Nursing staff shortages and job satisfaction in Iran: Issues and challenges

Battery-Free, Wireless Multi-Modal Sensor, and Actuator Array System for Pressure Injury Prevention

Simultaneous monitoring of critical parameters (e.g., pressure, shear, and temperature) at bony prominences is essential for the prevention of pressure injuries in a systematic manner. However, the development of wireless sensor array for accurate mapping of risk factors has been limited due to the challenges in the convergence of wireless technologies and wearable sensor arrays with a thin and small form factor. Herein, a battery-free, wireless, miniaturized multi-modal sensor array is introduced for continuous mapping of pressure, shear, and temperature at skin interfaces. The sensor array includes an integrated pressure and shear sensor consisting of 3D strain gauges and micromachined components. The mechanically decoupled design of the integrated sensor enables reliable data acquisition of pressure and shear at skin interfaces without the need for additional data processing. The sensor platform enables the analysis of interplay among localized pressure, shear, and temperature in response to changes in the patient's movement, posture, and bed inclination. The validation trials using a novel combination of wireless sensor arrays and customized pneumatic actuator demonstrate the efficacy of the platform in continuous monitoring and efficient redistribution of pressure and shear without repositioning, thereby improving the patient's quality of life.

Work-family conflict and the professional quality of life and their sociodemographic characteristics among nurses: a cross-sectional study in Tehran, Iran

Background

Nurses are exposed to work-family conflict (WFC) due to specific occupational conditions, such as exposure to patients and shift work, which can affect the professional quality of life (ProQoL). The aim of the present study was to determine the relationship between different levels of work-family conflicts and professional quality of life and their sociodemographic characteristics among the nurses in two hospitals in Tehran, Iran.

Methods

This cross-sectional study included 234 nurses from two hospitals. Data were collected using a three-part questionnaire, including items related to nurses’ demographic characteristics, the WFC questionnaire, and the ProQoL questionnaire.

Results

There was a significant positive correlation between conflict in terms of time and behavior with compassion satisfaction and between the three types of conflict with job burnout (p < 0.05). The results indicate that the WFC and ProQoL scores and the mean WFC were higher among women, people who had a disabled family member, and nurses who worked equal to or more than 175 hours a month. Regarding the dimensions of ProQoL, the mean compassion satisfaction was lower among people who lived with their parents, people who had a second job had a child younger than one-year-old, and a disabled family member had higher means of job burnout. Also, those who had younger children experienced less PTSD. Furthermore, the mean of WFC and burnout among single nurses was significantly lower than among married and divorced/widowed nurses. Additionally, the mean of WFC and burnout among nurses living in rental houses and nurses reporting the level of satisfying relationships with co-workers as ‘bad’ were significantly more than for other nurses.

Conclusion

Stable mental and emotional conditions are of great importance for nurses to provide safe and quality services to their patients. The results also revealed that nurses’ compassion satisfaction and job burnout were associated with different types of conflict. The WFC of nurses is related to their ProQoL and affects their job satisfaction and burnout. Reducing conflict may improve the nurses’ satisfaction and thus improve patient care and healthcare services.

Chinese nurses' self-expression media image during COVID-19 pandemic: A qualitative media image analysis

Aim

To explore and describe nurses' self‐expression media image during COVID‐19 pandemic in China.

Background

Nurses play an important role in COVID‐19 pandemic. Although nurses were widely reported by the media, which included praise for nurses and nursing work, the researches on how nurses expressed their self‐images were limited.

Design

Qualitative media analysis.

Methods

Qualitative media analysis was conducted from January to April 2020, the researchers collected images and texts of 16 Chinese nurses who take care of COVID‐19 patients. These images and texts were published on WeChat Moments by themselves. After analysed each image and text, researchers identified the denotative and connotative elements in each image and summarized each image in narrative way.

Findings

This study analysed 219 pictures and 15 short videos of 16 nurses' self‐expression in WeChat moments. In this study, the media image self‐expression of nurses were mostly positive. The images expressed by nurses in this study included care image; hero image; soldier image; female image; hope image and team image. Nurses rarely showed negative images in the media; The negative nurses image were expressed in hidden way, which included exhausted nurses image and fragile nurses image. Moreover, the nurse self‐expression media image emphasized the nursing professionalism, but less showed the nursing connotation.

Conclusions

The positive media image self‐expression of nurses should be encouraged. Nurse Managers should pay attention to the deficiency of nursing image expression and guide nurses to show the essence and connotation of nursing.

Investigating the relationship between workplace stressors and caring behaviours of nursing staff in inpatient wards: A cross-sectional study

AIM

The present study aimed to investigate the effects of various job stressors on caring behaviours of nursing staff.

DESIGN

A cross-sectional nationwide study.

METHODS

This cross-sectional, descriptive-correlational study was conducted on 260 nurses employed in the inpatient wards of seven teaching hospitals in Tehran, Iran during December 2019-February 2020. The participants were selected via convenience sampling. Data were collected using a demographic questionnaire, the nursing stress scale and the caring behaviours inventory. Data analysis was performed in SPSS version 20 using descriptive statistics and linear regression analysis.

RESULTS

The results of regression analysis indicated that job stress is correlated with nurses' caring behaviours (β = -.36; p = .001). Factors such as workload (β = -.27; p = .001), uncertainty about patient treatment (β = -.26; p = .017) and lack of emotional preparation (β = -.20; p = .017) were the important stressors associated with nurses' caring behaviours.

CONCLUSIONS

According to the results, high levels of perceived job stress due to workload, uncertainty about patient treatment and lack of emotional preparation are associated with lower levels of nurses' caring behaviours.

IMPACTS

The findings of this study showed that to provide patients with optimal caring behaviours, hospital and nursing managers should design interventions to reduce nurses' job stressors, especially in terms of their interactions with their colleagues and physicians.

The perception of nurses towards their roles during the COVID-19 pandemic

PURPOSE

The study aims to evaluate the available content on local Jordanian Facebook nursing groups regarding perception of their roles during coronavirus pandemic.

