Concerns and Challenges of Living Donors When Making Decisions on Organ Donation: A Qualitative Study

Background

Mental concerns of living donors can be a solid barrier to logical and informed decision-making for organ donation. The present study explores living donors' mental concerns and problems during the process of decision-making for organ donation.

Materials and Methods

present study was performed using qualitative content analysis. Twenty-one participants were selected by purposive sampling. The data were collected and recorded through semistructured interviews and analyzed by MAX Qualitative Data Analysis software 12, based on Graneheim and Lundman's contractual content analysis method.

Results

Data analysis extracted 425 codes, 13 subcategories, 3 main categories, and 1 core theme (conflict between doubt and certainty). The three main categories were individual barriers and concerns (faced by the donor), interpersonal concerns and barriers (experienced by the family), and socio-organizational concerns and barriers (at the community).

Conclusions

Based on the results, donors have significant concerns and face major problems when deciding on organ donation. Therefore, health-care professionals should take into account organ donors' concerns, raise awareness of donor associations, and formulate policies to increase living donors' satisfaction.

Effectiveness of resilience training on social self-efficacy of the elementary school girls during COVID-19 outbreak

Children, especially girls, are more vulnerable during crises, who need to acquire skills such as social self-efficacy to meet the challenges of the environment. Given that, much progress has been made in e-learning; its capabilities can be used to promote children's health. This study aimed to determine the effect of virtual resilience training on the social self-efficacy of elementary school girls. This experimental study was performed on primary school girls aged 9-10 years in southeastern Iran. Students were selected by convenience sampling and divided into intervention (n = 40) and control (n = 37) groups by using randomized allocation. The Children's Social Self-Efficacy in Peer Interaction Scale was used for data collection before, immediately, and one month after the intervention. No significant difference was found between the two groups of intervention and control in the score of social self-efficacy before the intervention. However, the score of students in the intervention group improved immediately and one month after the intervention, and a significant difference was observed between the two groups (p = .0001). Virtual resilience training has improved the social self-efficacy of elementary school girls and facing challenges is inevitable in today's world, so resilience training seems necessary to prevent social and psychological harm in such children.

The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study

Objectives

This study aimed to describe the experience of healthcare professionals in providing mental health services to women with postpartum depression (PPD).

Methods

In this qualitative study, data were collected through semi-structured interviews with five physicians, five midwives and five psychologists from 14 urban healthcare centres in Kerman, Iran, from April 2019 to September 2019. Purposeful sampling was used to select the participants. Data were qualitatively analysed using a content analysis approach.

Results

Data analysis revealed the main theme of the study: ‘the long way ahead for comprehensive, integrated and responsive mental health services’. This theme included four categories: ‘postpartum depression challenges’, ‘social and personal factors’, ‘structural challenges’ and ‘need for change in mental health services’. The participants described that depression diagnosis is difficult due to insufficient knowledge among healthcare providers and the hidden signs of PPD. They also described how different factors such as economic and cultural factors, personality traits, a community’s lack of knowledge, negative attitude towards depression and limited family support might cause depression. Moreover, providing mental health services involves certain challenges, such as limited human resources, insufficient financial resources and incomplete or inefficient policy-making.

Conclusion

Although measures have been taken to provide mental health services, there are many challenges regarding providing mental health services to mothers. Therefore, serious measures should be taken to improve mental health services and re-define the existing measures. Informing the community, empowering the healthcare providers and attempting to change the community’s attitudes and beliefs can affect the mental healthcare of women with depression.

The association between body mass index and health literacy in high school Students: A cross-sectional study

BACKGROUND

Obesity and overweight in children and adolescents have become a global problem in recent years. Adolescence increases the likelihood of obesity in adulthood and associated illnesses. Nowadays, health literacy is one of the greatest determinants of the health. This study was conducted to evaluate the correlation between body mass index (BMI) and health literacy in high school students.

