فصلنامه حیات
سال بیست و سوم شماره 4 (پیاپی 76، زمستان 1396)

World’s health systems have entered a critical period of human resource shortage. The shortage of qualified nurses has been suggested as one of the most important barriers to achieve effective healthcare systems (1). According to the WHO (2014), there is currently a shortage of 7.2 million health care providers at the international level. This shortage is estimated to reach 12.9 million by 2035 (2). In other words, in order to develop healthcare systems, achieve positive outcomes and ensure patient’s safety, recruiting well-qualified nurses is a global concern (3). Nursing shortage in Iran has also become a concern for managers and a major challenge to the healthcare system. The nursing deputy of the Iran Ministry of Health and Medical Education reported that the number of nurses working in health care settings is estimated to be 140,000, but there is a need for 2,60,000 nurses to deliver ideal levels of health care (4). While, qualified nurses adequacy is one of the essential components of the nursing professional practice environment (5). Poor nursing work environment, inadequate resources, imbalanced workload, disproportionate nurse-patient ratio, high bureaucracy (5), lack of supportive management, low salaries, and reduction in employment are major challenges that have caused Iran’s healthcare system to face a serious crisis of nursing shortage despite a large number of young nursing graduates (6). Evidence suggests that the nursing practice environment has a significant role in the retention of expert nurses, the quality of care and, safety of patients (7). Poor nursing work environments are related to adverse patient outcomes, including an increase in mortality rate, patient falls, and medication errors (8, 9). In addition, unhealthy workplaces are important causes of turnover, efficient nurses’ intention to leave, early retirement, job dissatisfaction and burnout (10, 11). Therefore, efforts to create environments that attract and retain nurses are worthwhile. Different strategies have been proposed to improve the nurses’ work environment. In this regard, making workplace attractive is a basis for increasing the quality of nursing practice environment (12).
Today, there are hospitals called "Magnet Hospital" that are renowned for attracting and retaining expert nurses. The Magnet hospital was first used in the United States. In the early 1980s, concurrent with nursing shortage crisis in the United States, extensive studies were begun to examine the organizational structures of Magnet hospitals. In a study, the American Academy of Nursing (AAN) identified 41 hospitals that were known to attract and retain qualified nurses, and used the term "Magnet" as a gold standard for nursing practice in these hospitals (13). Magnet hospitals are evaluated in terms of achieving goals in five areas including transformational leadership, structural empowerment, new knowledge, innovation, and empirical outcomes and development (14). Magnet hospitals with a more different organizational structure than non-Magnet ones play an important role in nurses’ job satisfaction and retention (15). One of the main reasons for the attractiveness of these hospitals is the existence of work environments focusing on decentralized decision-making, autonomy, control over practice, resource adequacy, supportive management, effective inter-professional communication, and career development (16). In other words, the organizational attributes of Magnet hospitals lead to the nurses’ empowerment by increasing autonomy and authority, and subsequently improving job satisfaction. These hospitals have designed a set of work environment standards to support professional nursing practice (17). Many studies have shown that Magnet hospitals provide a healthier environment with higher job satisfaction for nurses and better outcomes for patients, compared to non-Magnet ones (18, 19). In recent years, the development of Magnet hospitals has rapidly grown in various countries. Considering the complexity of nursing shortage phenomenon, paying attention to the factors influencing the nurses’ attraction, retention and productivity is important to overcome the challenge of nursing shortage (20).
The nurses’ dissatisfaction with the work environment and consequently, the shortage of competent and educated nurses, is a major challenge to Iran’s health system. Therefore, solving this crisis is vital to prevent adverse health consequences. In this regard, nursing managers and health policy-makers can create a quality work environment using the features of Magnet hospitals to increase the attraction and retention of health care professionals, especially nurses. This will not only result in the nurses’ job satisfaction but will also increase the quality of care and ensure the patients’ safety.

