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Antwi RS, Galanza JS. Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study. BELITUNG NURSING JOURNAL 2024; 10:134-142. [PMID: 38690302 PMCID: PMC11056842 DOI: 10.33546/bnj.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 05/02/2024] Open
Abstract
Background Nurses in adult care settings frequently encounter moral distress due to the daily ethical obligations they must fulfill. In contrast to other healthcare professionals, nurses often grapple with a heightened frequency of moral dilemmas, resulting in increased moral distress. Objective This study aimed to explore the levels and relationship between moral caring competency and moral distress among Ghanaian nurses in adult care settings. Methods This quantitative study utilized a descriptive-correlational design. A multistage sampling was used to select three public hospitals. Simple random sampling was used to recruit 231 nurses from the three public hospitals. Data were collected from June to July 2023 using validated questionnaires. The study utilized frequency and percentages, mean and standard deviation, and Spearman's Correlation. Results The nurses had a low level of moral caring competency (M = 2.18, SD = 0.340). The composite moral distress score was 227.31, indicating a high level of moral distress among the nurses. Furthermore, there was a moderate, negative significant relationship between moral caring competency and moral distress (rs = -.474, N = 231, p <0.001). Conclusions Nurses in public hospitals had limited personal cognitive, affective, and psychomotor abilities to address patient moral issues. The nurses also experience significant moral distress when delivering patient care. Furthermore, to decrease the level of moral distress, moral caring competency should be strengthened among nurses. Therefore, it is recommended that nurse administrators provide adequate organizational support and implement continuous moral training to improve nurses' moral caring competency and mitigate their moral distress. Healthcare policymakers are encouraged to develop or refine policies to navigate moral dilemmas and reduce moral distress among nurses. Future studies employing qualitative designs can explore the influence of culture on moral caring competency within the Ghanaian setting.
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Miley M, Mantzios M, Egan H, Connabeer K. Exploring the role of personality, perfectionism, and self-compassion on the relationship between clinical decision-making and nurses' wellbeing. Contemp Nurse 2024:1-15. [PMID: 38408166 DOI: 10.1080/10376178.2024.2319845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Clinical decision-making is a core competency of the nursing role, with nurses having to make decisions surrounding patient care and patient safety daily. With decision-making being linked to psychological outcomes, it is important to consider potential areas that may support or hinder nurses' wellbeing whilst navigating clinical decisions. AIM The present study sought to investigate the relationship between clinical decision-making and moral distress, and further explore the role of personality, perfectionism, philotimo (a virtue describing the desire to do right by oneself and others, aligning with one's sense of morality), and self-compassion. DESIGN An online cross-sectional survey was conducted using Qualtrics. Associations between clinical decision-making and moral distress, burnout, personality, perfectionism, philotimo, and self-compassion were examined using univariate and multivariate statistics. METHODS One hundred and forty-three nurses from the United Kingdom completed an online questionnaire. Eligibility criteria included individuals who had practised in the nursing profession for a minimum of six months. To ensure that all participants were practising across the United Kingdom, the eligibility criteria was made clear in the study advertisement, and the consent form. The consent form required participants to confirm that they reached these criteria to proceed with the study. RESULTS Results revealed that clinical decision-making was associated with moral distress experience, and that both openness to experience, and philotimo mediated this relationship, independently. In addition to this, self-compassion was significantly associated with clinical decision-making across senior banded nursing roles, but this was non-significant for junior banded nursing roles. CONCLUSION Findings highlight the role of individual differences when looking at the impact of clinical decision-making upon nurses' wellbeing and offers explanation for any variance in moral distress experience across nursing professionals. This research identifies fundamental differences between junior and senior nurses in relation to clinical decision-making and self-compassion that should be considered in future research.
