An Iranian perspective on patients' rights

Psychometric validation of the Persian version of the ethical awareness scale for nurses working in Iranian intensive care units

AIM

The purpose of this study was to translate and validate the ethical awareness scale for nurses working in Iranian intensive care units.

DESIGN

A cross-sectional psychometric study.

METHODS

The study was conducted in Oct 2020 to Sep 2021, involving the participation of 200 ICU nurses. The process included translation of the original version of the ethical awareness scale into Persian, following the World Health Organization guideline, for use in Iran. The translated version was then evaluated for reliability, face validity, content validity ratio, content validity index, convergent validity and construct validity.

RESULTS

The initial reliability of the scale was established. In qualitative face validity, a few items changed slightly and all items were retained in the quantitative face validity assessment. Based on Lawshe's values, three items were removed from the scale during CVR assessment. All items exhibited acceptable CVI scores. Convergent validity was established with an average variance extracted greater than 0.5. The fit indices, such as CFI = 0.94, GFI = 0.94, RMSEA = 0.01, AGFI = 0.97 and CMIN/DF = 2.99, supported the structural model of the scale. The fit indices for the structural model of the scale were all within acceptable ranges, suggesting that the model fit the data well. Its reliability was confirmed through the test-retest method, with Cronbach's alpha = 0.84 and McDonald's omega coefficient >0.8.

CONCLUSION

The findings of this study indicate the Persian version of the ethical awareness scale for Iran (EAS-IR) is comparable in content to the original version, demonstrating its validity and reliability for assessing ethical awareness among Iranian nurses in ICUs. The scale can be a valuable resource for measuring ethical awareness in the Iranian healthcare context and may contribute to improving ethical practices and decision-making in ICU settings.

PATIENT OR PUBLIC CONTRIBUTION

In this project, no patient or public contribution was necessary, because it was not applied to our work.

Components related to ethical decision making in medical science students: A structural equation model

BACKGROUND

Evaluating moral principles in the Society of Medical Sciences and health care workers (HCWs) is imperative due to their direct contact with the community and the significant impact of their attitudes and decisions on people's lives. This study aimed to determine the components related to ethical decisions in medical sciences students.

METHODS

One thousand two hundred thirty-five eligible students in the Alborz University of Medical Sciences participated in this descriptive study. We gathered their socio-demographic information, assessed their moral reasoning, and used the ethical decisions questionnaire, Lutsen moral sensitivity questionnaire, and general health questionnaire (GHQ) for data gathering. The data were analyzed with SPSS software version 25 and LISREL version 8.8.

RESULTS

According to the path analysis test findings, ethical reasoning significantly correlated with ethical decision-making (B = 0.40). The number of clinical courses passed, moral sensation (moral sensitivity), and the total number of passed academic semesters had the greatest positive and negative association with ethical decision-making, respectively. (B = 0.54), (B = 0.524) and (B = -0.11).

CONCLUSION

Based on the findings of the moral reasoning test, the moral sensation was associated with ethical decision-making, which indicates the necessity of attending to ethical aspects, promoting moral reasoning, sensitivity, and students' accuracy.

An educational program of reducing moral distress (PRMD) in nurses; designing and evaluating

BACKGROUND

Moral distress is common phenomenon that has negative consequences on nurses, patients, and healthcare systems. This study aims to design and evaluate an educational program to reduce moral distress in nurses.

METHODS

This multiphase mixed-method study was done in three stage on February 2021 in Shiraz/Iran. In pre-implementation stage, a content analysis study was conducted on 12 participants were interviewed using purposive sampling and then the program was designed according to qualitative data, panel of expertise and literature review according the seven steps of Ewles and Sminett's model and implemented in one group on 40 nurses using a quasi-experimental design. In Post-Implementation stage, effectiveness of program was evaluated through quantitative and qualitative methods. Quantitative data were gathered by Hamric's 21-question moral distress questionnaire analyzed via SPSS v.25 and analysis of variance repeated measures test. Also, a content analysis study was conducted on 6 PRMD participants using purposive sampling. In Program evaluation stage, convergence of quantitative and qualitative data and the effects of the program were examined. Trustworthiness of qualitative data was accomplished by Lincoln and Guba criteria.

RESULTS

First quantitative study revealed the causes of moral distress consisted of deficiency in professional competency, unsuitable organizational culture, personal factors, environmental and organizational factors, management factors, insufficiencies in proficient and efficient communication and nurses' observation of moral dilemma. Results of quantitative stage showed that there was a significant difference (p < 0.05) between the mean score of moral distress before, after, 1 and 2 months after the intervention. The participants in secondary qualitative stage, reported increasing their moral knowledge and skills, improving ethical climate, and moral empowerment.

CONCLUSION

The use of different educational tools and teaching methods and the participation of managers in designing strategies had a very effective role in the effectiveness of this educational program.

Patient Dignity in Iranian Clinical Care Settings as Perceived by Physicians, Caregivers, and Patients

Introduction

All over the world, healthcare team members are recommended to respect patients’ human dignity. However, the dignity of hospitalized patients is not preserved in many cases. Due to the abstract, complex, and cultural nature of the concept of human dignity, further studies are required to precisely determine the different aspects of this concept.

Purpose

The aim of the present study was to explore the experiences and perceptions of physicians, nurses, family caregivers, and hospitalized patients with regard to patient dignity in Iranian clinical setting.