METHOD

Researchers used the Facebook search engine to select local Facebook groups.

RESULTS

Nurses were perceived to perform a constructive role when acting as the first-line health provider, having a public awareness role and providing care for patients. Advocating and supporting the sick and their families, ignoring and underestimating their role, nurses have a positive perception of their roles during the coronavirus pandemic. Besides being responsible for their daily activities during the epidemic, they had additional roles of ensuring the safety and contentment of their patients.

CONCLUSION

In general, nurses in Jordan perceived their roles during the COVID-19 outbreak to be constructive. They performed the task of supporting and advocating for the sick and their families. Despite these efforts during the outbreak.

IMPLICATION FOR NURSING

Nurses in general, nursing leaders and managers are in the forefront of responding to the unique needs of their workforces during the COVID-19 crisis. There must be an explicit adoption of strategy in all clinical environments and other clinical institutions to enhance the nurse image among themselves and community members.

Preferences of Medical Sciences Students for Work Contracts in Deprived Areas of Iran: A Discrete Choice Experiment Analysis

Background

An unequal distribution of human resources affects access to health-care services. This study aimed to elicit the preferences of medical, dentistry, and pharmacy students about attributes of work contracts in deprived areas of Iran; this is a primary important step to decrease inequity.

Methods

Two-hundred and one students were entered into the study through proportional sample size estimation from Kermanshah University of Medical Sciences in the west of Iran in 2018. The attributes of work contracts were determined using the discrete choice experiment (DCE) method, then possible dual scenarios of work contracts were designed through the D-efficiency method of SAS software and the data were collected using a questionnaire designed by the researchers. The conditional logistic model was used to analyze the data.

Results

Salary, workplace, side facilities, scholarship, and workload were considered as important factors for working in the deprived areas (p<0.001). There were differences between the students’ preferences regarding their residential areas, majors, and state or tuition-paying education (p<0.001). Higher payments, side facilities, and availability of quota after working in the deprived areas were considered as creators of higher utility, and working in deprived areas and high workload were considered as creators of lower utility (p<0.001).

Conclusion

This study provides new evidence about the preferences of medical sciences students for work contracts in deprived areas of Iran. According to the findings, money is not the only factor that affects the decisions of medical sciences students related to working contracts in deprived areas of Iran. Designing work contracts that are matched with preferences of the workforce can lead to an improvement in equity, access, and utilization of health-care services.

Can brand theory help re-position the brand image of nursing?

AIM

The current vs desired brand position of the nursing profession is examined using brand theory.

BACKGROUND

The nursing brand has a long and revered image with various stakeholder groups. However, the current image frequently represents nurses as caring advocates rather than Influential Leaders who deliver, manage and administer health care services.

EVALUATION

Recent quantitative field research describes perceptions of nurses' current vs desired brand position. A perceptual map illustrated a gap on the axes of Patient-Centered Caregivers and Leaders in Healthcare. Empirical literature provided the foundation for prescriptive advice, which could address potential threats and opportunities for the brand.

KEY ISSUE

Brand theory is used to describe how nurses' current image seems at odds with nurses' role in contemporary society. The largest gap on the perceptual map was on the 'Leadership Axis', suggesting more effort is needed to change perceptions of the essential leadership role of nurses in various health care systems.

IMPLICATIONS FOR NURSING MANAGEMENT

The nursing profession needs to implement branding strategies, which close the gap between the current and desired brand positions. The central brand position of nurses as leaders should thread throughout practice, education, research and professional associations for effective brand repositioning to occur.

Healthcare workers' perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa

Background

Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention.

Aim

To analyse health care workers’ perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA.

Setting

The study took place at six different health districts and their six respective rural clinics in the KZN province of SA.

Methods

A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure.

Results

Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported.

Conclusion

The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers’ needs for training and preparation is crucial for successful implementation of VMMC.

Nursing shortage, a different challenge in Iran: A systematic review

Background: Nursing shortage is an important and multifaceted challenge in the health systems and has reached a warning threshold. The factors associated with nursing shortage vary from country to country. Therefore, this study compared the causes of nursing shortage and suggested strategies to help resolve this concern both in Iran and in the world.

Methods: To conduct this systematic review, search was done in English and Persian databases from 2000 to 2016. In the preliminary review, 537 articles were included in the study. After reviewing the titles, abstracts, objectives, and results of articles, 32 studies were finalized.

Results: The important causes of nursing shortage in the world included aging of the nursing workforce, inadequate admission and training of nurses, aging population, and job abandonment. However, the leading causes in Iran were unwillingness and lack of desire to enter and remain in the nursing field, job abandonment, inadequate salaries, low social status, and negative perception of nursing. Proposed strategies in the world are increasing the salaries, redesigning the work environment, improving the public’s perspective, retaining the existing nursing workforce, and flexible work schedules. In Iran, these strategies include increasing salaries and recruitment, enhancing the public’s perception of nursing, and supporting nursing organizations.

Conclusion: Nursing shortage is a multifaceted concept with varying magnitudes in different countries. Therefore, the strategies to resolve nursing shortage should be based on the unique conditions of each country. The most important strategies to overcome nursing shortage in Iran are focused on the improving the retention of existing nursing workforce.

Challenges of implementation of hospital accreditation in Iran: an exploratory factor analysis

BACKGROUND

Today, accreditation is considered as the most commonly used health assessment approach. Considering the importance and application of the process of this approach in the hospital, this study aimed to investigate the challenges of implementation of hospital accreditation in Iran using exploratory factor analysis.

METHODS

A cross-sectional study design was carried out from July to December 2017, consisting of 200 managers in the seven hospitals accredited by the MOH in Tehran, Iran. Samples were selected through the purposive sampling method, and data were collected using a structured questionnaire in which validity and reliability were confirmed. Likert's five-choice range was used for the rating of items. Exploratory factor analysis was used to categorize the identified challenges and extract the mathematical model on them.

