نشریه پرستاری ایران
پیاپی 125 (شهریور 1399)

Job plays a key role in health. The issue of health in hospitals is of a greater essence since the health of nurses is at a higher risk due to constant contact with patients. Important factors threatening the health of nurses include the stressful nature of the profession, high workload, ambiguity in job roles, communication problems and interpersonal conflicts, emotional problems, facing unpredictable situations, work shifts variables. Prolonged contact with critically ill patients and providing intensive care to specific patients predisposes nurses to a variety of mental disorders. Nurses working in intensive care units are at higher risk than nurses working in outpatient clinics. Reducing the feeling of well-being and health, despite the effect on nurses health, can indirectly effect the health of the community by reducing the quality of services provided by them. Because the environment of intensive care units is full of stressful conditions, including the observation of deaths, diseases and also the pressures exerted by patients companions on nurses, therefore, identifying the variables that are related to improving the general health of nurses working in intensive care units is more important than other occupations. The present study aimed to assess the general health of the intensive care unit (ICU) nurses of the selected teaching hospitals affiliated to Iran University of Medical Sciences.

This descriptive-correlational study was conducted on 193 ICU nurses of the selected hospitals affiliated to Iran University of Medical Sciences during January-May 2019. The participants were selected via stratified random sampling based on the inclusion criteria. Data were collected using a demographic questionnaire and the general health questionnaire (GHQ-28). The GHQ-28 consists of 28 items and four dimensions of physical examination, anxiety and insomnia, social functions, and depression. The items in the GHQ-28 are scored based on a Likert scale (Not at All, Normal, Abnormal, and Extremely Abnormal) within the score range of 0-3. The scores of the dimensions were summed up, and the total score was calculated within the range of 0-84.  The general health score is 23 and six in all the dimensions, so that the scores of ≤23 in general health and scores of ≤6 in the other dimensions represent healthy individuals or the absence of disease syndromes. In addition, the scores of ≥24 in general health and the scores of ≥7 in the other dimensions are indicative of disease syndromes. Data analysis was performed using descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics, including the analysis of variance, independent t-test for the normal variables, Kruskal- Wallis test for the non-normal variables, and simultaneous multiple linear regression analysis.  

The mean score of general health status was 28.86 ± 6.53, which indicated the average health status of the nurses with disease symptoms. Moreover the dimensions of physical symptoms (7.60 ± 2.29) and social functions (11.57 ± 1.81) showed health disorders, while the dimensions of anxiety and insomnia (6.74 ± 3.31) and depression (2.95 ± 3.00) were indicative of no health symptoms. Furthermore, significant correlations were observed between general health and the variables of age (P=0.023), marital status (P<0.001), economic status (P=0.023), and work shift (P=0.01). In addition, the results of the multiple linear regression analysis indicated that economic status (P=0.004) and marital status (P=0.010) became significant in the model, and their regression coefficients were estimated at 0.38 and -0.10, respectively, which showed the effects of these variables on the general health of individuals. In other words, the mean score of general health of the nurses with the income of less than 1.5 million was higher by 0.38 (lower general health) compared to those with the income of more than four million. Moreover, the general health score of the single nurses was lower by 0.10 (better general health) compared to the married nurses.  

Given the vital role of nurses as a treatment staff, it is necessary to pay attention to the problems of this group and try to maintain their health. Nurses who are not in good general health are unable to perform proper care such as physical and mental support for patients and this increases the risk of mistakes and occupational accidents, the consequences of which ultimately affect the patient and the nurse. Finally, it seems that the attention of officials to factors related to nurses health can be an important step in maintaining their health and inceasing their efficiency and will increase the quality of work. According to the results, special attention must be paid to the health of ICU nurses. Our findings in this regard could lay the groundwork for further research to adopt appropriate strategies for the improvement of the work conditions and skills training in an attempt to promote the general health of employees.