Materials and Methods

This is a qualitative, exploratory study in which physicians, nurses, family caregivers, and patients were recruited from 2 educational hospitals located in an urban area in Iran from April 2016 to February 2017 using the purposive sampling method (n = 24). Data were collected through individual interviews and subsequently analyzed using conventional content analysis in the software MAXQDA 2007, VERBI^O`.

Results

Three major themes emerged from analyses of the data obtained from the interviews: a peaceful environment, respect, and comprehensive support.

Conclusion

From the participants’ point of view, in order for their dignity to be preserved, patients need to be hospitalized in a peaceful environment in which they are treated with empathy, they receive comprehensive support, and the care settings are managed properly. Furthermore, it is important to respect patient’s values and beliefs, to provide unbiased care and treatment, and to maintain patient’s autonomy in order to maintain hospitalized patients’ dignity.

White lie during patient care: a qualitative study of nurses' perspectives

BACKGROUND

Keeping the patients well and fully informed about diagnosis, prognosis, and treatments is one of the patient's rights in any healthcare system. Although all healthcare providers have the same viewpoint about rendering the truth in treatment process, sometimes the truth is not told to the patients; that is why the healthcare staff tell "white lie" instead. This study aimed to explore the nurses' experience of white lies during patient care.

METHODS

This qualitative study was conducted from June to December 2018. Eighteen hospital nurses were recruited with maximum variation from ten state-run educational hospitals affiliated to Tehran University of Medical Sciences. Purposeful sampling was used and data were collected by semi-structured interviews that were continued until data saturation. Data were classified and analyzed by content analysis approach.

RESULTS

The data analysis in this study resulted in four main categories and 11 subcategories. The main categories included hope crisis, bad news, cultural diversity, and nurses' limited professional competences.

CONCLUSION

Results of the present study showed that, white lie told by nurses during patient care may be due to a wide range of patient, nurse and/or organizational related factors. Communication was the main factor that influenced information rendering. Nurses' communication with patients should be based on mutual respect, trust and adequate cultural knowledge, and also nurses should provide precise information to patients, so that they can make accurate decisions regarding their health care.

Patient's companions as a vulnerable group in Turkish hospitals: A descriptive study

BACKGROUND

In Turkish hospitals, in addition to health care professionals, there are people who are also a significant part of the health care services; even though they are not professionals. In Turkey, these people are known as refakatçi (a patient's companion).

OBJECTIVES

The purpose of this study was to identify and describe the concept of the patient's companion from their own perspective and to evaluate the concept of the patient's companion in terms of biomedical ethics.

METHODS

This was a descriptive study. Personal interviews were conducted via a structured questionnaire containing open-ended questions with the patients' companions. Thematic text analysis method was used to analyze the open-ended questions. The study was conducted at a University Research and Training Hospital in the Aegean Region of Turkey.

RESULTS

A total of 118 patient companions participated in the study. These patient companions stayed with the patients because of their concerns about trusting the health care professionals in caring for the patients. During their stay, the companions encountered several problems, including staying in ward-type rooms and resting in a single armchair, as well as staying for a mean time span of 4 days, primarily for 24 consecutive hours in each day. Despite these conditions, most of the companions surprisingly declared their satisfaction with their stays.

CONCLUSIONS

Patients' companions should be defined as bioethical subjects; more specifically, they should be defined as vulnerable subjects and should not be taken advantage of. The description of patient companions as a vulnerable group allows for the ethical evaluation of similar systems, such as those in Israel, Greece, Korea, and Iran, and could allow for the development of a common solution for these systems. Moreover, such a definition provides an important basis for social, ethical, or legal studies on the health care systems in all of these countries.

Developing a Model for Accreditation of Iranian Teaching Hospitals: A Qualitative Study

BACKGROUND

Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran.

METHODS

This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method.

RESULTS

Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71.

CONCLUSION

This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.

Strengthening ethical decision-making: the experience of Iranian nurses

AIMS

Ethical decision-making is a complex process that nurses perform daily. The aim of this study is to explain how ethical leaders in Iran strengthen ethical decision-making in their nursing teams.

METHOD

Data were collected using deep and semi-structured interviews with 20 Iranian nurses in 2015. Analysis was based on constant comparative analysis.

RESULTS

Ethical leaders strengthen ethical decision-making by promoting ethical commitment, developing an ethical atmosphere and guiding ethical decision-making.

CONCLUSION

The development of ethical decision-making in nursing can improve ethics-based nursing care.

Ethical conflict among nurses working in the intensive care units

BACKGROUND

Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it.

OBJECTIVES

This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units.

RESEARCH DESIGN

This was a descriptive cross-sectional research.

PARTICIPANTS AND RESEARCH CONTEXT

In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version).

ETHICAL CONSIDERATIONS

This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed.

FINDINGS

The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to "using resources despite believing in its futility," with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of "working with incompetent staff." The most frequently observed type of conflict was moral dilemma.

CONCLUSION

The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment.

Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial

PURPOSE

Intravenously administered erythropoietin (EPO) was firstly commenced (phase 1) in patients with indirect traumatic optic neuropathy (TON) by this group in 2011. It was re-tested by another group (phase 2) in 2014. This multicenter clinical trial was designed to compare its effect with intravenous steroid and observation.

METHODS

Included were TON patients ≥5 years of age and with trauma-treatment interval of ≤3 weeks. Follow-up visits were set at 1, 2, 3, 7, 14, 30, and at least 90 days after treatment. EPO and methylprednisolone were infused intravenously every day for three consecutive days. Primary outcome measure was change in the best corrected visual acuity (BCVA). Secondary outcomes included change in color vision and relative afferent pupillary defect (RAPD), side effects, and factors affecting the final visual improvement.