RESULTS

Exploratory factor analysis identified six dimensions (implementation, evaluation, content, structural, psychological, and managerial) with 40 items using a 5-point Likert scale. Each dimension accounted for greater than 63.20% of the total variance. The scale had strong content validity (indices = 0.84). Each dimension of Cronbach's alpha ranged from 0.74 to 0.94. Implementation, evaluation, content, structural, psychological, and managerial components also formed the final identified areas.

CONCLUSION

The present study showed that there were major challenges in the path to successful deployment of Iranian hospital accreditation, requiring serious action by managers and policymakers in this field.

Occupational stress and associated risk factors among nurses: a cross-sectional study

Background: Nursing can be demanding and stressful with occupational stress posing a serious threat to nurses and patient outcomes. Aims/Objectives: To determine the prevalence of nurses' occupational stress and its associated risk factors. Design: Cross-sectional survey design. Methods: Nurses in 115 tertiary-level hospitals in 13 provinces in Iran were surveyed from August 2016-December 2017. Demographic information and occupational stress were assessed. 5422 distributed questionnaires were distributed with 2895 of returned surveys analyzed. One-way ANOVA and multiple linear regression analyses identified risk factors for occupational stress. Results: Mean score for overall occupational stress was 3.48 indicating a stress level between moderate and high, with 78.4% of respondents reporting that their job was stressful. Nurses reported issues with shiftwork, staffing, pay, workplace discrimination, management, policy and excessive workloads as sources of occupational stress. Risk factors in the multivariate analysis for higher occupational stress were female gender (p = .002), being married (p = .008), having lower educational levels (p < .001), increased work hours (p <.001), and working in emergency (p = .025), general wards (p = .012) and teaching hospitals (p < .001). Conclusions: The high prevalence of occupational stress amongst nurses in Iran demonstrates the extent of the issue, with recent reforms not effectively addressing occupational stress. The risk factors identified allow for more targeted interventions.

Barriers to and Facilitators of Nurses' Adherence to Clinical Practice Guidelines: A Qualitative Study

BACKGROUND

Guidelines for clinical practice are needed in order for nurses to provide consistent, standardized care and avoid preventable harm.

AIMS

The present study aims to explore the barriers to and facilitators of nurses' adherence to clinical practice guidelines.

METHODS

Detailed semistructured interviews were conducted with 14 nurses from two educational hospitals in Kurdistan University of Medical Sciences, Sanandaj, Iran, about their involvement with clinical practice guidelines. The text of the interviews was analyzed by qualitative content analysis.

FINDINGS

Identified barriers to full adherence to clinical practice guidelines were work pressure, lack of facilities, paperwork, lack of motivational environment, and nonapplicability of guidelines. Facilitators identified were encouragement, improving working conditions, conscientiousness, training, and supervision.

CONCLUSION

Interventions to remove barriers to and provide facilitators of adherence to clinical practice guidelines should be designed and implemented. Removing organizational barriers is the responsibility of nursing managers.

Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study

Background

Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services.

Methods

The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire.

Results

In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance.

Conclusion

Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

Quality of work life and factors associated with it among nurses in public hospitals, Iran

BACKGROUND

There is an acute shortage of nurses worldwide including Iran. Quality of work life is important for nurses as it affects the safety and quality of care provided for patients as well as organizational factors. The aim of this study was to describe the status of quality of work life and to explore its predictors among nurses in Iran.

METHODS

A cross-sectional study was conducted on 2391 nurses in 85 Iranian public hospitals, selected through the convenience sampling. Data were collected using demographic information and the quality of work life questionnaires.

RESULTS

The mean score for total quality of work life was 2.58, indicating a low level of self-reported quality of work life, with 69.3% of nurses dissatisfied with their work life. The major influencing factors were inadequate and unfair payment, lack of solving staff problems by organization and poor management support, job insecurity, high job stress, unfair promotion policies, and inadequate involvement in the decision-making. Significant predictors in the multivariate analysis for lower quality of work life were male gender, being single, older age, having lower educational levels, and working in teaching hospitals.

CONCLUSION

The quality of nursing work life was at a low level and needs improvement interventions. The predictors identified allow for more targeted interventions. Nursing managers and policymakers should develop and implement successful strategies appropriately to improve the quality of work life. This includes the payments, organizational and managerial support, job security, fair promotion policies, and measures to reduce job stress.

Intention to Leave the Nursing Profession and Its Relation with Work Climate and Demographic Characteristics

BACKGROUND

Because of the importance of staff shortage in health systems, considering the intention to leave the job and its related factors among nurses is very important. The aim of this study was to identify the association between the intention to leave the nursing profession and work climate and demographic characteristics.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 206 nurses, by random sampling method from six hospitals (response rate = 92%). A set of self-administered questionnaires were applied for the evaluation of intention to leave and work climate.

RESULTS

The high level of intention to leave the profession was expressed by 23.70% of the participants; 25.10% of the participants had the moderate intention. Data analysis revealed that work climate, type of employment, marital status, and overtime working were significant predictors of nurses' intention to leave after controlling other independent variables (R2 = 0.10, p < 0.001).

CONCLUSIONS

It was found that work climate and some demographic characteristics can be seen as indicators for intention to leave among nurses; therefore, considering the so-called variables is required. Further studies are needed to identify other aspects of the issue.

Frequency and potential causes of medication errors from nurses’ viewpoint in hospitals affiliated to a medical sciences University in Iran

Purpose

The purpose of this paper is to investigate the prevalence of medication errors (MEs) and the factors affecting them among nurses of hospitals affiliated to Kurdistan University of Medical Sciences (KUMS) in 2016.

Design/methodology/approach

This is a cross-sectional and descriptive-analytic study. In total, 503 nurses were selected using census method from six hospitals affiliated to KUMS. A self-constructed questionnaire was employed to collect information on nurses’ socio-demographic characteristics (6 items), the prevalence and type of MEs (21 items) and their perceptions about the main causes of MEs (40 items). Data were collected from August 15 to October 15, 2016. In addition, nonparametric and linear regression tests were used to describe the descriptive statistics and analyze the data.