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Affiliation(s)
- Molly Miley
- Department of Psychology, Birmingham City University, 4 Cardigan St., Birmingham B4 7BD, UK
| | - Michail Mantzios
- Department of Psychology, Birmingham City University, 4 Cardigan St., Birmingham B4 7BD, UK
| | - Helen Egan
- Department of Psychology, Birmingham City University, 4 Cardigan St., Birmingham B4 7BD, UK
| | - Kathrina Connabeer
- Department of Psychology, Birmingham City University, 4 Cardigan St., Birmingham B4 7BD, UK
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Jain N, DeGuzman P, Figueroa N. The Impact of Nurse-Physician Relationships on Emergency Nurses' Moral Distress. J Emerg Nurs 2023:S0099-1767(23)00283-0. [PMID: 38043047 DOI: 10.1016/j.jen.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION Moral distress affects registered nurses' job dissatisfaction, and may ultimately be associated with higher rates of turnover. Nurse-physician relationships have been shown to affect moral distress in the intensive care unit setting, but no research has evaluated this impact on emergency nurses. The purpose of this study was to investigate the impact of nurse-physician relationships on the moral distress of emergency nurses. METHODS A quantitative correlational design was used to evaluate the study's aim. Point-of-care nurses currently working in an emergency department were asked to complete the Measure of Moral Distress Scale for Healthcare Professionals and the collegial nurse-physician relations domain of the Practice Environment Scale of the Nursing Work Index. Univariate and multivariate analyses were conducted to determine the impact of nurse-physician relationships on moral distress, controlling for demographic characteristics. RESULTS Thirty-two participants completed the survey. Multivariate regression showed that nurse-physician relationships are associated with moral distress in emergency nurses. Years of experience and gender did not affect moral distress in univariate or multivariate analyses. DISCUSSION Given current staffing shortages and the need to retain expert nurses in high-acuity settings, strategies to improve nurse-physician collaboration opportunities should be explored in ED settings.
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Lotfi-Bejestani S, Atashzadeh-Shoorideh F, Ghafouri R, Nasiri M, Ohnishi K, Ghadirian F. Is there any relationship between nurses' perceived organizational justice, moral sensitivity, moral courage, moral distress and burnout? BMC Nurs 2023; 22:368. [PMID: 37803416 PMCID: PMC10559416 DOI: 10.1186/s12912-023-01536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
AIM The present study is an attempt to investigate the relationship between Corley's model variables in mental health nurses. BACKGROUND Based on Corley's model, burnout and moral distress in nurses are, in retrospect, the consequences of the interplay of organizational and individual factors such as perceived organizational justice, moral sensitivity, and moral courage. The relationship between two variables or three variables of Corley's moral distress model has been investigated, but the test of Corley's moral distress model with more variables has not been done. Therefore, this research was proposed with the aim of investigating the relationship between the variables of moral courage and moral sensitivity (as characteristics of nurses), perceived organizational justice (as an antecedent), moral distress, and job burnout (as consequences of moral distress). METHODS The study was conducted as a descriptive correlational study involving 500 nurses working in the mental health wards of hospitals. Data collection was conducted using perceived organizational justice scale, moral sensitivity scale, moral courage scale, moral distress scale, and burnout inventory. RESULTS The results showed a significant relationship between perceived organizational justice, moral sensitivity, moral courage, and moral distress (< 0.05). Moreover, perceived organizational justice and moral distress had an inverse relationship. Moral sensitivity and moral courage had a direct relationship with moral distress (< 0.05). Furthermore, the results showed inadequate model fitness. CONCLUSIONS This study adds to the existing knowledge about the experiences of mental health nurses and their interactions with both organizational and individual factors. It highlights that the connections between perceived organizational justice, moral sensitivity, moral courage, moral distress, and burnout are intricate and multifaceted. As we deepen our understanding of these relationships, it opens the door for the development of interventions and strategies to enhance nurses' well-being and the quality of care they deliver in mental health settings. Moreover, future research and ongoing refinement and expansion of Corley's model will be crucial in addressing the complex challenges within the healthcare sector.