RESULTS

Out of 120 patients, 100 (EPO: 69, steroid: 15, observation: 16) were finally included. All three groups showed a significant improvement of BCVA which was not significantly different between the groups (adjusted for pretreatment BCVA). Color vision was significantly improved in the EPO group. Late treatment (>3 days) (odds ratio = 2.53) and initial BCVA of NLP (odds ratio = 5.74) significantly worsened visual recovery. No side effect was observed in any group.

CONCLUSION

EPO, steroid, and observation showed a significant improvement of BCVA in patients with TON. Initial BCVA of NLP and late treatment (>3 days) were significant risk factors for visual improvement.

Patient's Bill of Rights: Is it a Challenge for Quality Health Care in Saudi Arabia?

Background:

Increasing interest in patients' rights and the certainty of its impact on the quality of patient care has led to extensive research in both developed and developing countries. In 2006, the Government of Saudi Arabia publicized the Patient's Bill of Rights (PBR) that was aimed at improving patients' and health-care professionals' experience, with a focus on the quality of care provided.

Objective:

To determine the degree of awareness of rights among patients admitted to hospitals in Al-Madinah Al-Munawarah. The results would help policymakers understand the impact of patients' rights, and thus provide them with evidence to provide quality health-care service delivery and patient care through patients' rights.

Methodology:

This is an observational, analytical, cross-sectional study implemented in Al-Madinah Al-Munawarah, Saudi Arabia, using a self-administered questionnaire.

Results:

The study had a response rate of 83.01% and found an association between gender and knowledge for the selected items of patients' rights. However, there was no statistically significant difference between the knowledge of males and females regarding the consent form, with an awareness rate of 90% among the total sample size. However, almost half had never heard about patients' rights.

Conclusion:

This study shows that in Al-Madinah Al-Munawarah, Saudi Arabia, there is a low level of awareness among patients admitted to hospitals regarding their rights. Further, it was found that wall placards, mass media and health-care providers are important sources of knowledge regarding patients' rights. Health-care policymakers in Saudi Arabia should recognize the importance of patients' rights as means of providing better quality care and a higher rate of patient satisfaction by establishing measures to tackle obstacles that may impede the implementation of PBR.

Equity in nursing care: A grounded theory study

BACKGROUND:

Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health.

OBJECTIVES:

This study was conducted to explain the process of the realization of equity in nursing care.

RESEARCH DESIGN:

This qualitative study uses Glaser's approach to grounded theory.

PARTICIPANTS AND RESEARCH CONTEXT:

Sample selection began with convenience sampling and continued with purposive sampling. A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the "Six C's" coding family of Glaser.

ETHICAL CONSIDERATIONS:

The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects.

FINDINGS:

According to the findings, participants' main concern in providing equitable care is the rationing of nursing care. The identification of participants' main concern led to the emergence of the core category of the study, that is, "nurses' domination." The other categories revolving around the core category were conceptualized according to the six C's coding family: "nurses being dominated," "nurses' ineffective power in the health system," "low attention to equitable care in health system," "lack of clarity in measuring equitable care," "the health structure's inconsistency with equity," and "the inefficiency of the care system."

CONCLUSION:

There is a mutual relationship between providing fair care and nurses' perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded.

Ethical values in nurse education perceived by students and educators

BACKGROUND

Education is considered the first function and mission of the university, and observing educational ethics guarantees the health of the teaching-learning process in the university.

AIM

The aim of this study was to explore ethical values in nursing education from the perspective of Iranian nursing students and educators.

RESEARCH DESIGN

This qualitative study was conducted using the Thematic Content Analyses method. The data were collected from seven semi-structured individual interviews and three focus group discussions from July to November 2015. Participants and research context: The participants were faculty educators of nursing and nursing students in Tehran, capital of Iran, who were selected through purposive sampling. They were recruited gradually. Sampling was continued until data saturation when no new codes were extracted. Ethical committee: This study was conducted after obtaining the approval of Shahid Beheshti University of Medical Sciences Ethics Committee, and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process.

FINDINGS

Seven major themes emerged: human dignity, constructive human relations, educational justice, competency enhancement, excellence view, wisdom, and commitment and accountability.

CONCLUSION

The results of this study indicated that although many of the values, as universal values, were similar to those of other countries-which can be a reflection of the globalization process in the nursing profession and the presence of humanistic and spiritual approaches at the roots of the discipline, some differences could be found in the content of values due to factors such as the people's beliefs, culture, and religion. Iranian nursing students and educators revealed a unique and culture-based set of ethical values.

New visiting policy: A step toward nursing ethics

Background:

Patients’ rights arise from their expectations of the healthcare system, which are rooted in their needs. Visitation is seen as a necessary need for patients and families in intensive care units.

Objectives:

The authors attempted to design, implement, and evaluate a new visiting policy in the intensive care units.

Research design:

This study was an action research, including two qualitative and quantitative approaches.

Participants and research context:

The viewpoints of 51 participants (patients, families, doctors, nurses, and guards) on how to change the limited visiting policy were explained through semi-structured interviews and focus groups. The new visiting policy (contractual visitation) was designed, implemented, and evaluated with the involvement of participants.

Ethical considerations:

The hospital ethics committee approval was gained and the informed consent was obtained from all the participants.

Findings:

The content of interviews was analyzed and classified into four categories: advantages and disadvantages of visiting policies, and barriers and facilitators of changing the limited visiting policy. After implementation of the new policy (contractual visitation), a significant difference observed in satisfaction status before and after the changes (p value < 0.001).