MATERIALS AND METHODS

In this descriptive-analytical study, 430 high school students were enrolled in a multi-stage random method in Yazd city in the center of Iran. The data were collected through The Health Literacy Measure for Adolescents and calculate BMI with measurement of height and weight of adolescents. The data were then analyzed using SPSS 25 and descriptive and inferential statistics (Chi-square and multivariate regression).

RESULTS

The results showed that the mean score of BMI (21.76 ± 3.76) was in a normal range. The score of health literacy was at the borderline level (58.44 ± 13.79). BMI was not significantly correlated with health literacy (P = 0.09). BMI was significantly different in terms of age, high school grade, school type, and health status. School type and health status predict 37% of the variance of BMI (R ² = 37%) and the best predictor was health status (P < 0.05).

CONCLUSIONS

The results of the present study showed that BMI was not correlated with health literacy and student health literacy was at the borderline level. It is necessary to carry out further studies on the causes and facilitators and the barriers to increasing health literacy. Furthermore, educational interventions are needed to prevent the increase of BMI in adolescents and identify determining factors.

Empowerment of nurses for integrating clients' religion/spirituality into clinical practice: outcomes of an online training program

Background

Integration of clients’ religion/spirituality (R/S) into nursing practice can have effective outcomes in clients’ health. In this regard, nurses’ lack of competency can disrupt this process and interfere with the treatment process. Limited studies examined the impact of training programs on nurses’ competency in spiritual care and integration of clients’ R/S into clinical practice. This study aimed to investigate the impact of an online training program on nurses’ empowerment for integrating clients’ R/S into clinical practice.

Methods

In the present interventional study, 80 nurses were selected by stratified sampling from two hospitals in the southeastern Iran. Nurses were randomly divided into the intervention (n = 40) and control (n = 40) groups. An online training program was performed for the intervention group in four 2-hour sessions during three weeks. Data were collected from all participants using the R/S Integrated Practice Assessment Scale (RSIPAS) before and one month after the intervention.

Results

Prior to the intervention, scores of integrating clients’ R/S into clinical practice were not significantly different between the intervention and control groups (t = 0.23, p = 0.81). However, after the training program, these scores increased significantly with a very large effect size compared to the control group (t = 4.31, p = 0.001). Although the control group scores improved significantly after the intervention compared to the pre-intervention stage, the effect size was very small (t = -2.55, p = 0.01).

Conclusions

The online training program had a positive effect on nurses’ competency for integrating clients’ R/S into clinical practice in the intervention group. Due to the importance of integrating clients’ R/S into clinical practice, nurses’ competency should be strengthened in this area. Managers are suggested to consider appropriate strategies in order to empower nurses in integrating clients’ R/S into clinical practice. Nurse educators can benefit from our experiences in application of online training programs in nursing schools.

Determining the information needs of contact lens wearers for better education and more support: a qualitative study

BACKGROUND

Designing educational interventions tailored to the needs of Contact Lens Wearers (CLWs) are important and necessary. The present study aimed to determine the information needs of CLWs to educate and provide information to them to increase their knowledge and reduce complications and non-compliance behaviors.

METHODS

A qualitative approach was applied and semi-structured interviews were conducted in three contact lenses (CL) clinics in Iran among all their practitioners and 24 purposively selected patients. Data were analyzed using the Lundman and Graneheim conventional content analysis.

RESULTS

The qualitative analysis revealed knowledge and skill themes as two main categories. The knowledge category includes five subcategories of basic information for the CLWs, acquaintance with the CL, caring for CL, hygiene and vigilance of CL, and challenges of using CL. The skill category consists of two subcategories, including handling/insertion and removal of the CL, and stabilization of learned information. Moreover, 36 sub-subcategories emerged from these seven subcategories that reflected the information needs of CLWs.

CONCLUSIONS

A clear understanding of CLWs' information needs can help to design and develop appropriate educational approaches to overcome training barriers such as physicians' time constraints and high workload. Moreover, it can help deal with CLWs' insufficient knowledge and provide the required information simply and practically with the possibility of enough repetition.