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Affiliation(s)
- Sara Lotfi-Bejestani
- Master of Science in psychiatric nursing student, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing & Management, School of Nursing and midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Raziyeh Ghafouri
- Medical-Surgical Nursing Department, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kayoko Ohnishi
- Graduate School of Nursing, Nagoya City University, Nagoya, Japan
| | - Fataneh Ghadirian
- Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rezaei Z, Nematollahi M, Asadi N. The relationship between moral distress, ethical climate, and attitudes towards care of a dying neonate among NICU nurses. BMC Nurs 2023; 22:303. [PMID: 37670308 PMCID: PMC10478422 DOI: 10.1186/s12912-023-01459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Nurses working in neonatal intensive care units play a crucial role in providing care to critically ill or premature neonates. However, is not without its challenges, particularly when it comes to making difficult ethical decisions about end-of-life care. In some cases, neonates do not survive despite the best efforts of medical professionals. The present study aimed to investigate the relationship between moral distress, ethical climate, and attitudes towards end-of-life care among nurses working in neonatal intensive care units. METHODS This is a descriptive-analytical cross-sectional study (May 21, 2021).The research population included 126 nurses working in neonatal intensive care units in Kerman province (Kerman, Jiroft, Bam, and Rafsanjan). Data collection tools included four questionnaires: demographic information, the Frommelt Attitudes towards Care of the Dying (FATCOD), the Hospital Ethical Climate Survey, and the Moral Distress Scale. SPSS22 was used to analyze the data. RESULTS The results revealed that the mean frequency and intensity of moral distress were 44.42 ± 17.67 and 49.45 ± 17.11, respectively. The mean ethical climate was 92.21 ± 17.52 and the FATCOD was 89.75 ± 9.08, indicating NICU nurses' positive perceptions of ethical climate and their favorable attitudes towards EOL care, respectively. The results showed a direct and significant relationship between ethical climate and the FATCOD (P = 0.003, r = 0.26). DISCUSSION We suggest policymakers and managers design strategies for better ethical climate in hospitals and reduction of moral distress among nurses.
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Affiliation(s)
- Zeinab Rezaei
- Department of Pediatric and Neonatal Intensive Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Neda Asadi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
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6
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Shomalinasab E, Bagheri Z, Jahangirimehr A, Bahramnezhad F. The Nurses' Second Victim Syndrome and Moral Distress. Nurs Ethics 2023; 30:822-831. [PMID: 36988002 DOI: 10.1177/09697330221142079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND The increasing prevalence of moral distress in the stressful environment of the intensive care unit (ICU) provides grounds for nursing error and endangers patients' health, safety, and even life. One of the most important reasons for this distress is the treatment team's second victim syndrome (SVS), especially nurses, following errors in the treatment system. OBJECTIVES The present study aimed to determine the relationship between moral distress and SVS in ICUs. RESEARCH DESIGN This cross-sectional study involved a sample size of 96 ICU nurses working in hospitals affiliated with Tehran University of Medical Sciences, Iran, in the 2021-2022 period, who were selected via a simple random sampling method. Data were collected using the Demographic Questionnaire, the second victim experience and support tool (SVEST) and Moral Distress Scale-Revised (MDS-R). Descriptive statistics (percentage, frequency, mean, and SD) and analytical tests (Spearman correlation coefficient test, independent t-test, and ANOVA) were employed for data analysis. PARTICIPANTS AND RESEARCH CONTEXT This study used a sample size of 96 intensive care unit nurses working in hospitals affiliated to Tehran University of Medical Sciences selected by simple random sampling. ETHICAL CONSIDERATIONS The study obtained research ethics approval, and all participants were informed of the voluntary and anonymous nature of their participation. FINDINGS The results showed that 59.4% of nurses suffered a low level of moral distress, and 40.6% suffered from a moderate level of moral distress. The SVS score of 86.5% of the nurses was moderate. There was no significant and direct correlation between moral distress and SVS in nurses; however, there was a significant and inverse correlation between the moral distress intensity and SVS (p = 0.011). CONCLUSION Despite no significant correlation between moral distress and SVS, these variables were at moderate levels. Accordingly, it is suggested to provide a proper ground for expressing morally stressful situations, counseling and training strategies to deal with moral distress, creating support resources for those suffering from SVS, and implementing empowerment programs.
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Affiliation(s)
- Esmat Shomalinasab
- Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Fatemeh Bahramnezhad
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Watts T, Sydor A, Whybrow D, Temeng E, Hewitt R, Pattinson R, Bundy C, Kyle RG, Jones B. Registered Nurses' and nursing students' perspectives on moral distress and its effects: A mixed-methods systematic review and thematic synthesis. Nurs Open 2023; 10:6014-6032. [PMID: 37458290 PMCID: PMC10416007 DOI: 10.1002/nop2.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 08/12/2023] Open
Abstract
AIM To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well-being and professional and career intentions. DESIGN Joanna Briggs Institute mixed-methods systematic review and thematic synthesis. Registered in Prospero (Redacted). METHODS Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction. RESULTS Searches yielded 2343 hits. Seventy-seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well-being. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution to this systematic review.