Discussion:

Nowadays, many countries’ clinical guidelines recommend flexible visiting policy, which is consistent with the results of this study.

Conclusion:

Changing the limited visiting policy was a necessary need for patients and families that established with the involvement of them and staff.

Self-Preservation in Both Sides: Pathology of Spiritual Care in Iran

The aim of this study was to create a deeper understanding of the variables that may restrain or progress spiritual care in Iran. This manuscript provides an in-depth description of barriers to delivering spiritual care by nurses as well as patients' compensatory mechanisms against deprivation from spiritual care termed "self-preservation in both sides" emerged from an empirical study. It brings issues such as structural, hierarchical, social and personal concerns, which may prevent advancing spirituality within health care, to light. Thirty-five participants, nurses (n = 10), patients (n = 22) and their relatives (n = 3), took part in this study, and data were analyzed using qualitative content analysis method. Being aware of these results may help nurses and healthcare professionals to engage with and overcome some of the structural, hierarchical and social variables affecting spiritual care.

Ethical Sensitivity in Nursing Ethical Leadership: A Content Analysis of Iranian Nurses Experiences

Background:

Considering that many nursing actions affect other people’s health and life, sensitivity to ethics in nursing practice is highly important to ethical leaders as a role model.

Objective:

The study aims to explore ethical sensitivity in ethical nursing leaders in Iran.

Method:

This was a qualitative study based on the conventional content analysis in 2015. Data were collected using deep and semi-structured interviews with 20 Iranian nurses. The participants were chosen using purposive sampling. Data were analyzed using conventional content analysis. In order to increase the accuracy and integrity of the data, Lincoln and Guba's criteria were considered.

Results:

Fourteen sub-categories and five main categories emerged. Main categories consisted of sensitivity to care, sensitivity to errors, sensitivity to communication, sensitivity in decision making and sensitivity to ethical practice.

Conclusion:

Ethical sensitivity appears to be a valuable attribute for ethical nurse leaders, having an important effect on various aspects of professional practice and help the development of ethics in nursing practice.

Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran

INTRODUCTION

Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system.

METHODS

A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics' involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data.

RESULTS

In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well.

CONCLUSION

Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and legitimate the representative of people they served for. This model can provide a practical guide for managers and policy makers to involve people in making the decisions that influence their lives.

Psychometric evaluation of the Moral Distress Scale–Revised among Iranian Nurses

Background:

Experiencing moral distress is traumatic for nurses. Ignoring moral distress can lead to job dissatisfaction, improper handling in the care of patients, or even leaving the job. Thus, it is crucial to use valid and reliable instruments to measure moral distress.

Objective:

The purpose of this study was to determine the reliability and the validity of the Persian version of the Moral Distress Scale–Revised among a sample of Iranian nurses.

Research design:

In this methodological study, 310 nurses were recruited from all hospitals affiliated with the Qazvin University of Medical Sciences from February 2014 to April 2015. Data were collected using a demographic questionnaire and the Moral Distress Scale–Revised. The construct validity of the Moral Distress Scale–Revised was evaluated using principal component analysis and confirmatory factor analysis. Internal consistency reliability was assessed with Cronbach’s alpha.

Ethical considerations:

This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.

Findings:

The construct validity of the scale showed four factors with eigenvalues greater than one. The model had a good fit ( χ2(162) = 307.561, χ2/ df = 1.899, goodness-of-fit index = .904, comparative fit index = .927, incremental fit index = .929, and root mean square error of approximation (90% confidence interval) = .049 (.040–.057)) with all factor loadings greater than .5 and statistically significant. Cronbach’s alpha coefficients were .853, .686, .685, and .711for the four factors. Moreover, the model structure was invariant across different income groups.

Discussion and conclusion:

The Persian version of the Moral Distress Scale–Revised demonstrated suitable validity and reliability among nurses. The factor analysis also revealed that the Moral Distress Scale–Revised has a multidimensional structure. Regarding the proper psychometric characteristics, the validated scale can be used to further research about moral distress in this population.

The quality of obtaining surgical informed consent

Background:

Informed consent goes beyond signing a form; it is a process of providing necessary information, helping patients make an informed decision, and actively participate in their treatment.

Aim/objective:

This study aimed to assess the quality of obtaining surgical informed consent in hospitals affiliated with Tehran University of Medical Sciences.

Research design/participants/context:

In a cross-sectional, descriptive-analytical study, 300 patients were chosen through stratified sampling from seven hospitals affiliated with Tehran University of Medical Sciences. Data were collected using a questionnaire developed by the researchers and analyzed using descriptive and analytical statistics on SPSS software.

Ethical considerations:

Ethical approval of this study was granted by Tehran University of Medical Sciences research ethics committee. Written informed consent for participation was obtained. The participants were reassured that their information will be used anonymously and their answers will not affect their treatment and care.

Findings:

The mean score of quality of acquisition of informed consent was 17.13 out of 35, indicating that the quality falls in the inappropriate category. The results indicate that 48% of the signatories do not even read the form before signing it. Among the 52% who did read the consent form, 61.3% mentioned varying degrees of incomprehensibility of the consent form and 94.2% mentioned the presence of incomprehensible technical, medical and legal vocabulary. Only 12% and 18% of respondents reported that they were not in hurry and they had no fear or anxiety, respectively, when signing the form. The quality of obtaining informed consent was higher in women, younger patients, patients with higher education, and those who had special surgeries.

