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اخلاق پزشکی - پیاپی 40 (تابستان 1396)

فصلنامه اخلاق پزشکی
پیاپی 40 (تابستان 1396)

  • تاریخ انتشار: 1396/05/28
  • تعداد عناوین: 8
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  • مقاله پژوهشی/ اصیل
  • سیدعلی مهدیون، زینب پوشگان، معصومه ایمانی پور، زهرا رزاقی صفحات 7-14
    زمینه و هدف
    حساسیت اخلاقی ویژگی است که شخص را قادر می سازد کشمکش های اخلاقی خود را بازشناخته و به نتایج تصمیم گیری اخلاقی در مورد دیگران، پی ببرد. از آنجا که پرستاران باید بتوانند یک مراقبت با کیفیت و مبتنی بر اخلاق ارائه دهند و رعایت حقوق بیماران یکی از جنبه های مراقبت اخلاقی است، این مطالعه با هدف تعیین ارتباط بین حساسیت اخلاقی پرستاران و رعایت حقوق بیماران در بخش های مراقبت ویژه در سال 1395صورت گرفت.
    مواد و روش ها
    در این مطالعه توصیفی همبستگی، 260 نفر از پرستاران شاغل در بخش های مراقبت ویژه بیمارستان های وابسته به دانشگاه علوم پزشکی تهران به روش در دسترس انتخاب شدند. جهت جمع آوری اطلاعات از پرسشنامه حساسیت اخلاقی Lutzen و پرسشنامه پژوهشگرساخته رعایت حقوق بیماران استفاده شد. داده ها با استفاده از نرم افزار SPSS 20 و آزمون های آماری تحلیل شد.
    ملاحظات اخلاقی: درباره اهداف پژوهش و رعایت محرمانگی اطلاعات به شرکت کنندگان توضیح داده شده و رضایت آگاهانه کتبی جهت شرکت در مطالعه از آنان اخذ گردید.
    یافته ها
    سطح حساسیت اخلاقی پرستاران بخش های مراقبت ویژه (18/30±160/58) و رعایت حقوق بیماران توسط ایشان (12/19 ±127/81)، بالاتر از حد متوسط بود. بین حساسیت اخلاقی پرستاران و میزان رعایت حقوق بیمار توسط ایشان در بخش های مراقبت ویژه، ارتباط معنی دار مستقیم مشاهده شد (0/0001>P و r=0/326).
    نتیجه گیری
    با توجه به ارتباط مشاهده شده بین حساسیت اخلاقی با رعایت بیشتر حقوق بیماران، پیشنهاد می شود جهت ارتقای رعایت حقوق بیماران، راه کارهای مناسب در راستای افزایش سطح حساسیت اخلاقی پرستاران و ارائه مراقبت باکیفیت اتخاذ گردد.
    کلیدواژگان: حساسیت اخلاقی، حقوق بیمار، بخش مراقبت ویژه، پرستاران
  • هادی جعفری منش، بهمن توان، پگاه مطوری، مهدی رنجبران صفحات 15-27
    زمینه و هدف
    نظر به اهمیت شناخت متغیرهای موثر بر کیفیت زندگی دانشجویان، این مطالعه با هدف تعیین ارتباط بین جهت گیری مذهبی و کیفیت زندگی دانشجویان دانشگاه علوم پزشکی اراک در سال 1393 انجام شده است.
    مواد و روش ها
    در این مطالعه توصیفی مقطعی به روش نمونه گیری چندمرحله ای، 288 از دانشجویان، دانشگاه علوم پزشکی اراک انتخاب شدند. ابزار گردآوری داده ها در این مطالعه شامل پرسشنامه کیفیت زندگی سازمان بهداشت جهانی و پرسشنامه جهت گیری مذهبی آلپورت بود. تحلیل داده ها با استفاده از نرم افزار آماری SPSS 20 انجام شد.
    ملاحظات اخلاقی: پس از توضیح اهداف مطالعه، رضایت آگاهانه جهت شرکت در تحقیق از نمونه ها اخذ گردید. پرسشنامه ها بی نام بوده و به شرکت کنندگان اطمینان خاطر داده شد که اطلاعات آن ها محرمانه مانده و به صورت گروهی منتشر خواهد شد.
    یافته ها
    میانگین و انحراف معیار کیفیت زندگی در حیطه جسمی 2/16±12/24، حیطه روانشناختی 1/90±13/33، حیطه روابط اجتماعی 2/83±13/77 و حیطه محیطی 2/58±13/46 بود. میانگین و انحراف معیار جهت گیری مذهبی بیرونی 5/28±26/61 و جهت گیری مذهبی درونی 5/16±28/53 بود. بین جهت گیری مذهبی درونی با تمامی حیطه های کیفیت زندگی ارتباط مثبت و معنی دار وجود داشت (0/05>P). بین جهت گیری مذهبی بیرونی با حیطه جسمی و محیطی کیفیت زندگی ارتباط منفی و معنی دار وجود داشت (0/05>P).
    نتیجه گیری
    یافته ها نشان داد برخلاف بین جهت گیری مذهبی درونی با تمامی جنیه های کیفیت زندگی ارتباط معنی دار وجود دارد. با توجه به نقش مثبت جهت گیری مذهبی درونی در پیش بینی کیفیت زندگی دانشجویان، تقویت باورهای مذهبی و نهادینه سازی معنویت در محیط های دانشگاهی توصیه می گردد.
    کلیدواژگان: کیفیت زندگی، جهت گیری مذهبی، دانشجویان پزشکی
  • محدثه معتمد جهرمی، عباس عباس زاده، طیبه جلالی صفحات 29-37
    زمینه و هدف
    فرسودگی شغلی می تواند بر ایفای نقش های حرفه ای پرستاری به ویژه حمایت از بیمار تاثیر بگذارد. این مطالعه با هدف تعیین ارتباط بین نگرش نسبت به نقش حمایت از بیماران با فرسودگی شغلی پرستاران بخش های مراقبت ویژه انجام شده است.
    مواد و روش ها
    پژوهش توصیفی تحلیلی حاضر بر روی پرستاران شاغل در سه بیمارستان آموزشی وابسته به دانشگاه علوم پزشکی کرمان در سال 1392 انجام شده است. از میان 250 پرستار شاغل در بخش های مراقبت ویژه بزرگسالان و کودکان، 183 نفر که دارای معیارهای ورود به مطالعه بودند، به روش در دسترس انتخاب شدند. برای جمع آوری داده ها از پرسشنامه 3 قسمتی اطلاعات جمعیت شناختی، پرسشنامه فرسودگی شغلی «Maslach Burnout Inventory» و پرسشنامه سنجش نگرش پرستاران نسبت به نقش حمایت از بیمار استفاده شد. برای تحلیل داده ها از نرم افزار آماری SPSS 18 استفاده شد.
    ملاحظات اخلاقی: رضایت آگاهانه شفاهی از شرکت کنندگان کسب گردیده و به آن ها درباره محرمانگی اطلاعات، اطمینان داده شد.
