فهرست مطالب مرضیه پازکیان

The qualities of care in emergency wards (EWs) represent the general state of all services provided in the hospital. Nurses, as the largest group of health care providers, play a significant role in the quality and safety of health services and they are often involved in moral situations and moral decisions in clinical situations. The aim of this study was to investigate the correlation between moral distress and the quality of safe nursing care in emergency department nurses.

This descriptive cross-sectional study was conducted at the EWs of teaching hospitals in Tehran in 2018. Data were collected through the Corleychr('39')s Moral Distress Scale (CMDS) (2004) and Rashvandchr('39')s Assessment of Safe Nursing Care (ASNC). Data analyzed using the IBM SPSS software (Version 22) by using descriptive statistics (frequency distribution, mean index, and standard deviation) and Pearson correlation tests, independent t-test, and one-way ANOVA.

The mean score of moral distress in EW nurses was high. The mean score of the quality of safe nursing care was also moderate. There was a negative significant correlation between the quality of safe nursing care and moral distress frequency (r=-0.057, p=0.014) and a significant negative correlation between the quality of safe nursing care and the severity of moral distress (r=-0.038, p=0.022).

Given the correlation between quality of safe nursing care and moral distress in EW nurses, health planners and administrators are suggested to reflect on this issue and successively develop and implement appropriate programs such as holding symposiums With the aim of making effective changes in procedures, and taking advantage of nurseschr('39') opinions, to prevent and reduce moral distress.

The prevalence of multiple sclerosis (MS) has been on the rise, especially among the youth in Iran. MS is more common in the individuals in their 20s and 40s, while women are also twice as likely to develop MS compared to men. Statistics suggest that there are 2.5 million MS patients worldwide, and this figure has been reported to be 15-30 cases per 100,000 in Iran. According to the Iranian MS Association, approximately 50,000 Iranians have MS, including 9,000 registered cases, and the rate is constantly increasing. Some of the main symptoms of MS are neurological, sensory, motor, and balance disorders, and fatigue is considered to be the most debilitating and common symptom; about one-third of MS patients report fatigue within the first three years of the disease diagnosis. Fatigue is an early symptom in 40% of MS patients, and 38% experience fatigue as the first diagnostic symptom. Extensive research has assessed the correlations between MS and various demographic variables, including individual factors (age, gender, education level), familial factors (family history of the disease), social factors (support of social institutions), economic factors (monthly income), emotional factors (family support), and disease-related factors (age at onset, length of hospital stay, medication). The present study aimed to measure fatigue in a large population of MS patients and determine its association with demographic variables.

This correlational study was conducted on 296 MS patients referring to the Iranian MS Association in Tehran, Iran during June-August 2019 via computation within a specific period. Fatigue was measured using Krupp fatigue intensity (1989), which has been used in extensive medical research. The minimum and maximum possible scores in this scale are nine and 63, respectively. Scores 9-18 indicate low fatigue, scores 18-45 indicate moderate fatigue, and scores above 45 show high fatigue. In Iran, Shahvaroughi Farahani et al. (2009) have measured the internal consistency of the items in this scale, which has been confirmed at the Cronbachchr('39')s alpha coefficient of 0.96, showing that the items of this questionnaire measure a concept. In addition, the intraclass correlation-coefficient test has been applied to evaluate the relative reproducibility of the Persian version of the questionnaire, with the value reported to be 0.93. The inclusion criteria of our study were the ability to communicate, basic literacy, dealing with MS for a minimum of one year, and not being in the acute stage of the disease. Participation was completely voluntary and free. The patients were assured of confidentiality terms regarding their personal information, which was only disclosed to the research team and used for scientific purposes. Data of the patients were collected anonymously, and a code was assigned to each questionnaire to prevent the disclosure of information. Data analysis was performed in SPSS version 16 using independent t-test, ANOVA, Pearsonchr('39')s and Spearmanchr('39')s correlation-coefficient, Dchr('39')Agostino-Pearson omnibus test, a correlation matrix, and Wilcoxon matched-pairs signed ranks test.

