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Background & Aim: White lie is one of the inevitable challenges that creates an ethical dilemma during the patient care process. White lie remains an abstract concept in caring process. The aim of this study was to analyze the concept of white lie in the caring process using a hybrid model.
Methods & Materials: A hybrid model of concept analysis including three phases was used in this study. In the theoretical phase, different databases including PubMed, CINAHL, Scopus, Science Direct, Google scholar, SID and Magiran were searched for finding relevant articles published in 1980-2018. The keywords were truth, white lie, care and deception (in Persian and English). In the fieldwork phase, semi-structured in depth interviews were conducted with nurses. In next step, by combining the two previous stages, the final analysis was performed.
Results: In the theoretical phase, the attributes of the concept were determined, including “harmlessness”, “without personal motivation” and “use in compulsion situations”. In the fieldwork phase, three main categories such as “the sweetness of the bitter truth”, “harmless sentences to prevent harm” and “temporary relief to balance the situation” were identified from the data analysis. By merging the concepts extracted from the theoretical and fieldwork phases, “white lie in the patient care process” was defined as “an ethical decision without personal motivation, which is chosen in unstable situations to prevent predictable harms to the patient in facing the bitter truth”.
Conclusion: Although a definition of white lie was developed based on the above three phases, the further development of this concept requires a deeper look at the Iranian-Islamic culture. Therefore, further research is recommended in other medical centers in the country.
 

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Background & Aim: Patient participation is an important component of the patient-centered care approach and part of patients’ rights, with positive outcomes for the health care system. The aim of this study was to explore the nurses' experiences of patient participation in nursing care and its related factors.
Methods & Materials: This qualitative study was carried out with the participation of 18 nurses working in educational hospitals of Tabriz in 2019. The purposeful sampling through semi-structured interviews and focus group sessions was used to collect the data. Data analysis was performed using conventional content analysis. To achieve the accuracy of the data, the Lincoln and Guba criteria were used.
Results: Analysis of the data resulted in four main categories "giving information, decision-making, collaboration and respect". The patient’s participation from the nurses’ perspectives was: an interactive process of decision-making and collaboration between the nurse and the patient with the exchange of information, respect, and permission from the patient. The results also included the prerequisites, domains, outcomes, barriers, and solutions for patient participation in nursing care.
Conclusion: Patient participation today is considered the legal right of the patient and also the gold standard of international health care systems. So nurses, health system policy makers, patients and academic centers can use these results to improve patient participation in the care.
 

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Background & Aim: Cardiovascular diseases, especially coronary artery disease, are one of the most common causes of death worldwide. Recently, coronary intervention through the skin has been used for treatment, which has significantly reduced mortality rates. Nursing care behavior is of special importance in reducing the complications of angioplasty. The purpose of this study was to determine the effect of primary nursing care on the patients’ perception of nursing care behavior after coronary angioplasty.
Methods & Materials: In this randomized controlled clinical trial, 60 patients admitted from February 2018 to April 2018, to the CCU of Razi hospital in Birjand were selected by the convenience sampling method and assigned into two groups of 30, using a simple random allocation method. For the patients in the control group, routine care was delivered case by case, and for the patients in the primary nursing care group, care was provided based on the nursing process. At the time of discharge, the Caring Behaviors Inventory (CBI) was completed for the patients via interviews. Data were analyzed using the independent t-test and the significance levels of 0.05.
Results: The results showed that the mean scores of perception of care behavior and dimensions "respect" and "assurance of humanistic presence" in the intervention group were significantly higher than those of in the control group (P<0.05). However, no significant differences were observed between the two groups in the dimensions "positive attitude and relationship", "knowledge and professional skill" and "attention to other experiences" (P>0.05).
Conclusion: Provision of primary nursing care leads to improving the patient’s perception of nursing care behavior, increasing sense of respect, and assurance of humanistic presence of the nurse. Therefore, it is recommended to use this caring method in the cardiac intensive care unit.
 

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Background & Aim: Considering the importance of communication skills in nursing, we aimed to study the impact of online support and e-content on communication skills of nurses with patients.
Methods & Materials: In this quasi-experimental study with pre- and post-design, 100 nurses employed in the orthopedic wards of Chamran hospital affiliated to Shiraz University of Medical Sciences in 2018 were selected randomly and assigned into two groups of 50. Both groups received the electronic content of communication skills. In the intervention group, in addition to receiving educational content, online support was provided through social media for four weeks with the presence of a psychologist, so that by asking real questions and problems or simulated scenarios, appropriate behavior in that situation was discussed. Before and eight weeks after the intervention, communication skills in the both groups were assessed by the Burton Jay's Communication Skills questionnaire, and data was compared using independent t-test and analysis of covariance.
Results: The results showed that there was no significant difference between the two groups in the communication skills score before the intervention, but eight weeks after receiving the e-content, the participants' scores increased in the both groups. This increase was greater in the online support group (P<0.001). In fact, online support caused a difference (0.637) in the communication skills score between the two groups.
Conclusion: The results of this study showed the provision of e-content along with online support has led to the improvement of communication skills. It is recommended that in addition to education through e-content, social media be used in the empowerment programs of the treatment team including communication skills improvement, due to their advantages such as ease of use, availability and relatively low cost.
Clinical trial registry: IRCT20090127001599N27
 