Midwives play a key role in the delivery of care services to mothers and neonates in the health system. The provision of high-quality services by midwives has a great impact on the prevention of maternal and neonatal mortality and its consequences, as well as the empowerment of women. It has been recommended that countries expand their midwifery programs, maintain the highest global standards, and improve the environment where midwives could effectively address the needs of women and their families. To achieve these goals, it is essential to motivate midwives as high job motivation could promote their efficiency. Theorists consider several factors to be influential in job motivation, such as physiological needs, safety, social needs, respect, and self-actualization. In Herzbergchr('39')s two-factor theory, the needs and stimuli that motivate employees have been listed, as well as the approaches through which they could be addressed in an organization. Numerous studies have assessed the influential factors in the job motivation of midwives in Iran based Herzbergchr('39')s theory. Meanwhile, midwives in healthcare centers have exclusively focused on their job duties (i.e., care of women of the reproductive age, pregnant women, and neonates). It seems that some of the motivational dimensions proposed for midwives have been modified due to the changes in the job duties of healthcare midwives in the Health Sector Evolution Plan, in which all midwives have been regarded as healthcare midwives, their organizational position has changed, and they were obliged to provide non-specialized and non-midwifery services in addition to specialized midwifery services, such as care services for infectious and non-communicable diseases for all ages and genders. Since the influential factors in the job motivation of midwives have not been properly recognized after the Health Sector Evolution Plan, the present study aimed to determine the influential factors in the job motivation of midwives based on Herzbergchr('39')s theory.

This descriptive, cross-sectional study was conducted on 207 midwives employed in the health centers affiliated to Tehran University of Medical Sciences (TUMS), located in the south of Tehran, Iran during in October-December 2018. The participants were selected via stratified sampling. Since TUMS covers three health networks of the south, Islamshahr, and Shahreray, each health network was selected as a stratified rank. Based on the population of the midwives of each rank and considering an average of two midwives per each health center, 120 health centers (south=60 bases, Islamshahr=25 bases, Shahreray=35 bases) were selected using a random numbers table for sampling. Data were collected using the standard Herzberg questionnaire and two open-ended questions regarding job motivation and intention to continue the profession after the Health Sector Evolution Plan. The quantitative data were analyzed in SPSS version 16 using descriptive statistics (independent t-test, analysis of variance, and Pearsonchr('39')s correlation-coefficient). In addition, the qualitative data were analyzed by content analysis.

In the responses to the internal factors in Herzbergchr('39')s job motivation questionnaire, the highest score belonged to the nature of the job (mean: 2.86±1.01), and the lowest score belonged to recognition (mean: 2.10±0.93). Among the extrinsic factors, the highest score belonged to the interactions of colleagues (mean: 3.99±0.76), while the lowest score belonged to salary and income (mean: 1.65±0.94). Furthermore, work experience prior to the Health Sector Evolution Plan (P=0.027) and work experience after the plan (P<0.001) had significant, inverse correlations with the internal factors. Work experience before the plan (P=0.016; r=-0.167) and work experience after the plan (P=0.001; r=-0.239) also had significant, inverse correlations with the internal factors, so that increased age and work experience before and after the plan led to the reduction of the mean scores of these factors. In addition, employment status had a significant association with the internal factors (P=0.004), so that the mean score of the internal factors in the corporate midwives was significantly higher than the formal and contractual midwives. Significant associations were observed between the work experience before the plan (P=0.037) and work experience after the plan (P<0.001) with the external factors. In addition, work experience before the plan (P=0.036 and P=-0.146) and work experience after the plan (P=0.036 and P=-0.146) had inverse, significant correlations with the external factors, and the increment in these variables led to reduced scores of the external factors. In addition, age had a significant correlation with the external factors (P=0.035), and the mean scores of these factors were significantly lower in the subjects aged more than 40 years compared to the mean scores of those aged less than 40 years. The majority (81.1%) of the midwives who answered the open-ended questions about changing job motivation (first open-ended question) reported that their job motivation has decreased compared to before the implementation of the evolution plan, and more than half of the midwives who answered the open-ended question about the continuation of the job as a healthcare midwife were willing to quit.

In general, the analysis of the responses to the open-ended questions indicated that low income, heavy workload, stress, and unrelated tasks to midwifery reduced job motivation and increased the tendency to quit in the healthcare midwives after the health evolution plan. Therefore, it is recommended that healthcare authorities attempt to enhance the motivation of midwives and guarantee the quality and maintenance of midwifery care by designing appropriate evaluation and motivational mechanisms, providing a payroll system based on workload (improving the external factors), defining the job position of family midwives in the health system as opposed to healthcare midwives, and the fundamental review of the job description and position of midwifery in the health system (enrichment of the midwifery profession). Furthermore, conducting research on the views and opinions of middle-range managers of the Health Sector Evolution Plan about staff motivation and the challenges in improving the quality of the healthcare services provided by midwives and healthcare providers could result in the inclusive assessment of the issues and challenges and adoption of comprehensive, practical, and effective strategies.

