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Post-surgery pain is usually controlled by PRN drugs administered by nurses. According to the decision-making theories, this clinical decision-making depends on three factors: nurse-related factors child-related factors and hospital-related factors. This study deals with the first and second factors mentioned. This descriptive-analytic study aims at determining the perspective of nurses on factors which affect their decisions to administer the analgesic PRN to children after surgery in several chosen hospitals of Tehran. The study used a standardized questionnaire to collect data from 57 nurses in pediatric surgery wards. The questionnaire consisted of three parts: 1) nurses demographic data 2) 20 clinical scenario for nurses to make a decision for prescribing either analgesic medication, non-analgesic medication or no medication where necessary and 3) 12 factors which affect clinical decision-making in using analgesics.(in prioritizing among the above mentioned). The results show that factors such as age, nursing experience, pediatric nursing experience and motherhood were significantly related to choosing to use analgesics. Education and personal experience of extreme pain was also related to the type of analgesic chosen. Concerning the specifics of the children there was a significant difference between the choice to use analgesics and the type of analgesic used according to the various ages of the children. There was also a significant relationship between the type of surgery and the time of surgery and with the choice to use analgesics and the type of analgesics used, such that medication and analgesics were administered more frequently for complicated surgeries and in first 24 hours after surgery. Type of surgery, severity of pain, time of surgery and uneasy behaviors were selected respectively as the most effective in the administration of PRN analgesic drugs. Nurse and child related factors strongly influence nurses in making decisions to administer PRN analgesics postoperatively.

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Fear is an undesirable feeling which most of the time results in physiological changes and can affect on the cardiovascular function of the patient. This research is a cross-sectional descriptive study that describes the congruency opinions between 91 patients /nurses about the reasons for patients’ fear related to coronary angiography in two affiliated hospitals of Tehran University of Medical Sciences. The tools which were used included: questionnaire for study and recognition of patient and nurses demographic characteristics, a check list containing thirty probable reasons for patients’ fear which were filled out by patients and nurses, and a scale for analysis of the reasons for fear which were filled out by patients, descriptive statistics indicators, sign test, and t-test were applied in order to analyze the data, by SPSS software. The results showed that patients’ and nurses’ ideas about the reasons for fear before angiography are similar in two cases and only in one case after the operation. Among the thirty probable reasons which were mentioned for patients’ fear, seventeen cases caused less fear after angiography and two cases caused more fear after that. In the comparison between the intensity of fear caused by other reasons no insignificant result was observed. The comparison of intensity of fear showed that the intensity of patients’ fear after angiography is less than before (p= 0.005). According to these cases it may be concluded that because of the different reasons for patients’ fear concerning angiography, nurses need to pay more attention to patients’ fear. It is also suggested that an assessment tool be used in order to assess issues relating to patients, level of care and training related to coronary angiography.

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Introduction: Nurses as the main members of treatment-and-care team play an important role in improvement and promotion of health in society. Job stress is a recognized and integral part of modern nursing which has destructive effects on both nurses and patients.

Materials and Methods: The present descriptive and analytical study aims to determine the level of nurses&apos job stress in Tehran in 2004. It also tries to identify factors affecting job stress from nurses&apos point of view. A total of 111 nurses working in two educational and non-educational hospitals in Tehran were studied. The sampling was simple, i.e. the subjects volunteered to participate in the study. A questionnaire with 2 sections was developed. In the first section we asked about personal and professional characteristics and the second section was designed to evaluate job stress in following 5 categories: management, economy and welfare, mentality and social affairs, occupational health and ergonomics. There was also an open-ended question asking about nurses&apos attitude toward job stress. The questionnaire items were to be answered on a scale ranging from 0 to 4. We used descriptive statistics and Chi square statistical test to analyze the collected data.

Results: The results showed that 44.1% of samples had high levels of job stress while 54.1% suffered from medium and 1.8% from low levels of job stress. There was a significant relationship between hospital type and job stress job stress in the educational hospital was higher compared to the noneducational hospital. There was also an inverse relationship between years of experience and job stress.

