Journal of Hayat

Facing Nursing Shortage: a Complex Challenge

Reza Negarandeh

The results of several studies show the relationship between the ratio of nurses/patients with quality of care and patient outcomes (1-3). This means that less the ratio, more expected adverse outcomes for patients. These findings have led some institutions to establish mandated nurse-patient ratios (4). Establishing standard ratios could potentially improve patients' outcomes such as patients' safety (5, 6), decrease length of stay (3) and readmission rates (7), and improve recruitment and retention of nurses in the system and reduce their burnouts (8).

According to Mohammad Aqajani, Deputy of the Iran Ministry of Health and Medical Education (MOHME), the country is facing a serious nursing shortage as about 80 thousand nurses serve 80 thousand beds in public hospitals, i.e. one nurse per hospital bed. However, the national standards suggest at least two nurses per bed. Now each year there are nine thousand graduates of nursing baccalaureate program thus, even if no nurse is retired or leave the system and all graduates could be recruited to work in the nursing field, still at least nine years will be needed to provide adequate nurses. In fact, a significant number of nurses leave their job due to retirement, early retirement, turnover and migration so achieving the standard of nursing staffing in a ten-year timeframe seems impossible. ...

Nurses' Experiences of the Hospital Information Systems

Nahid Dehghan Nayeri

Background & Aim: With regard to the i ncreasing trends of information and complexities of health organizations , using of a dvanced tools and computers is necessary . Hospital staff is key members to develop health information systems, because they play not only a major role in the management of system, but also in the development, implementation and evaluation of the system. Since the evaluation of information systems is not possible without analyzing of the experiences and users ' views, thus the aim of this study was to explore nurses' experiences of the hospital information systems .

Methods & Materials: In this qualitative study, we investigated the nurses' experiences of the application of hospital information systems for the rich and deep understanding of the phenomenon . The c onventional content analysis was used to collect and analyze the data . Face- to-face and semi- structured interviews were conducted with participants to achieve full saturated information. Saturation was achieved with 18 interviews .

Results: The emerging themes were gradual system evolution, , audit and responsibility, security, effectiveness and accessibility .

Conclusion: Nurses' experiences were positive with the applying of the Health Information Systems. The negative experiences of the nurses were related with the application of the system and redundant work, not the system itself. Regarding to participants need, it is recommended that the system should be extended to other duties such as reporting so that more effective use of the system in order to improve the quality.

Nurses’ Perceptions about Causes of Medication Errors: a Qualitative Study

Aziz Kamran

Background & Aim: Medication errors are known as the most common preventable and life threatening medical errors. This study aimed to explore perceptions of nurses on medication errors .

Methods & Materials: This was a qualitative study with content analysis approach. Seventeen nurses were selected purposefully from the intensive care units of Shohada hospital in khoramabad in 2012. Data were gathered using semi structural interviews with the nurses. Data were analyzed using the Lundman and Graneheim method. We used the Linclon and Gouba method to ensure a ccuracy and trustworthiness of the data .

Results: Four main categories and six subcategories were recognized including: 1) Management factors (inefficiency in recruitment of human power, poor physical condition and workload) 2) Inefficiency in professionalism (lack of commitment among nurses, insufficient knowledge and inefficiency in the inter professional relationship) 3) Failure in the process of drug prescription by physicians and 4) Failure in production and packaging drugs by drug companies .

Conclusion: Training and recruiting professional and committed nurses, using electronic medical files, supervision on pharmacy companies to produce and package proper medication can reduce medication errors .

Factors Affecting Women's Birth Intervals: The Case of Women Referred to Health Centers in Ahwaz

Mohammad Reza Akhound

Background & Aim: Reproductive behavior of a society can be studied in different ways. One of these ways is to check the birth intervals. The aim of the present study was to assess the childbirth along with factors influencing childbirth behavioral patterns in Ahwaz .

Methods & Materials: In this study , factors affecting birth intervals of women aged 15-49 were investigated . To achieve this goal, given the nature of the birth intervals, the accelerated failure time model was applied. To estimate the parameters of this model, the R statistical software was used .

Results: Results indicated that women's educational level , husbands' ethnicity , place of residence , use of contraceptives , age at marriage and pregnancy status were factors significantly influencing first birth interval. Furthermore, women's ethnicity, contraceptive use, number of abortions or stillbirths, pregnancy status , duration of breast feeding and type of childbirth were the most important variables affecting the second birth interval. Also, husband's ethnicity, contraceptive use and duration of breast feeding had significant effects on the third birth interval in this study .

Conclusion: Comparing the results of this study with those of previous studies shows a recent decline in pregnancy acceleration and an increase in average birth interval. In other words, changes in socio-economic and cultural statuses have caused longer birth intervals and fertility decreases .

Relationship between Minor Psychiatric Disorders and Job Stability among Southern Iranian Nurses: Using Latent Class Regression Model

Jamshid Jamali

Background & Aim: Nurses’ m ental health is an important dimension of quality of life and health care delivery. Job instability can be threatening for mental health of nurses. This study was conducted to assess the relationship between minor psychiatric disorders (MPD) among nurses with their job stability .