With the advancement of science and technology in the current era, cancer in adolescents is not as deadly as before and has only become a chronic disease with a higher survival rate. Despite the advances in cancer treatment and care, the disease is still associated with severe psychological consequences. The impact of cancer on various dimensions of adolescentschr('39') life (especially psychological dimensions) necessitates interventions to foster adaptation in the psychosocial dimension. Adolescents with cancer use a variety of social support resources to deal with the diagnosis and treatment of their disease. Family plays a pivotal role in providing the emotional and social support to these patients, and the perception of family support is considered to be the most important facilitator of health behavior, as well as the most potent strategy to successfully deal with stressors. It seems that the provision of emotional support by the family to adolescents with cancer helps these patients rely on the family and feel confident in coping with their difficult and critical condition, refrain from isolation, and feel encouraged. The present study aimed to evaluate the correlations between perceived family support and psychosocial adjustment with the disease in adolescents with cancer.

This descriptive-correlational study was conducted based on the error level of α=0.05 with 80% test power and sample size of 85. Considering 10% attrition, 95 adolescents aged 11-20 years diagnosed with cancer, who referred to two hospitals affiliated to Shiraz University of Medical Sciences in 2019, were selected via convenience sampling. Data were collected using a questionnaire containing three sections of demographic characteristics, perceived family support questionnaire, and psychosocial adjustment questionnaire during July-November 2019. Data analysis was performed in SPSS version 16 using descriptive and analytical statistics at the significance level of P<0.05.

The mean age of the patients was 14.3 ± 2.7 years. The sample population included 36 females (37.9%) and 59 males (62.1%). The mean duration of cancer in the patients was 1.9 ± 1.8 years, and the majority of the patients were the youngest child in the family (41.1%). Among the patients, 41 cases (43.2%) were residents of small towns. In 33 cases (34.7%), the patients had a family history of a similar disease. The majority of the patients had acute lymphocytic leukemia (57.89%), and among the other diagnosed cancers were neurological (14.7%), lymphatic system (11.6%), kidney (6.3%), bone and joint (3.2%), and soft tissue cancer (3.2%). The mean score of perceived family support was significantly higher in the female patients compared to the males. However, the total score of psychosocial adjustment was not significantly different between the males and females, and the mean score of perceived family support and total score of psychosocial adjustment also had no significant differences between the patients with leukemia and other cancers. Furthermore, the total score of perceived family support (mean: 26.16 ± 5.51) was considered moderate, while psychosocial adjustment with the disease (total mean score: 2.01 ± 0.41) was considered high. The highest adjustment was observed in the dimensions of attitude toward the disease, and the lowest adjustment belonged to the dimension of psychological disorders. Perceived family support was directly correlated with the female gender, while psychosocial adjustment was inversely correlated with age and directly correlated with maternal education level. However, no significant associations were denoted between the other variables.

The results of the study indicated a direct correlation between the perceived family support and psychosocial adjustment with the disease in the adolescences diagnosed with cancer. Evidently, the sense of security and confidence in the home environment and encouragement of the family members and companions who will not leave them alone in any particular and critical situations helps adolescents with cancer become empowered and gain extra motivation to accept and cope with the disease and the new life situation with positive feelings. Based on our findings and the results of similar studies, it could be stated that family support plays a key role in the confrontation and psychosocial adjustment with cancer. Therefore, it is recommended that healthcare managers and officials emphasize and strengthen the role of family support in the psychosocial adjustment of adolescents against cancer through proper planning by adopting strategies to maintain and promote the psychosocial health of these patients. Moreover, informing parents and medical staff on the results of this research and provision of proper training to these individuals make it possible to provide family support through the optimal implementation of family-oriented care. It is also suggested that psychiatrists and psychologists pay more attention to the family support of adolescents with cancer, and the presence of a counselor or psychologist in the oncology department could be beneficial in this regard. The presence of trained nurses in these wards and their close communication with adolescents with cancer and their families could also largely contribute to the effective provision of family-oriented care and training on the care and support skills of the families.

The work environment of healthcare providers and hospitals is constantly exposed to tremendous work pressure, complexity, and chaos. Due to the changes in various fields of treatment and care, these work environments are constantly changing as well. Meanwhile, bullying is considered to be a serious phenomenon in these organizations, which has also been reported worldwide as an important issue in the nursing profession. Workplace bullying could variably affect nursing. In healthcare organizations, workplace bullying could increase absenteeism, job loss, and job dissatisfaction among the employees. Furthermore, this phenomenon may reduce the quality of nursing care in hospitals and medical centers. These issues are particularly highlighted in the nursing profession since as the largest group of healthcare providers in these organizations and the leading managers of hospitals, nurses play a pivotal role in patient care. Improving the quality of nursing care is the most important factor to accelerate the recovery and return of patients to the community; therefore, the quality assessment of nursing care is essential. In Iran, most of the studies on bullying have been performed on students and teachers in schools, and few studies have been focused on nurses. Given the lack of accurate statistics on the rate of workplace bullying among Iranian nurses and the fact that the quality of nursing care is an important issue that could be affected by the bullying phenomenon, the present study aimed to evaluate the level of workplace bullying among Iranian nurses and its association with the quality of nursing care.