    یافته ها
    بین نگرش نسبت به نقش حمایت از بیمار با فرسودگی شغلی ارتباط منفی معنی دار مشاهده شد (p=0/035 ،r=0/07). بین عامل شناختی نگرش نسبت به نقش حمایت از بیمار با ابعاد خستگی عاطفی (p=0/03 ،r=0/81) و فقدان موفقیت فردی، فرسودگی شغلی ارتباطی منفی معنی دار مشاهده شد (p=0/04 ،r=0/12). همچنین بین عامل رفتاری نگرش نسبت به نقش حمایت از بیمار با بعد فقدان موفقیت فردی فرسودگی شغلی ارتباط معنی دار منفی مشاهده شد (p=0/03 r=0/21).
    نتیجه گیری
    با توجه به تاثیر نگرش به نقش حمایت از بیمار در کاهش فرسودگی شغلی، گنجانیدن آن در برنامه آموزش ضمن خدمت پرستاران آنان توصیه می گردد.
    کلیدواژگان: فرسودگی شغلی، حمایت از بیمار، پرستاران، بخش مراقبت ویژه
  • طیبه رحیمی پردنجانی، علی محمدزاده ابراهیمی صفحات 39-51
    زمینه و هدف
    با افزایش میزان رفتارهای غیر اخلاقی در محیط های کاری، پرداختن به اخلاق کار اسلامی می تواند نقش مهمی در مدیریت اثربخش سازمان ها ایفا نماید. مطالعه حاضر با هدف طراحی و آزمون الگویی از برخی پیشایندها و پیامدهای مهم اخلاق کار اسلامی انجام گرفته است.
    مواد و روش ها
    پژوهش حاضر یک مطالعه از نوع مقطعی همبستگی است. نمونه پژوهش شامل 250 نفر از کارکنان دانشگاه علوم پزشکی سبزه وار در سال 1394 بودند که به روش سرشماری وارد مطالعه شدند. برای گردآوری داده ها از پرسشنامه محقق ساخته شامل ویژگی های فردی، مقیاس اخلاق حرفه ای اسلامی، شاخص توصیف شغل و پرسشنامه تعهد سازمانی استفاده شد. برای تحلیل داده ها از روش الگویابی معادلات ساختاری (SEM) به وسیله نرم افزار AMOS 22 و SPSS 22 استفاده شد.
    ملاحظات اخلاقی: پس از توضیح درباره اهداف مطالعه و محرمانگی پاسخ ها، رضایت آگاهانه شرکت کنندگان کسب گردید.
    یافته ها
    الگوی پیشنهادی با برخی تغییرات از برازش خوبی برخوردار بود. پس از حذف سه مسیر غیر معنی دار وضعیت تاهل (p<0/213)، سطح تحصیلات (p<0/255) و وضعیت استخدام (p<0/182) به اخلاق کار اسلامی از الگوی پیشنهادی، برازندگی بهتر مدل از طریق همبستگی خطاهای دو مسیر (مسیر رضایت شغلی به تعهد سازمانی و مسیر ارتقا به شرایط محیط کار) حاصل شد.
    نتیجه گیری
    یافته ها نشان داد که اخلاق کار اسلامی در سازمان ها از یکسو با سن، سابقه کاری و جنسیت کارکنان مرتبط بوده و از سوی دیگر سبب افزایش رضایت شغلی و تعهد سازمانی می گردد. به کاربردن این نتایج هنگام استخدام کارکنان و آموزش اخلاق حرفه ای اسلامی برای رضایت شغلی و تعهد سازمانی توصیه می گردد.
    کلیدواژگان: اخلاق کار اسلامی، متغیرهای جمعیت شناختی، رضایت شغلی، تعهد سازمانی، الگویابی معادلات ساختاری
  • محمدعلی زبانی شادباد، محمد حسنی، ابوالفضل قاسم زاده علیشاهی صفحات 53-62
    زمینه و هدف
    رعایت استانداردهای اخلاق حرفه ای از سوی کارکنان دانشگاه های علوم پزشکی می تواند در کیفیت فرایند و برونداد سیستم دانشگاهی موثر واقع شود. مطالعه حاضر با هدف تعیین تاثیر اخلاق حرفه ای بر پیامدهای فردی و سازمانی انجام شده است.
    مواد و روش ها
    مطالعه حاضر یک مطالعه توصیفی تحلیلی و مبتنی بر مدل یابی معادلات ساختاری است که بر روی 290 نفر از کارکنان شاغل در دانشگاه علوم پزشکی شهر تبریز در سال تحصیلی 95-94 انجام شده است. نمونه گیری به روش تصادفی طبقه ای نسبی انجام و برای جمع آوری اطلاعات از چهار پرسشنامه استاندارد اخلاق حرفه ای، درگیری شغلی، ترک خدمت و تلاش افزاینده استفاده شد. برای تجزیه و تحلیل داده ها از روش های تحلیل عاملی تاییدی و مدل معادلات ساختاری استفاده شد.
    ملاحظات اخلاقی: رضایت شفاهی مشارکت کنندگان اخذ و درباره محرمانگی اطلاعات به شرکت کنندگان اطمینان خاطر داده شد.
    یافته ها
    نتایج مدل یابی معادلات ساختاری نشان داد که بین اخلاق حرفه ای با درگیری شغلی و تلاش افزاینده (p<0/01 ،r=0/17 ،r=0/25) رابطه علی مثبت وجود دارد. همچنین بین اخلاق حرفه ای با ترک خدمت (0/32-=r) رابطه علی منفی مشاهده شد. بین درگیری شغلی و تلاش افزاینده (0/28=r) رابطه علی مثبت و نیز بین درگیری شغلی و تلاش افزاینده با ترک خدمت (r=0/27 ،r=0/32) رابطه علی منفی وجود داشت.
    نتیجه گیری
    یافته ها حاکی از آن است که توجه به اخلاق حرفه ای و ارتقای آن در بین کارکنان سازمان، باعث تعلق شغلی و درگیرشدن آنان با شغلشان و نیز تلاش افزاینده آنان می شود.
    کلیدواژگان: اخلاق حرفه ای، درگیری شغلی، تمایل به ترک خدمت، تلاش افزاینده
  • محمد حسنی، رقیه صداقت، مهدی کاظم زاده بیطالی صفحات 63-71
    زمینه و هدف
    پرستاری حرفه ای است که با تنش های روانی و مسائل اخلاقی متعدد آمیخته است. از این رو مطالعه حاضر با هدف تعیین ارتباط جو اخلاقی، استرس شغلی و رضایت شغلی پرستاران شاغل در بیمارستان امام خمینی ارومیه در سال 1394 انجام گردیده است.
    مواد و روش ها
    در این مطالعه مقطعی همبستگی، جامعه مطالعه را پرستاران شاغل در بیمارستان امام خمینی (ره) وابسته به دانشگاه علوم پزشکی ارومیه تشکیل می‏داد که از میان 366 نفر پرستار، 200 نفر به روش نمونه گیری سهمیه ای انتخاب شدند. برای گردآوری داده ها از پرسشنامه های استاندارد جو اخلاقی Victor و Cullen، استرس شغلی Sutherland و رضایت شغلی Brayfield و Rothe استفاده شد. داده ها با استفاده از آزمون‏های همبستگی پیرسون و رگرسیون به وسیله نرم افزار SPSS 18 تحلیل شد.
