior (P = 0.04, r = 0.09) and an ethical climate (P < 0.001, r = 0.65). There was a significant correlation between an ethical climate and nurses' organizational citizenship behavior (P < 0.001, r = 0.61). The regression analysis showed that ethical leadership and an ethical climate is a predictor of organizational citizenship behavior and confirms the relationship between the variables. CONCLUSION: Applying an ethical leadership style and creating the necessary conditions for a proper ethical climate in hospitals lead to increased organizational citizenship behavior by staff. To achieve organizational goals, nurse managers can use these concepts to enhance nurses' satisfaction and improve their performance.

Improving nurses' organizational commitment by participating in their performance appraisal process.

AIMS: To promote the nurses' organizational commitment by their participation in the improvement of the performance appraisal process. BACKGROUND: Organizational commitment is one of the factors that secures safe and high-quality care of patients. It also enhances motivation among nurses, which affected by various factors such as performance appraisal. METHOD: A participatory action research study was undertaken (March 2015 to February 2018) with 39 intensive critical care nurses and nurse managers in Social Security Hospital in Iran, using a complete enumeration sampling method. The data were collected using organizational commitment and job satisfaction questionnaires, focus groups, semi-structured interviews and Delphi technique. RESULTS: Three major themes emerged including inappropriate performance appraisal system, inefficient instruments and unskilled evaluators. There were significant differences between organizational commitment and job satisfaction with performance appraisal process before and after the change in appraisal process. CONCLUSIONS: Nurses' involvement in revising and improving the process of their performance appraisal leads to higher commitment. IMPLICATIONS FOR NURSING MANAGEMENT: Maintaining a committed nursing workforce is vital for high-quality health care. Nurse Managers can improve the process of nurses' appraisal to make more motivation among them and prevent some problems such as job dissatisfaction.

Factors predisposing to shared governance: a qualitative study.

BACKGROUND: The method of implementing shared governance varies among organizations. Identifying the predisposing factors can facilitate and precipitate its successful implementation and aid educational institutions in achieving their goals. This study determined the antecedents of shared governance in nursing schools. METHODS: Eleven participants including faculty members of nursing schools, and managers of three major medical universities of Tehran were selected using purposive sampling method and underwent in-depth semi-structured interviews in this qualitative study. Conventional content analysis was used to analyze the data. RESULTS: Data analysis led to the emergence of four categories including the participatory context of higher education institutions, infrastructural obligations, coordination with contemporary needs, and participation-oriented managers resulting in twelve subcategories. CONCLUSION: This study showed that managers can play a key role in the successful implementation of shared governance in the appropriate context of higher education institutions. Hence, the deliberate selection of managers who believe in managerial participation and their training are mandatory in nursing schools. The senior or higher level managers of educational institutions can empower themselves and their staff in participatory skills along with providing suitable resources of work serving as a suitable model of participation.

Characteristics of Shared Governance in Iranian Nursing Schools: Several Souls in One Body.

BACKGROUND: Shared governance is a decentralized structural model that gives individuals the right to make decisions and a position analogous to managers. The shared governance is different based on context in every organization. This study identified the characteristics of shared governance in Iranian nursing schools. MATERIALS AND METHODS: In this qualitative research, 11 participants were selected using purposive sampling method. Deep semi-structured interviews were conducted, and the data were analyzed using conventional content analysis. Lincoln and Guba's criteria were used to verify the accuracy and trustworthiness of the data. RESULTS: Through data analysis, the theme of "several souls in one body" was achieved in addition to the seven categories of "climates based on common interests," "conscious participatory decision-making," "mutual accountability," "multiplicity of ideas," "decentralized structure," "interrelationship," and "sublime organization." CONCLUSIONS: According to the findings, the characteristics of shared governance in the social culture of Iran are like several souls in one body, emphasizing all aspects of participation and morality in the organization. Managers and administrators in higher education and nursing faculties need to pay attention to all aspects of shared governance, including spirituality in managing the covered institutions.

The Relationship Between Work Commitment, Dynamic, and Medication Error.