This cross-sectional, descriptive-correlational study was conducted on 200 emergency department and intensive care unit (ICU) nurses at Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences, Iran in 2019. The sample size included 200 nurses who were selected via simple random sampling. The inclusion criteria were employment as a nurse in the emergency department or ICU of Imam Khomeini Hospital Complex, willingness to participate in the study, and minimum work experience of six months as a nurse in the department. The exclusion criterion was incomplete questionnaires. Data were collected using a demographic questionnaire (age, gender, marital status, admission to the nursing major based on interest/knowledge, education level, clinical ward, service history, type of employment, shift work, duration of employment in the current department, having a managerial position, interest in the workplace, and coercion in the current department), negative acts questionnaire-revised, and SERVQUAL questionnaire. Sampling was performed after the approval of the study protocol and receiving the ethics license from the Joint Organizational Ethics Committee of the School of Nursing and Midwifery and the School of Rehabilitation of Tehran University of Medical Sciences. Eligible nurses were selected after explaining the research objectives and procedures and being assured of the confidentiality of their information with oral consent. The questionnaires were completed anonymously and in a self-report manner. Data analysis was performed in SPSS version 16 using descriptive statistics to describe the samples (frequency distribution tables, mean, and standard deviation). In addition, research objectives were used to describe the samples. To determine the gap between the perceptions and expectations regarding the quality of nursing care, paired t-test was used, and to determine the correlation between workplace bullying and the quality of nursing care, Pearsonchr('39')s correlation-coefficient was employed at the significance level of 0.05.

About half of the nurses (51.5%) were female, with the mean age of 32.58 ± 6.38 years. The mean work experience of the subjects was 9.74 ± 5.86 years in the nursing profession and 4.59 ± 3.99 years in their current ward of employment. The majority of the nurses (51%) were formally employed, had rotating work shifts (77%), and worked in the ICU (61.5%). In addition, most of the nurses had a BSc degree (84.5%). Based on the experience of daily or weekly workplace bullying, the mean workplace bullying of the nurses in the work-related bullying dimension was 10.11%, while it was 4.27% in the person-related dimension, and 5.66% in the physical dimension, with an overall mean of 6.68%. The maximum and minimum mean values belonged in the dimensions of work-related bullying and physical dimension, respectively. The results of paired t-test indicated significant differences between the dimensions of the perceptions, expectations, and gaps in the quality of nursing care in the viewpoint of the nurses and the dimensions of reliability (P<0.001), assurance (P<0.001), and total score (P<0.001). Furthermore, workplace bullying had inverse, significant correlations with the dimensions of reliability (P=0.006; r=-0.194) and assurance of nursing care quality (P=0.001; r=-0.229), so that with decreased workplace bullying, the quality of nursing care increased in these dimensions.

Although the results of this study indicated the low prevalence of bullying among nurses, nursing managers and policymakers should properly plan for the recognition, prevention, and management of this phenomenon due to the physical, psychological, and organizational effects of workplace bullying on the nurses employed in hospitals and health centers. Moreover, the organizational factors that lead to the workplace bullying of nurses should be identified. Due to the significant associations between workplace bullying and the dimensions of the reliability and quality assurance of nursing care, hospitals must fulfill their promises accurately and consistently. By recruiting nurses with adequate knowledge and skills, a sense of trust and confidence should be created in patients. This study showed that the lower rate of workplace bullying is associated with the higher quality of nursing care. Therefore, it is recommended that further investigations be focused on the effects of workplace bullying on patient care and its dimensions, as well as the quality of the provided care in hospitals and health centers.