    ملاحظات اخلاقی: پس از توضیح درباره اهداف مطالعه و محرمانگی اطلاعات، رضایت شفاهی شرکت کنندگان کسب گردید.
    یافته ها
    بین متغیرهای جو اخلاقی با رضایت شغلی (0/395=r) و استرس شغلی با رضایت شغلی (0/243-=r) شرکت کنندگان همبستگی معنی دار مشاهده شد (0/01>P). همچنین بین جو اخلاقی و استرس شغلی شرکت کنندگان ارتباط آماری معکوس مشاهده شد (P<0/01 ،r=-0/379). با استفاده از تحلیل رگرسیون چندگانه، متغیر جو اخلاقی حدود 34 % از واریانس استرس شغلی و 53% از واریانس رضایت شغلی پرستاران را تبیین نمود (p<0/01).
    نتیجه گیری
    با توجه به ارتباط مشاهده شده، توصیه می گردد تا مدیران و مسوولان بیمارستان، بستر لازم برای نهادینه کردن اخلاق حرفه ای فراهم نموده و با ایجاد جو اخلاقی مطلوب، میزان رضایت شغلی پرستاران و کیفیت مراقبت از بیماران را بهبود بخشند.
    کلیدواژگان: جو اخلاقی، استرس شغلی، رضایت شغلی، پرستاران
  • مقاله مروری
  • رضا جهانگیری، آیدین آرین خصال صفحات 73-92
    زمینه و هدف
    پرداخت های غیر رسمی پدیده ای است که نظام سلامت بسیاری از کشورها با آن رو به رو بوده اند. این مرور نظام مند با هدف شناسایی ماهیت و انواع پرداخت های غیر رسمی و علل آن انجام شده است.
    مواد و روش ها
    واژگان کلیدی «پرداخت های غیر رسمی» یا «پرداخت غیر قانونی» یا «زیرمیزی» و «نظام سلامت» در پایگاه های اطلاعاتی داخلی و خارجی PubMed، Magiran، IranMedex، SID، Science Direct، HMIC و Scopus به زبان فارسی و انگلیسی، در بازه زمانی 2000 تا 2016 جستجو شدند.
    ملاحظات اخلاقی: صداقت و امانت داری در انتخاب و گزارش یافته ها و استناددهی به متون رعایت گردید.
    یافته ها
    سی و سه مقاله کامل برای مطالعه و تحلیل انتخاب شد. پرداخت های غیر رسمی یا غیر قانونی فاقد یک تعریف جهان شمول بوده و نگرش به آن ها در جوامع مختلف، متفاوت می باشد. علل پرداخت های غیر رسمی در سه دسته دلایل پرداخت کنندگان (دریافت خدمات باکیفیت، سریع تر و احترام)، دلایل دریافت کنندگان (پایین بودن دستمزدها و تعرفه ها، اعمال کسورات غیر منطقی از سوی سازمان های بیمه) و ضعف های نظام سلامت (ناکارآمدی بیمه ها در تامین مالی، نظارت ناکافی بر نحوه اعمال تعرفه ها و کمبود نیروی انسانی در برخی حرف) دسته بندی شد.
    نتیجه گیری
    پرداخت های غیر رسمی با هر نیت، انگیزه و علتی، عواقب جبران ناپذیر و بی عدالتی را به دنبال دارد. هزینه های کمرشکن، نابرابری در دسترسی به خدمات و کیفیت آن ها و نابرابری در پیامدهای سلامت، از اصلی ترین عواقب پدیده پرداخت های غیر رسمی محسوب می شوند. واقعی شدن تعرفه ها در کنار تقویت بیمه ها، اطلاع رسانی و آگاه ساختن بیماران از حقوق خود و بهبود نظارت برای کاهش پرداخت های غیر رسمی توصیه می گردد.
    کلیدواژگان: پرداخت های غیر رسمی، پرداخت های غیر قانونی، نظام مراقبت سلامت، عدالت، مرور نظام مند
  • آناهیتا معصوم پور، عباس عباس زاده، مریم رسولی، حمید علوی مجد صفحات 93-102
    زمینه و هدف
    به دلیل اهمیت رفتارهای غیر مدنی و اثر تخریبی آن بر فضای یادگیری، این مطالعه با هدف مرور نقادانه ابزارهای سنجش رفتار غیر مدنی در آموزش پرستاری انجام شده است.
    مواد و روش ها
    برای انجام مطالعه، از روش جستجوی نظام مند استفاده شد. بدین منظور، ابتدا مقالات مرتبط انگلیسی و فارسی، بدون محدوده زمانی در Google Scholar جستجو گردیده، سپس جستجوی اختصاصی در پایگاه های اطلاعاتی Science Direct، ProQuest،Wiely Inter Science و PubMed با استفاده از واژگان کلیدی انجام شد.
    ملاحظات اخلاقی: صداقت و امانت داری در تحلیل، گزارش و انتشار نتایج رعایت گردید.
    یافته ها
    از 80 مقاله دریافت شده، 15 مقاله که به حیطه پرستاری پرداخته بودند، مورد مطالعه و تحلیل قرار گرفتند. تمامی ابزارهای مورد مطالعه مطابق با فرهنگ جامعه هدف طراحی شده و از پایایی و روایی مطلوبی برخوردار بوده و قابلیت استفاده در مطالعات مختلف را داشتند. اغلب ابزارها، رفتار غیر مدنی مدرسین یا دانشجویان را به تنهایی بررسی می کردند. از میان ابزارهای مذکور تنها ابزاری که رفتار غیر مدنی مدرسین و دانشجویان را هم زمان بررسی می کند، ابزار سنجش رفتار غیر مدنی در آموزش پرستاری Clark است که روایی و پایایی آن ابزار به طور دقیق مورد اشاره قرار گرفته است، در حالی که در ابزارهای دیگر شاخص های فهرست Casmin رعایت نشده است.
    نتیجه گیری
    از آنجایی که رفتار غیر مدنی یک تعامل دوطرفه است و از طرف دیگر برخی از ابزارهای مورد مطالعه متناسب با شرایط اجتماعی و فرهنگی جامعه حاضر نبودند، لازم است این مقیاس های رفتار در دو گروه تعامل کننده مطابق با شرایط جامعه طراحی گردد.
    کلیدواژگان: رفتار غیر مدنی، آموزش پرستاری، ابزار، روان سنجی، مرور نقادانه
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  • Seyyed Ali Mahdiyoun, Zeynab Pooshgan, Masoomeh Imanipour, Zahra Razaghi Pages 7-14
    Background And Aim
    Moral sensitivity is a feature that enables a person to recognize his moral conflicts and to understand the results of moral judgment about others. Since nurses are required to provide high quality care and ethics, they must have moral sensitivity to deal with ethical issues that are encountered during the care process. One of the examples of ethical care is to pay attention to the patient's rights and protect them. So that nurses are expected to make appropriate moral decisions in defense of their patient's rights. Nurses should pay attention to the patient's rights in addition to protect and improve their health. Considering the fact that this issue is more important in the ICUs and since observance of patient's rights is one of the aspects of moral care, this study aimed to determine the correlation between nurse's moral sensitivity and respect for patient's rights in ICUs in 2016.