Gender Matter, Social Phobia and High-Risk Behaviors in Young Medical Students

Background

Young is one of the most sensitive stages of human life. Social phobia and high-risk behaviors are factors that enhance young crises. This study aimed to determine the relationship between gender role, social phobia and high-risk behaviors among young medical students.

Methods

In this descriptive correlational study, 400 students were selected by quota sampling method from a medical university in Southeastern Iran. For data collection, the demographic information questionnaire, Gender Trait Index (GTI), Social Phobia Inventory (SPIN), and Iranian Adolescent and Young Risk-Taking Scale (IAYRS) were used. Data were analyzed using descriptive statistics including mean and SD and analytic statistics such as Kolmogorov-Smirnov, Mann-Whitney U and Kruskal-Wallis tests using SPSS 25 and p ≤ .05.

Results

The mean scores of masculinity and femininity gender roles were 38.98 ± 7.92 and 44.12 ± 7.76, respectively. Also, 70.5% of the students had dominant feminine traits, and the gender identity was high in 58.8% of the students and moderate in 40.2% of them. Social phobia (37.12 ± 12.61) and high-risk behaviors (81.77 ± 26.08) were moderate. A significant inverse relationship was found between masculine traits and social phobia (p <0.001). Another significant inverse relationship was observed between feminine traits and high-risk behaviors (p <0.05).

Conclusion

Given the poor relationship between gender role, social phobia and high-risk behaviors, it is essential to conduct further studies to determine the predictors of social phobia and high-risk behaviors in medical students.

The effect of mindfulness-based stress reduction on resilience of vulnerable women at drop-in centers in the southeast of Iran

Background

Female sex workers and addicted women are among the vulnerable groups who impose high costs on the health system of every society. They are prone to psychological problems such as anxiety, stress, and reduced resilience due to their lifestyles. Since mindfulness-based stress reduction (MBSR) has been applied frequently by many psychotherapists to treat stress and anxiety, the present study investigated the effectiveness of MBSR on resilience of the vulnerable women.

Methods

The statistical population of this quasi-experimental study consisted of all eligible women who referred to the drop-in centers in Kerman in the southeast of Iran. Followed by random sampling, 63 vulnerable women were randomly assigned into the intervention (n = 30) and control (n = 33) groups. The MBSR intervention was conducted for the intervention group in eight 90-min sessions. Demographic information questionnaire and Connor-Davidson resilience scale were administered to collect data prior to and one month after the MBSR intervention.

Results

The pre-test resilience score was not significantly different between the intervention (53.40 ± 10.49) and the control (54.5 ± 9.27) groups (t = 0.43, p = 0.66). However, the posttest resilience score in the intervention group (60.66 ± 6.71) was significantly higher than the control group (53.88 ± 7.54) (t = 3.58, P = 0.001). Moreover, a comparison between the pretest and posttest scores revealed a significant decrease in resilience scores of the control group (t = 2.81, p = 0.009).

Conclusion

Since MBSR intervention increased resilience of the vulnerable women in the intervention group, researchers, managers, counselors, community health nurses, and psychiatric nurses are suggested to implement related interventions to promote the health of women, especially vulnerable ones.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01390-6.

Improving nurses' readiness for evidence-based practice in critical care units: results of an information literacy training program

BACKGROUND

One of the most important prerequisites for nurses' readiness to implement Evidence-Based Practice (EBP) is to improve their information literacy skills. This study aimed to evaluate the impact of a training program on nurses' information literacy skills for EBP in critical care units.

METHODS

In this interventional study, 60 nurses working in critical care units of hospitals affiliated to Kerman University of Medical Sciences were randomly assigned into the intervention or control groups. The intervention group was provided with information literacy training in three eight-hour sessions over 3 weeks. Data were collected using demographic and information literacy skills for EBP questionnaires before and 1 month after the intervention.

RESULTS

At baseline, the intervention and control groups were similar in terms of demographic characteristics and information literacy skills for EBP. The training program significantly improved all dimensions of information literacy skills of the nurses in the intervention group, including the use of different information resources (3.43 ± 0.48, p < 0.001), information searching skills and the use of different search features (3.85 ± 0.67, p < 0.001), knowledge about search operators (3.74 ± 0.14, p < 0.001), and selection of more appropriate search statement (x2 = 50.63, p = 0.001) compared with the control group.