Conclusion: Due to high percentage of the subjects with high to medium levels of job stress, employment of preventive and precautionary procedures regarding job stress is recommended.

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Introduction: Education of patients and helping them to be independent in process of self-care in both health and disease is one of the basic responsibilities of nurses.

Methods and Materials: This descriptive-analytic research was done to study perceptions of 317 nurses working in hospitals of Tehran University of Medical Sciences of factors affecting the process of patient education. Data was gathered by means of a questionnaire containing 30 questions about facilitating factors and 17 about inhibiting factors. We used Likert score to measure questions. Data analysis performed by SPSS software. Statistical test were Chi square, t test, variance analysis and correlation of variance.

Results: The highest percentage of nurses (52.1%) believed that enough attention is not being paid to facilitating factors such as considering patient education as priority in patient care, nurses being responsible for patient education, considering patient education as a criteria in nurses annual evaluation, importance of patient education for nurse administrators, having in-service education about patient teaching and having proper time, place and personnel for patient education. Majority of nurses (57.4%) believed factors such as shortage of nurses, lack of proper place, time and patient motivation for receiving education, nurses and nurse administrators’ inattention to patient education and negative attitude of doctors toward patient education by nurses are inhibiting factors in process of education. Statistical tests showed a meaningful relation between demographic variables such as sex, clinical background, shift work and position and facilitating factors. There was also a meaningful relation between variables like working in more than one shift, having clinical experience of patient education and being evaluated for patient education during study of nursing and inhibiting factors.      

Conclusion: This study shows low level of facilitating factors for patient education in hospitals of Tehran University of Medical Science. To improve patient education in these hospitals it is necessary to improve facilitating factors.

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Background & Aim: Today, quality of life measurement is important in health care systems especially for patients with chronic diseases. Heart failure has several complications that affect patients&apos lives. The aim of this study was to investigate the quality of life and its dimensions in patients with heart failure.

Methods & Materials: It is a cross-sectional study. Two hundred and fifty patients with heart failure referred to Tehran medical centers were selected using convenience random sampling method. Data were collected using "Ferrans and Powers quality of life Index". Data were analyzed using descriptive statistics, chi-square, and Pearson correlation coefficients.

Results: The study findings showed that 76/4% of the participants possessed undesirable and less desirable levels of quality of life. There was significant statistical relationship between quality of life with age, gender, education, marriage status, ejection fraction, length of heart disease, co-morbidity, and readmission.

Conclusion: Cardiac heart failure has negative effects on quality of life. So, it seems that if assessing the QOL of these patients becomes one of the nurses&apos duties, it will promote the major caring goals.

 

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Background & Aim: The present research attempted to investigate the effect of time management training on work-life conflict among two hospitals&apos nurses.

Methods & Materials: In this randomized trial, we recruited all nurses of two public hospitals (n=106) in Hamadan and Tehran according to the inclusion criteria. We used balanced (permuted) block randomization for assigning the study sample into control (n=53) and intervention (n=47) groups. Six individuals did not participate in the study. Data were collected using two instruments: 1) work-family conflict scale and 2) time management behaviors scale. For content validity, ten experts in the field of the study commented on the items. The reliability coefficients (Cronbach&aposs alpha) for these scales were 0.86 and 0.75, respectively. All participants completed the questionnaires at baseline. The time management skills were taught in the intervention group for eight hours. One month later, all participants in two groups completed the questionnaires again.

Results: Considering the baseline characteristics, the groups were homogenous. Independent sample t-test indicated no significant differences between the two groups in all dimensions before the intervention (P>0.05). There was significant difference between two groups in the work-family conflict after the intervention (P<0.001). Also, the paired t-test showed significant difference in work-family conflict before and after the intervention in the intervention group (P<0.001).

Conclusion: According to our findings in the present research, time management training intervention had positive effect on work-family conflict among hospital nurses.