Findings

The response rate was 73 percent and the monthly reported MEs per nurse was 6.27±11.95. Giving medication at non-scheduled time (28.4 percent), giving multiple oral medications together (22.4 percent) and giving painkillers after operation without physician’s prescription (15.3 percent) were three types of repetitive MEs, respectively. Gender, work experience, and having a second job affected the total number of MEs. “Long and unconventional nursing shifts,” “changing the dosage of medications for patients under observation due to multiple consultations and different doctors’ orders” as well as “failure to give feedback about the causes of errors to nurses by supervisors” were the three prioritized factors for MEs.

Originality/value

There is a need to reduce MEs in order to improve patient safety. It seems that in order to reduce MEs, systemic and managerial reforms such as reducing the working hours and workload of nurses, giving feedback about the causes of MEs to nurses, and using initiatives to reduce the stress in nurses are necessary.

Relationship between nurses' perception of ethical climates and job satisfaction in Jimma University Specialized Hospital, Oromia region, south west Ethiopia

BACKGROUND

The ethical climate is one aspect of an organization which refers to the shared perceptions of ethically correct behaviors and way of handling ethically deviated behaviors. Increased awareness of the complexity of ethical issues in the health care setting has fueled interest in nursing ethics. However; there is limited information on the relationship between nurses' perception of ethical climate and job satisfaction globally and no study was done on this issue particularly in Ethiopia. Therefore, this study was aimed to assess the relationship between nurses' perception of ethical climates and job satisfaction in Jimma University Specialized Hospital, southwest Ethiopia, 2016.

METHODS

Institutional based cross-sectional study was conducted on 266 nurses in Jimma University Specialized Hospital from March to April 2016. The study participants were invited by using simple random sampling method. Data were collected using self-administered questionnaires and were entered into Epidata 3.1 and analyzed using SPSS Version 20.0. Pearson's correlation was used to assess the correlation between each dimension of the hospital ethical climate and job satisfaction of nurses. Variables significant at bivariate analysis (P < 0.25) were considered as a candidate for the multivariable linear regression analysis. All analyses were conducted at the 0.05 significance level.

RESULTS

The percentage mean score for ethical climate and job satisfaction were 53.4 and 51.3% respectively. Law and code climate significantly influenced job satisfaction (β = 1.53, p = 0.000). Caring climate also significantly influenced nurses job satisfaction (β = 0.99, p = 0.000). The result also showed that an independence climate significantly influenced job satisfaction (β = 0.62, p = 0.041). On the other hand, rule climate and instrumental climate did not significantly affect job satisfaction (β = 0.380, p = 0.409 and β = - 0.208, p = 0.290 respectively). The adjusted R square was 0.601, indicating that 60.1% of the variations in job satisfactions was explained by ethical climate variables.

CONCLUSION

The different dimensions of ethical climates have a negative or positive impact on nurses' job satisfaction and maintaining a positive ethical climate is key to increasing nurses' job satisfaction.

Effect of the Walking Exercise Program on Cancer-Related Fatigue in Patients with Acute Myeloid Leukemia Undergoing Chemotherapy

Background:

Cancer-related Fatigue (CRF) is one of the most common complications of acute myeloid leukemia (AML) and its related therapies. It can influence all physical and psychological aspects of the patient’s life. Also, it is believed that exercise can improve CRF in patients with cancer.

Objective:

This study aimed to investigate the effect of the walking exercise program on CRF in patients with AML undergoing chemotherapy.

Methods:

In this quasi-experimental study with a pre- and post-test design, 50 patients with AML undergoing chemotherapy were selected using a convenience sampling method at a teaching hospital in an urban area of Iran. The intervention included daily 30 minutes of planned walking for ten days. Data was collected using a demographic data form and the Brief Fatigue Inventory, which were filled out before the intervention, and on the fifth and tenth days of the intervention.

Findings:

Statistically significant differences were reported in the reduction of CRF on the fifth day and tenth day of the intervention (p <0.001).

Conclusions:

The planned walking intervention can be used as an easy and low-cost method for reducing CRF in patients with leukemia.

Optimism and distress tolerance in the social adjustment of nurses: examining resilience as a mediator and gender as a moderator

Background

As nursing is recognised as one of the most stressful occupations in healthcare organisations, nurses are vulnerable to adjustment challenges.

Aims

The authors examine the association between optimism, distress tolerance and social adjustment through the mediating role of resilience and the moderating role of gender among Iranian nurses.

Methods

The sample consisted of 183 nurses working in six private hospitals in Iran. The authors employed structural equation modelling to test a moderation-mediation model of social adjustment.

Results

Findings reveal that: (a) resilience partially mediates the association between distress tolerance and social adjustment and the link between optimism and social adjustment - nurses with high levels of optimism and distress tolerance are significantly more likely to report greater resilience and subsequently report higher social adjustment; and (b) gender plays a moderating role in the model - women reported higher levels of optimism and lower levels of both resilience and distress tolerance than men. However, men reported higher levels of both distress tolerance and resilience as well as better social adjustment in comparison to female nurses.

Conclusions

The promotion of resilience may contribute to increased social adjustment, optimism and distress tolerance at work.

Health care reform in Iran: Implications for nurses' moral distress, patient rights, satisfaction and turnover intention

AIM

The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention.

BACKGROUND

Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population.

METHODS

This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran.

FINDINGS

Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention.

CONCLUSIONS

Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention.

IMPLICATIONS FOR NURSING MANAGEMENT

Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel.

A Qualitative Study of Specialized Clinical Nurses' Perceptions of Good Care in Practice

PURPOSE/AIMS

The aim of this study was to explore specialized clinical nurses' (SCNs') perceptions of "good care" through descriptions of actual care experiences.

DESIGN

We used a qualitative design with a conventional content analysis approach.

METHODS

We conducted semistructured interviews with 24 SCNs. These nurses have passed specialized clinical courses, are master's or bachelor's degree prepared, have additional course work beyond the bachelor degree, and practice with an expanded scope of responsibility. The participants were purposively sampled from general and specialty hospitals, and 6 field notes were collected.