    Materials And Methods
    In this descriptive-correlational study, 260 nurses working in ICUs of hospitals affiliated to Tehran University of Medical Sciences were selected by available method. The criteria for entering the study were to have a bachelor's degree and above, and at least one year of work experience in the ICU. Transfer to the other part while collecting data was considered as a criterion for leaving the study. To collect data, the Lutzen's Moral Sensitivity Questionnaire and Researcher-made Patient's Rights Questionnaire were used. The Lutzen moral Sensitivity Questionnaire has 30 questions on the 7-point Likert scale and includes six areas of interpersonal and communication acquaintances, structure of moral concepts, benevolence, respect for patient autonomy, experience of conflicts and moral challenges, trust in specialized professional knowledge and principles of care.
    The Patient's Rights Observatory questionnaire was also a researcher-made tool based on the Patient's Rights Charter and Nursing Ethics Codes in Iran. The questionnaire consists of 30 questions in five-point Likert scale and it was designed in five areas of receiving health services, the patient's privacy and respect for the principle of privacy, the right to receive information in an appropriate and adequate manner, the right to choose freely to receive services and the right to access an effective complaints system. The validity of the questionnaires was evaluated through content and opinion polls from moral experts and its reliability was verified using a re-test. Correlation coefficient of the moral sensitivity questionnaire was r = 0.997 and patient's rights observation questionnaire was r = 0.986. Data were analyzed using SPSS 20 and statistical tests.
    Ethical considerations: This research was approved by the Ethics Committee of Tehran University of Medical Sciences with 2015.2821 codes. Participation in the study was optional and informed written consent was obtained from nurses to participate in the study. In addition, the information confidentiality of the participants was observed.
    Findings: The mean age of participants was 32.7 ± 6.38 years and their average work experience in the ICUs was 7.4 ± 5.6 with a range of 1 to 26 years. Most of the participants in the study were women and married. Most of them had a bachelor's degree and worked in the ICU. Approximately half of the nurses had a history of professional ethics education, and most of them mentioned the history of the patient's rights training course. The level of moral sensitivity of nurses in ICUs (160.58 ± 18.30) and respect for patient's rights by them (12.19±127.81) were higher than average. There was a direct significant relationship between the moral sensitivity of nurses and the degree of observance of patient's rights in ICUs (P
    Conclusion
    According to the findings, the level of moral sensitivity of nurses in ICUs was higher than the average. This finding is consistent with most studies. There are, of course, studies that highlight the nurse's moral sensitivity at a low level. The result of these differences suggests that various factors are likely to be involved in the moral sensitivity of nurses, including the conditions of the work environment and clinical environment, age and attitude of people towards the profession, culture, educational level, ethics education, nursing care volume and number of patients under care. The results of this study showed that the average observance of patient's rights by nurses was higher than average, but not desirable. The results of other studies are consistent with our study. High work pressure and shortage of manpower, lack of sufficient time and lack of adequate knowledge, as well as specific constraints related to the work environment, including working hours and communicational environment have been considered as barriers for observing patient's rights.
    Nurses and other staff in the treatment team should provide health care services with respect for human dignity and taking into account the characteristics of each patient, regardless of their economic, social and cultural status. Regarding the observed relationship between moral sensitivity and observance of patient's rights, it is suggested to adopt appropriate strategies to improve the observance of patient's rights in order to increase the level of moral sensitivity of nurses and provide high-quality care.
    Keywords: Moral Sensitivity, Patient Rights, Intensive Care Units, Nurses
  • Hadi Jafarimanesh, Bahman Tavan, Pegah Matorypor, Mehdi Ranjbaran Pages 15-27
    Background And Aim
    Among the factors influencing the quality of life, the role of religion and religious orientation in improving the quality of life has been less respected by researchers. Students experience significant changes in social and individual relationships when they enter the university. Academic environment is a stressful environment and it is imperative to seriously take the issues related to health and the cognitive, emotional and psychological aspects of the quality of life of this stratum. Studies show that some inappropriate psychological conditions such as anxiety and depression among the students. Considering the importance of recognizing the variables affecting the quality of life of students, this study was conducted to determine the relationship between religious orientation and quality of life of students in Arak University of Medical Sciences in 2014.
    Materials And Methods
    In this descriptive cross-sectional study, 288 students of Arak University of Medical Sciences were selected through multistage sampling. First, the students were classified in terms of their field of study (midwifery, nursing, laboratory science, anesthesia, operating room, urgency Medical, and health). Then, each field of study was divided into several clusters in terms of the year of entering university and one cluster was randomly selected. Finally, 288 people were randomly selected from clusters. The criteria for entering the study were having at least one year of study and undergraduate or postgraduate education. In this study, the data gathering tool includes the World Health Organization's Quality of Life questionnaire and Allport's Religious Orientation Questionnaire. Data analysis was performed using SPSS 16 software with descriptive statistics and inferential statistics including Pearson correlation, independent t-test and one way ANOVA.
    Ethical considerations: This study is a result of a research project approved by Arak University of Medical Sciences with no. 2021. To conduct the study, a confirmation was obtained from the Ethics Committee of the Vice-Chancellor for Research and Technology of the University with code 14- 164-93. After explaining the goals of the study, informed consent was obtained from the samples for participation in the research. The questionnaires were anonymous and convinced participants that their information would remain confidential and would be published in groups.
    Findings: Most of the studied samples were women (66.7%), single (84.4%), undergraduate students (92.4%), urban residents (88.2%), and having no physical problems (93%). The mean age of participants was 21.86 ± 2.55 years and their mean of Lesson Underscores was 15.98 ± 1.20. The mean and standard deviation of the quality of life score in physical activity was 12.24 ± 2.16, in the psychological domain was 13.33 ± 1.90, in the sphere of social relation was 13.77 ± 2.83 and in the environmental domain was 13.46 ± 2.58 (score range 4-20). The mean score of external religious orientation was 26.61 ± 5.28 (score range 11- 44) and the internal orientation was 28.53 ± 5.16 (score range 10-44). There was a positive and significant relationship between internal religious orientation and all aspects of quality of life (P 0.05). There was a significant relationship between father's job and quadruple areas of quality of life, so that the quality of life score in students whose fathers had died was lower than others (P 0.05).
    Conclusion
    The findings of this study showed that, contrary to the external religious orientation, there are significant positive relationship between internal religious orientation and all aspects of quality of life; in other words, religious people have a higher quality of life. The internal religious orientation is inclusive with organized principles that serve to satisfy the inner need of man to attain his existential truth, "the essence of God's divine". While external religious orientation serves the satisfaction of external needs such as authority and security, and so on. Individuals with an internal religious orientation who resort to religion to face with their stressful situations have good mental health and quality of life. Considering the positive role of internal religious orientation in predicting the quality of life of students, strengthening religious beliefs and institutionalization of spirituality in academic environments are recommended.
