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.

The effect of transactional analysis on the self-esteem of imprisoned women: a clinical trial

BACKGROUND

The imprisoned women usually have low self-esteem and suffer from various physical and mental complaints; they may suffer from feelings of emptiness, isolation, and depression. Transactional analysis (TA) is part of a comprehensive system attributed to the individual and social psychiatry for personal development of self-esteem among the imprisoned women. Therefore, the present study aimed to investigate the effect of TA group-training on the self-esteem of imprisoned women.

METHODS

This clinical trial was conducted among the imprisoned women in a prison in Southeastern Iran using pretest-posttest design. In this regard, 76 women were randomly allocated to the intervention (n = 35) and control (n = 41) groups. The TA group-training program was held for eight 90-min sessions for the intervention group. Data were collected using a demographic questionnaire and the Rosenberg's self-esteem scale (RSES). Later, all participants were evaluated before and 1 month after the intervention.

RESULTS

In pre-test, the mean scores of self-esteem were 11.8 ± 4.67 and 7.97 ± 4.52 for the intervention and control groups, respectively. These scores showed low levels of self-esteem and the difference between the two groups was significant (p = 0.001, t = - 3.61). In the post-test, the mean scores of self-esteem improved to the moderate level (22 ± 2.52) in the intervention group compared to the control group (8.92 ± 4.04). This indicates the significant improvement of self-esteem in the intervention group (p = 0.001, t = 17.15).

CONCLUSIONS

The results showed that TA group-training had a significant effect on self-esteem. Therefore, the experienced and expert counselors and psychologists are recommended to hold transactional analysis group-training courses to enhance self-esteem among women prisoners.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials, IRCT20170725035289N5 Date registered: 25/08/2018.

Professional Values of Nurses and Nursing Students: a comparative study

BACKGROUND

The process of learning the professional values is started from the student's entering to the university and to the workplace. This study compared the importance of professional values from the perspectives of nurses and nursing students.

METHODS

This descriptive-analytical study was conducted on 250 nurses and 100 nursing students. Data were collected using the Nursing Professional Values Scale-Revised.

RESULTS

According to the findings, the mean scores of nurses (3.68 ± 0.16) and nursing students' (3.86 ± 0.17) perspective toward professional values were at an important level. Furthermore, the students' perspective toward the professional values' importance was significantly more favorable than those of nurses. The highest mean scores of professional values in the two groups were related to the caring and justice domains. Both groups considered activism and professionalism as the least important domains among the others.

CONCLUSIONS

As the findings suggest, we need to pay more attention to values training, especially professionalism and activism, during undergraduate education for preparing the nurses to work in today's complex healthcare context. It is necessary to conduct more comprehensive studies for exploring the gap between theory and practice in different cultures and contexts.

Antiretroviral therapy adherence based on information, motivation, and behavioral skills model and its association with depression among HIV-positive patients: Health promotion strategy towards the 909090 target

BACKGROUND

HIV-infected patients with poor antiretroviral therapy (ART) adherence are prone to depression, and depression can exacerbate the disease condition. This study was conducted to determine ART Adherence based on Information, Motivation, and Behavioral Skills (IMB) Model and its association with depression among HIV-positive patients.

MATERIALS AND METHODS

This descriptive-correlational study was carried out on people over the age of 18 years with HIV/AIDS, who referred to the Behavioral Diseases Counseling Center in Kerman City, Iran, in 2017. In this regard, 119 patients were selected using the table of random numbers. To collect the data, we used the Beck's depressioninventory-II and the IMB researcher made questionnaire to evaluate the ART adherence.

RESULTS

The results of the study reveal that a significant association was observed between the total adherence and all constructs of the IMB model (P < 0.001). Risk perception and self-efficacy had the highest mean scores regarding the ART adherence. The prevalence of depression was 71.5% among patients. Information, personal motivation, and total adherence had a significant association with depression.

CONCLUSIONS

IMB model was an appropriate and practical strategy with regard to the ART adherence among people living with HIV who are prone to depression and drug consumption is crucial for them to achieve the 90-90-90 target. This article created a questionnaire to assist policy-makers and health professionals designing interventions to improve adherence and health outcomes of ART.

