soolmaz moosavi

Immediate evaluation and management of brain trauma patients improves disease outcomes and reduces the neurobehavioral consequences of the injury. Emergency nurses are expected to manage patients based on the best available evidence.

The present study was performed with aim to develop and implement an evidence-based care package for the management of brain trauma patients.

This semi-experimental study was conducted on 60 nurses in the emergency departments from November 2022 to May 2023. The subjects were randomly assigned to intervention (n=30) and control (n=30) groups. The data collection tool included a demographic questionnaire and a brain trauma management checklist. The intervention included 4 training workshops based on the comprehensive evidence-based care package during two weeks. Both groups were assessed through a checklist before and after the intervention during 8 weeks.

There was a significant difference between the two groups in the mean scores of care management before the intervention (p<0.001). In addition, the variables of employment status and education level were not the same in the two groups. Therefore, the pretest score, employment status, and education level were included in the model as a covariate, and their effect was adjusted. The mean score of care management after the intervention in the intervention group was 12.3 points higher than that of the control group (p<0.001).

Implications for Practice: 

Evidence-based care package improved the management of brain trauma patients, so it can be considered a simple and affordable solution to implement evidence-based practice and overcome the existing obstacles.

Spiritual health is part of the general concept of child health. Considering the effects of spiritual health on the growth and development of children, it is necessary to understand the concept of spiritual health and its dimensions in children. Accordingly, this study explains the dimensions of children’s spiritual health. 

This qualitative study was conducted using conventional content analysis. The data was collected through semi-structured interviews with 17 children and 9 researchers and specialists in the field of children’s mental health. Interviews were conducted with an average duration of 30 min.

Dimensions of children’s spiritual health with two themes of balanced relationship in 4 categories of relationship with God, relationship with self, relationship with others, and relationship with the environment, and the theme of relationship transcendence in 2 categories of transcendent behaviors and love of God were explained. 

Regardless of other developmental principles that follow the rule of maturity, the balanced relationship of spiritual health and the relationship transcendence of spiritual health in children did not follow the rule of maturity, and due to the innateness of the themes of balanced relationship and relationship transcendence of spiritual health. These characteristics have existed in children since childhood, regardless of any religious-spiritual measures within the family, and their spiritual health potential has been realized from their potential state.

Infertility is a culturally dependent, challenging experience for individuals and families. Understanding characteristics of Iranian infertile couples and effective coping factors can help counselors in selecting appropriate models. This study assesses the role of spiritual health in predicting stress in infertile women through resilience mediating role.

This predictive correlational study was conducted on 105 women at gynecology clinics of Mashhad, Iran in 2021.They were selected through Convenience sampling method. Tools included Spiritual Well Being Scale, Connor & Davidson Resilience Questionnaire and, Newton, Schrard, and Glavas Perceived Infertility Stress.  The instrument used were paper and pen, and they were completed by the participants. Pearson correlation coefficient and structural equation modeling were employed to analyze the data using SPSS (version 22) and Smart PLS software (version 3).

Findings revealed significant negative and relationships between spiritual health and perceived stress, positive relationships between spiritual health and resilience, and a negative relationship between resilience and perceived stress. Resilience mediated the negative and significant relationship between spiritual health and stress in infertile women. The value of the VAF index was equal to 0.368 and the total effect of spiritual health on perceived stress was equal to -0.732.

Spiritual health and resilience effectively reducestress in infertile women. Recommending psychological counseling based on spiritual health and interventions in suggested.

Considering the importance of respecting and observing patients’ rights, this study aimed to assess the level of observance of hospitalized patients’ rights from both patients’ and health-care workers' (HCWs) perspectives. This cross-sectional descriptive-analytic study reports the responses of 486 patients and 887 HCWs in a public referral university hospital. The study illustrates that patients and HCWs think patients’ rights are respected at a medium level; however, HCWs reported lower levels of respect for patients’ rights than patients, and senior HCWs reported even lower levels than their younger colleagues. Older patients and those hospitalized in internal medicine wards reported lower respect for autonomy and responsiveness, and patients’ companions reported lower levels of respect for patients’ rights than the patients themselves.

 The socio-cultural status of any society depends on the health of children. Enjoying spiritual health, as one of the important dimensions of health, plays an essential role in ensuring the comprehensive health of the child. This qualitative study was done to explore the consequences of spiritual health in Iranian children.

 This qualitative study was conducted using semi-structured interviews. Participants included 17 children and 9 researchers and specialists in the field of children’s mental health. Data analysis was carried out using the qualitative content analysis approach developed by Graneheim and Lundman.

