فصلنامه حیات
سال بیست و هفتم شماره 3 (پیاپی 91، پاییز 1400)

Clinical decision-making is an essential part of the nursing profession. The nursing profession is based on ethical principles. Due to their commitment to patients, morally courageous nurses ignore occupational risks threatening their own lives.  The aim of this study was to investigate the relationship between moral courage of nurses and their participation in clinical decision-making.

This descriptive, cross-sectional study was conducted in 2019. The study population was nurses working in the CCU and ICU of Shahid Rajaie Cardiovascular Medical and Research Center. The sample size was 195 people. The data was collected using the Sekerka’s Moral Courage Scale, and the Participation in Decision Activities Questionnaire (PDAQ). Data was analyzed using descriptive statistics, independent t-test and Pearson correlation coefficient through the SPSS software version 19.

The mean scores of moral courage and PDAQ in nurses were 90.38 ± 11.48 and 117.24±39.42, respectively. A positive correlation was found between moral courage and participation in clinical decision-makings (r=0.397, P<0.001).

The results showed that moral courage has pride of place in the nursing profession that can encourage nurses to actively participate in clinical decision making. Therefore, professional ethics courses are suggested to be organized to improve decision-making and clinical ethical performance of nursing students and nurses.

Sexual function is an important part of the health of women, and the satisfaction of basic psychological needs is among the variables related to sexual dysfunction. The self-determination theory is one of the most important motivational theories, which considers one’s internal motive the main cause of behavior, and also views three psychological needs (autonomy, relatedness, and competence) as the basis of human behavior. This study was to determine the effect of sexual consulting based on the self-determination theory on women’s sexual function.

This clinical trial was conducted on 104 married women aged 18 to 49 years referred to Mashhad health centers in two groups of intervention and control in 2019. The intervention group received five sessions of two-hour group counseling based on the constructs of self-determination theory, with intervals of one week. The data was collected using the sexual performance questionnaire and the constructs of self-determination theory (basic psychological needs) before and after the intervention. Data was analyzed using the SPSS software version 16 through independent t-test, paired t-test, Mann-Whitney and Wilcoxon tests.

There was no statistically significant difference between the two groups in the average score of sexual function before the intervention. However, after the intervention, the difference in the average score of sexual function between before and after the intervention was 2.76±3.02 for the intervention group and -0.25±0.73 for the control group, which showed a significant increase in the sexual function score of the intervention group compared to the control (P<0.001). Moreover, after the intervention between the intervention and control groups, a statistically significant difference was observed in the average scores of autonomy, competence and relatedness (P<0.001).

Providing group sexual counseling based on the self-determination theory can satisfy the basic needs relating to sexuality and improve women's sexual performance.

In recent years, women's experience of disrespect and misconduct during childbirth has been raised as a significant problem around the world. This study aimed to determine the prevalence of disrespectful maternity care and its associated factors.

This is a cross-sectional study conducted in 2019 on 357 mothers who gave birth at hospitals affiliated to TUMS. The data collection tool included socio-demographic characteristics form, and the disrespectful maternity care questionnaire, measuring various domains of abuse. The questionnaire was completed by interviewing mothers. Data was analyzed using descriptive tests, Chi-square test and multivariate logistic regression through the SPSS software version 24.

All participants reported at least one form of disrespect, of which “not allowing for mobility, fluid and companion” was the most prevalent (99.7%) and “stigma and discrimination” was the least prevalent (4.5%). Statistical analysis showed a significant relationship between older age, ethnic minority, primiparity, higher socioeconomic status, delivery time (night, day) and a history of illness with more experience of different forms of disrespect.

This study confirmed a relatively high prevalence of disrespectful maternity care in hospitals based on international standards, which requires serious and prompt attention of top-level managers to take action to eliminate or limit this type of behavior.

Childhood vaccination as the most common iatrogenic pain is the main source of pain, anxiety and stress in children and parents, which is often done without pain management. Therefore, given the importance of pain control in children, and the recognition and application of pain control methods by the health team members, this study was conducted to evaluate the effect of ShotBlocker on vaccination pain in 6-month-old infants.

In this clinical trial study, 80 infants referred to Mehrshahr health center in Birjand in 2018-2019, were selected using the convenience sampling method based on the study criteria, and then randomly assigned to the control or experimental groups. In the experimental group, 20 seconds before the injection until the end of the injection, pressure was applied to the injection site with a ShotBlocker. The control group only received routine care. The pain status in the two groups was measured using the Pain Behavioral Response Scale (FLACC) 15 seconds after injection, and also the duration of crying from the time of vaccine injection to the end of crying was compared between the two groups. Data was analyzed using descriptive and inferential statistics including Mann-Whitney, t-test, and analysis of covariance at the significance level of less than 0.05.

The study results revealed the mean pain intensity (4.32±0.99), duration of crying (14.4±3.92), and the time of onset of crying (4.05±0.933) were lower in the experimental group than those of in the control group (P<0.001).

Considering that ShotBlocker is effective in reducing pain intensity, the duration of crying and delay in onset of crying, it is recommended to use this simple, safe, and low-cost device to manage pain during vaccine injection.

Anxiety is one of the most common complications in cancer patients that can affect the physical and mental health of patients and disrupt the treatment process. For this reason, cancer patients undergoing chemotherapy need education about the disease and ways to cope with its complications and problems. The aim of this study was to compare the effects of video and written training methods on anxiety in patients with gastric and esophageal cancer undergoing outpatient chemotherapy.