CONCLUSIONS

Nurses can learn EBP skills and apply research findings in their nursing practice in order to provide high-quality, safe nursing care in clinical settings. Practical workshops and regular training courses are effective interventional strategies to equip nurses with information literacy skills so that they can apply these skills to their future nursing practice.

Mothers and nurses' perceptions of the family-centered care barriers in pediatric departments of an educational hospital in Iran

PROBLEM

Family-centered care (FCC) is a concept used to describe an approach to caring for children and their families within health services. This study compared mothers and nurses' perceptions of barriers to FCC.

METHODS

This cross-sectional study was conducted in an educational hospital affiliated to Kerman University of Medical Sciences at the southeast of Iran in 2019. Using a researcher-designed questionnaire, we assessed mothers' and nurses' perceptions of barriers to FCC with a census method (60 nurses and 82 mothers).

FINDINGS

Mothers (49.8 ± 21.1) and nurses' (49.2 ± 16.4) mean scores of the perception of FCC barriers were at a moderate level. No significant difference was found between mothers' and nurses' perceptions of barriers to FCC. A significant relationship was observed between age, child's admission history, and the perception of FCC barriers in the mothers' group.

CONCLUSION

Findings suggest that national and regional policies of educational hospitals should assess factors contributing to the FCC barriers, focus on how to reduce these barriers, and provide appropriate collaborative care by nurses and the family of patients.

Assessing the effect of virtual education on information literacy competency for evidence-based practice among the undergraduate nursing students

Background

Information literacy competency is one of the requirements to implement Evidence-Based Practice (EBP) in nursing. It is necessary to pay attention to curricular development and use new educational methods such as virtual education to strengthen information literacy competency in nursing students. Given the scarcity of the studies on the effectiveness of virtual education in nursing, particularly in Iran, and the positive university atmosphere regarding the use of virtual education, this study investigated the effect of virtual education on the undergraduate nursing students’ information literacy competency for EBP.

Methods

This interventional study was performed with two groups of intervention and control and a pretest and posttest design. Seventy-nine nursing students were selected and assigned to the intervention or control groups by random sampling. Virtual education of the information literacy was uploaded on a website in the form of six modules delivered in four weeks. Questionnaires of demographic information and information literacy for EBP were used to collect data before and one month after the virtual education.

Results

The results showed no significant difference between the control and intervention groups in all dimensions of information literacy competency in the pre-test stage. In the post-test, the virtual education improved dimensions of information seeking skills (t = 3.14, p = 0.002) and knowledge about search operators (t = 39.84, p = 0.001) in the intervention groups compared with the control group. The virtual education did not have any significant effect on the use of different information resources and development of search strategy with assessing the frequency of selecting the most appropriate search statement in the intervention group.

Conclusion

Virtual education had a significant effect on information seeking skills and knowledge about search operators in nursing students. Nurse educators can benefit from our experiences in designing this method for the use of virtual education programs in nursing schools. Given the lack of effectiveness of this program in using different information resources and development of search strategy, nurse educators are recommended to train information literacy for EBP by integrating several approaches such as virtual (online and offline) and face-to-face education.

Spiritual Well-Being and Purpose in Life Among Conscripts: A Case Study in Iran

BACKGROUND

Spiritual Well-Being (SWB) is an important aspect of health. Since soldiers, as members of community, are faced with numerous spiritual, psychological, and physical problems, belief in spirituality can play an important role in explaining their purpose in life (PIL). Therefore, this study aimed to evaluate SWB, PIL, and the relationship between these two concepts in conscripts. In this cross-sectional study, 301 soldiers were selected by available sampling method from one of the military barracks in Iran 2019. Data were collected using the demographic, SWB, and PIL questionnaires. The results showed that SWB of the soldiers were at the high level (100.6 ± 12.30) and their PIL were at the moderate level (112.92 ± 13.70). Furthermore, a direct and intermediate relationship was observed between the soldiers' SWB and PIL (P <0.001, r = 0.50). Based on the findings, increased SWB enhanced PIL in soldiers and vice versa. To increase generalizability of the data, studies over a larger statistical population are recommended in different cultures. Findings of this study can also identify the interventional strategies to increase the soldiers' purpose in life.