Moral sensitivity has various dimensions including personal sentiments, scientific competency, and reasoning and decision making capabilities. To achieve this, some personal traits and educational preparedness are needed. The aim of this study was to determine nurses’ moral sensitivity and its relationship with demographic and professional characteristics in hospitals affiliated to Tabriz University of Medical Sciences.
Methods & Materials: This descriptive, correlational study was conducted on 198 nurses working in the medical wards of hospitals affiliated to Tabriz University of Medical Sciences in 2016. Census sampling method was implemented. Data were collected through a demographic and professional characteristics form and the Moral Sensitivity Questionnaire (MSQ). The data were analyzed by the SPSS software version 13 using descriptive statistics, T test, Pearson correlation coefficient and ANOVA.
The mean score for nurses’ moral sensitivity was 4.84±0.48 (out of 7). The highest scores were related to the domains of “Interpersonal orientation” and “following the rules”. The lowest scores were related to the domains of “experiencing moral conflict” and “modifying autonomy”. There was a significant and inverse correlation between age and “modifying autonomy” (P=0.008, r=-0.193) and also between age and “following the rules” (P=0.034, r=-0.156). Moreover, there was a significant and inverse correlation between work experience and “following the rules” (P=0.009, r=-0.187).
Given that the nurses gained a low score in the domain of “modifying autonomy”, it is suggested that client centered care and patient’s autonomy be emphasized in developing nursing curriculum and in service training programs.

Urinary incontinence is a common disorder in women. Pelvic floor muscle exercise is one of the effective treatment methods. Self-efficacy is considered an effective and strong predictor of willingness to perform and continue these exercises. In Iran, there is no appropriate tool for assessing self-efficacy. So this study was performed to determine the psychometric properties of the Broome scale in women with urinary incontinence.
Methods & Materials: A psychometric study of the Broome scale was conducted on women with urinary incontinence who referred to health centers affiliated to Tehran University of medical sciences in 2015.In this study, following processes were implemented: translation, back translation, face validity, content validity using CVR and CVI, reliability using Cronbach’s α coefficient, and construct validity using explanatory factor analysis.

The face validity was confirmed through the modification of ambiguous items based on the patients’ views. Content validity (CVR= 0.8 and CVI= 0.8 to 0.9) and reliability (Cronbach’s α= 0.96) were also confirmed. Explanatory factor analysis showed two factors with eigen value more than 1 including pelvic floor exercise self-efficacy in usual and special situations. These factors explained 82.08 percent of the total variance.

The reliability and validity of the Broome scale were confirmed for using by Iranian women with urinary incontinence, and this scale can be used to measure these women's self-efficacy in performing pelvic floor exercises.

Nurses play an important role in the health system and their turnover disrupts its performance. The aim of this study was to investigate intention to turnover and its relationship with healthy work environment among nursing staff.
Methods & Materials: This cross-sectional study was conducted on 295 nursing staff from Imam Khomeini hospital complex in Tehran in 2016. Nurses were selected by the stratified random sampling with a proportional allocation, and completed a demographic data form, the Healthy Work Environment questionnaire and the Anticipated Turnover Scale (ATS). Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson/Spearman correlation coefficient and multiple linear regression tests using the SPSS software version 20.
The mean score for the intention to turnover was 36.21 (SD=4.38) ranged from 12 to 60. “Authentic leadership” and “skilled communication” domains obtained the highest (9.60±3) and lowest (8.97±2.74) scores respectively. There was poor correlation between the meaningful recognition domain and the anticipated turnover score (r=-0.135, P=0.024). In addition, the anticipated turnover score was significantly higher in male nurses than in female nurses (P=0.023).
Although there was no relationship between anticipated turnover and healthy work environment in this study, considering the importance of nurses’ recruitment and retention, there is a need to investigate the reasons for turnover, including characteristics of work environment, and take necessary measures.

Spiritual care along with other nursing interventions balance body and soul. This study aimed to determine the effect of spiritual care on death anxiety in hemodialysis patients with end-stage of renal disease.