RESULTS

We identified 3 overarching themes to classify the findings: patient-centered care, knowledge-based care, and skillful practice. Participants regarded these 3 components as interdependent and related, which we conceptualize as 3 sides of an equilateral triangle termed the Good Care Triangle.

CONCLUSIONS

The Good Care Triangle provides a heuristic approach to consider professional standards from the perspectives of SCNs and provides needed insight into SCNs' perspectives on the fundamental yet underexplored concept of good care. Clinical leaders can consider how the 3 themes identified are reflected and enacted in the care practices of SCNs. Future research could examine the utility of the Good Care Triangle in guiding nursing education and evaluating SCNs' perspectives of the care that they are providing.

Northern Ghana final-year nurses' attitudes towards nursing and remaining post qualification

Background

Recruitment and retention concerns nursing globally, including Ghana, as the country attempts to meet health demands. A link exists between nursing students’ attitudes towards nursing and decisions to enter, remain in or withdraw from the profession.

Objectives

To describe northern Ghana final-year student nurses’ current attitudes towards nursing and remaining in nursing post qualification.

Method

Non-experimental quantitative descriptive design used convenient sampling targeting final third-year student nurses (n = 80) studying towards a Diploma in Registered General Nursing in a northern Ghana college (N = 220). Data were gathered using the attitude dimension of a self-administered questionnaire, developed by Al-Omar.

Results

The response rate was 87.5% (n = 70). Respondents were 20–30 years of age, more men and predominantly from urban areas. The mean attitude dimension score (range 10–50) was 35.41 (SD 4.03) with no skewness (0.37); mean of single-item question about intention to stay in nursing was 3.68 (SD 1.14) with negative skewness (-0.92). Male and urban respondents’ attitudes were more positive than those of female respondents. No association was found between attitude score and demographics or intention to stay in nursing, but significant association was found between gender and habitation and attitude categories. Medium positive correlation existed between intent to stay in nursing and attitude score. Pay, travel opportunities and nursing being a challenging career attracted unfavourable attitudes.

Conclusion

Ghanaian male student nurses’ attitudes are non-typical of general stereotypes held of nurses and gender, suggesting increased recruitment of male nurses. Demographic variables hold a small amount of value in the development of attitudes in Ghanaian nurses.

Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study

Background

One helpful strategy adopted for pain management in non-verbal, intubated patients is the use of a proper pain assessment scale. The purpose of the present study is to achieve a better and deeper understanding of the existing nurses' challenges in using pain assessment scales among patients unable to communicate.

Methods

This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until data saturation. The participants included 20 nurses working in intensive care units. Data was collected using semi-structured interviews and analysis was done using an inductive approach.

Results

Four categories and ten sub-categories were extracted from the experiences of the nurses working in the intensive care units in terms of nursing challenges in using non-verbal pain assessment scales. The four categories included "forgotten priority", "organizational barriers", "attitudinal barriers", and "barriers to knowledge".

Conclusions

The findings of the present study have shown that various factors might influence on the use of non-verbal pain assessment scales in patients unable to communicate. Identifying these challenges for nurses can help take effective steps such as empowering nurses in the use of non-verbal pain assessment scales, relieving pain, and improving the quality of care services.

Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran

BACKGROUND

The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards.

DESIGN

A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data.

RESULTS

Four themes were developed based on the analysed data: "experiencing psycho-social challenges," "experiencing psychological challenges," "encountering catalysts causing challenges," and "employing various strategies for coping with challenges."

CONCLUSIONS

Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.

Perspectives of Oncology Unit Nurse Managers on Missed Nursing Care: A Qualitative Study

Objective:

The main objective of this study was to explore factors affecting missed nursing care in oncology units from the perspective of nurse managers.

Methods:

Twenty nurse managers working at oncology units of referral teaching hospitals in Iran participated in this study. Data were collected through individual face-to-face and telephonic interviews using an interview guide. Focus groups were also conducted. Data were analyzed using conventional content analysis.

Results:

System structure, underlying factors, and barriers to missed-care reports were identified as factors that affect missed nursing care.

Conclusions:

Nurse managers should reduce the effects of nursing staff shortages and increased workloads in addition to providing materials and equipment. They need to distribute experienced staff according to the type of ward or patients' needs. Nurse managers should create a favorable environment for reporting missed nursing care by having an open relationship with nurses by teaching and emphasizing nursing practice. Moreover, using a nonpunitive managerial approach and minimizing the use of an apathetic management style can be helpful.

Depression among Iranian nurses: A systematic review and meta-analysis

Background: Depression is one of the most commonly diagnosed mental disorders. Nurses and other hospital service providers are a group at high risk for developing depression. Thus, knowing the prevalence of depression among nurses can help the health care decisionmakers to plan ad hoc prevention programs to control depression in this group. This study was conducted to quantitatively assess the prevalence of depression in nurses by performing a systematic review and meta-analysis. Methods: ISI/Web of Science (WoS), PubMed/MEDLINE via Ovid, PsychInfo, and Embase, as well as Iranian databases such as Irandoc, SID, and Magiran were searched from January 2000 to March 2017. To calculate the pooled prevalence rate, the random effects model based on the DerSimonian-Laird approach was used. I2 and the Q tests were used to examine heterogeneity among studies. To investigate the causes and sources of heterogeneity, the impact of such variables as quality, sample size, geographic region, and criteria used to diagnose depression was analyzed performing subgroup analyses. The quality of reviewed studies was assessed according to the 22-item STROBE checklist. Sensitivity analysis was performed to investigate the stability and robustness of the obtained results. All data were analyzed using the "meta" package included in the R Software Version 3.4.0. Results: A total of 30 studies were retained in the current investigation. The overall prevalence of depression was 22% [95%CI 19- 27] among nurses, with a high statistically significant heterogeneity (I2= 94% and Q-test= 479.87). Conclusion: This rate was higher than the prevalence of depression among the general population in Iran. Presence of happy nurses with good mental state at hospitals is essential for promoting the care provided to patients.