Psychosocial Needs of the Families With Hospitalized Organ Transplant Patients in an Educational Hospital in Iran

Nurses are required to understand and meet the physiological needs of the family members of the patients hospitalized in transplant wards of the hospitals. Considering the importance of this issue, this study aimed to investigate the psychosocial needs of the families with an organ transplant patient. The study employed a cross-sectional design and was conducted in Afzalipour Educational Hospital affiliated to the Kerman University of Medical Sciences in 2018. The 45-item questionnaire of the psychosocial needs was applied to assess the psychosocial needs of the families with an organ transplant patient, including kidney, liver, and bone marrow. The quota sampling method was used and 230 participants completed the survey. Data were analyzed using descriptive mean and SD and analytical statistics independent t-test, anova, and Pearson's correlation coefficient tests by SPSS 22 (version 22, SPSS, Chicago Inc., IL). The results indicated that the mean scores of psychological needs of families with transplanted patients hospitalized in three wards of bone marrow, kidney, and liver were at a high level (143/16 ± 12/29). The mean scores of psychosocial needs in the bone marrow transplantation ward (148/60 ± 8/18) were significantly higher than those of the patients hospitalized in the liver (141/24 ± 16/41) and kidney (141/25 ± 11/30) wards. A significant difference was observed among the three wards of the liver, kidney, and bone marrow transplantation with regard to the provided support, information, and proximity. To improve the psychological needs of the family members with patients hospitalized in transplant wards and reduce their mental reactions, they should be provided with more precise information about the patient's treatment procedure.

The psychosocial needs and quality of life of family caregivers of patients with organ transplant

Background

Families of patients with organ transplants experience many problems, both with the onset of illness and during the hospitalisation of their relative for an organ transplant. The healthcare providers try their best to give high-quality care to patients. However, they neglect quality of life and psychosocial needs of family caregivers.

Aims

This study aimed to assess the psychosocial needs and quality of life of the family caregivers of post-transplant patients and the relationship between these two variables.

Methods

This descriptive correlational study was conducted on liver, kidney and bone marrow transplant wards in the largest transplant centre affiliated with a university of medical science in south-eastern Iran. The sample included 230 family caregivers of post-transplant patients, who were selected using quota sampling. Data were collected using the 45-item questionnaire of psychosocial needs (the Critical Care Family Needs Inventory) with five dimensions (assurance, comfort, information, proximity and support), and the Short Form-36 Quality of Life questionnaire with eight scales (physical functioning, physical problems, emotional problems, social functioning, pain, vitality, mental health and perception of health). In the Critical Care Family Needs Inventory, 1 indicates not important and 4 very important. In the Short Form-36 Quality of Life questionaire, 0 indicates the worst health and 100 the best health.

Results

The participants rated the mean of their psychosocial needs as important (3.18 ± 0.27). Also, the mean of quality of life of participants was at an undesirable level (45.17 ± 92.66). The psychosocial needs of the caregivers showed a poor, inverse significant relationship with their quality of life (r = -0.16, p = 0.01).

Conclusion

The results showed that with increasing psychosocial needs of family caregivers of post-transplant patients, their quality of life declines. Healthcare providers should implement developed plans and appropriate strategies to fulfil psychosocial needs and improve the quality of life of family caregivers of these patients.

The importance of professional values from nursing students' perspective

Background

Professional values of nursing students may be changed considerably by curricula. This highlights the importance of the integration of professional values into nursing students’ curricula. The present study aimed to investigate the importance of professional values from nursing students’ perspective.

Methods

This cross-sectional study was conducted at the Kerman University of Medical Sciences, Iran. Data were gathered by using a two-section questionnaire consisting of demographic data and Nursing Professional Values Scale-Revised (NPVS-R). By using the stratified random sampling method, 100 nursing students were included in the study.

Results

Results showed that the mean score of the students’ professional values was at high level of importance (101.79 ± 12.42). The most important values identified by the students were “maintaining confidentiality of patients” and “safeguarding patients’ right to privacy”. The values with less importance to the students were “participating in public policy decisions affecting distribution of resources” and “participating in peer review”. The professional value score had a statistically significant relationship with the students’ grade point average (P < 0.05).