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Affiliation(s)
- Tessa Watts
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Anna Sydor
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Dean Whybrow
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Eunice Temeng
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | - Rachael Hewitt
- School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | | | - Richard G. Kyle
- Public Health WalesCardiffUK
- Academy of NursingUniversity of ExeterExeterUK
| | - Bethan Jones
- School of Healthcare SciencesCardiff UniversityCardiffUK
- School of Health and Social WellbeingUniversity of West of EnglandBristolUK
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Scott M, Wade R, Tucker G, Unsworth J. Identifying Sources of Moral Distress Amongst Critical Care Staff During the Covid-19 Pandemic Using a Naturalistic Inquiry. SAGE Open Nurs 2023; 9:23779608231167814. [PMID: 37050934 PMCID: PMC10084528 DOI: 10.1177/23779608231167814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/21/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Moral distress can have a significant impact on the mental health and well-being of practitioners. Causes of moral distress in critical care have been identified as futile treatment, conflict between family members and staff, lack of resources, and dysfunctional teams. Objectives This study explores the sources of moral distress during the COVID-19 pandemic and the meaning that staff attached to these events. The study aims to examine whether the sources of moral distress are similar, or different, to those that commonly occur in critical care departments. Methods Naturalistic inquiry using semi-structured individual interviews with 17 participants drawn from nursing ( n = 12), medicine ( n = 3), and the allied health professions ( n = 2). The interviews were recorded and transcribed verbatim. The transcripts were analyzed using reflexive thematic analysis. Results The results suggested that while there were some similar sources of moral distress including caring for dying patients and not being able to provide the usual standard of care, the nature of the disease trajectory and frequency of death had a significant impact. In addition, the researchers found that providing care which was counter-intuitive, concerns about the risks to the staff and their families and the additional burdens associated with leading teams in times of uncertainty were identified as sources of moral distress. Conclusion This study explored the potential sources of moral distress during the pandemic and the meaning that practitioners attached to their experiences. There were some similarities with the sources of moral distress in critical care which occur outside of a pandemic. However, the frequency and intensity of the experiences are likely to be different during a pandemic, with staff describing high volumes of deaths without family members present. In addition, new sources of moral distress related to uncertainty, counter-intuitive care and concerns about personal and family risk of infection were identified.
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Affiliation(s)
- Margaret Scott
- Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Rachel Wade
- Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
| | - Guy Tucker
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
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Shehadeh J, Almaraira O, Hamdan-Mansour A. Determinants of Moral Distress Among Mental Health Professionals. Open Nurs J 2022. [DOI: 10.2174/18744346-v15-e2203030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.
Objectives:
To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.
Methods:
A cross-sectional descriptive design was used, employing self-administered questionnaire.
Results:
Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R2 = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R2 = .243.
Conclusion:
Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.
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Shehadeh J, Almaraira O, Hamdan-Mansour A. Determinants of Moral Distress Among Mental Health Professionals. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2203030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.
Objectives:
To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.
Methods:
A cross-sectional descriptive design was used, employing self-administered questionnaire.
Results:
Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R2 = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R2 = .243.
Conclusion:
Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.
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Işik MT, Özdemir RC, Serinkaya D. Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors. Indian J Crit Care Med 2022; 26:288-293. [PMID: 35519912 PMCID: PMC9015944 DOI: 10.5005/jp-journals-10071-24143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Technological advances in critical care contribute to patient survival, but healthcare professionals working in these units, which require technical expertise, experience highly challenging ethical decision-making processes. Aim The aim of this study is to determine the attitudes of intensive care nurses toward ethical problems they face during clinical practice and the affecting factors. Method The study included a total of 294 nurses working in the intensive care units at a city hospital. Data was collected using the Personal Information Form and Ethical Attitude Scale for Nursing Care. Findings About 58.8% of the participants were females and 71.1% had undergraduate degrees. The total scale score was 56.48 ± 15.98. A statistically significant difference was found between participants’ gender, weekly working hours, ethical definition status, and scale score averages. Conclusion More than half experienced frequent ethical problems and tried to solve them on their own. Trainings aimed at developing ethical sensitivity and participation in symposiums/conferences that address ethical issues specific to intensive care are recommended. How to cite this article Işik MT, Özdemir RC, Serinkaya D. Ethical Attitudes of Intensive Care Nurses during Clinical Practice and Affecting Factors. Indian J Crit Care Med 2022;26(3):288-293.