Failed pregnancy is a destructive and common experience associated with physical, psychological, and cognitive complications, including a negative self-image, doubts about onechr('39')s fertility, considering the body to be inefficient, and feeling of failure in playing the feminine role and fulfilling the feminine identity adequately, which are manifested through reduced sexual activity and unwillingness to become pregnant again. In addition, the lack of sexual drive causes communicational tensions between parents. Therefore, a failed pregnancy affects the approach and attitude toward parenting, and since attitude is the foremost factor in the development of reproductive behavior, changing attitudes toward childbearing decreases fertility. Repeated pregnancy positively influences the stress caused by a failed pregnancy despite a sense of doubt and hesitation in the parents. After fetal loss, the majority of women need consultations and follow-ups regarding the causes of the incident, estimated risk of future pregnancy, and prevention of recurrence, while they may not be presented with the opportunity and receive no training, and the lack of awareness leads to concerns about the recurrence of the incident, unwillingness for another pregnancy, and even the attempt to conceive inappropriately. Therefore, the provision of an educational, care, and support program for these women with an emphasis on their experience of a failed pregnancy is paramount. Knowledge-based empowerment interventions promote the knowledge of fertility, self-efficacy, self-esteem, and self-control, thereby improving social communication, reducing negative emotions, and creating the right attitude to life experiences; in relation to failed pregnancies, such interventions have not been performed in Iran. The present study aimed to evaluate the impact of empowerment on women with a history of failed pregnancies.

This clinical trial was conducted on 80 women with a history of failed pregnancies who were admitted to Shahid Akbarabadi Hospital in Tehran, Iran within the past 3-6 weeks for the termination of pregnancy during January-May 2020. The inclusion criteria were the age of 18-40 years, basic literacy, no medical prohibition for pregnancy, no children, absence of mental disorders, no pregnancy after a failed pregnancy, history of failed pregnancies up to the maximum of two cases, no history of infertility, and intentional failed pregnancy. The exclusion criteria were stressful events during the study, absence in more than one training session, and pregnancy during the study. The names of eligible subjects were extracted from the hospital medical records unit continuously until the completion of the sample size. The women were invited to participate via phone. After obtaining written informed consent from all the subjects, they were assigned to two groups of intervention and control with four random blocks, and each sample was assigned a specific code. In the intervention group, empowerment training was performed based on the steps of threat perception, problem-solving, training participation, and evaluation in four training sessions and group discussions for four consecutive weeks at Akbarabadi Medical Training Center. Before and six weeks after the intervention, data were collected using Soderbergchr('39')s attitudes toward fertility and childbearing scale, which was completed by both groups. Data analysis was performed in SPSS version 16 using independent and paired t-test, analysis of covariance (ANCOVA), Chi-square, and Fisherchr('39')s exact test, and the P-value of less than 0.05 was considered significant.   

The intervention and control groups had no significant differences in terms of the mean age of the women and their spouses, womenchr('39')s age upon marriage, duration of marriage, womenchr('39')s age in the first pregnancy, fetal age, education level, occupation status of the spouses, cause of the failed pregnancy, gender of the expired fetus, method of pregnancy termination, and current method of contraception (P>0.05). Before the intervention, no significant differences were observed in the mean scores of attitude toward the fertility and childbearing of the women and all the subscales, with the exception of fertility required for the fulfillment of prerequisites (P=0.032) between the intervention and control groups (P>0.05). Six weeks after the intervention, the results of independent t-test and ANCOVA indicated significant differences in the mean scores of attitude toward fertility, female fertility, and all the subscales between the study groups (P<0.001), and the scores of the intervention group were significantly higher compared to the control group. In addition, the results of paired t-test showed significant differences in the mean scores of attitude toward fertility, childbearing, and all the subscales in the intervention group after the intervention as the scores were higher compared to before the intervention (P<0.001), while the difference was not considered significant in the control group (P>0.05). The results of independent t-test also indicated that the increase in the scores of attitude toward pregnancy, childbearing, and all the subscales was more significant in the intervention group compared to the control group six weeks after the intervention than before the intervention (P<0.001).   

The present study aimed to assess the effects of empowerment on the attitudes toward fertility and childbearing in the women with a history of failed pregnancies. According to the results, the mean total score and mean scores of the subscales of attitudes toward fertility and childbearing were significantly higher in the intervention group after the empowerment training compared to the control group, indicating that the implementation of an empowerment program with the aim of increasing knowledge, motivation, self-esteem, and self-efficacy results in self-control, preventive behaviors, and improved attitudes, which in turn positively influence the promotion of health and quality of life. Although pregnancy could be a pleasurable experience for the mother and family, the awareness of loss and feelings of shock, sadness, anger, and rejection cause tremendous ambiguity and concerns about the consequences of future pregnancies, while also causing negative attitudes toward fertility and childbearing, which may lead to immediate attempts for repeated pregnancy without considering the challenges of a terminated pregnancy and recurrence of failed pregnancy or the unreasonable delay of the next pregnancy regardless of the time limit of female fertility. Therefore, psychological support and training along with physical care by knowledgeable experts could be effective by empowering these vulnerable women through providing correct information to eliminate misconceptions, which in turn enhances healthy fertility by improving the attitudes toward fertility and childbearing. Since midwives have more interaction with these women as one of the most effective healthcare team members, they could use our findings to take effective steps toward improving this crisis and finding proper solutions.