 During the analysis of the text of the interviews, three themes of “psychological consequences” with three categories (mental vitality, mental growth, and cognitive growth), “socio-moral consequences” with two categories (ethical growth and social growth), and “religious-spiritual consequences” with two categories (religious behavior, religious transcendence) were obtained.

 The spiritual health in children helps them grow in all aspects, which indicates the capacity of spiritual health in children. It seems that focusing on moral-spiritual development in order to ensure the spiritual health of the child helps to prevent moral-behavioral disorders and provides the ground for excellence and meaningful growth. Therefore, considering the importance of having spiritual health in children, it is necessary for those in charge of education to implement and evaluate written and practical programs based on the consequences of spiritual health and in accordance with the family system, community, and school.

Although ethical practice is critical in anesthesiology, few practical measures have been presented to implement ethical clinical practice to this specialty.

This study was performed aimed to identify Iranian anesthesiologists' perceptions of moral distress in caring of anesthetized patients.

This qualitative study was performed using conventional content analysis approach based on semi-structured interviews of 15 anesthesiologists which worked in the hospitals affiliated to Tehran University of Medical Sciences in 2019. The sampling method was purposive and the data were analyzed based on Granheim and Landmann method.

Ethical distress perceived by anesthesiologists was classified into the following eight categories: (i) Ethical distress regarding informed consent and respect for patient autonomy, (ii) Ethical distress regarding the cancellation or postponement of patient's surgery, (iii) Ethical distress regarding the anesthesiologist's relationship with patients undergoing surgery, (iv) Ethical distress regarding surgical patients' companions, (v) Ethical distress regarding patients' privacy and confidentiality, (vi) Ethical distress regarding surgeon's colleagues and other OR colleagues, (vii) Ethical distress regarding end-of-life patients, and (ix) Ethical distress regarding fair distribution of resources and equipment.

Implications for Practice: 

The findings of the present study can provide a better understanding of situations that cause moral distress for anesthesiologists and can be used in policy making and preparing ethical codes and ethical guidelines for working in the operating room. Identifying ethical distresses of anesthesiologists in the hospital is the first step in conducting managerial interventions to improve the state of clinical ethics and organizational ethics in a care provider setting.

Accreditation of hospitals plays an important role in promoting the quality, safety and effectiveness of medical services, and increasing the efficiency of hospitals. The effectiveness of the accreditation system depends on the quality of the accreditation standards, the comprehensiveness of the accreditation method, and the quantity and quality of the accreditation appraiser. There is a need for appropriate metrics to review and evaluate the implementation of the charter of patients’ rights in the accreditation of hospitals. The aim of this study was to explain the challenges of patients’ rights in the Iranian hospitals accreditation system.

This qualitative study was conducted using a conventional content analysis approach with the participation of 13 key informants. In parallel with the interviews, with the aim of assessing the comprehensiveness, the coverage of the patients’ rights components was assessed by accreditation metrics in four sessions. Data analysis was conducted using the Graneheim and Lundman method.

The challenges of the accreditation system were explained by two categories "Content deficiencies of hospitals accreditation standards", "Managerial challenges of accreditation system".

Accreditation has an effective and serious role in the improvement of hospital services and can be a good monitor for observing the rights of service recipients and the charter of patients’ rights. This study provides useful information on the content deficiencies of the country's accreditation standards in terms of service recipients’ rights and its implementation challenges that can be used by policy makers.

Coronavirus epidemic, along with other countries around the world, in Iran, also raised the need for social distancing and home quarantine. As a result, the continuation of face-to-face education was disrupted and virtual education was chosen as a strategy for not stopping education in schools and universities. Alternatively, virtual education was adopted in order not to stop education, thereby causing new challenges for students and universities. This qualitative study aimed at investigating the experiences of university professors of the problems of virtual education during the COVID-19 pandemic.

This qualitative study was conducted using conventional content analysis. The aim of this study was to answer the question “What is the experience of university teachers about the challenges of virtual education during covid-19 pandemic?”. Participants were 24 university teachers in different fields whom were selected with purposeful sampling. Teachers of different disciplines at the university with a master’s degree or higher who also had at least three years of teaching experience were included in the study. Semi-structured interviews with open-ended questions were used to collect data. Analyzing data was done through conventional content analysis with Lundman and Graneheim methods with Maxqda.