Conclusions

In light of the low importance of some values for nursing students, additional strategies may be necessary to comprehensively institutionalize professional values in nursing students.

Antiretroviral Therapy Adherence Among People Living With HIV: Directed Content Analysis Based on Information-Motivation-Behavioral Skills Model

Antiretroviral therapy (ART) is one of the complexities of treatment and care for people living with HIV (PLHIV). It is essential to understand the challenges of admitting ART in PLHIV based on the Information Motivation Behavioral skills (IMB) model. This study was conducted using qualitative and directed content analysis on 15 participants. The participants included 10 patients and five health-care providers selected from the behavioral diseases counseling center affiliated with a medical university in southeast of Iran using purposive sampling method. Data were collected through semistructured interviews. Data analysis has led to three main categories—information, motivation, and behavioral skills—and eight subcategories. ART adherence in an Iranian context is like an iceberg that the IMB model can deeply identify underwater and unanticipated motivations and factors that lead to nonadherence. Therefore, it can be useful in designing and developing context-based nonadherence to ART interventions.

Antiretroviral therapy adherence and its determinant factors among people living with HIV/AIDS: a case study in Iran

Objectives

This descriptive-correlational study was conducted on 122 Iranian people living with HIV (PWHIV), who referred to a behavioral diseases counseling center in 2018. The AIDS Clinical Trial Group (ACTG) questionnaire was used to collect the required data. The study aimed to determine the level of medication adherence and its determinants in PWHIV.

Results

About 75.4% (confidence interval 67.2%–82.8%) of the samples had a good combined antiretroviral therapy (cART) adherence and 74.6% (n = 91) of them were sure about the positive effects of medications on their health. Patients reported that most important reasons for medication non-adherence included forgetfulness, high drug dosage, lack of knowledge about ART value, and transportation problems.

Factors influencing the selection of a picture archiving and communication system: A qualitative study

BACKGROUND

Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection.

METHODS

This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim.

RESULTS

Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories.

CONCLUSION

The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

Adherence to Medication and Physical Activity among People Living with HIV/AIDS

Background:

The aim of this study was to investigate the adherence to medication and Physical Activity (PA) among People Living with HIV (PLHIV).

Materials and Methods:

In the present cross-sectional study, 122 PLHIV were selected. The research tools included the Baecke questionnaire and the AIDS Clinical Trials Group questionnaire. Data were analyzed by independent t test and multiple logistic regression.

Results:

The results of 7- and 30-day recalls showed that 76.21 and 82.23% of patients had proper medication adherence. The mean score of PA in patients was less than the recommended average score in the questionnaire. Furthermore, there was no significant difference observed between the medication adherence and PA.

Conclusions:

Although the adherence to medication was appropriate, nurses and health care providers should increase the level of PA for PLHIV by dealing with the related barriers to live an active life.

What is the supporting role of health care providers from the perspective of patients with renal allograft rejection? A qualitative study

Coping with the new conditions for patients with renal allograft rejection is a complex phenomenon influenced by a number of factors. It appears that the supportive role of health care providers in many aspects is 1 of the most important factors in patient satisfaction, increased quality of life, and application of proper coping mechanisms. This study explored the perceptions of patients with renal allograft rejection about the supportive role of health care providers. This study was conducted with a qualitative research approach and content analysis. Participants were 19 patients with renal allograft rejection in teaching hospitals in southeastern Iran who were selected by purposive sampling. Data were collected through semistructured interviews and analyzed by qualitative content analysis. During content analysis, 2 categories emerged: empathy and emotional support and educational counseling. These themes reflect the nature of patient perceptions of the supportive role of health care providers. The findings suggest that the supportive role of health care providers plays an important role in the promoting a feeling of comfort, reliability, and security in patients with renal allograft rejection and improves their coping mechanisms. These findings give health care providers greater motivation to provide comprehensive care from knowledge of their supportive role.

The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses

Background

The safety culture has recently attracted the attention of healthcare organizations. Considering the importance of the roles of nurses with regard to patient safety, their knowledge and experiences of the challenges that influence patient safety culture can facilitate the development and implementation of better strategies. The aim of this study was to explore the nurses’ experiences of the challenges influencing the implementation and integration of safety culture in healthcare.