In total, 296 MS patients were enrolled in the study with the mean age of 37.15 ± 8.85 years and mean disease duration of 29.95 ± 22.06 years. Regarding the treatment costs, 18 patients reported low treatment costs, 74 cases reported moderate costs, while 102 and 63 patients reported high and extremely high treatment costs, respectively. Notably, the variable of medical expenses was correlated with the type of patient insurance (P=0.009), and the patients with armed forces insurance paid the least expenses for their treatment. The mean exercise duration of the MS patients was 4.34 ± 2.91 hours per week, and the mean total fatigue score was 39.18 ±14.56. According to the obtained results, 31 patients (10.5%) had low fatigue, 157 patients (53.3%) had moderate fatigue, and 108 patients (36.2%) had high fatigue. A significant association was also observed between the involved organs of the patients and fatigue (P=0.004), so that fatigue was higher in the patients whose four limbs were affected by MS and those with visual impairment in addition to the four affected limbs. In the general classification of disorders in the MS patients (sensory, motor, and sensorimotor disorders), motor disorders were most prevalent (41.89%), followed by sensorimotor disorders (41.71%) and sensory disturbance (35.66%). Furthermore, a significant correlation was observed between the number of hospitalizations due to MS and fatigue (P=0.001), so that with the increased number of hospitalizations, the patients expressed more fatigue. On average, our participants had three hospitalizations, and a significant association was denoted between marital status and fatigue (P=0.042). Compared to the single patients, fatigue was more common among the married, divorced, and widowed patients. In addition, monthly income was significantly associated with fatigue (P=0.001), and the patients with inadequate income expressed more fatigue. Exercise was also significantly correlated with fatigue (P=0.018), and less fatigue was observed in the patients who had physical exercise.

Considering that fatigue is a common symptom in MS patients, special attention should be paid to the influential factors to identify, eliminate or reduce the factors that are changeable. According to the results, fatigue is one of the most debilitating and common symptoms experienced by MS patients. Therefore, these patients, their families, and the treatment team (especially nurses) must recognize the influential factors in fatigue in order to increase patient awareness and reduce fatigue in these patients. We attempted to identify and report some of the influential factors in fatigue, such as individual and psychological, environmental, and disease-related factors, in the MS patients. It is recommended that proper measures be taken to reduce the debilitative factors and strengthen the factors that reduce fatigue. Moreover, healthcare officials should plan to increase income and create suitable job opportunities for MS patients who experience the limitations caused by the disease. The family members of these patients (especially spouses) could also provide great support, which plays a key role in adapting to the disease, taking measures to reduce fatigue, adherence to the treatment regimen, and reducing the number of hospitalizations in MS patients.

The success of the surgical safety checklist in reducing surgical mortality and morbidity largely depends on the degree of compliance with the checklist and correct implementation of its components by the staff. The aim of this review is to determine the challenges of effective implementation of the surgical safety checklist and to provide solutions for its more effective implementation.

 In the present systematic review, all the relevant qualitative papers published from 2010 to October 2018, were examined. A  literature search was done in databases SID, Iran Medex, Iran doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochran Library with keywords patient safety, surgical procedures, operative, checklist, World Health Organization, implementation science, qualitative research and their equivalent terms in Persian. Inclusion criteria were articles written in English or Persian, qualitative studies and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentations, letters to editor and quantitative studies.

The findings of the review of 14 qualitative studies showed that the most important challenges in effective implementation of the surgical safety checklist were unpredictable priorities, lack of collaboration and coordination of the surgical team members, mismatch between the checklist and hospital setting, lack of patient’s cooperation and lack of a planned approach towards implementing the checklist. The strategies to improve the implementation of the surgical safety checklist included checklist localization, improving the collaboration and coordination of all the team members, training and practicing, patient participation, and active organizational leadership.

The introduction of the surgical safety checklist to the health care setting is a permanent challenge and requires ongoing evaluations and its integration into the workflow in the hospital, active and effective leadership, explanation of why and how to use it by managers and receiving support from the organization. Continuous education, performance evaluation and the participation of all the surgical team members in the implementation of the checklist are key factors for effective implementation of the surgical safety checklist.