The descriptive results of the study revealed that the age range of the participants was from 30 to 50 years old. 62.5 percent of the teachers were female. Their teaching experience varied from 3 to 26 years. In terms of academic degree, 58 percent were assistant professor, 20 percent were instructor, 16 percent were associate professor, and 6 percent were full professor. Additionally, 66 percent of them were teaching at state universities. The results obtained from the qualitative part of the study included Technology-related problems with 3 subcategory, Problems with the teaching process with 5 subcategory and Poor interaction with 3 subcategory.

Due to the long closure of universities and the long-term use of e-learning Managers and policymakers in the education system need to design programs to address these issues.

Achieving spiritual health is an aspect of human development and there are differences in the spiritual health of children with adults. Despite the importance of the issue of children’s spiritual health, there are very few studies in this field. Therefore, this review study was conducted to review the knowledge about children’s spiritual health in the sources.

This scoping review study was performed using the JBI checklist. The electronic databases of PubMed, Scopus, Ambis, Web of Science, Google Scholar, the database of Iranian journals and magazines, and the database of the Jihad Daneshgahi Scientific Information Center were searched for information.

Spiritual health in children means awareness, inner experience of wonders, curiosity, and belief in a strong force. The spiritual health in children are classified into three dimensions: emotional, relational, and existential. Important factors affecting children’s spiritual health were the child’s socio-cultural context, children’s own experiences, their relationship with others, parental and media behaviors, and spiritual health outcomes, including a wide range of positive outcomes.

The findings of the present study showed that the concept of spiritual health and its dimensions in children are as ambiguous as adults and also less attention has been paied to this issue. On the other hand, based on the findings of the present study, most studies in this field have been done in recent years, which could be a sign of increased sensitivity in this area. Therefore, considering the important role and impact of the cultural context of each country, it is necessary to conduct studies to explain the spiritual health of children and its indicators.

One important part of a nurse’s job is to create and help maintain a safe work environment. Evidence shows that negative behaviors such as incivility are not uncommon in the nursing profession. This systematic review and meta-analysis aimed to examine the prevalence of incivility toward nurses. For this purpose, all observational studies that primarily investigated the rate of incivility toward nurses were selected. The electronic databases PubMed, Embase, Web of Sciences, Magiran, IranDoc, and Scopus were searched for studies published during the period of January 1, 1996 to December 31, 2019. The quality of studies was assessed using Hoy’s Critical Assessment Checklist. The study was undertaken using the random effects model, and data were analyzed using STATA14. Data on 60 articles, including data on 30801 individuals, published between 1997 and 2019, entered the study. The findings showed the prevalence of incivility to be 55.10% (95%, CI: 48.05, 62.06). Due to the high prevalence of uncivil behavior, especially of the verbal type, nursing managers should identify risk factors in the workplace. Planners should develop programs to increase workplace safety, especially in centers that are most exposed to these behaviors. It is also recommended that future studies focus on implementation of effective evidence-based interventions based on organizational culture.