Validation of Multidimensional Persian Version of the Work-Family Conflict Questionnaire among Nurses

Background:

Several instruments have so far been developed in English language to measure the level of work-family conflict and further validation is required for non-English speakers.

Objective:

To test factorial structure and construct validity of the Persian version of workfamily conflict scale among Iranian nurse.

Methods:

This study was conducted among 456 Iranian nurses working at public hospitals in 17 provinces from March 2015 to September 2015. We used a self-administrated questionnaire to collect information. Exploratory factor analysis was run using SPSS 21. Then, construct validity was evaluated using confirmatory factor analysis (CFA), convergent validity, and discriminant validity by AMOS 21.

Results:

Exploratory factor analysis extracted four dimensions that explained 65.5% of the variance observed. The results of confirmatory factor analysis showed that our data fitted the hypothesized four dimensional model of work-family conflict construct. The average variance extracted was used to establish convergent and discriminant validity.

Conclusion:

The Persian version of work-family conflict questionnaire is a valid and reliable instrument among Iranian nurses.

A qualitative exploration of facilitators and inhibitors influencing nurses' intention to leave clinical nursing

OBJECTIVE

The aim of this study was to determine the barriers and facilitators shaping the development of an intent to leave the nursing profession, from the perspective of Iran's clinical nurses.

METHOD

The study was completed using qualitative content analysis And included 21 Participants who were clinical nurses with a variety of work experience across a range of clinical posts. Semi-structured interviews were used to collect data and data obtained from the interviews were analyzed and interpreted utilizing a content analysis method.

RESULTS

During data analysis, 2 main themes, 5 categories and 12 subcategories were extracted as follows. Facilitators include: (I) spoiled identity (weak social status and violation of dignity), (II) frustration (feeling subordinate including a lack of appreciation), and (III) experience of hard labor (job stress, hard work and shift work). Inhibitors include: (I) positive management behaviors (rewards and support systems), and (II) being valuable (spiritual satisfaction, the efficient presence and professional capabilities development).

CONCLUSION

Based on the findings, it can be concluded that managers can prevent nurses from leaving clinical nursing by providing appropriate activities for them and increasing their motivation and satisfaction.

A Grounded theory study of the intention of nurses to leave the profession

Objective

this study explores the process of the development of an intention to leave bedside nursing.

Method

the process was studied from the perspective of 21 nurses using the grounded theory method. Data were collected using semi-structured interviews and the constant comparative method of Corbin and Strauss was used for data analysis.

Results

according to the participants, the two main categories, "social image of nursing", and "culture and structure of the bedside", were the contextual factors that influence why nurses are leaving bedside care provision. Disappointment with a perceived lack of progress or improvement in the clinical experience formed primary psychosocial concerns for the participants. Competence and a process of self-control were steps taken by the participants. These, associated with interventional conditions produced the outcomes of the loss of professional commitment and desire to leave bedside nursing. "Failure to integrate personal expectations with organizational expectations: in search of escape" was the central category of the study that linked the categories together.

Conclusion

the findings of this study provide useful information about the needs of nurses for overcoming the intention to leave bedside care. The identification of this process can help in recognizing emerging problems and providing solutions for them.

Adequate Resources as Essential Component in the Nursing Practice Environment: A Qualitative Study

INTRODUCTION

Attracting and retaining well qualified nurses to develop healthcare systems and ensure patient safety is a global concern. In this regard, the quality of the practice environment plays a crucial role.

AIM

To explore Iranian nurses perception on the key constituents of the nursing practice environment.

MATERIALS AND METHODS

This study was conducted using a qualitative approach. Twelve participants were purposively selected from five teaching hospitals in Shiraz, Iran. Data was collected through semi structured interviews, and analysed using qualitative content analysis.

RESULTS

Data analysis led to the extraction of two categories of 'adequate staff', with two subcategories of balanced workload and well qualified nurses, and 'adequacy of physical resources', with subcategories of equipment adequacy and appropriate physical structure as key elements of the nursing practice environment.

CONCLUSION

Imbalanced workloads, inappropriate nurse-patient ratios, and inadequate physical resources negatively affected nurse's perceptions of the quality of the nursing practice environment. The findings provide baseline data for health policymakers in different national and global areas to remodel the practice environment. The improvement of the practice environment, with adequate staffing levels and appropriate allocation of physical resources, is achievable to resolve this challenge and thus improve outcomes.

Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting

OBJECTIVES

This study aimed to examine the prevalence and types of medication errors (MEs), as well as barriers to reporting MEs, among nurses working in 7 teaching hospitals affiliated with Kermanshah University of Medical Sciences in 2016.

METHODS

A convenience sampling method was used to select the study participants (n=500 nurses). A self-constructed questionnaire was employed to collect information on participants' socio-demographic characteristics (10 items), their perceptions about the main causes of MEs (31 items), and barriers to reporting MEs to nurse managers (11 items). Data were collected from September 1 to November 30, 2016. Negative binomial regression was used to identify the main predictors of the frequency of MEs among nurses.

RESULTS

The prevalence of MEs was 17.0% (95% confidence interval, 13.7 to 20.3%). The most common types of MEs were administering medications at the wrong time (24.0%), dosage errors (16.8%), and administering medications to the wrong patient (13.8%). A heavy workload and the type of shift work were considered to be the main causes of MEs by nursing staff. Our findings showed that 45.0% of nurses did not report MEs. A heavy workload due to a high number of patients was the most important reason for not reporting MEs (mean score, 3.57±1.03) among nurses. Being male, having a second unrelated job, and fixed shift work significantly increased MEs among nurses (p=0.001).

CONCLUSIONS

Our study documented a high prevalence of MEs among nurses in the west of Iran. A heavy workload was considered to be the most important barrier to reporting MEs among nurses. Thus, appropriate strategies (e.g., reducing the nursing staff workload) should be developed to address MEs and improve patient safety in hospital settings in Iran.

Challenges experienced by nurses in the implementation of a healthcare reform plan in Iran

Introduction

The Healthcare Reform Plan is counted as a plan for improving healthcare services in Iran. Undoubtedly pros and cons can be seen either in plan or implementation. This study was conducted to describe nurses’ challenges in implementing healthcare reform in Iran.