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Background & Aim: Traumatic brain injury management focuses on the prevention and treatment of secondary brain injuries. The aim of this study was to adapt a clinical guideline (CG) for nursing care of secondary brain injuries in adults.
Methods & Materials: This study was carried out through a multi-stage evolutionary study at Isfahan University of Medical Sciences in 2017. Based on the opinions of experts using AGREE tool, the quality of 8 out of 13 CGs for the treatment and care of head injuries was assessed as optimal. These were used in drafting the adaptive CG. In addition, 12 CGs, 13 articles and 5 books were used to complete the recommendations of the mentioned guideline. The CG draft was evaluated using the Delphi method and the panel of experts. Finally, it was presented as an adaptive CG.
Results: The adaptive CG for nursing care of secondary brain injuries was developed in 158 recommendations and five sections; nursing care to prevent and manage the increased intracranial pressure, nursing care to maintain and increase cerebral blood pressure, nursing care to prevent and control seizures, nursing care to prevent and control brain infections, and nursing care to prevent and control secondary extracranial injuries.
Conclusion: The nursing staff of emergency and neurological wards and intensive care units can apply the recommendations of this clinical guideline to address some of the care needs of the injured patients and improve their health conditions.
 

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Background & Aim: Clinical decision-making is an essential part of the nursing profession. The nursing profession is based on ethical principles. Due to their commitment to patients, morally courageous nurses ignore occupational risks threatening their own lives.  The aim of this study was to investigate the relationship between moral courage of nurses and their participation in clinical decision-making.
Methods & Materials: This descriptive, cross-sectional study was conducted in 2019. The study population was nurses working in the CCU and ICU of Shahid Rajaie Cardiovascular Medical and Research Center. The sample size was 195 people. The data was collected using the Sekerka’s Moral Courage Scale, and the Participation in Decision Activities Questionnaire (PDAQ). Data was analyzed using descriptive statistics, independent t-test and Pearson correlation coefficient through the SPSS software version 19.
Results: The mean scores of moral courage and PDAQ in nurses were 90.38 ± 11.48 and 117.24±39.42, respectively. A positive correlation was found between moral courage and participation in clinical decision-makings (r=0.397, P<0.001).
Conclusion: The results showed that moral courage has pride of place in the nursing profession that can encourage nurses to actively participate in clinical decision making. Therefore, professional ethics courses are suggested to be organized to improve decision-making and clinical ethical performance of nursing students and nurses.
 

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Background & Aim: Nurses' organizational loyalty to health systems plays an important role in expanding organizational performance. Investigating the role of factors such as citizenship behaviors and adaptive performance can be helpful in this regard. The aim of the present study was to investigate the relationship between citizenship behavior and adaptive performance with organizational loyalty in nurses.
Methods & Materials: This descriptive, cross-sectional study was conducted in 2019 on 200 nurses working in Valiasr hospital affiliated to Shahrekord University of Medical Sciences in Borujen, and were selected by the random sampling method. A demographic information form, the Lee & Allen’s citizenship behavior questionnaire, the Charbonnier-Voirin and Roussel’s adaptive performance scale, and the Kumar and Shekhar’s organizational loyalty questionnaire were used to collect the data. The data was analyzed by descriptive and inferential statistical tests using the SPSS software version 16.
Results: The Pearson's correlation coefficient indicated a significant positive correlation between citizenship behavior and adaptive performance with organizational loyalty (P<0.05). Regression tests showed that citizenship behavior (ADJ.R²=0.199) and adaptive performance (ADJ.R²=0.131) significantly predicted organizational loyalty. All dimensions of citizenship behavior and some dimensions of adaptive performance such as creativity, learning efforts and job stress management can predict organizational loyalty in nurses. The average scores for citizenship behavior (66.85±18.26), adaptive performance (68.76±16.98) and organizational loyalty (120.67±24.09) were reported to be moderate.
Conclusion: Managers and planners should pay attention to factors such as creativity, stress management, and continuing education along with improving healthy working relationships and nurses’ participation, which can play an important role in expanding organizational loyalty through the development of citizenship behavior and adaptive performance.
 