Data collection is among important steps that needs the use of right tools. Psychometric tools for measuring medication errors and strategies to reduce medication errors are very important. This study aimed at assessing validation of tools for measuring medication errors model variables that have been modeled on Reason human error.
In this methodological study after obtaining a planning permission for 6 instruments associated with medication error, Reason's model was used. This model includes care complexity, work dynamics, commitment, doctor/nurse relationship, medication error, and climate learning, and uses a seven-step learning process based on the translation of Wild et al. in 2005. In this study, firstly, the English version of the tools was translated to Persian and then back translated to English. The tools were then revised and summed to psychometrics, face validity and reliability using Cronbach's alpha coefficient in 63 samples for homogeneity and stability in a sample of 12 nurses at Imam Hussein healthcare center in Tehran.
The face validity of the views of nurses and nursing faculty members, and tools used in the proposed amendments were reviewed. The face validity of the views of nurses and nursing faculty members, and tools to review the proposed amendments were then applied. Also reliability using Cronbach's alpha coefficient for internal consistency and correlation coefficient in test-retest for stability, complexity of care (r = 0.88, α = 0.61), work dynamics (r = 0.96, α = 0.81), work commitment (r = 0.96, α = 0.88), physician-nurse communication (r = 0.80, α = 0.80), the climate learning t (r = 0.98, α = 0.80) and medication errors (r = 0.83, α = 0.83) were obtained and instruments in terms of reliability and validity were confirmed.
The results showed that foreign tools of medication errors can be used in the Iranian society. Validity of the instrument using confirmatory factor analysis to examine the factor structure, is recommended.

Medication errors as a one of the medical error is the most challenging factors related to patient safety. According to the Reason Human Error model, professional communication is one of the variables that influence the occurrence of drug errors by nurses.
Aim: The aim was psychometric characteristics of “physician-nurse communication scale” in medication errors based on Reason Model.
This research a methodological study that for determing the validity and reliability of nurse-physician communication scale (2003 Gittell), a confirmatory factor analysis was performed. After translation of the scale, based on the pattern of Wilde et al. (2005), construct validity was done by factor analysis and formal validity with nursing experts and nurses. Study population were nurses that working in different wards of teaching hospitals in Shahid Beheshti University of Medical Sciences. Based on inclusion criteria, 150 nurses were selected by convenience sampling method. To examine internal consistency and stability, Cronbach’s alpha coefficient and correlation coefficient of test-retest were used and factor validity used for construct validity. Data was analyzed using SPSS 18 software.
The mean of nurses’ age was (34.8±7.87) years and majority of them were female. The mean work experiences was (10.10±6.80)years. Factor analysis, rotated matrix determined one factors. Also reliability using Cranach’s alpha coefficient for internal consistency showed high reliability of scale (α=0.80) and intra class correlations (ICC) was (0.74).
Nursing managers can use this scale to examine professional nurse- physician communication and ultimately improve their communication in health systems. In order to nurses would be decrease medication errors that they resulted from interprofessional communication.

Twenty-first century challenges of nursing work is increasing complexity of care in the workplace. On the other word، medical errors is major challenge threaten for patient safety in all countries. The most common medical errors that identified are medication errors. With changing patterns of health services، the complexity increases in all workplaces. Since the medication administration is the main duties of nurses and drug companies influence of different drugs and different drugs for many patients، illegible handwriting of doctors، no prescription necessary recommendations، policies and new technology enterprise to apply، so it is a complicated process and in health care، the care complexity is one of the variables the affect on the occurrence of medication errors by nurses. This aim of study was translation، validity and reliability of care complexity scale in medication errors by nurses that for this purpose، the scale translates by Wilde and colleagues model (2005)، content and face validity using the 12 specialists and nurses reviewed and revised. Then the 115 nurses in teaching - therapeutic centers of shaheed Beheshti University of Medical Sciences were asked to complete the scale. Factor analysis revealed that scale had single factor. Also reliability using Cranach''s alpha coefficient for internal consistency showed moderate reliability of scale (α =0. 61) and correlation coefficient in test- retest for stability (r =0. 88). Although translation of care complexity scale in medical errors has satisfactory reliability and validity and can be used in the Iranian health system but is recommended criterion validity of scale examine by using other scales.