The present study aimed to evaluate the relationship between teamwork and performance of the medical staff of Shahid Rajaei Cardiovascular, Medical and Research Center in Tehran, Iran. In a health system, teamwork is highly important for increasing the quality of services and the provision of safe and effective care. In addition, teamwork is recognized as an integral part of safe and efficient performance in a hospital. In addition, patient safety and health are considered a critical issue in the health systems of various countries. Therefore, teamwork and communication to prevent and reduce the medical staff’s errors are of utmost importance. The present study was carried out to assess the relationship between the teamwork of nurses and the performance of the medical staff of Shahid Rajaei Cardiovascular, Medical and Research Center in Tehran.

This descriptive-analytical research was performed in 2016. The statistical population included all nurses with a BSc, MSc, or higher degree working at medical centers of the university (n=290). The present research was carried out as correlational research, which is a type of descriptive study (non-experimental) that evaluates the relationship among variables based on research objectives. In total, 290 individuals were selected by simple non-random sampling method, and data were collected using a staff performance questionnaire by Choharie et al. and a teamwork questionnaire by Luncheon. The validity and reliability of the researcher-based questionnaire used in the present study were confirmed, and data analysis was performed in SPSS version 16 using the Pearson correlation coefficient and t-test.

In the evaluation of the correlation of two variables, the Pearson correlation coefficient will be applied if both variables are in relative and distance scale. If the correlation coefficient of the population is ρ and the correlation coefficient is a sample with n volume of the population r, r might be obtained randomly. To this end, we exploited the significance test of the correlation coefficient to determine whether the two variables were random or independent. In other words, the question was: are the correlation coefficient of community zero or not. The coefficient estimates the level of correlation between two distance or relative variables with a value in the range of +1 and -1. A positive value is interpreted as changes occurred in the two variables in the same direction. In other words, an increase in one variable leads to an increase in the other variable. On the other hand, a negative r value means that the two variables operate in the opposite direction. In other words, an increase in the value of one variable decreases the value of the other variable and vice versa. In addition, a zero value shows the lack of relationship between the two variables, whereas a positive and negative value is indicative of a completely positive and completely negative correlation, respectively. In the present study, the mean and standard deviation of the components of teamwork and performance of the staff was estimated at 3.28 ± 0.69 and 3.64 ± 0.55, respectively. Moreover, the mean of dimensions of commitment, trust, accountability, constructive approach, and purposefulness was reported to be 3.21 ± 0.75, 3.18 ± 0.84, 3.18 ± 0.80, 3.34 ± 0.75, and 3.54±0.90, respectively. According to the Pearson correlation coefficient, there was a direct and significant relationship between the performance of the staff and teamwork among clinical employees (0.514<r

According to the analysis performed, teamwork is a dynamic process, which includes two or several professional members sharing common treatment goals, necessary health skills, and specialties, who work with each other in an intimate working environment for solving specific and common goals. Team processes are a vital component of forming a coherent, committed, and united treatment team. Every year, healthcare providers are expected to use fewer employees with higher treatment safety. The importance of having a robust medical team and teamwork is highlighted due to the shortage of personnel and educational costs, medical errors, and increasing patient expectations. Teamwork in the healthcare field is so crucial that numerous studies have been conducted on training medical staff and team-making topics. It is notable that the organizations that apply teamwork have experienced significant improvement in their staff’s creativity, productivity, and satisfaction. According to the results, the level of teamwork among the staff was above average. Nonetheless, their teamwork should be enhanced to reach higher levels. In addition, managers in various sectors and hospital management should pay more attention to people’s achievements and use their opinions. Moreover, they should teach teamwork and related skills to their staff and use the necessary control levers in group management. All of these measures will ultimately lead to reduced possibility of re-hospitalization, decreased duration of hospital stay, and improved safety and performance results of the medical staff. Teamwork is not the regular placement of individuals in a specific location. In fact, teamwork requires adapting to each otherchr('39')s performance, understanding the treatment needs, being able to anticipate the priorities of others, and acclimating to changes in the environment. In addition, teamwork is required for better patient management and establishment of treatment safety.The results were indicative of a significant relationship between teamwork and performance of the medical staff of Shahid Rajaei Cardiovascular, Medical and Research Center in Tehran with the components of commitment (coefficient of), trust (coefficient of 0.79), accountability (coefficient of 0.84), constructive approach (coefficient of 0.77), and purposefulness (coefficient of 0.78). furthermore, strengthening teamwork among various employees and establishing educational workshops on communication skills can contribute to the improvement of staff’s performance.</r