    Keywords: Quality of Life, Religious Orientation, Medical Students
  • Mohadeseh Motamed-Jahromi, Abbas Abbaszadeh, Tayebeh Jalali Pages 29-37
    Background And Aim
    Nurses suffer from burnout due to frequent and daily exposure to stressful situations more than those in other occupations. Nurses in ICUs are more exposed to burnout compared to the nurses of other parts due to exposure to various stresses such as high pressure, decision making in urgent situations and responsiveness to the results of each decision, permanent attempt to prevent mistakes, especially exposure to death and disability of patients. For this reason, job burnout in nurses working in ICUs is more than other nurses and can affect the role of nursing professionals, especially patient advocacy. The aim of this study was to determine the correlation between attitude towards the role of patient advocacy and job burnout among nurses in ICUs.
    Materials And Methods
    This descriptive-analytic study was conducted on nurses working in three educational hospitals affiliated to Kerman University of Medical Sciences in 2013. Of the 250 nurses working in adult and child ICUs (ICU, NICU, CCU, dialysis), 183 subjects who had inclusion criteria were selected using the available method. The criteria for entering the study include having at least undergraduate degree in nursing, a 6-month work history in clinical settings, and full-time clinical work. A three-part demographic questionnaire, "Maslach Burnout Inventory", and a nurse's attitude survey questionnaire on the role of patient advocacy were used to collect the data. The first part examines demographic characteristics, including age, gender, marital status, education level, employment area and years of work experience. The second part is a 22-item questionnaire that covers all three areas of occupational burnout; nine items are related to the emotional exhaustion of nurses against the clients and the workplace; five items are related to depersonalization (nurse's disinterest and indifference to clients); and eight items are related to the lack of individual's success that helps the nurse to express the degree of satisfaction and achievement of success in patient care. The frequency of questionnaire items is from zero to six as never, several times a year, once a month, several times a month, once a week, several times a week, and every day. The Persian translation of the Maslach Burnout Inventory has been reviewed by Akbari et al (2011) and has been approved by three English language instructors in terms of accuracy of translation and compliance with its English Principles. In this study, the validity of this questionnaire was evaluated by 10 faculty members, and the CVI was calculated as 88%. Cronbach's alpha was calculated as 0.89 with a sample size of 30. The third part, the 19-item questionnaire, was selected from the questionnaires used in the Barrett-Sheridan and Hanks study, which evaluates nurse's attitude towards the role of patient advocacy. Two-way translation of English to Farsi and vice versa, and validity and reliability, and factor analysis of this questionnaire were done by Motamed et al. (2012) and CVI is estimated as 86% and Cronbach's alpha is 0.77. All items of the present questionnaire are ranked using the 5-point Likert scale. Attitudinal questions were divided into two subscales of the cognitive aspect (10 items) and the behavioral aspect (9 items) (5). For data analysis, descriptive statistics and inferential tests (Pearson correlation coefficient, independent t-test and one-way ANOVA) were used in SPSS 18 software.
    Ethical considerations: After acquisition of the code of ethics committee approval of number K / 93/30 from the Vice-Chancellor for Research, Kerman University of Medical Sciences and obtaining other necessary permits, and explaining the objectives of the research, the informed consent of the participants was obtained and it was assured about the confidentiality of information. The response rate to the questionnaires was 96.3% (183 out of 190 questionnaires). The median age of participants was 35 ± 1/34 years in the range of 22 to 48 years old.
    Findings: The majority of them were female (90.3%) and had undergraduate education (9.1%). More than half of the nurses had a work experience of between 6 months and 10 years. In terms of type of division, the majority of participants were engaged in adult ICUs. The average burnout rate of participants was 4.02 ± 0.26 and the mean of attitude towards the role of patient advocacy was 3.72 ± 0.50. There was a significant negative relationship between attitude towards the role of patient advocacy and job burnout (r = -0.07, p = 0.035). There was a significant negative relationship between cognitive factors of attitude towards the role of patient advocacy with dimensions of emotional exhaustion (r = -0.81, p = 0.03) and lack of personal success and burnout (r = -0.12, p=0.04). But this relationship was not meaningful with the dimension of burnout. (r=0.10, p=0.15). Also, there was a significant negative relationship between attitudinal behavioral factor towards the role of patient advocacy with the dimension of the lack of personal success and burnout (r = -0.21, p = 0.03). But this relationship was not significant with the dimensions of emotional exhaustion and depersonalization of burnout (r = 0.03, p = 0.65). There was no statistically significant correlation between mean of burnout and demographic characteristics of participants (p = 0.86). But there was a significant statistical relationship between the mean attitude towards the role of patient advocacy and education level of the participants (p = 0.04).
    Conclusion
    Regarding the existence of a significant negative correlation between attitude towards the role of patient advocacy and job burnout among nurses working in ICUs, providing the necessary conditions to support patients causes the improvement of nurse's attitudes towards patient advocacy, competence and their efficiency and thus reduces their burnout. Also, considering the significant relationship between the attitude towards the role of patient advocacy and the education level of the participants, it is suggested to include training the role of patient advocacy, the ability to identify patient advocacy situations, how they are correctly expressed to others and manage it, in the nursing program so as to help nurses become professional and increase their efficiency and competency which will ultimately increase job satisfaction and reduce burnout. Among the limitations of this study are available sampling and the absolute use of a questionnaire to measure variables. In order to generalize the findings, the study is proposed in both quantitative and qualitative methods in a wider geographical range with larger sample size.
    Keywords: Burnout, Patient Advocacy, Nurses, ICUs
  • Tayebe Rahimi Pordanjani, Ali Mohamadzadeh Ebrahimi Pages 39-51
    Background And Aim
    Nurses suffer from burnout due to frequent and daily exposure to stressful situations more than those in other occupations. Nurses in ICUs are more exposed to burnout compared to the nurses of other parts due to exposure to various stresses such as high pressure, decision making in urgent situations and responsiveness to the results of each decision, permanent attempt to prevent mistakes, especially exposure to death and disability of patients. For this reason, job burnout in nurses working in ICUs is more than other nurses and can affect the role of nursing professionals, especially patient advocacy. The aim of this study was to determine the correlation between attitude towards the role of patient advocacy and job burnout among nurses in ICUs.