Methods

A qualitative method centered upon conventional content analysis was applied. We used purposive sampling and data saturation was obtained by 30 participants. Data were analyzed using MAXQDA software.

Results

Challenges experienced by nurses in the implementation of this reform include; unsuitable infrastructure, unfavorable vision, a complicated challenge, the necessity of monitoring, control plan outcomes, the impact on nurses, people’s misconceptions and solutions.

Conclusions

The Healthcare Reform Plan in Iran is a solution to establish equality in the health system, however, to eliminate these challenges, revision and appropriate foundation of infrastructures is called for.

The Chains Around Academic Freedom in Teaching-Learning

Freedom as a concept has been much debated. Is freedom an innate part of being, or does freedom even truly exists? These are questions that have gleaned countless hours of discourse over the years. Two components of freedom that can influence nurse higher education are freedom of speech, in the form of media, and academic freedom. The author of this column first introduces three views of freedom to demonstrate the differences surrounding it. A discussion of the media’s use or misuse of freedom of speech and its influence on nursing education is then presented, followed by an examination of current threats to academic freedom in today’s institutes of higher learning and specifically in the nursing education arena. The author concludes with suggestions on being a nurse educator through living as a humanbecoming professional while navigating issues surrounding nursing education.

Nurse Staffing Norm in Iran Hospitals: What Features Should be Included for Success?

BACKGROUND

Designing and implementing a model for estimation and distribution of required nurse is one of strategies to prevent unequal distribution of nurses within and between hospitals. The purpose of this research was to determine required features for hospital nursing staff estimation model.

METHODS

We conducted a qualitative study using a Colaizzi analysis approach. We used semi-structure and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in area of policy making in human resources in Ministry of Health, 10 decisions making in employment and distribution of human resources in treatment and administrative chancellors of medical universities, and 12 process owners in hospitals). The data were analyzed using ATLAS.ti software version 6.0.15.

RESULTS

The ten following sub-themes emerged from data analysis: Skill mix and task shifting, work measurement, legal support, stakeholder involvement in designing a model, considering the ward activity, considering type and extent of care patients required, model development by experts predominate in nursing process, considering the nurses availability, considering the capabilities and professional merits of nurses, fitness with social, cultural, and belief of people. The main themes were occupation analysis, planning and policy making, real workload, acceptability, nurses' efficiency, and being a native.

CONCLUSIONS

Given that standardization of nursing staff estimation is announced as one of the challenges in reaching Iran's 20-year vision plan. Hence, design and implementation of a nursing staff estimation model in regard to identified features could be part of priorities in Ministry of Health in Iran.

Barriers against required nurse estimation models applying in Iran hospitals from health system experts' point of view

Introduction

One of the strategies for accessing effective nursing care is to design and implement a nursing estimation model. The purpose of this research was to determine barriers in applying models or norms for estimating the size of a hospital’s nursing team.

Methods

This study was conducted from November 2015 to March 2016 among three levels of managers at the Ministry of Health, medical universities, and hospitals in Iran. We carried out a qualitative study using a Colaizzi method. We used semistructured and in-depth interviews by purposive, quota, and snowball sampling of 32 participants (10 informed experts in the area of policymaking in human resources in the Ministry of Health, 10 decision makers in employment and distribution of human resources in treatment and administrative chancellors of Medical Universities, and 12 nursing managers in hospitals). The data were analyzed by Atlas.ti software version 6.0.15.

Results

The following 14 subthemes emerged from data analysis: Lack of specific steward, weakness in attracting stakeholder contributions, lack of authorities trust to the models, lack of mutual interests between stakeholders, shortage of nurses, financial deficit, non-native models, designing models by people unfamiliar with nursing process, lack of attention to the nature of work in each ward, lack of attention to hospital classification, lack of transparency in defining models, reduced nurses available time, increased indirect activity of nurses, and outdated norms. The main themes were inappropriate planning and policymaking in high levels, resource constraints, and poor design of models and lack of updating the model.

Conclusion

The results of present study indicate that many barriers exist in applying models for estimating the size of a hospital’s nursing team. Therefore, for designing an appropriate nursing staff estimation model and implementing it, in addition to considering the present barriers, identifying the norm required features may positively impact on norm acceptance and implementation.

Maintaining Equilibrium: Socialization and Gendered Identities of Iranian Male Nurses

The aim of this study was to explore the process of Iranian male nurses’ professional socialization and how they negotiate a gendered identity. A purposive sample of 22 male nurses was recruited from six public hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Study data were collected by conducting semi-structured interviews. Data collection was continued until reaching data saturation. Totally, 25 interviews were conducted. Data analysis was carried out using Corbin and Strauss’s techniques for qualitative data analysis. The core category of the study, that is, the socialization process of male nurses who participated in the study, was “maintaining equilibrium.” Our participants’ strategies for socialization included informing, conforming, and self-establishing. The study findings can be used for developing effective strategies for male staff recruitment and retention.

Nurse’s perceptions of organisational barriers to delivering compassionate care: A qualitative study

Background:

Compassionate care is an international priority of healthcare professionals. There is little understanding about how workplace issues impact provision of compassionate care in nursing practice. Therefore, it is important to address the workplace issues and organizational factors which may hinder compassionate care delivery within nursing practice.

Objective:

The aim of this study was to explore workplace and organizational barriers to compassionate care from the nurses’ perspective.

Research design:

The study used a qualitative exploratory design, and data were analyzed by conventional content analysis.

Participants and research context:

A total of 15 nurses working in different fields of nursing were recruited from four hospitals at northwest of Iran. Participants were selected by purposive sampling. Semistructured interviews were conducted for data collection.

Ethical consideration:

Ethical approval of this study was gained from the Ethical Review Board of Tabriz University of Medical Sciences.

Findings:

The main theme which emerged from data analysis was “unsupportive organizational culture.” This theme had two main categories including “excessive workload alongside inadequate staffing” and “the lack of value on compassionate care.”