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Affiliation(s)
| | - Rana Can Özdemir
- Department of Medical History and Ethics, Akdeniz Üniversitesi, Antalya, Turkey
- Rana Can Özdemir, Department of Medical History and Ethics, Akdeniz Üniversitesi, Antalya, Turkey, e-mail:
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Tajalli S, Rostamli S, Dezvaree N, Shariat M, Kadivar M. Moral distress among Iranian neonatal intensive care units' health care providers: a multi-center cross sectional study. J Med Ethics Hist Med 2022; 14:12. [PMID: 35035800 PMCID: PMC8696547 DOI: 10.18502/jmehm.v14i12.7667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Due to the unique nature of the neonatal intensive care unit (NICU) and its moral distress, this study aimed to investigate moral distress in the NICU. This cross-sectional study was conducted on 234 physicians and nurses working in the neonatal wards of eight hospitals. The Corley’s Moral Distress Scale was used to collect data. Findings showed that 25 of the participants were physicians and 209 were nurses. The intensity and frequency of distress among physicians and nurses were assessed as moderate. The mean intensity and frequency of moral distress among nurses and physicians were 48.3%, 41.5% and 46.46%, 15.62% respectively. The results showed that the mean intensity and frequency of distress were higher, however not significantly, among nurses. The intensity and frequency of moral distress had a statistically significant and direct correlation with the intention to leave and the number of staff in each working shift among the nurses. Moral distress in the NICU practitioners was moderate, so addressing this issue and trying to alleviate it was important. Identifying the causes behind moral distress can help adopt appropriate measures to prevent and reduce them.
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Affiliation(s)
- Saleheh Tajalli
- Researcher, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Rostamli
- Researcher, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazi Dezvaree
- Researcher, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Professor, Maternal and Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Kadivar
- Professor, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Rashidi K, Ashktorab T, Birjandi M. Impact of poetry-based ethics education on the moral sensitivity of nurses: A semi-experimental study. Nurs Ethics 2021; 29:448-461. [PMID: 34872390 DOI: 10.1177/09697330211041741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nurses' moral sensitivity is the first step to make right decisions in difficult moral situations. Therefore, its education and promotion is highly important. RESEARCH OBJECTIVES The aim of this study was to examine the impact of poetry-based ethics education on the nurses' moral sensitivity. RESEARCH DESIGN AND METHODS This was a semi-experimental study. The sample consisted of 108 nurses who were selected by convenience sampling method and randomly assigned to three groups: intervention with poetry (G1), who read a booklet about values and principles of professional ethics as well as poems related to these subjects for 1 month; intervention without poetry (G2), who only read the booklet without any poetry; and control group (G3), who did not receive any intervention. Data were collected by Moral Sensitivity Questionnaire that was completed by the participants prior to the intervention (T1), 1-month post-intervention (T2), and 2-month post-intervention (T3). Data were analyzed by SPSS 16 software. ETHICAL CONSIDERATIONS This study was conducted in accord with the principles of research ethics and regulations relating to informed consent. FINDINGS Changes in the mean score of total moral sensitivity were significantly higher in G1 than in G2, which was in turn significantly higher than in G3. This increase was significant from T1 to T2 and T2 to T3 (P < 0.001). In all subscales, there was a significant difference between the mean changes in the three groups, so that in these subscales, the mean changes in G1 were significantly higher than those in other groups. DISCUSSION In line with previous studies, our results showed the effectiveness of poetry-based education on the transfer of educational concepts and increase moral sensitivity scores with greater lasting effect. CONCLUSION The use of interdisciplinary subjects such as poetry, due to its entertaining, fun, and lasting effect on minds; level of awareness; and actions of nurses, can help raise nursing moral sensitivity.
