Journal of Hayat

Challenges of professional self-regulation in Iranian nursing

Reza Negarandeh

The essence of nursing is protecting the public and nursing profession believes that receiving high quality and safe services, is the community’s right. During the past decades nursing has been considered as a significant profession with characteristics such as autonomy, professional commitment, expertise and responsiveness (1). The body of contemporary nursing is consisted of knowledge and skills, value system, academic education and professional socialization. Autonomy has been defined as nurse’s capacity for determining their action through independent choosing in all the fields of nursing practice and self-regulatory in nursing practice is necessary for achieving professional freedom of action (2).
Professional self-regulatory is the decision-making power for determining the inclusion criteria for the members to enter the profession and start their activity in that profession. It will determine who, with what specialties and how much knowledge and skills have the inclusion criteria for the profession (3). During the mid-19^th century, combination of knowledge and skills, emphasis on commitment to duty against seeking personal interests and also independence from external interferences in professional matters (autonomy) were mentioned as the most important features of self-regulated professions. From the early 20^th century, the motivations for professionalization got in line with professional self-regulatory (2). According to the Donabedian Model, a “social contract” exists between the society and the profession and under this contract the society will accept profession’s independence in exchange for their services and will give independence to that profession so that they could manage their own matters. In return for this privilege, the profession would act responsively to maintain the public interests (4).
Professional self-regulation would be granted to a profession as a privilege when the public would be able to receive the best possible services after that professions’ self-regulation (4). In fact, professional self-regulatory would guarantee the quality of services (2,5,6). During the past two decades, World Health Organization (WHO), to educate and employ competent and skilled nursing workforce, has recommended the governments to strengthen their professional self-regulatory frameworks. International Council of Nurses (ICN) in cooperation with the WHO has published a statement of their perspective of professional self-regulatory. This statement has mentioned that safe and high quality care, creating a monitoring system for licensing, professional policy making and applying the professional laws and rules could be reached by creating and improving the infrastructures of professional self-regulatory systems. ICN stated that professional self-regulatory is a method for applying discipline, stability and control over the profession and its performance (7, 8). National and international studies have shown that would improve educational and clinical standards which in turn would increase the power of the profession in managing its own matters.
Since professional self-regulatory would lead to the activity of qualified and competent individuals in a profession, it would increase people’s trust in professional services providers as capable and honest individuals and would provide the public interests (1). In professional self-regulatory, by firing professionally unqualified and uncommitted to the ethical codes individuals from the profession, the interests of the profession would be provided (4).
In the main, there are two ways a profession can be regulated: by the profession itself (professional self-regulatory) or directly by government. If the government would take the responsibility of managing the profession, the members of the profession would be forced to accept the laws and rules of the profession; while the approved laws by the self-regulated profession are flexible and would be accepted voluntarily (9).
Self-regulatory professions have two separate bodies for their activities: 1- the monitoring body and 2- the supporting body. The monitoring body maintains the interests of the profession through creating the inclusion criteria for the profession, licensing, certifying and disciplinary actions; while the supporting body would perform toward promoting the economic and professional benefits of the profession’s members. The goal of the supporting body is to develop the profession to assist the members and advance the profession; but the monitoring body will develop the profession to support the public interests. Most of the times, the public interests are not in conflict with the profession’s interest, but in case of such conflicts, professional self-regulatory should act toward achieving the public interest (10).
The condition of professional self-regulatory in Iranian nursing
Iranian nursing has had significant advancements during the recent years which development of academic education, formation of Iranian Nursing Organization (INO), establishment of Scientific Association of Iranian Nursing, establishment of research centers and publishing numerous research-scientific journals in different fields of nursing are some of them (11). However, the profession of nursing in Iran still has many shortcomings. Evaluating the laws of the Nursing Organization of the Islamic Republic of Iran, which is the greatest non-governmental nursing organization in Iran, although the goals of the organization are in line with the self-regulatory goals of the profession, but in most of the self-regulation requirements, no independent role has been defined for the organization, in a way that, in the definition of 6 duties out of 8 defined duties for the INO cooperation with or helping other organizations has been used and only in the third duty, “trying for improvement of the quality, skills and knowledge of nursing graduates” and the seventh duty, “determining standards for issuing, extending or cancelling membership cards”, the legislator has appointed an independent role for the organization. Maybe for this reason, and many other reasons that are not in the scope of this article, the INO has not considered professional self-regulation performances sufficiently. Other nursing associations in Iran, due to lack of regulatory mechanism and also the low number of members from the nursing profession, could not have an effective role in professional self-regulatory. In Iran, regulating the rules and managing the matters of nursing have always been a responsibility of the government (6,12). On the other hand, during the recent years, we have witnessed the establishment of the nursing deputy in the Ministry of Health and Medical Education (MOHME) which indicates the efforts for governmental management of this profession.
The authorities’ approach toward the nursing profession during the recent years for encountering various challenges is one of the examples of governmental management and lack of professional self-regulatory. For example, the nursing shortage could be mentioned which is a global problem. To resolve this problem, the MOHME has increased the capacity of training nursing students and the number of nursing schools. These measures have led to educating students at schools with no infrastructures and no competent educational board which is in conflict with the quality of services (public interests). In return, the next measure to compensate for the shortage in nursing workforce is educating practical nurses by the MOHME. Most of the experts have suggested this solution for the problem of shortage in nursing workforce, but it has been perceived as compulsory by the members of the profession and they disagree with it (13).
Considering that finding an appropriate self-regulatory mechanism for the profession requires the involvement of all the beneficiaries, especially the members of the profession, it is recommended that all of the active organizations in the field of nursing would start determining the characteristics and features of an appropriate self-regulatory organization for the nursing profession of Iran through conversations and then would make their best efforts for its establishment.