Methods & Materials:

A clinical trial (IRCT2016308226961N1) was performed in Hamadan’s Shahid Beheshti and Besat hospitals in 2016. A total of 60 hemodialysis patients with end-stage of renal disease were randomly assigned into two groups of intervention (30 patients) and control (30 patients). In the intervention group, the spiritual care program consisted of protective care, supporting the patient’s rituals and using the support systems, was performed in hemodialysis ward at the patient’s bedside. The control group only received routine nursing care. The Templar’s death anxiety questionnaire was completed by both groups before and after the intervention. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.

The average score for death anxiety before the intervention between the intervention group (8.10±2.26) and control group (8.53±2.47) had not significant difference (P=0.482), while the average score for death anxiety after the intervention had statistically significant difference (P=0.004) between the intervention group with median value of 8.0 (6.00-8.25) and control group with median value of 9.0 (7.00-10.25), and the patients’ death anxiety reduced in the intervention group.

Spiritual care program reduced death anxiety in hemodialysis patients with end-stage of renal disease. Nurses can use spiritual care program to reduce patients’ death anxiety.

Prostate carcinoma is the most common cancer among men and the second lethal cancer. The present study aimed to investigate the prostate cancer screening behaviors and its related cognitive psychological factors among men over 50 years of age using the health belief model.
Methods & Materials: This cross-sectional study was performed on 300 men over 50 years of age in Hamadan, selected by cluster sampling method. Data collecting tool was a questionnaire consisted of three sections: demographic information, prostate cancer screening behaviors and health belief model constructs. Data were analyzed using Chi-square test, Fisher's exact test and logistic regression through the SPSS software version 18.
Findings revealed that 12% and 9% of the participants reported having a digital rectal examination (DRE) and prostate specific antigen (PSA) testing respectively. Perceived benefits and perceived barriers were the predictors of prostate cancer screening behaviors (P Given that the health belief model is effective in predicting prostate cancer screening behaviors, using these findings in designing educational interventions for people over 50 is recommended.

The premenstrual syndrome (PMS) is a set of physical and psychological symptoms that occurs periodically and affects women’s social and individual functionings. This study aimed to investigate the effect of stress management group counseling on the symptoms of premenstrual syndrome.
Methods & Materials: This semi-experimental study (IRCT2016052127994N1) was conducted on 44 students with PMS (22 in the intervention group and 22 in the control group) from Zanjan University of Medical Sciences in 2016. Data were collected using a demographic characteristics form and premenstrual symptoms screening test (PSST). Descriptive and inferential statistics including independent t-test, Chi-square, ANCOVA and repeated measurement test were used for data analysis via the SPSS software version 21.
Before treatment, the mean scores of mood-behavioral symptoms, physical symptoms and the impact of symptoms on life had not any significant differences between the two groups. At the first month after treatment, mood-behavioral symptoms (P Stress management group counseling is effective in reducing the symptoms of premenstrual syndrome, and it can be used as a non-pharmacological method with no side effects.

Sedation after coronary artery bypass graft surgery can prevent the side effects of the treatment. The purpose of this study was to determine the effect of controlled sedation based on the Richmond scale on the duration of mechanical ventilation and the changes of blood pressure in patients following coronary artery bypass graft surgery.
Methods & Materials: In a single blind randomized clinical trial (IRCT2017050517693N2) from June to August 2017, a convenience sample of 80 patients after coronary artery bypass graft surgery, hospitalized in the intensive care unit of Heshamat Center, Rasht, were selected and randomly allocated into two groups (each group=40). Sedative drug dose was determined using the Richmond agitation sedation scale in the intervention group and determined routinely (based on hemodynamic changes) in the control group. Pain as a confounding variable was evaluated using CPOT tool. Data were analyzed by descriptive statistics and Chi-square, Mann-Whitney, independent t-test and repeated measures ANOVA using the SPSS software version 22.
The mean age of samples was 59.89±7.53 and 66.7% of them were male. There was a significant difference between two groups in the duration of mechanical ventilation (P Utilizing the Richmond tool can reduce the patient’s dependence on ventilator and changes in arterial pressure. Also, using this tool can prevent unnecessary and early administration of sedative and vasopressor drugs in patients.