    Materials And Methods
    This descriptive-analytic study was conducted on nurses working in three educational hospitals affiliated to Kerman University of Medical Sciences in 2013. Of the 250 nurses working in adult and child ICUs (ICU, NICU, CCU, dialysis), 183 subjects who had inclusion criteria were selected using the available method. The criteria for entering the study include having at least undergraduate degree in nursing, a 6-month work history in clinical settings, and full-time clinical work. A three-part demographic questionnaire, "Maslach Burnout Inventory", and a nurse's attitude survey questionnaire on the role of patient advocacy were used to collect the data. The first part examines demographic characteristics, including age, gender, marital status, education level, employment area and years of work experience. The second part is a 22-item questionnaire that covers all three areas of occupational burnout; nine items are related to the emotional exhaustion of nurses against the clients and the workplace; five items are related to depersonalization (nurse's disinterest and indifference to clients); and eight items are related to the lack of individual's success that helps the nurse to express the degree of satisfaction and achievement of success in patient care. The frequency of questionnaire items is from zero to six as never, several times a year, once a month, several times a month, once a week, several times a week, and every day. The Persian translation of the Maslach Burnout Inventory has been reviewed by Akbari et al (2011) and has been approved by three English language instructors in terms of accuracy of translation and compliance with its English Principles. In this study, the validity of this questionnaire was evaluated by 10 faculty members, and the CVI was calculated as 88%. Cronbach's alpha was calculated as 0.89 with a sample size of 30. The third part, the 19-item questionnaire, was selected from the questionnaires used in the Barrett-Sheridan and Hanks study, which evaluates nurse's attitude towards the role of patient advocacy. Two-way translation of English to Farsi and vice versa, and validity and reliability, and factor analysis of this questionnaire were done by Motamed et al. (2012) and CVI is estimated as 86% and Cronbach's alpha is 0.77. All items of the present questionnaire are ranked using the 5-point Likert scale. Attitudinal questions were divided into two subscales of the cognitive aspect (10 items) and the behavioral aspect (9 items) (5). For data analysis, descriptive statistics and inferential tests (Pearson correlation coefficient, independent t-test and one-way ANOVA) were used in SPSS 18 software.
    Ethical considerations: After acquisition of the code of ethics committee approval of number K / 93/30 from the Vice-Chancellor for Research, Kerman University of Medical Sciences and obtaining other necessary permits, and explaining the objectives of the research, the informed consent of the participants was obtained and it was assured about the confidentiality of information. The response rate to the questionnaires was 96.3% (183 out of 190 questionnaires). The median age of participants was 35 ± 1/34 years in the range of 22 to 48 years old.
    Findings: The majority of them were female (90.3%) and had undergraduate education (9.1%). More than half of the nurses had a work experience of between 6 months and 10 years. In terms of type of division, the majority of participants were engaged in adult ICUs. The average burnout rate of participants was 4.02 ± 0.26 and the mean of attitude towards the role of patient advocacy was 3.72 ± 0.50. There was a significant negative relationship between attitude towards the role of patient advocacy and job burnout (r = -0.07, p = 0.035). There was a significant negative relationship between cognitive factors of attitude towards the role of patient advocacy with dimensions of emotional exhaustion (r = -0.81, p = 0.03) and lack of personal success and burnout (r = -0.12, p=0.04). But this relationship was not meaningful with the dimension of burnout. (r=0.10, p=0.15). Also, there was a significant negative relationship between attitudinal behavioral factor towards the role of patient advocacy with the dimension of the lack of personal success and burnout (r = -0.21, p = 0.03). But this relationship was not significant with the dimensions of emotional exhaustion and depersonalization of burnout (r = 0.03, p = 0.65). There was no statistically significant correlation between mean of burnout and demographic characteristics of participants (p = 0.86). But there was a significant statistical relationship between the mean attitude towards the role of patient advocacy and education level of the participants (p = 0.04).
    Conclusion
    Regarding the existence of a significant negative correlation between attitude towards the role of patient advocacy and job burnout among nurses working in ICUs, providing the necessary conditions to support patients causes the improvement of nurse's attitudes towards patient advocacy, competence and their efficiency and thus reduces their burnout. Also, considering the significant relationship between the attitude towards the role of patient advocacy and the education level of the participants, it is suggested to include training the role of patient advocacy, the ability to identify patient advocacy situations, how they are correctly expressed to others and manage it, in the nursing program so as to help nurses become professional and increase their efficiency and competency which will ultimately increase job satisfaction and reduce burnout. Among the limitations of this study are available sampling and the absolute use of a questionnaire to measure variables. In order to generalize the findings, the study is proposed in both quantitative and qualitative methods in a wider geographical range with larger sample size.
    Keywords: Islamic Work Ethics, Demographic Variables, Job Satisfaction, Organization Commitment, Structural Equation Modeling
  • Mohammadali Zabani Shadbad, Mohammad Hasani, Abolfazl Ghasemzadeh Alishahi Pages 53-62
    Background And Aim
    Ethical issues are continually linked to the organizational, professional and everyday activities of individuals and are important in discussion related to decision making and determination of organizational policies, such as human resources, marketing, operational and production management and, finance, etc. Everything that is done in the workplace is somewhat based on moral beliefs. In fact, organizational decisions are interwoven with morality. Therefore, the elaboration and development of a set of common ethics in the organization will make individuals committed and leads to creation of an organizational culture that embraces ethics and strengthens positive organizational behaviors in the organization. Compliance with professional ethics standards by staff at medical universities can be effective in quality of the process and output of the academic system. The present study has been carried out with the objective of determining the effect of professional ethics on individual and organizational outcomes.
    Materials And Methods
    The present study is a descriptive-analytic study based on structural equation modeling. The statistical population of this study consisted of 1200 male and female employees working in Tabriz University of Medical Sciences in the academic year of 2015-2016. The sample size was estimated to be 250 individuals using Cochran's formula which was increased to 290 due to possibility of falling and its adequacy was confirmed on the basis of statistical power above 0.8 and a significant level of 0.50 in the analysis of hypotheses. Sampling was done using relative random – classed method among different classes of staff at the faculties of the University of Medical Sciences. Four questionnaires including standard professional ethics questionnaire, job engagement questionnaire, quitting questionnaire and increasing efforts questionnaire were used to collect data. The Standard job engagement questionnaire of Kanungo (1982) ontains 10 questions with a Likert scale of 5 degrees which its Cronbach's alpha coefficient has been reported to be 0.79. Discretionary effort was measured using the scales of increasing effort of Lloyd (2008) with 7 items which its Cronbach's Alpha has been estimated to be 0.87. Intention to quit job was measured using the scale of Intention to quit job by Colarelli (1984) with 3 items which its Cronbach's alpha is estimated to be 0.75. Professional Ethics Questionnaire has been created by Gregory & Hill (1990). This tool has been created in four dimensions of professional ethics (attachment and interest in work, perseverance and seriousness in work, healthy human relationships at work, and collective spirit and participation in work) and has the necessary validity due to appropriate theoretical background and the approval of experts with the subject specialization. This tool is responded based on 5-point Likert scale (1 = completely disagree, 5 = completely agree). Gregory & Hill (1990) reported Cronbach Alpha coefficient for this scale to be 0.81. In this study, Cronbach's alpha was 0.71 for professional ethics questionnaire, was 0.75 for job involvement, was 0.84 for quitting and was 0.78 for increasing effort.