Promoting the psychosocial and communication aspects of nursing care quality using time management skills training

BACKGROUND

Although using time management skills is a major component of nursing professional practice, they have not received much attention. Time management training can improve the psychological and communication aspects of nursing care quality. Therefore, this study aimed to evaluate the effect of time management skills training on the psychosocial and communication aspects of nursing care quality.

MATERIALS AND METHODS

This semi-experimental study was conducted at Valiasr Hospital of Shahr Babak City, Kerman Province, in the Southeast of Iran, during 2018. The study population consisted of 100 nurses who were randomly assigned to one of the two groups: an intervention group or a control group. To identify and measure the outcomes, nurses' perceptions of the psychosocial and communication aspects of care quality were first assessed by the Quality Patient Care Scale (Qualpacs) at pretest. Then, the intervention group received the 2 days of training on time management skills for 12 h. The posttest outcome data were collected from both the groups 1 month after the intervention.

RESULTS

No statistically significant differences were observed between the two groups with respect to the total mean scores of nursing care quality and its psychosocial and communication aspects before the intervention (t = 1.96, P = 0.09). However, there was a statistically significant difference between the two groups in this regard after the intervention, and the mean nursing care quality scores and its related aspects were improved in the intervention group (t = 5.76, P < 0.0001).

CONCLUSIONS

The time management skills training could significantly improve psychosocial and communication aspects of nursing care quality. Health-care managers should allocate facilities to clinical training programs so that health-care professionals can acquire the time management skills. The higher effectiveness of time management training can be determined by its application in diverse domains of health care.

The Effect of Patient Safety Education on Undergraduate Nursing Students' Patient Safety Competencies

Patient safety is influenced by a set of factors in various levels of the healthcare system. One of the factors affecting patient safety is safety competencies of the nursing students. The current study aimed to evaluate the effect of patient safety education on patient safety competencies of the nursing students. This quasi-experimental study was conducted with a pretest-posttest deign. The levels of patient safety competencies of 50 nursing students were investigated in a nursing school affiliated to large university of medical sciences in the south of Iran in 2019. Data were collected using Health Professional Education in Patient Safety Survey (H-PEPSS). The data were analyzed in SPSS 21 using descriptive statistics and repeated measures ANOVA. The three investigated intervals were significantly different in terms of the total H-PEPSS dimensions, while the lowest was attributed to the dimension "managing safety". Mean scores of "how broader patient safety issues are addressed in health professional education" and "comfort speaking up about patient safety" significantly increased during the follow-up periods. The educational intervention was partially effective in improving patient safety competencies of the nursing students over long term.

Effect of information, motivation, and behavioral skills model on adherence to medication, diet, and physical activity in HIV/ADIS patients: A health promotion strategy

BACKGROUND

Adherence to treatment is one of the major challenges in patients with HIV/ADIS. If the patients do not adhere, they will face recurrent consequences, such as disease progression. The aim of this study was to investigate the effect of information, motivation, and behavioral Skills (IMB) model on medication adherence, diet adherence, and physical activity in HIV/ADIS patients.

MATERIALS AND METHODS

This interventional study was conducted on 122 patients with 20 years of age and over with HIV/AIDS in Kerman City, Iran, in 2018. A total of patients were selected by census method and categorized into the intervention and control groups. Later, a researcher-made questionnaire on IMB was used before and 3 months after the intervention to assess medication adherence, diet adherence, and physical activity .The intervention study consisted of at least 8 training sessions (90 min) over a 12-week period.

RESULTS

In adherence to medication, information (P = 0.034) and personal motivation (P = 0.003) constructs and in adherence to diet, information (P = 0.025), personal motivation (P = 0.001), self-efficacy (P = 0.010), and skills (P = 0.011) were significantly different between the two groups after the intervention (P = 0.011). However, regarding the adherence to physical activity, no significant difference was found between the two groups after the intervention.