Methods

A qualitative study with deep and semi-structured individual interviews was carried out using a purposive sampling method to select 23 nurses from four hospitals affiliated with a large medical university in Southeast Iran. Data were analysed using the conventional content analysis of Lundman and Graneheim.

Results

Data analysis reflected the main theme of the study, “A long way ahead of safety culture”. This theme includes four categories: 1) inadequate organizational infrastructure, 2) insufficient leadership effectiveness, 3) inadequate efforts to keep pace with national and international standards, and 4) overshadowed values of team participation.

Conclusion

While practical strategies for creating a safety culture may seem simple, their implementation is not necessarily easy. There are several challenges ahead for cultivating an effective and positive safety culture in healthcare organizations. To keep pace with international standards, healthcare managers must employ modern methods of management in order to overcome the challenges faced by the institutionalization of safety culture and to make a difference in the healthcare system.

Health promoting behaviors of staff in a university of medical sciences in southeast of Iran

Background Health promoting behaviors are appropriate indicators to determine individuals' health status. The staff of a health care system plays an important role in enhancing health promoting behaviors in society; therefore, the present study is aimed to evaluate health promoting behaviors of the staff in a university of medical sciences. Methods A descriptive study was conducted on 140 staff of the Kerman University of Medical Sciences in the southeast of Iran. Data were collected using the Persian version of the Health Promotion Lifestyle Profile-II questionnaire with six dimensions of spiritual growth, health responsibility, interpersonal relationships, stress management, exercise and physical activity and nutrition habits. The data were analyzed using SPSS (version 18), descriptive statistics, Student's t-test and analysis of variance (ANOVA). Results The mean of health promoting behaviors of the staff was at the moderate level (2.22 ± 0.10). The highest and lowest means were related to the dimensions of nutrition habits (2.75 ± 0.29) and exercise and physical activity (1.70 ± 0.24), respectively. There was a significant difference in the scores of health promotion behaviors based on age, so that the health promoting behaviors in the age group younger than 40 years old were higher than that in other age groups (p = 0.04). Conclusion Some health promoting behaviors such as exercise and physical activity have not been appropriately merged into daily life. It is recommended to provide educational programs for all aspects of health promoting behaviors of the staff's health in order to promote productivity.

Health-promoting behaviors in nursing students: is it related to self-efficacy for health practices and academic achievement?

Background Nursing students play a role in promotion of public health as health promoters and professional care providers. Therefore, health-promoting behaviors in nursing students and their self-efficacy for health practices are important in providing better services to patients and clients. With regard to the importance of these factors in the academic progress of students, this study was conducted to examine the level of health-promoting behaviors among nursing students and its relationship with self-efficacy for health practices and academic achievement. Methods This descriptive and correlational study was conducted on 217 nursing students of a large university of medical sciences in the south of Iran in 2016. Data were collected using the Persian version of the health promotion lifestyle profile (HPLP II), self-rated abilities for health practices scale (SRAHPS) and the grade point average of the students (levels A, B, C). Results The mean health-promoting behaviors (2.48 ± 0.35) and self-efficacy for health practices of the students (2.55 ± 0.62) were moderate. The mean score of the students' academic achievement was at level B (16.02 ± 1.85). The health-promoting behaviors were significantly correlated with self-efficacy for health practices (r = 0.623, p < 0.0001) and academic achievement (r = 0.285, p < 0.0001). Moreover, self-efficacy for health practices was significantly correlated with academic achievement (r = 0.282, p < 0.0001). Conclusion The correlation between the health-promoting behaviors and health self-efficacy with academic achievement can be a good basis in devising health and educational programs for students. In planning for promoting academic achievement and health-promoting behaviors of students, it is essential to pay special attention to enhancement of self-efficacy for health practices.