 

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Background & Objective: Research utilization is an important way to extent the knowledge in nursing practice. It empowers the nursing profession. Research utilization is a new paradigm in Iran&aposs nursing care. This study aimed to assess the extent of research utilization in nursing clinical practice in Tehran, Iran.

Methods & Materials: This is a cross-sectional study. The clinical nurses with at least one year of work experience were selected through a multistage stratified sampling method. They completed a five-sectioned self-report questionnaire. The scores were categorized into high, intermediate, and low. Data were analyzed using descriptive statistics and Chi-Square test in SPSS.

Results: Findings revealed that the research utilization in 66.9% of the nurses was low. There was significant relationships between the extent of research utilization and the level of education, professional condition, clinical setting, research activities, work shift, job satisfaction, and English language skills.

Conclusion: The majority of nurses&apos practice is not according to the research findings. We need to find appropriate strategies to enable us to utilize the research findings.

 

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Background & Objective: Conflict occurs more frequently in health care organizations than the other settings due to complexity, frequent interaction between personnel, variations in specialties, roles, and hierarchy. Although conflict is not harmful and destructive in its nature and some degrees of conflict can help to improve health care services, high levels of conflict or its continuity may be harmful. Therefore, it is necessary to manage and control conflict. This study was carried out to assess the relationship between components of the conflict control model.

Methods & Materials: In this cross-sectional study, we developed a questionnaire that probed the relationships between components of conflict control model. A total of 290 nurses were recruited to the study using multi-stage sampling procedure from general educational hospitals in Tehran. Data were gathered using a questionnaire. Content validity of the questionnaire was examined by the expert panel. The internal consistency of the questionnaire was 0.81. Data were analyzed in the SPSS using descriptive statistics and spearman statistical test.

Results: The range of age was 22-53 (34.5±8.2). The majority of the respondents (88.6%) were female, 57.6% were married and 84.8% were staff nurses. From the majority of nurses&apos perspective, the meaning of conflict was discoordination, disagreement and disparity. However, some of the nurses meant it as violence, and difficult issues. About 41.4% of the respondents used negotiation, when they faced up to conflict. Other strategies were aggression, disagreement, avoidance, forgiveness, ignorance, and imposing own ideas to the others. From the respondents&apos point of view, factors that might cause or control the conflict were "mutual understanding and interaction" (32.4%), personality of nurses and their individual characteristics (26.6%), and conditions of the job (21.7%). Interaction was recognized to be the core strategy in conflict control model. Interaction had also significant associations with the five main variables in this study.

Conclusion: Lack of appropriate and efficient communication was an important factor in occurrence of conflict from the nurses&apos point of view. It is essential to improve nurses&apos and managers&apos communication channels by helping personnel to use effective communication skills. This measurement can be helpful for staff in understanding each other and reducing misconceptions. In addition, recognizing additional factors and variables that increases the occurrence of conflict can help to modify effective approaches.

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Background & Objective: Nurses&apos perspective on organizational climate can affect job satisfaction and quality of care. Organizational climate influences staffs&apos attitudes and behaviors in either positive directions, such as productivity, satisfaction, and motivation, or negative directions, such as absenteeism, staff turnover, and work accidents. The purpose of this study was to determine factors that influence the nurses&apos perspectives about organizational climate.

Methods & Materials: This descriptive study was carried out in four educational hospitals in Tehran during fall 2009. A total of 140 nurses were selected for the study using simple sampling method. Data were gathered using organizational climate questionnaire including 25 items about in-service education, work communication, group participation, leader supervision, job promotion, and work policies and standards. Data were analyzed in the SPSS v.13.

Results: The most important dimensions of organizational climate from the respondents&apos point of view were: leader supervision (31.4%), coworker communication and support (19.26%), and skills in practice (17%). The most important negative factors that influenced the nurses&apos perspectives were: lack of reward system (49.3%), high work pressure (47.1%), and lack of participation in important decision-makings (39.3%). The most important positive factors influenced nurses&apos perspectives were: adequate job information (63.6%), having good communication with coworkers and having supportive coworker (47.9%), and having good communications with the leaders (40.7%).