Today, the rate of kidney diseases and urinary tract stones is on the rise. A common treatment method for urinary tract stones is the use of extracorporeal lithotripsy using shock waves, which may cause pain in the patients when the waves penetrate the skin. Pain could affect hemodynamic parameters and cause restlessness and movement in the patients, thereby disrupting the lithotripsy process. To reduce the pain in these patients, pharmacological methods such as the injection of various narcotic and non-steroidal analgesics are used. In addition to these medications, non-pharmacological methods such as mental distraction could effectively decrease patientschr('39') pain during painful procedures. Previous studies have indicated that mental distraction methods could variable affect pain relief and reduce anxiety in patients during different painful techniques. The present study aimed to compare the effects of visual and auditory distraction the pain and anxiety of these patients.

This three-group quasi-experimental study (auditory intervention, visual intervention, and control) was conducted with a pretest-posttest design at Shahrekord University of Medical Sciences, Iran in 2019. The sample population included the eligible candidates of extracorporeal lithotripsy referring to the lithotripsy unit of Ayatollah Kashani Hospital in Shahrekord in 2019 for outpatient treatment. The patients were selected via non-random sampling from the crusher candidates to achieve the sample size based on the inclusion criteria. The inclusion criteria were the initial diagnosis of kidney stones, age range of 20-50 years, auditory and visual health, and no history of using anti-anxiety medications and painkillers. The exclusion criteria were pain intolerance during the procedure, higher blood pressure than 140/90 mmHg, receiving drug therapy, drug addiction, history of mental and respiratory diseases, and previous experience of stone crushing. Data were collected before and after the intervention using the demographic information questionnaire, McGill short-form pain questionnaire, and Spielberger state-trait anxiety inventory. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, frequency percentage, mean, and standard deviation) and inferential statistics (paired t-test, t-test, Pearsonchr('39')s correlation-coefficient, and analysis of variance).

The Smirnov-Kolmogorov test showed that the study variables were normal (P>0.05). In total, 48% of the patients were male, and 42% were female. In terms of age, the research units were aged 23-51 years. The analysis of variance (ANOVA) and Chi-square indicated that demographic variables were not significantly different in the three study groups (P>0.05). The mean pain in the studied units was not considered significant in the study groups before the intervention (P=0.13), while this mean value was significant between the groups after the intervention (P<0.001). The lowest pain level during the intervention was observed in the visual intervention group, and Tukeychr('39')s post-hoc test for the difference between the groups also showed that the mean anxiety in the visual intervention group was significantly lower compared to the auditory group (P<0.001). In addition, paired t-test demonstrated that the mean pain was significant in the intervention groups before and after the intervention, and the intervention was effective in the intervention groups (visual and auditory). However, no significant difference was observed in the mean pain before and after the intervention in the control group (P>0.05). No significant correlations were observed between the mean pain and anxiety with the demographic variables (P>0.05), mean anxiety (P=0.84), and pain of the patients (P=0.13) before the intervention in different group, while a significant difference was denoted in the mean anxiety (P<0.001) and pain (P<0.001) after the intervention between the groups. The mean anxiety in the auditory group (P<0.001) and the mean pain in the visual group decreased more significantly (P<0.001) compared to the other groups. Furthermore, the mean pain in the visual group (P<0.001) and auditory group (P=0.02) and anxiety in the auditory group (P<0.001) and visual group (P<0.001) were significantly lower after the intervention compared to before the intervention.

The present study aimed to compare the effects of auditory and visual distraction on the anxiety and pain of the patients undergoing extracorporeal lithotripsy. According to the results, both the auditory and visual distraction techniques were effective in reducing the anxiety of the patients undergoing lithotripsy, while the auditory method had a more significant effect on the reduction of anxiety. Moreover, the visual method could decrease pain more significantly than the auditory method. Given the positive impact of music and movies on the anxiety and pain of the patients undergoing lithotripsy, as well as their lower demand for painkillers, these methods could be applied in the lithotripsy wards of hospitals and medical centers. In addition, using soft music and educational videos in this field while informing the patients about the incidence of kidney stones and treatment and its symptoms could reduce pain and anxiety; this decreases painkiller use and the side-effects of these medications. Such distractions (especially in the first lithotripsy session of the patients) could positively affect their anxiety and pain. The results of this study could be planned by the directors of medical institutions to reduce the pain and anxiety of the patients undergoing kidney stone crushing. Furthermore, nurses in stone-breaking wards should be familiar with various methods of visual and auditory distraction and their positive effect, so that they could be used on patientschr('39') demand as non-pharmacological methods to relieve anxiety and pain and increase patient satisfaction in those undergoing kidney stone crushing or other invasive procedures. It is also suggested that in the further investigations in this regard, the effects of this intervention be evaluated on the patients in the waiting room and on the personnel and researchers also determine the barriers to the use of non-pharmacological methods (e.g., mental distraction) in healthcare centers.