Assessment of clinical competence is of great importance in nursing which identifies the scientific gap between university education and clinical needs among graduate nurses. Hence, the aim of this study was to evaluate the clinical competence among MSc students of critical care nursing. In this descriptive cross-sectional study, 250 MSc students of critical care nursing were selected by convenience sampling from 17 state nursing schools of Iran in 2013-2014. A researcher-made questionnaire was used to collect data in five areas of care management, technical competence, individual management, patient-oriented care and scholarship. The content and face validity of the questionnaire were assessed and its reliability was calculated by Cronbach’s alpha coefficient for internal consistency (α = 0.86).A five-point Likert scale was used to measure the items. The collected data were analyzed using independent t-tests and one-way ANOVA. Ultimately, 217 questionnaires were analyzed. The total mean score of clinical competence was 4.30±0.41. The mean scores were 4.38±0.43 for care management, 4.40±0.56 for technical competence, 4.36±0.45 for individual management, 4.29±0.60 for patient-oriented care, and 3.66±0.79 for scholarship. Clinical competence was 4.23±0.43 in males and 4.36±0.39 in females (p=0.001, T=-2.15). There was a significant difference between years of education in scholarship area (p =0.01, T=30.15). The results showed that the clinical competence of female students was higher than male students. Also the level of clinical competence was high in most areas; however, it was different in terms of years of education in the scholarship area. Accordingly, a revised curriculum is recommended to enhance the efficiency of this course. It is recommended that more field studies be conducted on this area.

Medication errors are one of the most common medical errors. Since the performance of a theory in nursing is the extent of its application for description or prediction of evidence and also its potential in handling of the results as an occasional theory; this research was done to test the theoretical model of Reason human errors in nursing medication error. It was a descriptive, correlational study that was conducted at a large teaching hospital in Tehran, I.R. The nursing staffs (n = 150) were chosen in different wards affiliated to Shahid Beheshti University of Medical Sciences through convenience sampling. A researcher made questionnaire was utilized to collect demographic data, Velasquez nursing care complexity scale, Salyer work dynamic scale, Gittel et al., nurse-physician communication scale, Minick et al., work commitment scale, Wakefield et al., reporting medication error scale and Rybowiak et al., learning climate questionnaire were used to test the hypotheses related to individual and organizational factors based on Reasons Human Error Model. Using SPSS-PC (v.16), and LISREL 8.8 the data were analyzed by descriptive and path analysis tests (P_ value<0.01). The age of the majority of the respondents ranged between 31 to 40 years old (44.7%) and they had 10.60 ± 7.24 years of work experience. Model fit indices (CFI =1, GFI=0.99, RSMEA=0.00, = 4.83 RMR=0.65) showed that the paths considered for relationship between variables was appropriately predicted. Learning climate correlated with work commitment with standardized coefficient of (r =0.40) and learning climate correlated with physician - nurse communication with standardized coefficient of (r =0.20). There was no significant relationship between other variables. Based on the nursing medication error model, encouraging nurses to report error and using the model as a way to self-learning and other colleagues’ learning would be very helpful in the future. Also by creation of positive learning climate and modifying punishment for unintentional errors and proposing approaches to prevent recurrent errors in future occasions, mangers would be very influential.

Fatigue is a common symptom of Multiple Sclerosis. While the patients are advised to do exercise، no study has been conducted to assess the impact of fatigue on the level of fatigue. This research was conducted to investigate the effect of aerobic exercise on the level of fatigue in patients with Multiple Sclerosis. This clinical trial study was conducted with 80 patients referred to the Multiple Sclerosis Association in Tehran، Iran. The patients'' disability status severity was shown to be between 0-5. 5 Using the Expanded Disability Status Scale severity (EDSS). The patients chosen using the convenience sampling method were divided to the experiment and control groups. The patients were trained to do exercise for 6 weeks (18 sections). Data was gathered using the Fatigue Scoring Scale. Descriptive and inferential statistics were used for data analysis. There were a statistically significant difference in the level of fatigue between the patients in the experiment and control groups (P<0. 001). The aerobic exercise reduced the level of fatigue in patients with Multiple Sclerosis. It is believed that aerobic exercise reduces fatigue through energy conservation.