    Also, validation factor analysis (CFA) was used to determine the validity of the questionnaires. In order to show that structures of professional ethics, job vacancies, efforts and job involvement are different structures, we initially entered them into the equation with each other. X2 /df statistic shows that the value obtained for 4 factor model is 2.38 which is smaller than the target for this model. Therefore, the 4 factor model is likely to fit better with the data and is more consistent with the original theoretical model. Evaluation of other fitting statistics for models also shows that the best values based on above mentioned criteria are related to six-factor model in all cases. X2, DF, GFI, AGFI, CFI and NFI statistics in 4 factor model which are respectively equal to 26.15, 113, 0.90, 0.87, 0.93, and 0.89 are closer to one which shows the better fit of the model. The Root Mean Square Error of Approximation (RMSEA) index is also equal to 0.068 in 4 factor model which is considered to be a good value. As a result, based on the obtained data, 4 factor model is more appropriate than other models and is approved.
    Confirmatory factor analysis and structural equation modeling were used to analyze the data and to evaluate relations between variables and present the structural model.
    Ethical considerations: Oral consent of the participants was obtained after obtaining the certification of Ethics Review Committee with the code of 1830-241 and expressing the objectives of study. Participants were reassured about the confidentiality of information.
    Findings: 170 of participants were male (68%) and 80 of them were female (32%). Results of structural equation modeling showed that there is a positive causal relationship between professional ethics with job involvement and incremental effort (r = 0.25, r = 0.17, r = -0.01). Also, a negative causal relationship was observed between professional ethics and quitting (r = -0.32). There was a positive causal relationship between job involvement and increasing effort (r = 0.28) and there was also a negative causal relationship between job involvement and increasing effort and quitting (r = -0.22, r = -0.22).
    Conclusion
    Given the many challenges that today's education system faces in medical science universities, improvement and assurance of quality are required. One of the areas that the University of Medical Sciences should pay particular attention to is the field of ethics. Findings indicate that attention to professional ethics and its promotion among employees of the organization leads to job involvement and engagement of employees in their jobs as well as the increasing efforts of staff. Also, intention to quit the job by staff is reduced in this environment. Hence, special attention to professional ethics in the organization is recommended.
    Keywords: Discretionary Effort, Employee Engagement, Intention to Quit, Professional Ethics
  • Mohammad Hassani, Roqayyeh Sedaqat, Mehdi Kazemzadehbeytali Pages 63-71
    Background And Aim
    Nursing is a profession mixed with stress and psychological stress and numerous ethical issues. The attitudes and perceptions of nurses and their perception of the governing climate affect their performance and their job satisfaction or stress in organizational affairs. Climate is a phenomenon that always exists in the organization and dominates the attitude of the people as the hidden force. The climate is the perception channel through which the effects of the environment on the views and behaviors are determined. Ethical climate is important for organizations and affects employee's ethical behavior. The discovery of the relationship between ethical climate and employee's attitudes and behavior is considered as one of the most important issues in organizational studies. Therefore, the present study aimed to determine the correlation between ethical climate, job stress and job satisfaction among nurses working in Imam Khomeini Hospital, Urmia in 2015.
    Materials And Methods
    The study population of this cross-sectional correlational study included nurses working in Imam Khomeini Hospital affiliated to Urmia University of Medical Sciences. Of the 366 nurses, 200 were selected using quota sampling method. Data collection was carried out using Victor and Cullen's Standard Ethical Climate (1999), Sutherland Job Stress (1995) and Brayfield & Rothe Job Satisfaction Questionnaires (1991). Cronbach's alpha of Ethical Climate, Job Stress and Job Satisfaction Questionnaires were calculated 0.72, 0.82, and 0.74, respectively. Also, in order to investigate the validity of the questionnaires, despite the standardization of the tools and their repeated use in domestic and foreign research, factor analysis was performed on the data obtained from the implementation of this scale were in the sample group. This analysis has been carried out in the form of exploratory analysis using the main component (PC) with Varimax rotation. The KMO coefficient was equal to 0.73 and the Xi value of Bartlett Sprite test 14506.8 was obtained, which was significant at 0.01, indicating the adequacy of the sample size and the sample variables for performing factor analysis. The results were confirmed and aggregate variance of 0.78 was obtained. For data analysis, descriptive statistics, Pearson correlation and regression tests were used in SPSS ver. 18 software. This research is the outcome of the M.A thesis of Urmia University, number A4/863.
    Ethical considerations: After obtaining the necessary permissions and familiarizing the participants with the objectives of the research, participant's oral satisfaction was obtained. Participants were assured about the confidentiality of information and the publication of the results of the study as a group.
    Findings: Participant's demographic information was as follow: female population (58%), age group of 26 to 30 years old (32.5%), Nurses with bachelor's degree (79%) and job experience of 6 to 10 years (49%). The mean and standard deviation of ethical climate, job satisfaction and job stress scores of participants were 80.55 ± 3.47, 28.44 ± 4.86 and 97.61 ± 17.21, respectively. Significant correlation was observed between the variables of ethical climate with job satisfaction (r = 0.395) and job stress with job satisfaction (r = -0.243) (P 0.01). Regression analysis showed that ethical climate predicts 34% of nurse's job stress (P
    Conclusion
    The results of this study showed that there is a significant relationship between ethical climate, job stress and job satisfaction of nurses; in fact, as the hospital climate becomes more ethical, the job stress of nurses is less and their job satisfaction is higher. The limitations of this study include the lack of control of economic, social, and cultural variables. Considering the limited statistical population of this study, generalization of the results to nurses working in other hospitals and employees of other organizations should be carried out with caution. Our suggestions for future studies include investigation of the relationship between ethical climate and ethical stress with individual and organizational performance and their interaction on linking job satisfaction with organizational results and outcomes in similar professional environments and other health professionals. Considering the correlation observed between ethical climate, job stress and job satisfaction, it is suggested that hospitals managers and authorities provide the necessary ground for institutionalization of professional ethics and decrease nurse's job stress and enhance their job satisfaction and quality of care for patients by creating an appropriate ethical climate. Also, holding training nurses on how to deal with ethical issues is recommended.
    Keywords: Ethical Climate, Job Stress, Job Satisfaction, Nurses
  • Reza Jahangiri, Aidin Aryankhesal Pages 73-92
    Background And Aim
    Nowadays health systems are not only responsible for improving the health of people, but also to protect them against illness and illness costs. Hence, one of the challenges faced by governments is the reduction of out of pocket payments to health care. Unofficial or informal payments are one kind of out of pocket payments that include payments to individuals or service providers, in cash or non-cash beyond formal payment processes. According to statistics and evidences, between 10 to 45 percent of the total out of pocket payment across low-income countries are informal. Addressing this phenomenon requires information about such illegal payments and their roots. Owing to high prevalence of informal payments through many health systems and nations, this systematic review aimed at identifying the nature, types of informal payments and their causes.
    Materials And Methods
    In this systematic review, the keywords of "unofficial payments" or "illegal payments" or "under-the table payment" or "Bribe" and "health system" in the Iranian databases of SID, IranMedex, Magiran and international databases of PubMed, Scopus, Science Direct, and Health Management Information Consortium (HMIC) were searched between years of 2000 to 2016. Also Google Scholar was used to find relevant resources and making sure about the search strategy coverage. Exclusion criteria included studies outside the health system studies published in languages other than Persian or English. Two researcher independently selected papers based on inclusion and exclusion criteria and disagreements were resolved through consultation between them. Also bibliographic search was done to find possible relevant studies. The result was 58 articles. After reviewing the titles and abstracts of the articles, 13 were excluded on relevance, 9 due to duplication and 3 because of language. Finally, 33 articles were included for the final analysis. Microsoft Excel was used for data extraction. The data were analyzed based on the emerging themes narratively.