Incidence of medication errors in intensive care unit (ICU) can cause irreparable damage for ICU patients. Therefore, it seems necessary to find the causes of medication errors in this section. Work commitment and dynamic might affect the incidence of medication errors in ICU. To assess the mentioned hypothesis, we performed a descriptive-analytical study which was carried out on 117 nurses working in ICU of educational hospitals in Tehran. Minick et al., Salyer et al., and Wakefield et al. scales were used for data gathering on work commitment, dynamic, and medication errors, respectively. Findings of the current study revealed that high work commitment in ICU nurses caused low number of medication errors, including intravenous and nonintravenous. We controlled the effects of confounding variables in detection of this relationship. In contrast, no significant association was found between work dynamic and different types of medication errors. Although the study did not observe any relationship between the dynamics and rate of medication errors, the training of nurses or nursing students to create a dynamic environment in hospitals can increase their interest in the profession and increase job satisfaction in them. Also they must have enough ability in work dynamic so that they don't confused and distracted result in frequent changes of orders, care plans, and procedures.

A qualitative study on individual experiences of chronic hepatitis B patients.

AIM: The aim of this study was to explain the perception of patients with chronic hepatitis B regarding problems in the Iranian society. DESIGN: Descriptive qualitative research. METHODS: In this qualitative study, 27 patients with chronic hepatitis B in Iran were selected through purposive sampling. The data were collected over 22 months, in 2015-2016, by means of semi-structured interviews and field notes. The interview transcripts were coded using MAXQDA10 software®. To extract categories and themes, the thematic analysis approach was used. RESULTS: The participants' age ranged from 25-52 years. Analysis of the data revealed seven themes: insufficient self-care, misperceptions, stigmatization, psychological consequences, failure, spiritual struggle and post-traumatic growth.

The Process of Transition to Hemodialysis: A Grounded Theory Research.

BACKGROUND: Transition is a passage or movement from one state, condition, or place to another. Patients with chronic disorders such as end-stage renal disease experience transitions. This study aims to explore the process of transition to hemodialysis. MATERIALS AND METHODS: This is a qualitative grounded theory of a doctoral dissertation. Twenty-four participants (19 patients on hemodialysis, 2 family members, 2 nurses, and a physician) were selected through purposive and theoretical sampling until data saturation. Data collection was conducted through semi-structured interviews, as well as field notes and memos. Data analysis was done concurrently with data collection in three levels of open, axial, and selective coding according to the Strauss and Corbin (1998) method. Core variable was appeared at the end of selecting coding stage. RESULTS: Confronting unexpected situation of hemodialysis, challenge of accepting hemodialysis, comprehensive and pervasive changes, efforts made to self-management, and integration of hemodialysis with everyday life were considered to be the main themes of the process of transition to hemodialysis. CONCLUSIONS: The results would increase evidence-based knowledge regarding the process of transition to hemodialysis. Through identification of this process, effective factors such as determining strategies for management would lead to facilitate more specialized care of people undergoing hemodialysis, appropriate nursing interventions and more effective training programs to prepare patients and their families during the process of transition to hemodialysis. These results can be used for conducting and preparing other qualitative and quantitative studies.

Nurses' Perception of Challenges in the Use of an Electronic Nursing Documentation System.

This qualitative study was based on the Technology Acceptance Model and conducted through directed content analysis to explore perceptions of nurses in Iran of the challenges of using an electronic documentation system. Participants were selected through purposive sampling via interview from a teaching hospital in western Iran. Data were analyzed using MAXQDA 10. Data consistency was ensured through validation methods and by the researcher's prolonged engagement in the subject. Twelve codes, four subcategories, and two main categories ("perceived usefulness" and "perceived difficulty") emerged from the analysis of the data based on the Technology Acceptance Model. "Perceived usefulness" consisted of the subcategories "subjective norms" and "experienced benefits"; and "perceived difficulty" contained the subcategories "rationalization" as well as "challenges in accepting change." According to the Technology Acceptance Model, to promote acceptance of this system, the benefits of usage should be highlighted. The biggest hurdle to acceptance is familiarity and comfort with previous methods.

Attrition among Iranian nursing students: A qualitative study.

Attrition is a major challenge facing nursing students that results in substantial costs on the education, health, and treatment systems across countries and can have an unwanted effect on the quality and quantity of health services provided as well as on the health of citizens. This descriptive study investigated nursing students' perceptions toward factors influencing attrition. We conducted a qualitative study using a content analysis approach. Nineteen students enrolled in nursing bachelor program were recruited using purposive and snowball sampling. Data were collected using face-to-face interviews, focus group interviews, and participant observation, and analysed using conventional content analysis approach. Attrition factors were categorized into two themes: 'before admission' and 'after admission'. The most important factors were obligation to choose nursing in the National Entrance Exam, poor management in workforce provision and improper supervision, discrepancy between expectations and experiences, and being work abused in clinical training. Authorities in education and practice sectors can use these findings to improve the quality of clinical and theoretical education and to avoid nursing student attrition. This can be achieved through an increase in community awareness of the identity of nursing, efficient management of workforce provision and clear and concise supervision of activities in both theoretical and clinical fields.