Courage is one of the moral virtues and the source of many personal and social achievements that are essential for providing quality care. Moral courage is to take action act fearlessly and act on the basis of will; that is, the individual acts without regard to other factors, only on the basis of values and what is good to others. Nurses are the ethical focus of the professional career group and inspiration source for moral care and compassionate. Moral courage is a professional management competence and the most important elements among the four virtues necessary for management; including foresight, justice and moderation, as well as a factor stabilizing the action. By seeing managers as ethical and behavioral models, nurses learn the correct and expected performance, and the courage to respond correctly to one situation is strengthened in them. The purpose of this study was to compare the mean moral courage of nurses and nursing managers working in hospitals affiliated to Shahid Beheshti University of Medical Sciences.
This descriptive cross-sectional study was conducted for 3 months starting from September to November 2015. A total of 70 nurses and 61 nurse managers were selected using convenient sampling method. Data collection was carried out using the Moral Courage Scale developed by Sekerka et al. in 2009. This scale consists of 15 questions categorized into five areas of moral agency, multiple values, endurance of threats, going beyond compliance, and moral goals. The response scale is 5-point Likert scale that is always arranged from Never (1) to Always (5). This scale was translated and back translated by Mohammadi et al. in Iran, and its validity was assessed through a survey of 10 experts in the field of medical ethics and content validity index (CVI) of 81% was obtained. Cronbach's alpha coefficient of 0.85 was obtained for the instrument reliability. To determine the reliability, the scale was completed by 20 nurses and nurse managers and the Cronbach's alpha of 0.86 was obtained. Data analysis was carried out by SPSS ver.22. Descriptive analysis of data was performed using central indices and comparison of mean moral courage in two groups using independent t-test. Pearson correlation coefficient was used to determine the relationship between age, work experience and moral courage. The response rate was 100% and 87% in the nurses and nursing managers groups, respectively.
Ethical considerations: To carry out the research, the relevant permission was obtained from Ethics Committee of the Shahid Beheshti University of Medical Sciences. The informed consent was obtained from participants after explaining the research aims and its implementation procedure. Also, the researcher assured participants about the confidentiality of their information and documents and explained to them about the freedom to withdraw from the research at any stage without being suffered from any adverse consequences.
Findings: A total of 40 (30.5%), 21 (16%), 38 (29%) and 32 (24.4% ) of cases of the 131 nurses and nursing managers participating in the study, were employed in internal medicine, surgical wards, ICU and emergency departments and the nursing office, respectively. Nursing managers included 31 (23.7%) head nurses, 27 (20.6%), educational and clinical supervisors, and 3 matrons (3.2%). The mean moral courage was 4.31 ± 0.40 and 4.33 ± 0.32 among nurses and nursing managers, respectively. The mean moral courage of the two groups was not significantly different (P= 0.06). There was a significant relationship between age, nursing management experience and moral agency (P= 0.04), as well as nurse's work experience, and then multiple values and going beyond compliance (P= 0.035). The mean moral courage was desirable among nurses and nursing managers. There was no significant difference between nurses and nursing managers in terms of mean of moral courage and its 5 items (moral agency, multiple values, endurance of threats, going beyond compliance, and moral goals).
The desirability of the mean moral courage of nurses and nursing directors in this study is a clear and positive point for health service providers that can be used to promote professional performance. Regarding the fact that there was a significant relationship between increase in age and work experience and the dimensions of moral courage in both groups, and considering that moral behavior and courage may decrease over time due to the influence of anxiety, fear and its negative consequences; therefore, to increase the moral courage of members of the organization, appropriate planning for training staffs, holding workshops and discourse sessions and encouraging and protecting moral behaviors are recommended. Also, strengthening the moral capabilities of managers and nurses having a higher work experience can provide the appropriate models for promoting moral performance in the organization.
Please cite this article as: Moosavi S, IzadiA. Comparison of moral courage of the nurses and nursing managers working in hospitals affiliated to Shahid Beheshti University of Medical Sciences. Med Ethics J 2017; 11(41): 17-24.

Diabetes is the most common metabolic disorder in Iran. Due to the nature of the disease, the patient's cooperation in self care is very important. One of the most effective and affordable ways to empower patients is education, which, to be beneficial, must be provided in accordance with related standards. The current study was conducted to investigate accordance of time of discharge diabetic patients with the standards of education for diabetics Type 2 in hospitals, affiliated in Yazd University of Medical Sciences.
At discharge, data on patient education provided by nurses to 385 diabetic patients, was documented using the “nursing diabetic patient education-discharge time check list” and were analyzed using descriptive statistics and SPSS 20.
Conformity rate of discharge nursing education in patients with Diabetes Type 2 with standards was 14.5%, which indicated a low quality of education. Conformity rate in the dimensions of “insulin therapy” was 34.7%, in “foot care education” was 6.75%, in “diet programs” was 1.8%, in “physical activity” was 0.1%, in “prevention of infection” was 1.8%, and in “oral antihyper­glycaemics drugs” was 13.3%.
Based on the poor compliance with the standards of education for diabetics Type 2 patients, application of nursing clinical guidelines during discharge for type 2 diabetic patients and clinical supervision by nursing managers for optimizing quality of care is recommended.