Discussion:

This study shows a poor practice in obtaining surgical informed consent in Iran. It seems necessary to consider fundamental changes in the process of acquiring consent based on the temporal and local conditions of the patients.

Nurses' adherence to ethical codes: The viewpoints of patients, nurses, and managers

BACKGROUND

Ethical codes are guidelines that orient nurses and ensure that their decisions are in accordance with the values of the professional system. These codes show that there is a connection among values, patients' rights, and nurses' duties.

OBJECTIVES

This study aimed to compare the viewpoints of patients, nurses, and nurse managers regarding the extent to which clinical ethical codes are observed.

RESEARCH DESIGN

In this descriptive-comparative study, data were collected using three questionnaires based on Iranian nurses' ethical codes with a focus on clinical care. The reliability of the questionnaire was verified by test-retest method (r = 0.9). The patients were interviewed by the researcher, but nurses and managers completed the questionnaires themselves. After all, the data were analyzed using the SPSS statistical software (v 15).

PARTICIPANTS AND RESEARCH CONTEXT

In all, 100 patients, 100 nurses, and 30 managers from internal and surgical wards of two major hospitals in Shiraz, Iran, participated in 2014.

ETHICAL CONSIDERATIONS

This research was approved by the Ethics Committee of Shiraz University of Medical Sciences. All the participants signed written informed consents.

FINDINGS

According to the results, 70% of the patients, 86% of the nurses, and 53.3% of the nurse managers rated nurses' adherence to ethical codes as satisfactory. The mean scores (standard deviation) of the level of adherence to ethical codes were 38.44 (6.91) in the patients, 41.08 (4.82) in the nurses, and 37.83 (6.98) in the nurse managers. The results of analysis of variance revealed a significant difference between the attitudes of the nurses and the other two groups (p = 0.001).

DISCUSSION

Nurses' adherence to ethical codes was satisfactory in all three groups. Accordingly, our findings agree with the results of some national and international studies, although there are still controversies in this regard.

CONCLUSION

Although the nurses rated their performance in certain fields more satisfactory compared to the patients and managers, all the three groups agreed that clinical ethical codes were properly observed in the internal and surgical wards. Nurses can improve the quality of care by considering the viewpoints of patients and managers about their ethical performance.

The effect of an education-based intervention on self-reported awareness and practice of Iranian nurses in observing patients' rights

Background:

For patients’ rights to be observed, first patients and health care providers should be aware of these rights. Nurses’ lack of awareness of these rights leads to their inability to recognize patients’ legal and ethical issues, and reduces the quality of provided services. This study was conducted to determine the effect of an education-based intervention on self-reported awareness and practice of nurses in observing patients’ rights.

Methods:

In this quasi-experimental study, awareness and practice of 90 nurses on Patient’s Bill of Rights were examined in case and control groups, before, 2 and 4 weeks after an educational intervention program on. Participants were selected from teaching hospitals of Mazandaran University of Medical Sciences, Iran. Data was gathered using the valid and reliable 21-item questionnaire in a 3-point Likert scale during a 5-month period from October 2013 to March 2014. For data analysis, descriptive statistical methods, paired t-test, and repeated measure analysis of variance at significant level P<0.05 were used.

Results:

Participants’ mean age and work experience were found 37.1±5.71 years and 11.76±5.99 years respectively. Mean scores of nurses’ awareness and practice before intervention were 15.12±2.19 and 9.13±2.36, accordingly. Repeated measure analysis of variance test showed a significant difference in awareness and practice of nurses before and after intervention (P<0.001).

Conclusion:

Enhancing nurses’ awareness on Patient’s Bill of Rights through revision of educational curriculum in nursing schools, together with considering appropriate relevant content in continuous education programs in health systems can lead to improved quality of nursing care services.

Critical care nurses' understanding of the concept of patient-centered care in Iran: a qualitative study

This study explores the perception of nurses working in critical care units about the patient-centered care, which is a crucial factor in attaining quality in nursing care. A qualitative exploratory study with conventional content analysis was used. Three main themes were extracted from the data: from accepting to understanding the patient; improved care as the result of skill and expertise; and adherence to patients' rights charter.

The profile of patients' complaints in a regional hospital

BACKGROUND

A hospital should be an institution of understanding and respecting patients' rights, their families, physicians and other caregivers. Hospitals and all other healthcare centers must be cautious toward respecting ethical aspects of care and treatment. On the other hand, patients' satisfaction reflects capabilities of physicians and medical staff as well as the extent patients' rights and treatment quality are observed. Nowadays, complaints handling is considered as an essential component of healthcare system in line with promoting health standards. In the present study, researchers attempt to identify the resources, individuals, complained issues, and measures which are considered to handle these issues in a regional hospital.

METHODS

We employed a descriptive, cross-sectional study to conduct this research. The research population included cases registered at the complaints unit of one of the hospitals in Isfahan in selected months of 2012 to 2013. The data were collected through observation of available documents. Excel software program was used for data analysis.

RESULTS

Findings indicate that despite a decrease in the total number of complaints, there was an increase in the number of complaints about medical staff. Nursing staff were considered as the second highly complained unit during the study period.

CONCLUSION

RESULTS obtained from the present study can be taken as experiences to modify and amend the hospital's future performance. In general, the existence of complaints in a system is an indication of gaps when providing healthcare services. Creating an organized system to collect complaints and reviewing them helps hospitals to be cognizant of their defects and plan to prevent their reoccurrence.