The Association Between Obstructive Sleep Apnea and Depression in Older Adults.

BACKGROUND: Depression is the most frequent psychiatric disorder among the elderly. Obstructive sleep apnea (OSA) is a chronic and prevalent disease that has an ambiguous role in triggering depression. Several researches with contradictory findings have been performed about the association between OSA and depression. OBJECTIVES: This study aimed to investigate the association between OSA and depression among elderly. PATIENTS AND METHODS: A total of 350 home residing elderly took part in this case-control study. The participants were selected using clustering method. All cases were divided into two groups of depressed and non-depressed using the geriatric depression scale (GDS). Then they were matched in age, gender, education and body mass index (BMI). Berlin questionnaire (BQ) was used to diagnose OSA. Data analysis was performed using Mann-Whitney U test, t-test, Chi-square and Fisher's exact tests and odds ratio. RESULTS: Totally, 60.6 % of depressed group and 18.9 % of non-depressed group were in high risk for OSA. A significant association was found between OSA and depression (P < 0.001, OR = 6.61, CI 95 % = 4.1 - 10.7). In addition, a significant association was found between gender and OSA (P = 0.008). CONCLUSIONS: OSA was associated with depression among the elderly patients. Given the high prevalence of OSA in older adults, implementation of screening methods is necessary to identify people at high risk of OSA.

The effect of mentoring on clinical perioperative competence in operating room nursing students.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effects of mentoring on the clinical perioperative competence of nursing operating room students in Iran. BACKGROUND: Mentoring is an essential part of clinical education, which has been studied in different populations of students. However, there is a need to assess its effectiveness in operating room students' competence. DESIGN: A randomised controlled trial was performed. METHODS: Sixty nursing operating room students were randomly assigned to experimental and control groups. Both the control and experimental groups had routine training in the form of faculty supervision. The experimental group had an additional mentoring program. Using the Persian Perceived Perioperative Competence Scale-Revised, clinical competence was compared between the two groups, before and after the intervention. Using SPSS 19, descriptive and inferential statistics, including chi-square and t-tests, were conducted. RESULTS: In the experimental group, the difference between the mean scores of clinical competence before (19·43 ± 2·80) and after (27·86 ± 1·87) the intervention was significant (p ≤ 0·001). After intervention, the difference between the mean scores of the control (3·9 ± 0·15) and experimental (8·61 ± 0·68) groups was significant (p ≤ 0·003). CONCLUSION: Findings affirmed the positive effect of mentorship programmes on clinical competence in nursing operating room students. RELEVANCE TO CLINICAL PRACTICE: Mentoring is an effective method for preparing nursing students in practice. Health care systems may improve as a result of staff-student relationships that ultimately increase the quality care for patients.

Nurse-led action research project for expanding nurses' role in patient education in Iran: Process, structure, and outcomes.

BACKGROUND: Patient education is among the lowest met need of patients in Iran; therefore, expansion of that role can result in greater professional accountability. This study aimed to explain the practical science of the process, structure, and outcomes of a nurse-led action research project to expand the nurses' role in patient education in Iran. MATERIALS AND METHODS: This study was part of a participatory action research. Daily communications and monthly joint meetings were held from January 2012 to February 2014 for planning and management. These were based on the research protocol, and the conceptual framework included the Mobilizing for Action through Planning and Partnerships process by means of Leadership for Change skills. Data were produced and gathered through participant observations. Administrative data included project records, official documents, artifacts, news, and reports, which were analyzed through qualitative content analysis. RESULTS: A participatory project was established with three groups of participants organized from both academic and clinical fields. These consisted of a "core research support team," "two steering committees," and community representatives of clients and professionals as "feedback groups." A seven-stage process, named the "Nurse Educators: Al-Zahra Role Expansion Action Research" (NEAREAR) process, resulted from the project, in which strategic issues were gradually developed and implemented through 32 action plans and quality improvement cycles of action research. Audits and supervision evaluations showed meaningful changes in capacity building components. CONCLUSIONS: A nurse-led ad hoc structure with academic-clinical partnerships and strategic management process was suggested as a possible practical model for expanding nurses' educational role in similar contexts. Implications and practical science introduced in this action research could also be applicable for top managers and health system policy makers in a wider range of practice.

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.