    Ethical Considerations: This study was approved by the Ethics Committee of the Vice-Chancellor of Research, Iran University of Medical Sciences (IUMS / 93-04-16-25284). Integrity and trustworthiness in selecting of articles, reporting of findings and referencing were considered.
    Findings: Thirty-three full papers were selected for study and analysis. Seven of the studies were related to Iran and 26 of them were related to other countries, especially the Eastern European nations. No study was found from North America nor the Western Europe. Most of studies were conducted in higher-income countries. Studies described different characteristics for informal payments, so there was no uniform definition for this phenomenon. These payments are either made in cash or non-cash. Most cash payments are made before and through receiving services and non-cash payments when service is received. The causes of informal payments were categorized into three groups. First, payers, namely, patients and their families, wish to receive higher quality services, better access to services or in order to saving time, such as the waiting time for surgery and appointment of a doctor visit. Second, from the caregivers’ perspective, especially physicians, was low wages and tariffs, and irregular deductions from insurance companies. Finally, the health system's weaknesses as the third reason include insufficiency of insurance coverage, inadequate monitoring of tariffs and the lack control over charges, lack of human resources in some cases, and the asymmetry of information between provider and patient.
    The job and income level, level of education, age, gender and place of residence (rural or urban) of the patient and his/her family are factors influencing the amount and volume of informal payments. Among the doctors, the reputation and type of expertise are the most important determinants, so that surgeons and gynecologists had more informal inquiries in comparison to internists and psychiatrists. Also, doctors asked more money in urgent and critical cases. Famous doctors as well as doctors who worked in big cities received more informal payments. Also, the amount of payments were more in hospitals, inpatient wards and in sophisticated treatments and those used higher technology and modern facilities.
    Conclusion
    Informal payments are not defined universally, and attitudes toward them are different among different societies, because of different norms, resulted from different cultural and social values of societies. Informal payments, with any intention and for whatever reason, have generally certain negative consequences on the health systems and can affect patients and even service providers. Catastrophic costs, inequality of access to services and discriminated access to high quality care, and inequality in health outcomes are the main consequences of informal payments. The major impact, however, is to limitation of patients’ access to health care due to their higher costs. This result in inequalities in health outcomes. In addition, social justice will be vanished as one of the main responsibilities and missions of states, which will lead to the loss of public confidence in the health system. Revisions in the payment systems along with the redefinition of charges, reinforcement of insurance systems, informing patients about their rights and improving control over the reduction of informal payments are recommended.
    Keywords: Informal Payments, Illegal Payments, Health Care System, Equity, Systematic Review
  • Anahita Masoumpoor, Abbas Abbaszadeh, Maryam Rassouli, Hamid Alavimajd Pages 93-102
    Background And Aim
    Incivility behavior is a multidimensional and growing behavior and effects of it are considered to be lasting and important. These behaviors not only crash the learning environment but also question the ethical values of the nursing profession. The American National Association of Nurses has considered the necessity of creation of an ethical environment and promotion of civic culture which is the same respect for human dignity in 2015 in its ethical codes and has considered behaviors such as humiliation, harassment and threats to be morally unacceptable. Hence, the measurement of incivility in nursing education will identify these behaviors and adopt appropriate strategies and interventions to reform nursing education. The have so far been a limited number of studies and scales in the field of incivility behavior in nursing education. It is necessary to evaluate the quality of methodological studies which explain the characteristics of such scales. This study has been carried out with the objective of having a critical review about psychometry of scales for evaluation of incivility behavior in nursing due to the importance of incivility behaviors in nursing education and its destructive effect on learning environment.
    Materials And Methods
    systematic search was used to conduct the study. For this purpose, related English and Persian articles were first searched for in Google Scholar without a time limit and then, specified search was done in Science Direct, ProQuest, Wiely Inter Science, PubMed databases using the keywords of incivility or nursing education or Nursing Educators or Nursing Students and Scale. The screening result of these articles was identification of 15 scales in the field of incivility behavior. The results were organized in two sections of introduction and critique of scales after studying and analyzing these scales. Scales were initially described based on the time of design and creation and the same scales were then criticized.
    Ethical considerations: Integrity and trustworthiness were observed in analyzing, reporting and publishing the results.
    Findings: From 80 received articles, 15 articles which were devoted to nursing were studied and analyzed. All the studied scales were designed in accordance with the culture of the target society and had satisfactory validity and reliability and could be used in different studies. Most studies showed a Cronbach’s Alpha between 0.80 - 0.90. Internal consistency, content validity and methodology have been referred from all necessary criteria raised for verifying the validity and reliability of all the examined scales. INE, OCS, NIS, and UBCNE scales demonstrate a good content validity in aspect of being related and comprehensive and are quite consistent with the target population.
    Most scales evaluated the incivility behavior of instructors or students alone. The only tool which evaluates the incivility behavior of instructors or students with each other is incivility behavior measurement tool in nursing education by Clark et al. in which the validity and reliability of tool has been accurately mentioned while Casmin indexes are not met in other scales. The list of these scales is as follows: “Incivility in Nursing Education Scale (INES) “
    “Work place Incivility Scale (WIS)"
    “Workplace Aggression Tolerance Questionnaire (WATQ)”
    “Uncivil Work place Behavior Questionnaire (UWBC)”
    “Incivility in Nursing Education Scale (INES)”
    “Bullying in nursing education Questionnaire (BNEQ)”
    “Negative Acts Questionnaire –Revised (NAQ-R)”
    “Nursing Education Environment Survey (NEES)”
    “Nursing Incivility Scale (NIS)”
    “Uncivil Behavior in Clinical Nursing Education (UBCNE)”
    “Incivility in Online Learning Environments (IOLE)”
    “Nurses Intervention for civility Education Questionnaire (NICE-Q)”
    “Faculty –to-faculty Incivility Survey (F-FI)”
    “Incivility in Nursing Education Scale- Revised (INES)-R”
    Conclusion
    Most studies showed Cronbach Alpha between 0.80 and 0.90. Burns & Groove (2005) write that high levels of internal correlation show high level of correlation between phrases that measures the concept of study. On the other hand, compatibility of an external instrument with the culture of the target society is essential for using this type of tool which will make comparison of scientific findings with other countries possible by creating a common language. Hence, proper translation and adaptation of the foreign scales with the culture of the research society is extremely important. In each society, there is the need to design and use scales appropriate to its social and cultural conditions. Since incivility behavior is a two-way interaction and on the other hand, some of the studied scales did not meet the social and cultural conditions of the society, these scales of behavior in two interacting groups should be designed in accordance with conditions of the society.
    Keywords: Incivility Behavior, Nursing Education, Scale, Psychometric, Critical Review