Association between awareness of patient rights and patient's education, seeing bill, and age: a cross-sectional study

Background:

Considering the controversial results of previous reports on awareness of bill of patients’ rights in different regions, as well as the fact that no report is available on the awareness of patients of their rights in teaching hospitals of Sari, we conducted the present study.

Materials and Methods:

This is a cross-sectional Study conducted in teaching hospitals of Sari in 2011. The study population consisted of 336 patients recruited from 4 hospitals affiliated with Mazandaran University of Medical Sciences in Sari, through calculating the selection quota of each hospital. Data were collected through face-to-face interview on discharge, using a two-section questionnaire based on the bill of patient rights and with verified reliability and validity. Data analysis was accomplished on SPSS soft- ware version 10.

Results:

55.4% of patients were women and 44.6% were men. The patients’ mean age was 40.93 ± 15.04 years and the mean length of stay was 4.6 ± 3.34 days. Most patients had elementary education (36%) or were illiterate (25%). The majority (63.4%) had not seen the bill of patients’ rights. 58.9% had poor knowledge, 12% had intermediate knowledge, and 29.1% had good knowledge. As for the articles of the bill, the poorest awareness correlated to the 9^th article (the right to participate or refrain from participating in research). We found a significant relationship between awareness of the bill, and the patient’s education, seeing the bill, and age (p<0.0005).

Conclusion:

The results of the present study indicate that patients are not sufficiently aware of their rights, and this problem requires comprehensive planning to be resolved.

Surgical informed consent in Iran—how much is it informed?

Introduction:

Informed consent constitutes one of the most important legal, professional, and ethical principles of a surgical operation. Consent obtained from a patient is only valid when the patient has received enough information regarding the proposed treatment option. This study aims to determine how much the patients are informed before undergoing surgery, as well as the factors influencing it in hospitals affiliated with Tehran University of Medical Sciences.

Method:

This is a cross-sectional, descriptive–analytic study of 300 patients undergoing surgery in 7 teaching hospitals affiliated with Tehran University of Medical Sciences. The patients were recruited through clustered sampling. Data were collected using a questionnaire completed by interview. Data were analyzed on SPSS software using descriptive and inferential statistics.

Result:

The mean score of data provision for patients was 27.09 out of 60, indicating the level of information provided as unacceptable. Among 12 questions dealing with data provision, patients had received an intermediate level of information about nature of the disease, type of surgery, benefits and importance of the surgery, and complications of rejecting the recommended therapy. On the contrary, they had not received enough information about the surgical procedure, type of anesthesia, potential complications of surgery, potential risks of surgery, other therapy options instead of surgery, length of hospital stay for surgery, postsurgical follow-up, and expenses of the surgery. In the majority (85%) of cases, the surgeon was reported to be the information provider. Among the variables studied, level of information received was directly related to the patient’s education level.

Discussion:

The findings of this study indicate that during the process of obtaining an informed consent for surgery, patients do not receive sufficient information, and it is necessary to provide the essential information in an understandable manner adjusted for the patient’s level of education.

Factors influencing job satisfaction among registered nurses: a questionnaire survey in Mashhad, Iran

BACKGROUND

Job satisfaction is a critical factor in health care. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care.

OBJECTIVE

To determine the level of nurses' job satisfaction and its associated factors.

METHOD

A stratified random sample of 421 registered nurses working at a large hospital in Mashhad, Iran was surveyed.

RESULT

The results showed that autonomy, task requirement and work interaction had scores higher than their respective median on the subscales. There were significant differences between demographic characteristics and the autonomy, task requirement, work interaction, salary, work condition, professional development, supportive nursing management, decision making, professional status subscales and mean total job satisfaction. In univariate analysis, young age, being female and being married were significantly associated with a higher level of job satisfaction. The adjusted R(2) for this model was 0.14, indicating that the model explained 14% of the variability. The regression model was highly significant, F (4298) = 13.194, P < 0.001.

CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT

The authors emphasise that the human resources policies and incentives need to be re-visited. Efforts undertaken to improve working conditions, supportive nursing management, improved professional status, professional development and increased salaries are some of the ways for nurse managers to improve job satisfaction.

Estimation of nursing staff in selected hospitals of ilam and ahvaz provinces, Western iran

Background:

The nurses as the largest group among different groups of hospital workforce play a crucial role in success of the hospital activities and promotion of community health.

Objectives:

This study aimed to obtain an estimation of the necessary nursing workforce status in educational hospitals affiliated to Ilam and Ahvaz University of Medical Sciences based on the scientific formula.

Materials and Methods:

This research was a cross sectional-descriptive study, which was done in hospitals affiliated to Ilam and Ahvaz University of Medical Sciences during 2010. Using three researcher-made forms, data was collected from all clinical, para-clinical, financial, administrative and support departments of hospitals. Data was analyzed in accordance to the standards of Iran's Ministry of Health and Medical Education using the Excel software.

Results:

The results showed that the nursing staffs in the 42 wards (89.5 %) were lower than the standards, only one ward (2 %) matched the standards and the rest of the wards (8.5%) were higher than the standards. The organizational dislocation (utilization of nurses in non-related jobs) of nursing staffs obtained for Imam Khomeini of Ilam, Mostafa Khomeini, Taleghani, Razi and Imam Khomeini of Ahvaz Hospitals were 8, 5, 3, 8 and 21, respectively.

Conclusion:

Generally, the studied hospitals were faced with a lack of nursing manpower and distribution of manpower was not appropriate. Proper planning and management of manpower in accordance with the lack of personnel, compensates and achieves the standards required for hospital’s nursing manpower and this would lead to an increase in the efficiency of hospitals activities and can provide satisfaction for the nursing staff.