CONCLUSIONS

The IMB model can be effective in promoting the diet adherence in HIV/AIDS patients. In this regard, more qualitative and quantitative studies are recommended on the adherence to medication and physical activity.

Nurses' experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran

Background

Information technology (IT) plays an important role in nursing practice. Hence, nurses’ experiences and viewpoints about IT integration into healthcare help improve nurses’ adoption of IT. This study aimed to explore the nurses’ experiences and viewpoints about the benefits of IT integration and adoption in healthcare.

Methods

This study was conducted with a qualitative research approach. Participants included 14 nurses from four hospitals affiliated to a large medical university in Iran, who were selected using a purposive sampling method. Data were collected through semi-structured interviews and analyzed using the conventional content analysis of Lundman and Graneheim.

Results

Six categories in the study reflected the nurses’ experiences and viewpoints about the benefits of integrating IT into health care. These categories included improving the quality and efficiency of medical services and care, facilitating the communication management in the technological environment, improving information documentation, management, and monitoring, improving resource management, improving management performance and policymaking, and facilitating pathways of organizational and professional growth.

Conclusions

Lessons learned in this study can help overcoming the barriers of IT adoption, and developing appropriate strategies to familiarize nurses with the benefits of IT in healthcare settings. Healthcare managers are recommended to investigate the experiences of nurses with IT in their hospitals and organize courses to orient hesitant nurses toward adopting IT.

Improving the informatics competency of critical care nurses: results of an interventional study in the southeast of Iran

BACKGROUND

Nursing informatics (NI) along with growth and development of health information technology (HIT) is becoming a fundamental part of all domains of nursing practice especially in critical care settings. Nurses are expected to equip with NI competency for providing patient-centered evidence-based care. Therefore, it is important and necessary to improve nurses' NI competency through educational programs for effective using of HIT. This study aimed to evaluate the impact of a training program on NI competency of critical care nurses.

METHODS

This interventional study was conducted in 2019. Stratified sampling technique was used to select 60 nurses working in critical care units of three hospitals affiliated with a large University of Medical Sciences in the southeast of Iran. These nurses were assigned randomly and equally to the control and intervention groups. NI competency was trained to the intervention group in a three-day workshop. Data were collected using demographic questionnaire and the adapted Nursing Informatics Competency Assessment Tool (NICAT) before and 1 month after the intervention. Rahman in the US (2015) developed and validated the original NICAT to assess self-reported NI competency of nurses with 30 items and three dimensions (Computer literacy, Informatics literacy Information management skills). The NICAT is scored on a five-point Likert scale and the overall score ranges from 30 to150. Two medical informatics specialists and eight nursing faculty members approved the validity of the adapted version of NICAT and its reliability was confirmed by Cronbach's alpha (95%).

RESULTS

All 60 participants completed the educational program and returned the completed questionnaire. Majority of participants in the intervention and control groups were female (83.30%), married nurses (70.90, 73.30%) aged 30-40 years (51.6, 35.5%). In the pretest stage, both intervention and control groups were competent in terms of the NI competency and its dimensions, and no significant difference was observed between them (p = 0.65). However, in the posttest, the NI competency and its dimensions in the intervention group significantly increased with a large effect size compared with the control group (p = 0.001). This difference showed that the intervention group was proficient in the posttest stage. The highest mean difference in the intervention group was associated with the informatics literacy dimension and the lowest mean difference was associated with the informatics management skills dimension.

CONCLUSIONS

The improved scores of NI competency and its dimensions after using the training program implied the effectiveness of this method in enhancing the NI competency of nurses working in the critical care units. The application of the training program in diverse domains of nursing practice shows its high efficiency. The project is fundamental for improving nurses' NI competency through continuous educational programs in Iran, other cultures and contexts.

The effect of anger management skills training on anger status of the people with HIV

PURPOSE

This study investigated the effect of anger management skills training on the anger status of people with HIV.