Discussion:

Organizational barriers to development of compassionate in clinical practice were identified in this study. A closer examination of these barriers is required to move compassionate practice from an individual responsibility to a collective responsibility that is owned and shared by organizations.

Conclusion:

For compassionate care to flourish, policy makers, managers, and healthcare providers must foster an organizational atmosphere conducive to compassionate care.

Expectation of fairness: a turning point in the professional satisfaction of Iranian nurses

Introduction

The professional satisfaction of staff is one of the most challenging organizational concepts that can enhance the efficiency level of organizations. In a similar vein, the professional satisfaction of nurses is of considerable importance, in that, professional dissatisfaction among nurses could result in emotional detachment, depression, anger, evasion from work, and inefficacy and would negatively impact the organization’s work rate. The aim of this study was to understand Iranian nurses’ experiences of the concept of professional satisfaction.

Methods

This was a qualitative study conducted with a targeted sampling of 10 nurses (4 men and 6 women) in 2015. The data were collected through conducting in-depth interviews, and textual data were analyzed subsequently using the Qualitative Content Analysis (QCA) method.

Results

The findings of this study pointed to “fair conduct,” which was comprised of three sub-categories, i.e., expectation of fairness in social-professional settings, expectation of fairness in receiving professional benefits, and expectation of fairness in the area of professional interactions.

Conclusions

There are various ups and downs in nursing due to the challenging nature of the profession, from the initial education at the university until retirement. According to the findings of this study, a lack of fairness in social-professional settings, a lack of fairness in receiving professional benefits, and a lack of fairness in the area of professional interactions were among the factors that have great impacts on the degree of professional dissatisfaction among nurses.

Threats to nurses’ dignity and intent to leave the profession

Background:

It is essential to pay attention to and respect the dignity of nurses to maintain them in their profession while they deliver skilled nursing care. Little is known, however, about how a sense of dignity influences the practitioner.

Objectives:

The purpose of this study is to describe nurses’ experiences of threats to their dignity occurring within clinical settings, which generates an intention to leave clinical practice.

Research design and method:

The study was performed using qualitative content analysis. The participants were 21 clinical nurses with work experience who were employed across a range of clinical posts. Data obtained from the semi-structured interviews were analyzed and interpreted using a content analysis approach.

Ethical considerations:

The study was approved by the Ethics Committee of Tabriz University of Medical Sciences and was guided by the ethical principles of voluntary enrolment, anonymity, privacy, and confidentiality.

Findings:

Within data analysis, three main themes and nine categories were extracted as follows: (1) lack of professional pride (physician’s dominance, intangible nature of nursing, and negative attitude toward clinical nurses); (2) oppressive work environment (high workload, disrespect, discrimination, and lack of support); and (3) suppression of progressivism (lack of appreciation and attention to meritocracy).

Discussion:

Almost all of the participants have experienced some degree of disrespect and violation of dignity. In general, attempts made by the participants to show their objection to the threats and to support and protect their dignity have not been effective and in fact made them more inclined to leave the clinical work.

Conclusion:

According to the views of nurses themselves, identification of the factors threatening nurses’ dignity can be one of the appropriate solutions for the broader and deeper investigation of this phenomenon and can help promote and support nurses’ dignity and their retention within the profession.

Experiences of Iranian Nurses that Intent to Leave the Clinical Nursing: a Content Analysis

INTRODUCTION

Despite the current shortage of nurses, it is important to know the reasons nurses want to leave the clinical setting. The purpose of this study was to explore the experiences of nurses who intend to leave clinical nursing.

METHODS

In a qualitative content analysis study, data obtained from 13 in-depth face-to-face semi-structured interviews with nurses working in hospitals affiliated to the Tabriz and Urmia University of Medical Sciences in Iran, selected through purposive sampling. A conventional content analysis was used for data analysis.

RESULTS

Four categories and eleven subcategories emerged during data analysis. The extracted categories and sub categories consisted of (I) Entry routes into nursing (implicitly entry, targeted entry), (II) Defects in dignity (lack of professional vision toward the nurses, social status of nurses), (III) Work in non-ideal working environment (lack of support, discrimination, conflict, lack of opportunities for advancement), and (IV) Dissatisfaction with working conditions (heavy workload, lack of power, unusual working hours).

CONCLUSION

The findings of this qualitative study reflect professional turnover as a complex, ongoing, multidimensional process. By identifying the factors responsible, it could be possible to retain nurses in the field.

A grounded theory of humanistic nursing in acute care work environments

Background:

Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment.

Objective:

To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting.

Research design:

Data were collected from interviews and observations in 2009–2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred.

Participants and research context:

In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling.

Ethical considerations:

The research was approved by the Ethics Committee of the university and hospitals.

Results:

The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation–education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others’ needs, resulting in “success and accomplishment” of nurse/nursing manager and patient/family.

Conclusion:

This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses’ professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses’ rights are violated.

How Likely Is It for a Nurse Student to Become a Competent Nurse? A Protocol for Scale Development and Validation Using a Mixed Methods Study

The aim of the paper was to develop and validate a scale for estimating the likelihood of a nurse student to become a competent nurse.

Admitting students to nursing schools without assessing their personal characteristics has led to serious consequences, including low quality of nursing care. Early detection of students who are at risk of attrition or becoming non-competent nurses can save the time, money, and energy devoted to educating and training the future nurses.

A mixed methods design will be employed. Using literature review and interviews with nurse students, clinical nurses, nurse experts, and nurse managers during the first qualitative phase, we will build a comprehensive item pool that has a focus on nurse students’ personal characteristics. To increase the trustworthiness of interview findings, we will distinguish competent versus incompetent nurses by measuring their competence levels. In the second quantitative phase, the Nurse Competence Predicting Scale will be developed and tested for psychometric properties.

We believe that Nurse Competence Predicting Scale may help in early identification of nurse students who are at risk of not acquiring expected nurse competencies on graduation or joining the workforce. In such cases, educational managers may take timely remedial interventions.