Researchers tend to understand children’ response to disease, hospitalization and their health and disease experiences for various reasons. The importance of information has increased the demand for qualitative research on children in order to gain sufficient and deep knowledge and understanding of their insights in this age group about health and disease so that we can plan for better physical, mental care and finally improve their quality of life by acquiring of necessary knowledge and information. Although ethical considerations in qualitative research are similar in different groups, ethical considerations are critical in this group considering the complex process of qualitative research and children’s vulnerable nature. This study was designed to determine the ethical considerations in qualitative research with children’s participation.
In this review, Persian and English articles published in Scopus, PubMed, SID, Irandoc, Magiran and Google Scholar databases were searched with no time limit using main keywords of "Ethical Considerations and Qualitative Research "or" Qualitative Research and Children ". The title and abstract of all articles were studied, duplicate and non-related articles were deleted, and contents of related articles were later analyzed.
Ethical Considerations: This study has been approved by the Vice Chancellor for Research and Technology, and Ethics Committee of Shahid Beheshti University of Medical Sciences with the identification code: IR.SBMU.RESEARCH.REC1395.514. Publication of the results is carried out without bias, honestly and by citing the original reliable resources and references.
Findings: Review of extract studies revealed general principles and ethical considerations in qualitative research with children’ participation are similar to other qualitative research and include attention to children’s participation, obtaining informed consent, ability to establish friendly and honest relationships, confidentiality and researcher’s sensitivity regarding publication of information and the imbalance of power.
The findings suggest that the ability to establish a friendly relationship and win the child's trust play a very important role in the child's active participation in the research process as well as reducing the imbalance of power between the researcher and the child. So, it is essential to directly obtain information from the child. Obviously, the participation of children in research play a very important role in empowering and valuation to view of this vulnerable group. Thus, children' research must be carried out in a valuable, supportive and safe environment using appropriate methods to support their social and mental abilities, so that children easily express their opinions. Obtaining informed consent is an ongoing process that requires researcher’s patience and the guarantee that the child has understood the necessary information. In fact, obtaining children’ consent and encouraging them to make a decision strengthen the right to participate in or withdraw from the study, even if the parents are not willing to participate in the study. Therefore, the researcher must ask children in the process of research regarding their consent and participation in the study and must pay attention to their body language and gestures. The ethical principle of confidentiality of information is the challenging part because most children are not independent of their parents; therefore, interviewing with children alone is associated with some problems. Sometimes a child may also disclose information and researchers in support for vulnerable children, are forced to disclose certain informationin some cases. Two other very important concepts in the process of qualitative research with children’s participation include freedom, power, and thus an imbalance of power between researcher and participant. Establishing a friendly false relationship is immoral, so the way in which the researcher introduces him/herself, the language and clothes used and body language and manner of interacting with children have an impact on their relationship. The difference in children’s perception and experience of the world’s, compared with adults, and their different ways of communication, make it different and challenging to implement and observe ethical principles. Long tradition of the research on children mainly focused on getting information from families and caregivers instead direct research on children. Today, researchers should know that the concept of children research is defined as study ‘’with’’ child instead of "on" child. This fact highlights the importance of Children's participation and consent in the process of research. Even if researchers attend to active participation of children in the process, the concept of vulnerability is still dominant in them that require more caution for children's participation in the research. Children’s research must be conducted in a supportive and safe environment using appropriate methods, but different from adults, in order to support their social and mental abilities, so that, children easily express their opinions. The researcher must frequently review the thoughts and process through self-reflection and ask questions regarding whatever is doing in this process. Also, the researcher must clearly explain his/her motivation regarding the involvement of children. He must win trust and honesty of adults responsible for children and to do so, all forms of applied ethics should be completed in research and child-centered approach must be used in their study. Also, in qualitative research with children’s participation, in addition to the fact that methodology and ethical considerations should be assessed by knowledgeable individuals, the Research Ethics Review Committee should carefully examine the capacity and strength of children in a proposed research project.

Maintaining dignity and respect is among patients’ most fundamental rights. The importance of patient dignity, the status quo, patients’ needs, and a shortage of survey studies in this area were the underlying incentives for conducting this study.This was a cross-sectional descriptive study in which data were collected through Patient Dignity Inventory (PDI). The questionnaire was completed by 280 inpatients in 2012 to determine their perspectives on their personal state of human dignity.In this study, the mean score of patients’ dignity was 1.89 out of 5 (SD = 0.81). Results indicated a significant relationship between type of hospital and the distress caused by disease symptoms, peace of mind, and social support (P < 0.05). There were also relationship between type of ward and dependency (P < 0.05), type of disease and dependency (P < 0.05), gender and social support (P < 0.05), household size and peace of mind (P < 0.05). The person’s satisfaction with household income showed significant relationship with symptom distress, dependency and existential distress (P < 0.05). Results showed a significant inverse correlation between age and patient dignity (P = 0.005, r = - 0.166). However, the relationship between employment status, health insurance, education level and the above factors were insignificant. Studies indicate that there is a relationship between patients’ dignity and mental distress, and therefore policy makers and health services officials should establish and implement plans to maintain and enhance patients’ dignity in hospitals. Educating the health team, particularly the nurses can be very effective in maintaining patients’ dignity and respect.