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Background & Aim: Patient safety in general and medication errors in particular are the important indicators of hospital care quality. Risk management is an important and fundamental approach to preventing events caused by medication errors. The aim of this study was to determine the effect of risk management program on the rate of medication errors among intensive care unit nurses.
Methods & Materials: The present study was a non-randomized pre-test, post-test study with a control group, conducted in 2020 in two hospitals in Tehran. The hospitals were randomly assigned to either an experimental group or a control group. According to the inclusion and exclusion criteria, 150 nurses (75 nurses in each group) were selected by the convenience sampling method. For the experimental group, a risk management program was implemented. Data collection tools included the nurses’ demographic questionnaire, the 14-item Wakefield medication error self-reporting questionnaire, and the nurses’ medication quality checklist. Data was collected before and after the intervention and analyzed by the SPSS software version 16 using descriptive and inferential statistics.
Results: The results of independent t-test showed no statistically significant difference between two groups in demographic information and the rate of medication errors before the study (P>0.05). After the intervention, difference in the rate of medication errors was statistically significant between the two groups (P<0.005), indicating a decrease in medication errors in the nurses of the experimental group compared to the control group. The results also showed that the rate of medication error observed in nurses was significantly higher than the error reported by them (P<0.001).
Conclusion: The results showed that the implementation of risk management program was effective in reducing nurses’ medication errors. Implementing a risk management program is recommended to nurses as a way to promote safe medication and achieve safe and desirable nursing care.
 

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Background & Aim: The Covid‐19 pandemic has posed numerous ethical challenges to nurses and has exacerbated moral distress in clinical settings. Hence, due to the important role of nurses in pandemics, this study was conducted to investigate the severity and frequency of moral distress among nurses working in clinical settings at Maragheh teaching hospitals during the outbreak of COVID-19.
Methods & Materials: This was a cross-sectional study conducted on 174 nurses working in surgical-medical, intensive care, pediatric and emergency wards of Maragheh hospitals in 2020-2021. Data were collected using a demographic form and the Corley’s Moral Distress Scale.
Results: The median (Interquartile Range (IQR) = Q3 − Q1) of the severity and frequency of moral distress experienced were 54 (44-59) and 52 (43-58), respectively. The median of moral distress experienced in the intensive care and emergency wards were 56 (51-59) and 46 (43-51), which was more severe than that of in other wards. The median of frequency and severity of moral distress in men were 48 (41-59) and in women 50 (43-59), respectively, which was significantly higher than that of in women (P<0.001). The severity and frequency of moral distress had a statistically significant relationship with age, and work experience (P>0.05) so that with increasing age and work experience, the severity and frequency of moral distress decreased.
Conclusion: Given the high frequency of moral distress among nurses during the COVID-19 pandemic in specific clinical settings, the use of management strategies in order to improve working conditions and create a positive setting can be helpful. It seems that holding courses on coping with moral distress in nurses in the context of the COVID-19 pandemic is an appropriate practical solution.

 

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Background & Aim: In the health care system, manpower recognized as a key factor for development, has an important role in community health. Ensuring the quality of service delivery necessitates the maintenance and enhancement of job satisfaction among service providers. One influential aspect of job satisfaction is the individual’s happiness. This study aimed to determine the correlation between job satisfaction and happiness among nurses working in hospitals affiliated to Tehran University of Medical Sciences.
Methods & Materials: This descriptive-correlational study was conducted with a sample of 362 nurses from hospitals affiliated to Tehran University of Medical Sciences. Sampling was performed using a quota sampling method. The data collection tools included a socio-demographic characteristics questionnaire, a Job Satisfaction Questionnaire, and a Happiness Questionnaire. Data were analyzed using Kendall Tau-b correlation and Pearson correlation, with SPSS software version 26.
Results: The mean score for nurses' job satisfaction was 217.40, while the mean score for happiness was 69.27, with both scores indicating an average level. The results of the study revealed a significant positive relationship between job satisfaction and happiness (r=0.614, P<0.05), indicating that happier nurses tend to have higher job satisfaction, whereas lower job satisfaction is associated with decreased happiness.
Conclusion: Nurses’ job satisfaction and happiness are not at optimal levels. However, a positive correlation between the two has been identified. Therefore, healthcare system administrators and officials should focus on creating essential infrastructure and planning initiatives to enhance nurses’ job satisfaction, ultimately fostering greater happiness among nursing staff.

 

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Background & Aim: Nurses, due to the demands of their profession, are frequently exposed to high-stress clinical situations, such as the COVID-19 pandemic, which can lead to moral distress and affect their resilience, ultimately contributing to job burnout. This study aims to investigate the relationship between moral distress, resilience, and burnout among nurses.
Methods & Materials: In this descriptive, cross-sectional study, 188 nurses working in hospitals affiliated with the Birjand University of Medical Sciences during the years 2021-2022 were selected through simple random sampling. The data collection tools included demographic information, the Moral Distress Scale, the Davidson Resilience Scale, and the Maslach Burnout Inventory. Data were analyzed using descriptive and inferential statistics in SPSS software version 21.
Results: The results indicated that the nurses experienced low moral distress (30.28±12.59), high resilience (63.70±13.44), and high levels of burnout (54.98±12.30). A direct and significant relationship was found between moral distress and burnout, while a weak and significant inverse relationship was observed between moral distress and resilience (P<0.001).
Conclusion: Given the significant relationship between moral distress, resilience, and burnout, it is recommended that policymakers develop strategies to enhance resilience, which could lead to a reduction in moral distress and burnout among nurses.