Conclusion: Using effective communication skills and making supportive systems in hospitals can help to create optimal organizational climate and may reduce rate of job dissatisfaction, absenteeism, and staff turnover.

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Background & Aim: Quality of health care services shows the degree of achievement of health outcomes. From ethical and legal perspectives, nurses should be responsible for quality of presented care. Retired nurses can help to elaborate real and valuable concepts related to effective factors on quality of nursing care due to their experiences. The aim of this study was to explore the perspectives of retired nurses on factors that affect quality of nursing care in Semnan.

Methods & Materials: In this qualitative content analysis method, 20 retired nurses were invited to the study using purposeful sampling. Data were collected mainly using semi-structured interviews. The analysis was carried out using content analysis.

Results: Findings of the study yielded to three significant themes including: 1) necessity of humanistic relationships 2) suitable selection and education (3) planning and organizing nursing cares related to quality of nursing cares.

Conclusion: Findings of this study explored perspectives of retired nurses on the effective factors on quality of nursing care. The three themes emerged in the study should be mentioned in planning programs.

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Background & Aim: Moral distress, a major issue in nursing, affects nurses in all healthcare sections. The existence of such distress and its consequent job dissatisfaction may pose a threat to nurses&apos physical and mental health, as well as their quality of life and hinder their accomplishment of individual and social goals. The aim of this study was to determine the relationship between the moral distress and job satisfaction In nurses.

Methods & Materials: This cross-sectional correlational study was conducted on 210 nurses employed in the selected healthcare centers of Tehran University of Medical Sciences in 2009. Data were collected using a questionnaire consisting demographic characteristics, the Corley&aposs moral distress scale, and the Minnesota Satisfaction Questionnaire. Data were analyzed using descriptive statistics and independent t-test, analysis of variance, Wilcoxon test and Pearson&aposs correlation coefficient in the SPSS v.14.

Results: According to the findings of the study, the mean of the moral distress was 1.77 out of four and the mean of the job satisfaction score was 3.17 out of 5 indicating a moderate job satisfaction among the nurses. A significant relationship was observed between the moral distress and nurses&apos job satisfaction in the present study, indicating that by decreasing moral distress, job satisfaction increases.

Conclusion: Although numerous factors govern nurses&apos job satisfaction, the observed relationship between moral distress and job satisfaction indicates that identifying and limiting factors influencing these distresses can lead to improved job satisfaction for nurses.

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Background & Objective: Hospitals and healthcare centers, like any other organizations, have some common norms and beliefs called as organizational culture. Organizational culture plays a key role in organization&aposs and staffs&apos performances. Nurses&apos perspectives on the organizational culture affect the way they play their role in. This study aimed to investigate the role of organizational culture from perspectives of nurses working in selected hospitals at Tehran University of Medical Sciences.

Methods & Materials: In this cross-sectional study, 230 nurses working in different wards of selected hospitals of Tehran University of Medical Sciences were recruited to the study. Data were collected using a demographic characteristics checklist as well as the nurse and organizational culture questionnaire extracted from the Robbins criteria. Data were analyzed using descriptive statistical indexes, independent t-test, Pearson correlation coefficient and regression in the SPSS v.17.

Results: Results showed that the existing organizational culture in the selected hospitals was in a moderately good level from nurses&apos perspectives. From the scores obtained for various dimensions of the organizational culture, the highest and lowest scores were for control (44.2%) and conflict tolerance (31.8%), respectively.

Conclusion: The level of the organizational culture from the nurses&apos perspectives might lead them to decrease the quality of their performance. Optimizing the organizational culture can improve nurses&apos performance and motivate them to increase their quality of work.

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Background & Aim: Implementation of the motivational program by nurse managers can improve nurses&apos performance and behaviour, provide better care for patients, and promote patients&apos satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients&apos satisfaction.