Improving the self-efficacy of teachers in schools: results of health promotion program

Background In order to effectively facilitate behavior change, it is essential to conduct health promotion programs on self-efficacy. Given the importance of the role of teachers in fostering the next generation, it appears that the promotion of self-efficacy in them can greatly contribute to the health of the community. The present study aimed to evaluate the impact of a health promotion training workshop on self-efficacy for health practices and also, on general self-efficacy of teachers in schools. Methods This study was a quasi-experimental study, in which 120 teachers were selected by random sampling and randomly divided into two equal intervention and control groups (60 in each group). A health promotion training workshop was conducted for the intervention group. Data were collected by a three-section questionnaire (demographic, self-rated ability for health practices scale and general self-efficacy) before and 1 month after the training intervention. Results The self-efficacy scores for health practices and general self-efficacy were not significantly different between the intervention and control groups before the intervention (p > 0.05). However, participants in the intervention group reported higher scores on both the self-efficacy for health practices (t = 4.05, p = 0.001) and general self-efficacy (t = 2.92, p = 0.004) compared to those in the control group one month after the intervention. Conclusion The health promotion training program had improving effects on the self-efficacy for health practices and general self-efficacy. This program was potentially a valid community health nursing intervention that can be presented and evaluated in various community settings.

Relationship between adaptation and self-esteem in addicted female prisoners in the south east of Iran

Background Reduction of the adaptation and self-esteem can be the consequence of opium addiction and imprisonment. Drug use causes inappropriate behaviors in women, which are quite different from those in men. Social deviations, prostitution, high-risk sexual behaviors, abortion, divorce and imprisonment followed by loss of self-esteem are the consequences of women's addiction. The present study was conducted to assess the relationship between adaptation and self-esteem in addicted female prisoners. Methods In this descriptive analytical study, 130 addicted female prisoners were selected from a prison in the south east of Iran using census sampling. The data were collected by a demographic questionnaire, the Rosenberg's self-esteem scale and the bell adjustment inventory (BAI). Results According to the results, women's adaptation fell into the 'very unsatisfactory' range. The highest mean was related to the emotional dimension, while the lowest mean was in terms of the health dimension. In total, 96.4% of the participating women had low adaptation. The mean total self-esteem fell into the low range; in fact, 84.6% of the women had a low self-esteem. The results showed no significant relationships between adaptation and self-esteem in these women; however, self-esteem was significantly and inversely related to health and emotional adaptation. Conclusion The findings showed that the majority of the women had unsatisfactory adaptation as well as poor self-esteem. No significant relationships were observed between adaptation and self-esteem in the addicted female prisoners.

Comparing health promotion behaviors of male and female high school students in Southeast of Iran

Background Adolescence is one of the most challenging periods of human life. Many healthy or risky behaviors may be formed during this period and continue to the end of life. The aim of this study was to examine and compare the health promotion behaviors of male and female students in high schools. Methods In this descriptive-comparative study, 609 high school students were selected using multi-stage random sampling method. Data were collected using demographic and health-promoting lifestyle profile (HPLPII) questionnaires. Results The mean of health promotion behaviors was moderate in female (2.43 ± 0.46) and male (2.61 ± 0.45) students. The highest and lowest means in the male students were respectively the dimensions of spiritual growth and health responsibility. Also, the highest and lowest means in the female students were dimensions of interpersonal relationships as well as physical activity and exercise. The status of male health promotion behaviors was significantly more favorable than that of the female (p = 0.001, t = -4.71). The male students had a better situation than female in terms of all the six dimensions of HPLPII, so there was a significant difference between them in the four dimensions of spiritual growth, stress management, physical activity and health responsibility. There was also a significant relationship between the history of physical and mental illness in the past year and the students' health promotion behaviors (p < 0.05). Conclusion The results indicated the importance of promoting self-care and educational interventions in the aspects such as physical activity and health responsibility of young people in order to improve the health of the community.

Nurses' professional competency and organizational commitment: Is it important for human resource management?

Background

Professional competency is a fundamental concept in nursing, which has a direct relationship with quality improvement of patient care and public health. Organizational commitment as a kind of affective attachment or sense of loyalty to the organization is an effective factor for professional competency.

Objective

This study was conducted to evaluate the nurses´ professional competency and their organizational commitment as well as the relationship between these two concepts.