This study is a randomized clinical trial that was conducted on 58 patients with gastric and esophageal cancer who underwent outpatient chemotherapy in Shariati and Imam Khomeini hospitals in Tehran. Participants were randomly assigned to either the video training group (n=28) or the written training group (n=30). Data was collected using the Spielberger State Anxiety Inventory (STAI), at the beginning of the study and then weekly for 12 weeks. The SPSS software version 20 was used to analyze the data.

The results showed that the level of anxiety in both groups was significantly lower compared to before the intervention (P<0.05). There was no statistically significant difference in the anxiety mean score between the video group (56.07±9.85) and the written group (56.40±8.13) after the intervention (P=0.89).

In general, the results of this study showed that self-care education using video and written methods reduces the anxiety of cancer patients undergoing chemotherapy and both methods can be effective in reducing patients' anxiety.

Nurses' organizational loyalty to health systems plays an important role in expanding organizational performance. Investigating the role of factors such as citizenship behaviors and adaptive performance can be helpful in this regard. The aim of the present study was to investigate the relationship between citizenship behavior and adaptive performance with organizational loyalty in nurses.

This descriptive, cross-sectional study was conducted in 2019 on 200 nurses working in Valiasr hospital affiliated to Shahrekord University of Medical Sciences in Borujen, and were selected by the random sampling method. A demographic information form, the Lee & Allen’s citizenship behavior questionnaire, the Charbonnier-Voirin and Roussel’s adaptive performance scale, and the Kumar and Shekhar’s organizational loyalty questionnaire were used to collect the data. The data was analyzed by descriptive and inferential statistical tests using the SPSS software version 16.

The Pearson's correlation coefficient indicated a significant positive correlation between citizenship behavior and adaptive performance with organizational loyalty (P<0.05). Regression tests showed that citizenship behavior (ADJ.R2=0.199) and adaptive performance (ADJ.R2=0.131) significantly predicted organizational loyalty. All dimensions of citizenship behavior and some dimensions of adaptive performance such as creativity, learning efforts and job stress management can predict organizational loyalty in nurses. The average scores for citizenship behavior (66.85±18.26), adaptive performance (68.76±16.98) and organizational loyalty (120.67±24.09) were reported to be moderate.

Managers and planners should pay attention to factors such as creativity, stress management, and continuing education along with improving healthy working relationships and nurses’ participation, which can play an important role in expanding organizational loyalty through the development of citizenship behavior and adaptive performance.

Patient safety in general and medication errors in particular are the important indicators of hospital care quality. Risk management is an important and fundamental approach to preventing events caused by medication errors. The aim of this study was to determine the effect of risk management program on the rate of medication errors among intensive care unit nurses.

The present study was a non-randomized pre-test, post-test study with a control group, conducted in 2020 in two hospitals in Tehran. The hospitals were randomly assigned to either an experimental group or a control group. According to the inclusion and exclusion criteria, 150 nurses (75 nurses in each group) were selected by the convenience sampling method. For the experimental group, a risk management program was implemented. Data collection tools included the nurses’ demographic questionnaire, the 14-item Wakefield medication error self-reporting questionnaire, and the nurses’ medication quality checklist. Data was collected before and after the intervention and analyzed by the SPSS software version 16 using descriptive and inferential statistics.

The results of independent t-test showed no statistically significant difference between two groups in demographic information and the rate of medication errors before the study (P>0.05). After the intervention, difference in the rate of medication errors was statistically significant between the two groups (P<0.005), indicating a decrease in medication errors in the nurses of the experimental group compared to the control group. The results also showed that the rate of medication error observed in nurses was significantly higher than the error reported by them (P<0.001).

The results showed that the implementation of risk management program was effective in reducing nurses’ medication errors. Implementing a risk management program is recommended to nurses as a way to promote safe medication and achieve safe and desirable nursing care.

Pre-hospital emergencies are one of the most stressful medical professions. Stressful jobs affect employees’ resilience and their ability to control anger. The aim of this study is to determine the effect of psycho-education on the level of anger and resilience among pre-hospital emergency staff.

In this quasi-experimental study, 120 people employed in urban and road centers in Zahedan were included through the convenience sampling method. To determine the intervention and control group, out of 24 available centers, 12 centers were randomly assigned to the intervention group and 12 centers to the control group. First, a demographic information form and the self-reported anger and resilience questionnaires were completed by both groups. Then, the intervention group participated in five sessions of psycho-education in groups of 8-12 people. The questionnaires were completed again by both groups two months after the intervention. Data was analyzed by the SPSS software version 16 using descriptive (mean and standard deviation) and inferential statistics (Chi-square test, independent t-test and paired t-test).

The results of independent t-test showed no significant difference in the mean and standard deviation of resilience score among pre-hospital emergency staff between the intervention and control groups before the intervention (P=0.492), but after the intervention the difference was significant (P=0.009). Also, the results of independent t-test showed no significant difference in the mean and standard deviation of anger control score among pre-hospital emergency staff between the intervention and control groups before the intervention (P=0.672), but after the intervention, mean and standard deviation of anger control score in the intervention group were significantly higher than those of in the control group (P<0.001).

The present study showed that psycho-education improved the resilience of emergency workers, and the employees were able to control their anger by enhancing resilience. It is suggested that in-service training programs for pre-hospital emergency staff include a psycho-education program to enhance resilience and control anger in those who face many stressful situations.