Methods & Materials: This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed (α=0.72). Fourty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1) determining nurse managers&apos expectancies from nurses, assessing nurses&apos attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses&apos performance 2) implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses&apos performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16.

Results: There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention (P<0.05).

Conclusion: This motivational program designed based on the "expectancy theory" has clear steps to be implemented among nurses and can be used as a practical guide by nurse managers to improve patients&apos satisfaction.

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  Background & Aim: The most common types of medical errors are medication errors. Medication errors can cause serious health problems and should be considered a threat to patients' safety. The aim of this study was to investigate the prevalence and types of medication errors and barriers to reporting errors by nurses in an educational hospital in Kermanshah University of Medical Sciences in 2012 .

  Methods & Materials: In this cross-sectional study, 96 nurses working in an educational hospital were randomly selected to the study. Review of medication errors and reporting them over the last three months were assessed using a valid and reliable questionnaire. Data were analyzed using the SPSS-20. 

  Results: The prevalence of medication errors was 79.2%. The most common errors included giving oral drugs by mistake (53.1%) and medication later or earlier than the stipulated time (41.7%), respectively. Reporting the medication errors was 14%. Among the barriers to reporting the errors, barriers related to administrative issues were more highlighted than the staff relating barriers.

  Conclusion: The results showed high prevalence of medication errors and low rates of error reporting. Holding periodic courses on safe medication and using management strategies to encourage nurses to report errors are recommended.

  

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  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.

  

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  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 .

  

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  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 .

  

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  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.

  

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  Background & Aim: The &beta-Thalassemia major is a chronic disease that needs a regular blood transfusion. The blood transfusion is a complex process with high probability of human errors during the process which results in serious adverse events in patients. Nurses should deliver care based on the best available evidence or best practice. The aim of this study was to develop an evidence-based clinical guideline of blood transfusion in children with thalassemia .

  Methods & Materials: This study was conducted during 16 months from 2013 to 2014 based on three-step process of guideline adaptation including set up, adaptation and finalization. During these steps, topic and aims of the study were clearly identified. Then health questions were designed based on the PIPOH method. After conducting systematic searches, quality of the retrieved clinical guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and a committee consisting of experts and policy-makers in nursing field. After external review, expert panel meetings and consensus between members, the final version of the guideline was developed . 

  Results: The criteria of clinical practice regarding stages of blood transfusion were determined based on the evidence, cultural and health conditions and were presented in twelve sections.

  Conclusion: This clinical practice guideline developed based on evidence can guide blood transfusion process in clinical practice.

  

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Background & Aim: Evidence-based practice (EBP) education is essential in nursing education. Therefore, identifying factors influencing nurses' adoption of EBP is very important to perform optimum quality nursing interventions. The aim of present study was to determine the factors affecting the adoption of EBP based on Rogers' diffusion of innovations models in nurses.

Methods & Materials: This was a descriptive–analytical study. The research subjects were 130 nurses who worked in the hospitals affiliated to Tehran University of Medical Sciences in 2014. The research instruments were four questionnaires including demographic data; knowledge, attitude and the adoption of EBP; individual innovation and perceived attributes of EBP. Data were analyzed by descriptive and inferential statistics (Pearson correlation coefficient and path analysis) on SPSS v.19 and EQS.

Results: The study findings showed that age and the working experiences of nurses had significant inverse relationships with knowledge of EBP (r=-0.809, r=-0.805). There was a direct relationship between individual innovation and knowledge (r=0.776). In addition, knowledge not only had a significant direct relationship with the adoption of EBP but also had the greatest impact on the adoption of EBP compared to other variables of model (r=0.937). Perceived attributes of EBP had significant direct relationships with attitude and the adoption of EBP (r=0.898, r=0.888 respectively). Attitude toward EBP also had a direct and significant relationship with the adoption of EBP (r=0.869). The results of the path analysis indicated the model variables to have an optimal fit (P<0.001).

Conclusion: The results of this study identify the factors affecting the adoption of EBP. Determining these factors can be an effective step to more adopt it in clinical environments.