Medication errors are common incidences in the nursing profession, which could lead to the increased length of hospital stay and treatment costs and occasionally severe damage to the patients or even mortality. The Many studies have investigated medication errors, with a few considering medication errors as a severe issue in the clinical setting. Other findings have confirmed that the cooperation of medical personnel and medical system could influence the rate of medication errors. Considering the essential role of nurses in all the steps of medication preparation to administration, limited studies have evaluated nurses’ viewpoint regarding the influential factors in the incidences of medical malpractices, and mostly the viewpoints of emergency ward or ICU nurses have been investigated. The present study aimed to determine the influential factors in the medication errors by the nurses of the internal wards of the teaching hospitals affiliated to Iran University of Medical Sciences.

This descriptive study was conducted on 241 nurses employed in the internal wards of the teaching hospitals affiliated to Iran University of Medical Sciences in Tehran, Iran during June-September 2019. Data were collected using a demographic questionnaire and the questionnaire of nurses’ views on medication errors designed by Bijani et al. (2013), which were completed by the nurses. Demographic data included age, gender, marital status, number of children, education level, interest in the nursing profession, nursing profession work experience (years), occupation status, working shift schedule, economic status, clinical workplace, workplace changes in recent months, and number of the off days in the past month. The questionnaire of nurses’ views on the influential factors in medication errors has been developed by Bijani et al. (2013) with 22 items in three domains of the factors related to nurses in medication errors (11 items), factors related to the ward in medication errors (seven items), and factors related to the nursing management in medication errors (four items). The scoring system for each item is based on the significance of each factor on a four-point Likert scale (Very Low, Low, Moderate, and High), and each option is assigned a score within the range of 1-4, respectively. The mean score of each domain was calculated, with the low mean scores indicating the low significance of the domain in the incidence of medication errors and the high mean scores indicating the high significance of the domain in the viewpoint of the nurses. The questionnaire was completed by the nurses in a self-report manner and delivered to the researcher after one week. Data analysis was performed in SPSS version 16 using statistical tests.

According to the results, exhaustion due to heavy workload (mean score: 3.11 ± 0.85) was the most common cause of medication errors in the dimension of medication errors by nurses. In the dimension of hospital ward, heavy workload (mean score: 3.09 ± 0.85) was the most frequent cause of medication errors, and in the dimension of nursing management, the insufficient number of nurses in proportion to the number of patients (mean score: 3.53 ± 0.61) was the most common cause of medication errors. In addition, the factor of nursing management (mean score: 2.77 ± 0.51) had the highest mean value, while the factor of ward (mean score: 2.55 ± 0.54) had the lowest mean value among the influential factors in the incidence of medication errors in the viewpoint of the surveyed nurses. Lack of educational workshops (mean score: 2.3 ± 0.81) was the least significant cause of medication errors. The numerical indices of the influential factors in the incidence of medication errors in the domains of nurses, wards, and nursing management based on the demographic characteristics of the nurses indicated that only the number of children had a significant correlation with the incidence of medication errors (P=0.023), and the achieved mean score by the nurses without children was significantly lower compared to those with children (P=0.017). The incidence of medication errors in the domains of ward and nursing management had no significant correlations with the demographic characteristics of the nurses (P>0.05).

According to the results, the most significant influential factors in the incidence of medication errors in the viewpoint of the nurses were respectively nursing management, nurses, and the conditions of the internal wards. Therefore, it is suggested that to reduce the incidence of medication errors, the approaches to nursing management be revised. In addition, the implementation of educational workshops regarding medication errors could effectively decrease the incidence of medication errors by nurses, which should be considered by the authorities of educational centers. The incidence of medication errors could be reduced through academic education and by applying theoretical and practical courses during master’s and bachelor’s degree education. Regarding the related factors to the ward, it is recommended that the workload of nurses be decreased by increasing the nursing staff in proportion to patients, so that the working hours and working shifts of nurses could decrease to change their schedule, which could in turn minimize the incidence of medication errors.