The effect of stretching exercises on the severity of restless legs syndrome symptoms in patients with multiple sclerosis

Meimanat Hosseini

Background & Aim: Restless legs syndrome (RLS) is a sensorimotor disorder that is frequently observed in patients with multiple sclerosis. This study aimed to determine the effect of stretching exercises on the severity of restless legs syndrome symptoms in patients with multiple sclerosis.

Methods & Materials: This quasi-experimental study with control group (IRCT2016041627427N1) was conducted on 60 patients with multiple sclerosis (30 in the intervention group and 30 in the control group) referred to the multiple sclerosis society of Kermanshah in 2015. “The demographic questionnaire”, “the symptoms of restless legs syndrome and their severity”, and “exercise recording form” were used to collect the data. The intervention group was taught the correct way to exercise during four half-hour sessions. The severity of RLS symptoms was measured before the intervention and the end of the fourth and eighth weeks. Data were analyzed by descriptive and inferential statistics using SPSS software version 20.

Results: Before the intervention, the mean score for the severity of RLS symptoms was respectively 19.08±8.12 and 17.42±5.24 in the intervention and control groups (P=0.569). One month (P=0.002) and two months after the intervention (P<0.001), the score was changed to 9.70±5.24 and 7.08±4.08 in the intervention group and 17.61±5.31 and 17.92±5.52 in the control group.

Conclusion: Stretching exercises can improve the severity of RLS symptoms in patients with multiple sclerosis. Therefore, the stretching exercises program is recommended for this group of patients.

Contributing factors to nursing error in emergency department: A qualitative study

Abbas Abbaszadeh

Background & Aim: Error always occurs in the health system and it can lead to irreparable consequences. Therefore, error prevention must be taken into account by the health systems. Detection of factors contributing to error is a key factor for the prevention of error. Hence, the aim of this study was to explore factors contributing to nursing error in emergency department.

Methods & Materials: This study was conducted using a qualitative approach. 17 emergency nurses participated in this study. Semi-structured interview was used to collect the data. Sampling was started as the purposive sampling and continued until the saturation of data was reached. Data were analyzed using the Elo & Kyngas (2008) qualitative content analysis approach. To achieve trustworthiness, participants were selected with maximum variation in terms of age, gender, work experience, and educational background.

Results: The analysis of data led to the emergence of 500 open codes and four categories including the predisposing factors of nurse-related error, predisposing factors of organization-related error, predisposing factors of error related to the culture of emergency department and predisposing factors of patient-related error.

Conclusion: Factors contributing to nursing errors in emergency department were very wide and multifactorial. Identifying the factors contributing to error is a first step to prevent errors. For reducing nursing error, nursing managers should pay special attention to the contributing factors of error identified by this study and implement interventions to reduce and mitigate these factors.

The effect of Nigella Sativa syrup on the relief of cyclic mastalgia: A triple-blind randomized clinical trial

Ameneh Sotoodeh Moridiani

Background & Aim: Mastalgia is one of the most common complaints of women and its cyclic type constitutes two-thirds of the cases. This study aimed to determine the effect of Nigella Sativa syrup on cyclic mastalgia.

Methods & Materials: This study is a triple-blind randomized clinical trial (IRCT201104304785N3). The study samples included 65 women with cyclic mastalgia referred to the Breast Cancer Research Center (BCRC), Academic Center for Education, Culture and Research (ACECR) in Tehran in 2014-2015. The samples were randomly divided into two groups: intervention group (Nigella Sativa=36) and placebo group (oral paraffin=36). The pain was measured by the VAS and McGill Short Form questionnaire two months before and three months after the intervention. Data were analyzed using statistical tests on the SPSS software version 18.

Results: The results of the VAS and McGill pain score changes showed a significant difference between the two groups. Considering that the interaction between time and group was significant, the two groups were compared at each stage using independent t-test and the Bonferroni correction test. Thus, there was no significant difference between the two groups of Nigella Sativa and placebo on the basis of the McGill instrument but a significant difference was observed between the two groups on the basis of the VAS (P=0.002).

Conclusion: According to the results, Nigella Sativa reduces pain more than placebo. Therefore, it can be used along with other medications for the treatment of mastalgia.