Methods and materials

This descriptive-analytic study was conducted at the hospitals affiliated with a University of Medical Sciences, in the southeast of Iran in 2016. The sample included 230 nurses who were selected using stratified random sampling. Data were gathered by three questionnaires including socio-demographic information, competency inventory for registered nurse (CIRN) and Allen Meyer's organizational commitment.

Results

Results showed that professional competency (Mean±SD: 2.82±0.53, range: 1.56–4.00) and organizational commitment (Mean±SD: 72.80±4.95, range: 58–81) of the nurses were at moderate levels. There was no statistically significant correlation between professional competency and organizational commitment (ρ = 0.02; p = 0.74). There were significant differences in professional competency based on marital status (p = 0.03) and work experience (p<0.001).

Conclusion

The results highlighted that the nurses needed to be more competent and committed to their organizations. Developing professional competency and organizational commitment is vital, but not easy. This study suggests that human resource managers should pursue appropriate strategies to enhance the professional competency and organizational commitment of their nursing staff. It is necessary to conduct more comprehensive studies for exploring the status and gaps in the human resource management of healthcare in different cultures and contexts.

S100A12-CD36 axis: A novel player in the pathogenesis of atherosclerosis?

S100A12 is a member of the S100 family of EF-hand calcium-binding proteins and have a variety of intracellular and extracellular activities. It exerts its proinflammatory effects by binding to the receptor for advanced glycation end products (RAGE) and Toll-like receptor 4 (TLR4). CD36 is a class B scavenger receptor that acts as a fatty acid transporter. Both S100A12 and CD36 are implicated in vascular inflammation and atherosclerosis. It has recently been demonstrated that S100A12 binds with high affinity to CD36. On the other hand, RAGE and TLR4 play a key role in the regulation of CD36 expression. These observations point to the fact that S100A12 is an interesting molecular target for the development of therapeutics. This Cytokine stimulus will focus on the possible mechanisms of S100A12-CD36 axis in the pathogenesis of atherosclerosis.

The importance of professional values from clinical nurses' perspective in hospitals of a medical university in Iran

Background

Today, nurses are required to have knowledge and awareness concerning professional values as standards to provide safe and high-quality ethical care. Nurses’ perspective on professional values affects decision-making and patient care. Therefore, the present study aimed to investigate the importance of professional values from clinical nurses’ perspective.

Methods

The present cross-sectional study was conducted in 2016 in four educational hospitals of Kerman University of Medical Sciences, Iran. Data were collected via the Persian version of Nursing Professional Values Scale-Revised (NPVS-R) by Weis and Schank. Sampling was conducted through the use of stratified random sampling method and 250 clinical nurses participated in the study.

Results

Results indicated that the total score of the nurses’ professional values was high. (102.57 ± 11.94). From nurses’ perspective items such as “Maintaining confidentiality of patients” and “Safeguarding patients’ right to privacy” had more importance; however, “Recognizing role of professional nursing associations in shaping healthcare policy” and “Participating in nursing research and/or implementing research findings appropriate to practice had less importance. A statistically significant relationship was observed between NPVS-R mean scores and nurses’ age, work experience as well as participation in professional ethical training (P < 0.05).

Conclusions

Although the total score related to the clinical nurses’ perspective on professional values was high, the importance of certain values was at a lower level. Owing to the emerging ethical challenges, it is indispensable to design educational programs in order to improve nurses’ awareness and understanding of the comprehensive importance of professional values. Furthermore, it is recommended that mixed methods studies should be conducted in order to design an instrument to evaluate the use of values in nursing practice.

Evaluating factors associated with implementing evidence-based practice in nursing

RATIONALE, AIMS AND OBJECTIVES

Evidence-based practice (EBP) has emerged as an innovation for quality improvement in health care. Nurses have important role in implementing EBP but they face many challenges in this context. Evaluation of factors influencing implementation of EBP seems necessary. The aims of this study were to examine nurses' attitude towards EBP, their self-efficacy and training needs, as well as supporting factors and barriers for implementing EBP.