Neonatal nurse practitioners in Iran: are we facing any challenges in the beginning?

With an increased demand in the clinical field, physicians and nursing leaders in Iran have been working on developing an advanced practice nursing role. A neonatal nurse practitioner (NNP) program was developed by Tehran Medical University with cooperation of Iran's Neonatologist Association. The first group of master's students started their formal education in September 2009 with the principal goal of becoming "clinical nurse practitioners" ready to work in the neonatal intensive care unit as "first responders." Neonatal nurse practitioners are an integral and important aspect of the interdisciplinary team. Although it is a newly practiced role in Iran, it has been well accepted by those in the clinical and academic field. Comparing Iran's admission criteria with other well-experienced countries through the world will better help the development of this new specialty.

Iranian intensive care unit nurses’ moral distress

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses’ moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care.

Iranian nursing staff's self-reported general and mental health related to working conditions and family situation

BACKGROUND

There is increasing global evidence that today's work environment results in higher risk of adverse health among nursing staff than among other professions.

AIM

To investigate self-reported general and mental health among Iranian nursing staff, and associations with organizational, physical and psychosocial working conditions and family situation.

METHODS

520 nursing personnel from 10 university hospitals in Tehran participated in this cross-sectional study. Data were collected using a validated questionnaire in the Persian language, containing the Copenhagen Psychosocial Questionnaire, physical items from the Nurse Early eXit Study and two scales relating to general health and mental health from the Short Form-36. The Chi-square test with P<0.05 and logistic regression were used to analyse data.

RESULTS

Three out of four nursing staff reported overtime work. The self-reported general and mental health rates of participants were poor/fair (38%, 41%), good (44%, 39%) and very good/excellent (18%, 20%), respectively. Family demands were associated with general health but were not associated with mental health. Adverse physical and psychosocial work conditions gave an elevated odds ratio for poor health.

CONCLUSION

Poor general and mental health was associated with adverse working conditions and family demands. Physical and psychosocial working conditions of nursing personnel should be improved. Social facilities such as daycare for children and care for the elderly should be available during work shifts to help Iranian nurses play their family roles.

Assessing knowledge of the patient bill of rights in central Saudi Arabia: a survey of primary health care providers and recipients

BACKGROUND AND OBJECTIVES

Little is known about the implementation of the patient bill of rights (PBR) in Saudi Arabia. Therefore, this study was conducted to explore to what extent health care recipients and providers know about the bill and its implementation.

DESIGN AND SETTING

A cross-sectional survey conducted on health care professionals and patients at Primary Health Care Centers in Riyadh, Saudi Arabia, during July 2010.

PATIENTS AND METHODS

The study employed a self-administered questionnaire to collect data from 500 patients (aged 18 years or older) and 500 health care providers (physicians and nurses) in primary health care (PHC) centers in Riyadh. Data was collected on the respondents' knowledge of the existence and contents of the bill, the extent to which the bill is implemented, and the obstacles that may hinder bill implementation. The data was analyzed and presented in a descriptive fashion.

RESULTS

More than three quarters of patients and one third of PHC providers did not know about the existence of the bill. Among those who knew about its existence, about three quarters of patients and almost half of PHC providers had little (or very little) knowledge about the bill contents. In general, patients scored lower means of perception than PHC staff about the implementation of the bill's aspects. PHC staff reported several obstacles that may hinder the implementation of the PBR in Saudi Arabia.

CONCLUSIONS

Patients and health care providers lack necessary knowledge about the PBR. More dissemination of information about the bill, taking into account the particularities of the Saudi population is needed. Future research is required to establish measures that are effective in ensuring that patients rights are ensured.

Duties of the patient

Patient’s duties are a topical but little researched area in nursing ethics. However, patient’s duties are closely connected to nursing practice in terms of autonomy, the best purpose of care and rethinking from the patient’s perspective. This article is a metasynthesis ( N = 11 original articles) of patient’s duties, aimed to create a tentative model. In this article, a tentative model called ‘right-based duties of a patient’ was constructed. With its aid, a coherent structure of patient’s duties within different roles and objects of a patient can be defined. In addition, the ethical basis, prerequisites, outcomes and risks of patient’s duties can be named. In conclusion, so-called right-based duties of a patient constitute the basic argument. Patient’s duties are not unambiguous for all patients, and the global perspective to duties has been challenged. However, due to both conceptual and practical reasons, rethinking of patient’s duties is needed.

Perceived ethical values by Iranian nurses

Nursing, a scientific and practical discipline, faces continuing challenges of finding new direction in order to decipher its core values and develop current ethical codes for nursing practice. In 2009–10, 28 nurses were purposely selected and interviewed using a semi-structured format in focus groups and individually. Thematic Content Analysis helped explore the perception of Iranian nurses on ethical values in patient care. Seven major themes emerged: respect for dignity, professional integrity, professional commitment, developing human relationships, justice, honesty, and promoting individuals and the nursing profession. Iranian nurses revealed a unique and culture-based set of ethical values. This study found that Iranian nurses place a greater emphasis on preserving the dignity of those accompanying the patient and in showing regard for patients' religious beliefs in a gender appropriate environment.