Comparing the effect of telenursing and education without follow-up in the caregivers of heart failure patients on the self-care behavior and clinical status of heart failure patients

Maryam Heidari

Background & Aim: Besides medical treatment, self-care education is necessary for patients with heart failure. The aim of this study is to compare the effect of telenursing and education without follow-up in the caregivers of heart failure patients on the self-care behavior and clinical status of heart failure patients.

Methods & Materials: This clinical trial (IRCT2016080829184N2) was performed on 66 heart failure patients referred to the clinic of Taleghani hospital in Abadan in 2015-2016. The patients were randomly divided into three groups: control, intervention-1 and intervention-2 groups. Control group did not receive any intervention. Patients and caregivers in the intervention-1 group received verbal education, and caregivers in the intervention-2 group received continuous phone follow-up plus verbal education. Self-care behavior, fatigue severity and exercise tolerance were assessed in the patients by the self-care behavior questionnaire, fatigue severity scale and six minutes walking test at baseline and the end of 3 months. Descriptive statistics, chi-square, paired t-test, ANOVA, ANCOVA and Scheffe post hoc test were used to analyze the data using the SPSS software v.18.

Results: At baseline, three groups were consistent in terms of demographic variables and three variables. At the post-test, there was a significant difference between the intervention-2 group with the control group and intervention-1 group in self-care behavior (P<0.001) and the patients’ fatigue score mean (P<0.004). But, no significant difference was observed between three groups in the patients’ exercise tolerance score mean.

Conclusion: Telenursing for the caregivers of heart failure patients can lead to the improvement of self-care behavior and decrease in fatigue among the patients.

Exploring the consequences of culturally sensitive care in pediatric nursing: A qualitative study

Parvaneh Aghajari

Background & Aim: Culturally sensitive care is an essential component of professional development process and one of the predictive factors of nurses’ cultural competency. This care is the most important approach to improve the quality of nursing care in culturally diverse groups. The current study aimed to explore the consequences of culturally sensitive care in pediatric nursing.

Methods & Materials: This study is a qualitative study using conventional content analysis. 25 nurses and 9 parents were purposefully selected with maximum variation sampling from the pediatric wards of three referral teaching hospitals in Tabriz and Tehran in 2015-2016. Data were collected through in-depth interviews and field notes and simultaneously analyzed using MAXQDA software version 10.

Results: The consequences of culturally sensitive care in pediatric nursing emerged in two categories: justice-based care (with three subcategories: the lack of cultural bias, culture-based communication and effective participation) and cultural satisfaction (with two subcategories: reduced cultural stress and safe care). Culturally sensitive care prevents misunderstandings and improves nurse-child/parents communication and leads to parents’ honesty to share information and express cultural needs. The expression of cultural needs decreases stress levels in parents and children and results in safe care by reducing intractable traditional treatment.

Conclusion: According to the findings of this study, it is suggested that effective culturally sensitive interventions in pediatric wards should be included in in-service courses and nursing curriculum.

Social reasons for young pedestrian’s risky road crossing behaviors: A qualitative study

Reza Negarandeh

Background & Aim: Pedestrians are the most vulnerable road users. In many cases, pedestrian-vehicle crashes are often the result of their risky road crossing behaviors. So, this qualitative study aimed to explore the reasons for risky road crossing behaviors among young people.

Methods & Materials: The current study was designed as a qualitative content analysis. Twelve males and females who had a car-accident were purposefully selected with maximum variation sampling. Data were collected and analyzed by semi-structured individual interviews.

Results: Conformity with the masses including “conformity with peers and conformity with the public space of society”, and anomie emerged as the most important social reasons for young pedestrian’s risky road crossing behaviors.

Conclusion: According to the results of this study, young pedestrian’s risky road crossing behaviors are affected by conformity with the masses and peers and as well as anomie so that risky behaviors have been commonplace and inevitable and a part of their lifestyle.

Correlation between knowledge-skill and the importance of physical assessments in nurses: A descriptive correlational study

Om Salimeh Roudi Rasht Abadi

Background & Aim: Patients’ assessment is fundamental to nursing practice and the more precise assessment nurses can perform, the better outcomes patients can achieve. Better practice requires suitable knowledge, skills and attitude regarding the importance of physical assessment. This study aimed to determine correlation between knowledge-skill and the importance of physical assessment in nurses employed in hospitals.

Methods & Materials: In this descriptive correlational study, 300 nurses employed in the medical, surgical, ICU and CCU wards of hospitals affiliated to Kerman University of medical sciences, were chosen conveniently in 2016. The data collecting instrument included demographic data, knowledge-skill and the importance of physical assessment items. Data were analyzed by the SPSS software version 19 using correlation coefficient test, linear regression and ANOVA.

Results: The mean score of knowledge-skill was 3.14(±0.74) and the median (mode) score of importance was 4(0.52). There was a significant and positive correlation between knowledge-skill and the importance of physical assessment. The nurses had higher knowledge-skill scores for those skills that they had considered more important. The most effective variable on the correlation between knowledge-skill and importance was education.

Conclusion: Nurses’ self-assessment of their skills in performing physical assessment was at a low level but they considered all skills important. Effective educational programs can fulfill the nurses’ needs for physical assessment skills.