METHODS

A cross-sectional study was conducted on 182 nurses from four teaching hospitals in Kerman, Iran. Data were collected using a questionnaire consisting of two main sections; a section to collect socio-demographic information of participants and a section collecting information on five topics (staff's attitude, self-efficacy skills of EBP, supporting factors, barriers and training needs for implementing EBP).

RESULTS

The majority (87.4%) of the nurses had not attended any formal training on EBP and 60% of them were not familiar with the concept of EBP. Nurses' attitude towards EBP was unfavourable (2.57 ± 0.99) and their self-efficacy skills of EBP were poor (2.93 ± 1.06). The most important supporting factor was mentoring by nurses who have adequate EBP experience (3.65 ± 1.17) and the biggest barrier was difficulty judging the quality of research papers and reports (2.46 ± 0.95). There was a moderate demand for training in all areas of EBP (3.62 ± 1.12).

CONCLUSIONS

Nursing care needs to move towards quality improvement using EBP. It is necessary to equip nurses with knowledge and skills required for EBP. Managers should design an appropriate strategic plan by considering supporting factors and barriers for integrating EBP into clinical setting.

Rocky milieu: challenges of effective integration of clinical risk management into hospitals in Iran

Healthcare risks and clinical risks have been recognized as a major challenge in healthcare. Clinical risks can never be eliminated and can have serious adverse effects on patient safety. Thus, a clinical risk management (CRM) system has been introduced in the healthcare system to improve quality services. The aim of this study was to explore nurses' experiences related to the challenges of implementing CRM in the organizational context. This qualitative study was based on the conventional content analysis of the Lundman and Graneheim approach, and it consisted of 22 interview sessions with 20 nurses. The purposive sampling method was used to choose the participants from three hospitals affiliated with the Kerman University of Medical Sciences. We used semi-structured interviews and review of relevant documents to collect data. The analysis of the data led to the emergence of "rocky milieu" as the main theme, and it consisted of three categories that, along with their subcategories, explain the challenges of implementing CRM. The three categories and their subcategories were (1) organizational culture and leadership challenges (decision and performance of leadership and cultural resistance to change), (2) limitation of resources (financial, human, and physical and equipment resources), and (3) variations and complexities in working conditions (the emotional, psychological, and social atmosphere and the heaviness of workload). Attempts have been made to establish CRM through clinical governance and accreditation, but organizational challenges have created a rocky milieu for implementing CRM. However, from an organizational context concerning the suitability of healthcare in Iran, there are obvious needs to move toward quality improvement and safe practices through the effective implementation of CRM.

Information seeking and retrieval skills of nurses: Nurses readiness for evidence based practice in hospitals of a medical university in Iran

BACKGROUND

With the explosion of medical information, and emergence of evidence-based practice (EBP) in healthcare system, searching, retrieving and selecting information for clinical decision-making are becoming required skills for nurses.

AIMS

The aims of this study were to examine the use of different medical information resources by nurses and their information searching and retrieving skills in the context of EBP.

METHOD

A descriptive, cross-sectional study was conducted in four teaching hospitals in Iran. Data were collected from 182 nurses using a questionnaire in 2014.

RESULTS

The nurses indicated that they use more human and printed resources than electronic resources to seek information (mean=2.83, SD=1.5; mean=2.77, SD=1.07; and mean=2.13, SD=0.88, respectively). To search online resources, the nurses use quick/basic search features more frequently (mean=2.45, SD=1.15) than other search features such as advanced search, index browsing and MeSH term searching. (1.74≤mean≤2.30, SD=1.01). At least 80% of the nurses were not aware of the purpose or function of search operators such as Boolean and proximity operators. In response to the question measuring skills of the nurses in developing an effective search statement by using Boolean operators, only 20% of them selected the more appropriate statement, using some synonyms of the concepts in a given subject.

CONCLUSION

The study showed that the information seeking and retrieval skills of the nurses were poor and there were clear deficits in the use of updated information resources. To compensate their EBP incompetency, nurses may resort to human resources. In order to use the latest up to date evidence independently, nurses need to improve their information literacy. To reach this goal, clinical librarians, health information specialists, nursing faculties, and clinical nurse educators and mentors can play key roles by providing educational programs. Providing access to online resources in clinical wards can also encourage nurses to learn and use these resources.