DESIGN AND METHODS

This interventional study was conducted on 60 people with HIV. The intervention group was trained on anger management skills. Data were collected using Spielberger's State-Trait Anger Expression Inventory-II.

FINDINGS

The intervention group's training on anger management skills showed a significant reduction in mean scores of the state-trait anger, and anger expression as well as a significant increase in mean scores of anger control-out and anger control-in.

PRACTICE IMPLICATIONS

Expert counselors, psychologists, community health, and psychiatric nurses are recommended to train anger management skills to people with HIV.

Outcomes of Effective Integration of Clinical Risk Management Into Health Care From Nurses' Viewpoints: A Qualitative Study

The aim of this study was to explore nurses' experiences and viewpoints about the outcomes of effective integration of clinical risk management (CRM) into health care. This qualitative study was conducted using purposive sampling and semistructured interviews with 19 nurses from three hospitals affiliated with a large medical university. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim. Data analysis reflected the following concepts: improving the quality of services and promoting health, preserving and protecting patient safety, increasing satisfaction, improving staff morale, and improving organizational awareness and vigilance. According to the results, CRM with its positive outcomes can help the development of a patient-oriented culture. The results can be a starting point for further quantitative and qualitative research to explore other strategies, potentials, and capacities of quality improvement activities such as CRM in other contexts and cultures.

Nurses' perceptions of systems thinking and safe nursing care: A cross-sectional study

AIM

To assess nurses' perceptions of systems thinking, safe nursing care and the correlation between them.

BACKGROUND

Systems thinking and safe nursing care are the key elements of quality improvement approaches, such as accreditation and patient safety programmes. However, these two variables have not been well studied in different health care settings.

METHODS

In this cross-sectional study, 300 nurses were selected using the stratified random sampling method. The data were collected using a demographic data form, systems thinking scale and assessment of safe nursing care questionnaire.

RESULTS

The scores of nurses' perceptions of systems thinking (63.25 ± 9.20) and safe nursing care (4.13 ± 0.60) were above average. A positive correlation was found between systems thinking and safe nursing care (r = .66, p < .001), and its dimensions: nursing skills (r = .61, p < .001), psychological needs (r = .56, p < .001), physical needs (r = .51, p < .001) and teamwork (r = .56, p < .001).

CONCLUSION

Regarding the correlation between systems thinking and safe nursing care, nurses and other medical professionals, especially novices, are recommended to strengthen their systems thinking skills to improve the safe nursing care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should deal with organisational condition and factors affecting some poor aspects of systems thinking and safe nursing care. They must lead, support and allocate resources to the foundations of systems thinking to achieve safe nursing care.

Promoting drug abuse preventive behaviors in adolescent students based on the health belief model

Background Nowadays, drug abuse is one of the most important health problems that can affect the quality of life of people in mental, psychological, physical, and social dimensions. Theory-based education can help the adolescents to promote their drug abuse preventive behaviors. Objectives The aim of this study was to determine the effectiveness of education based on the health belief model (HBM) on drug abuse preventive behaviors in adolescent students. Methods This study was an interventional quasi-experimental study with a pre-test/post-test design conducted in two high schools in the southeast of Iran. A two-step cluster sampling method was used and 120 students were randomly selected and categorized into the control (n = 60) and intervention (n = 60) groups. The intervention group participated in an education program based on the HBM in four 75-min sessions. Data were collected using demographic and drug abuse preventive behavior questionnaires based on the HBM. Results In the pre-test stage, the mean scores of drug abuse preventive behaviors and its dimensions were not significantly different between the intervention and control groups (t = -2.597 p = 0.641). In the post-test stage, the mean scores of the intervention and control groups were significantly different; the drug abuse preventive behaviors and its dimensions improved in the intervention group (t = 14.57, p < 0.001). Conclusion The findings showed that education based on the HBM had a significant effect on drug abuse preventive behaviors and its dimensions. Therefore, educational packages based on the HBM are recommended to improve these behaviors in adolescents.