Patient rights in Iran: a review article

A significant development for conducting research on patient rights has been made in Iran over the past decade. This study is conducted in order to review and analyze the previous studies that have been made, so far, concerning patient rights in Iran. This is a comprehensive review study conducted by searching the Iranian databases, Scientific Information Database, Iranian Research Institute for Information Science and Technology, Iran Medex and Google using the Persian equivalent of keywords for 'awareness', 'attitude', and 'patient rights'. For pertinent Iranian papers published in English, scientific databases PubMed, and Google Scholar were searched using the keyword 'patient rights' and 'Iran'. A total of 41 Persian and five English articles were found for these keywords, only 26 of which fulfilled the objective of our study. The increasing number of papers published indicates that from 1999 onwards, this subject has begun to draw the attention of Iranian researchers in a progressive fashion and Iranian papers in English have also been compiled and published in international sources.

Nursing profession in Iran: an overview of opportunities and challenges

AIM

Iran's health-care system has witnessed profound changes in the last decades. Despite its progress, the system has currently faced many challenges in one of the important subsystems, nursing. The present review article aimed to present an overview of the opportunities and challenges of the Iranian nursing system, based on recent literature.

METHODS

A broad search of the English and Persian-language literature was carried out, incorporating both electronic and manual components from 1999 to 2009. The results of the investigations among the searched literature are summarized.

RESULTS

The major challenges are nursing shortages, job dissatisfaction, poor social position of nurses, the gap between theory and practice, lack of community-based nursing care, lack of an appropriate student recruiting system, and shortages in the nursing educational curriculums.

CONCLUSION

The authors believe that media, political and public support play a pivotal role in improving the image of nursing in society, increasing motivation among Iranian nurses, and promoting the sociocultural climate and the welfare of nurses, which will result in higher levels of quality of care as well as greater patient satisfaction.

Nurses' perceptions of ethical issues related to patients' rights law

August 2006 marked the 10th anniversary of landmark legislation when Israel's parliament passed the unique Patient's Rights Law. This law underscores the importance of medical ethics in Israeli society. During a seminar at the Shaare Zedek School of Nursing, third-year students performed a qualitative research study investigating ethical issues arising in the field of nursing, and how nursing staff dealt with these issues in relation to the law. The research was conducted using semistructured questionnaires. The results showed that the staff participants knew the law, but did not differentiate between legal and ethical problems. The establishment of a framework for dealing with these issues would help to promote professional ethics, encourage broad-based agreements related to ethical decisions, reduce ethical conflict, and increase implementation of the law on patients' rights.

Information disclosure to family caregivers: Applying Thiroux’s framework

In the UK, community care has led to more complex relationships for mental health nurses. They need to respect the rights of service users to confidentiality while also respecting the rights of family caregivers to information that directly affects them. An unsatisfactory situation has arisen in which utilitarian and legally driven motives have seen family caregivers’ interests become subsidiary to those of service users and providers. An ethical case is made for sharing information with family caregivers, even against the wishes of service users. Through the use of a conceptual framework based on elements proposed by Thiroux — value of life, goodness or rightness, justice or fairness, truth-telling or honesty, and individual freedom — the article concludes that there is an ethical argument for sharing some information with family caregivers and that nurses should respect caregivers’ rights through their actions. Nurses’ actions are a commitment to seeking what is ‘good’ by making judgements based on what matters. It is argued that people and their relationships matter more than strict adherence to laws and codes.

What makes a phenomenological study phenomenological? An analysis of peer-reviewed empirical nursing studies

This article contributes to the debate about phenomenology as a research approach in nursing by providing a systematic review of what nurse researchers hold as phenomenology in published empirical studies. Based on the assumption that presentations of phenomenological approaches in peer-reviewed journals have consequences for the quality of future research, the aim was to analyze articles presenting phenomenological studies and, in light of the findings, raise a discussion about addressing scientific criteria. The analysis revealed considerable variations, ranging from brief to detailed descriptions of the stated phenomenological approach, and from inconsistencies to methodological clarity and rigor. Variations, apparent inconsistencies, and omissions made it unclear what makes a phenomenological study phenomenological. There is a need for clarifying how the principles of the phenomenological philosophy are implemented in a particular study before publishing. This should include an articulation of methodological keywords of the investigated phenomenon, and how an open attitude was adopted.

Caring for people at the end of life: Iranian oncology nurses' experiences

AIM

To explore the meaning of Iranian oncology nurses' experiences of caring for people at the end of life.

MATERIALS AND METHODS

A phenomenological hermeneutic approach was applied. Fifteen nurses working in oncology units were interviewed in 2007 regarding their experiences of caring for people at the end of life.

RESULTS

Participants experienced caring for people at the end of life as sharing space and time to be lost within an organizational context. This main theme was divided into three subthemes including being attentive to the dying persons and their families, being cared for by the dying persons and their families, and being faced with barriers.

CONCLUSION

The study suggests that the nurses' success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.

The Meaning of Patient Advocacy for Iranian Nurses

Patient advocacy has been a topic of much discussion in the nursing literature for a number of decades. Ambiguities remain, however, concerning definitions of advocacy in nursing. This qualitative grounded theory-type study aimed to inquire into the meaning of patient advocacy from Iranian nurses' perspective. A purposive sample of 24 nurses (staff nurses, head nurses and supervisors) working in a large university hospital in Tehran was used. Data were collected using in-depth semistructured interviews and reflective diaries kept by the participants. The data were analyzed using elements of Strauss and Corbin's' approach. Advocacy was defined by the participants as: informing and educating; valuing and respecting; supporting; protecting; and promoting continuity of care for patients. The participants also believed that advocacy could take place only if there was respect for patients' individuality and their inherent human dignity. Many of the descriptions given by the participants are consistent with previous research in this area and represent a comprehensive account of their perceptions of patient advocacy.