Osteoporosis and the related fractures due to discomfort، disability، decreased quality of life and death are major health problems in the world. According to the importance of recording and reporting osteoporosis، the aim of this study was development and psychometric evaluation of an «Assessment Form of Osteoporosis». This study is a systematic review of the literature review، Internet search and library studies on osteoporosis assessment form with the key word «Form»، «Osteoporosis»، «Incidence» and «Investigation» began between the years 1997-2008. In this searching، we obtained 2 forms and 3 questionnaires in this field and performed analyses and developed «Assessment Form of Osteoporosis». For validity of the form، researchers used content validity and consulted with experts in this field (5 nurse specialists، 2 orthopedic specialists in Bone Marrow Densitometry Center، 3 physiotherapists) about osteoporosis، its causes، the complications of the disease. After gaining enough knowledge and experience، their comments were reviewed and applied carefully. In this study «Assessment Form of Osteoporosis» developed and evaluated validity. Benefits of the form is as follows: in many forms there was not any question related to hormonal history in men or did not pay attention to the risk factors for osteoporosis in men، whereas the previous studies showed that hormonal disorder such as testosterone deficiency and prostate cancer can increase the risk for osteoporosis. So in this form، questions were designed in domains that assess individuals perfectly. The new form is applicable for all patients referring to health centers and bone marrow densitometry، schools، universities، and ultimately the whole community has the performance capabilities. «Assessment Form of Osteoporosis» is a comprehensive form and its data can identify the disease osteoporosis and the fractures. The data can prevent worsening of the disease.

Medical errors are among the most threatening faults against patient’s safety in all countries. The most frequent medical errors are medication errors which can lead to serious effects and even death in patients. Therefore، this study aimed to explain factors affecting medication eroors from the viewpoints of nurses in order to present strategies to reduce these errors. This study is a qualitative research based on directed content analysis approach. A porpuseful sample of 20 nurses working in Imam Hossein teaching hospital of Tehran، who had at least two years of clinical experience participated in semi-structured interviews. The regour and confirmability of data were verified through external check (member and peer check) as well as confirmation by participants. Data was simultaneously analyzed using qualitative content analysis. Participants stated factors influencing errors in two themes: individual approach (including «individual and psychological characteristics of nurses،» «characteristics of patients»، «error resulted from physician orders»)، and organizational culture and approach (including «working conditions»، «learning process»، «risk management procedures and how to deal with it»، «drug information»، «inevitability of errors in nursing»، and «complications of medication errors»). Factors affecting medication errors are diverse، variable، and influenced by personal، organizational، and situational factors. The results of this study showed the importance of comprehensive educational programs، qualified role models، opportunity for field experience، and availability of useful feedbacks in a favorable environment during academic years and in workplace.

Fatigue is among the most common symptoms of multiple sclerosis. Hence, exercise is recommended to multiple sclerosis patients. This research has been conducted to compare of stretching with aerobic and aerobics exercises on fatigue levels in patients. In this experimental study designed as a clinical trial, 80 eligible patients with multiple sclerosis referred to MS society in Tehran were selected according to inclusion criteria and then were randomly divided into two groups (stretching with aerobic and aerobics). The data gathering tool was a questionnaire consisted of two parts. The first part contained demographic characteristics, and the second part included fatigue severity scales (FSS). Exercises were done for 18 sessions and the exercise execution and period were assessed using a checklist. Data were analyzed using chi-square, paired and independent t-tests, and analysis of covariance. There were significant difference between the two groups in pretest fatigue level (p<0.005). Analysis of covariance showed that the mean of posttest fatigue level was significantly different between stretching with aerobic and aerobics groups and before-intervention fatigue severity was moderated (p=0.001). According to the findings of this research, both aerobic and stretching exercises are effective in reduction of fatigue in the multiple sclerosis patients. However, stretching with aerobic exercise is more effective in the decrease of fatigue.

Clinical education, the most important part of nursing education, is the integral part of professional education. The aim of this paper is to answer the question related to challenges in clinical training in Iran. In this article the literature review, Internet search and library studies about the challenges of clinical education with the key words "Clinical Education", "challenge" and "nurse" between the years 1997-2008, using databases such as MEDLINE and CINAHL, the ISI, and 10 qualitative articles related to keywords were selected & criticized. Based on the results of studies selected and according to key concepts discussed, it was shown that factors such as reducing importance of clinical education, lack of adequate access to clinical instructors, lack of proper coordination between faculty and clinical training facilities in the performance of hospitals, lack of proper time necessary for dealing with different cases of disease for the full practice learned in the clinical environment, lack of integration between clinical and theoretical training, stressful conditions and clinical problems. Major challenges in clinical education gap between theory and practice and the factors affecting its prevalence can be associated with teacher, educational environment, the system and the patient. Successful clinical nursing education, creative atmosphere without stress, the need to provide facilities, equipment, clinical review and clinical evaluation tools and processes has been confirmed in many studies. Improving performance of teachers and professional collaboration among experts can improve clinical education.