Methods & Materials: This was a cross-sectional-analytical study. A total of 771 nurses working in Bushehr and Fars provinces were recruited to the study through multi stage sampling. Mental health status was evaluated using the GHQ-12 questionnaire. The employment type -contractual, apprenticeship, permanent, and fixed term- were used as items to measure job stability. Data were analysed using latent class regression .

Results: About 27.48% of nurses suffered from MPDs. There was no significant relationship between the types of employment with MPD . There was a significant relationship between MPD with gender (P=0.049). Females were 20% more likely to have MPD .

Conclusion: Prevalence of MPD among nurses was in the moderate level. High prevalence of MPD among female nurses shows necessity of providing appropriate strategies to control MPDs such as anxiety and stress among nurses .

Perspectives of Nurses on Nature, Causes and Consequences of Crisis in Emergency Departments: a Qualitative Study

Nahid Dehghan Nayeri

Background & Aim: H ospital emergency departments in Iran are prone to crisis for different reasons. Understanding nurses’ perspectives about these crises help in crisis management. The purpose of this study was to explain the nature, causes and consequences of crisis in emergency departments from nurses’ points of views .

Methods & Materials: This was a qualitative study with content analysis approach. Data were collected using semi-structured interviews with 12 nurses working in emergency departments of general and trauma hospital. Participants were selected through purposive sampling method. Interviews lasted between 45 minutes to an hour. The data were recorded and transcribed. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed using qualitative content analysis with conventional approach .

Results: Five themes were emerged through data analysis including: 1) unexpected imbalance 2) events 3) defect in service provider factors 4) positive consequences and 5) negative consequences .

Conclusion: The results of this study revealed that every factor that can affect balance and daily tasks can make a crisis in emergency departments. Causes of the crisis can be divided into internal or external factors. Several measures should be planned to decrease the crisis in emergency departments from high rank decision making in the ministry of health and medical education to planning appropriate programs in hospitals .

Critical Thinking in Nurses: Predictive Role of Emotional Intelligence

Zahra Madadkhani

Background & Aim: Critical thinking is a necessary and important component of nursing profession. Since nurses are not limited to work under predetermined roles and need to meet various needs of patients, they should have critical thinking skills. This study aimed to determine the role of emotional intelligence and its components in critical thinking disposition .

Methods & Materials: In this cross-sectional study, 118 female nurses working in educational hospitals of Qazvin were selected using quota sampling method. They completed the Trait Metal Mood Scale (TMMS) and the California Critical Thinking Disposition Inventory (CCTDI). Data were analyzed using descriptive statistics (frequency, mean, standards deviation and Pearson correlation coefficient) and inferential statistics (Multiple Regression) in the SPSS-16 .

Results: The results showed that there was a significant positive correlation between the total score of emotional intelligence with the total score of disposition toward critical thinking (r=0.385). There were also positive relationships between the total score of disposition toward critical thinking with the two subscales of emotional clarity (r=0.459) and emotional healing (r=0.220). There was no statistically significant relationship between the subscale of attention to emotion and total critical thinking score (r=0.117). The subscale of emotional clarity significantly predicted 21% of changes in critical thinking .

Conclusion: Nurses who were more aware of their emotions and emotional transparency had higher critical thinking tendency. Empowering critical thinking can directly affect patients’ conditions. Given the major role of emotional intelligence in critical thinking, teaching nurses such skills could result in better performance and improving the quality of nursing care.

Effect of a Self-Management Program based on 5A Model on Dyspnea and Fatigue Severity among Patients with Chronic Obstructive Pulmonary Disease: a Randomized Clinical Trial

Maryam Heidari

Background & Aim: Exacerbation of the symptoms among patients with chronic obstructive pulmonary disease is a part of the disease's cycle . Despite having medical treatments, most patients experience severe degrees of dyspnea. Self-management programs can help relieving the symptoms. T his study aimed to assess the effect of a self-management program on dyspnea and fatigue severity in patients with chronic obstructive pulmonary disease (COPD) .

Methods & Materials: In this randomized clinical trial, 50 patients with COPD referred to Apadana clinic in Ahvaz were recruited into the study. Patients were randomly allocated to control and intervention groups. The intervention group received a self-management program designed based on the 5A model the control group did not receive any intervention. Patients were assessed using the Fatigue Severity Scale and the Borg Dyspnea Scale at baseline and three month later. The Chi-squared test and t-test were used to analyze the data .

Results: There was no significant difference between the two groups in fatigue severity at baseline. At the end of the three months, the fatigue severity score differed significantly between the two groups (P=0.004). There was also significant reduction in the patients' dyspnea in the intervention group than the control group after 12 weeks (P<0.001) .

Conclusion: Our program was effective in reducing the COPD symptoms among patients. This simple and non-expensive program can be applied as a beneficial intervention to decline major difficulties of the disease among patients with COPD .