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Affiliation(s)
- Kobra Rashidi
- Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Mehdi Birjandi
- Nutrition Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
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14
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Nemati R, Moradi A, Marzban M, Farhadi A. The association between moral distress and mental health among nurses working at selected hospitals in Iran during the COVID-19 pandemic. Work 2021; 70:1039-1046. [PMID: 34842218 DOI: 10.3233/wor-210558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In the event of an epidemic outbreak, the mental health of medical staff, including nurses who serve on the frontlines of hospitals, can be affected; thus, the identification of factors affecting nurses' mental health is of importance. OBJECTIVE This study aimed to examine the association between moral distress and the mental health of nurses working at four selected hospitals in Iran during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A cross-sectional questionnaire survey was conducted on 296 nurses working at the selected hospitals in Bushehr and Shiraz (south of Iran) at the time of the COVID-19 outbreak. The collected data were analyzed via logistic regression analysis. RESULTS The mean scores for nurses' moral distress were low (54.31±24.84). The results of this study indicated more symptoms of mental issues among nurses (73.60%). Moreover, a significant association was observed between mental health and moral distress. Among the examined demographic variables, only gender had a significant association with mental health (p-value = 0.014). CONCLUSION The results of this study indicated that an increase in moral distress would lead to a significant increase in mental health issues of the examined nurses. Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of mental health, as well as providing adequate emotional and family support for nurses. Considering the intensifying role of gender in this association, timely interventions are necessary to reduce the negative effects of workplace pressure/stress on female nurses.
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Affiliation(s)
- Reza Nemati
- Department of Medical Emergencies, School of Allied Medical Sciences, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ainaz Moradi
- Bone and Joint Diseases Research Center, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Marzban
- Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
| | - Akram Farhadi
- Department of Health Education and Promotion, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran
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Experience of General Practice Residents Caring for Dependent Elderly during the First COVID-19 Lockdown-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312281. [PMID: 34886006 PMCID: PMC8657085 DOI: 10.3390/ijerph182312281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022]
Abstract
Background: Understanding the experiences of general practice (GP) residents caring for dependent elderly people during the first lockdown as part of the countries COVID-19 pandemic strategy. The aim was to explore themes that could explain the gap between the missions and values at the heart of GP practice during this period of strict isolation. Method: Qualitative study using an iterative approach. Semi-structured interviews were conducted with 13 GP residents using a pre-established interview guide. Audio recordings were transcribed verbatim. Data were analyzed according to a coding grid, developed using Nvivo software (NVivo Qualitative Data Analysis Software; QSR International Pty Ltd. Version Release 1.5.1 (940) 2021), to identify emerging themes. Results: Three themes emerged from this qualitative research: cognitive dissonance, psychosocial risks, and fear. General practice residents have lived in the paradox between care and deprivation of liberty of dependent elderly people. Conclusion: The results suggest that the GP residents experienced a form of work-related suffering in this situation of deprivation of liberty of dependent elderly people. The present research serves as a pilot study to explore how GP residents experienced their care of locked-up dependent elderly people.
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Ghafouri R, Lotfi-Bajestani S, Nasiri M, Ohnishi K, Atashzadeh-Shoorideh F. Psychometrics of the moral distress scale in Iranian mental health nurses. BMC Nurs 2021; 20:166. [PMID: 34507581 PMCID: PMC8431900 DOI: 10.1186/s12912-021-00674-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the challenges that nurses often face in ethical decision-making situations is moral distress. Moral distress is caused by the conflict between professional and individual values in decision-making situations. Despite its importance, there is no reliable scale in Persian to measure it. Therefore, this study was conducted to validate the moral distress scale in mental health nurses in Iranian culture and Persian language. METHODS This study was conducted in two parts: Translation and cross-cultural adaptation and psychometric analysis. The translation and cross-cultural adaptation process was conducted based on the Polit approach. Next, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined. This part of the study was a cross-sectional study. In this step, a demographic questionnaire and the Moral Distress Scale were sent to 500 nurses working in selected educational and medical centers in Iran via online questionnaires. Then, the construct validity of the "Moral Distress Scale" was confirmed by confirmatory factor analysis and the reliability of the instrument was examined by studying the internal consistency with Cronbach's alpha and the internal correlation of the AIC. RESULTS The confirmatory factor analysis showed an acceptable ratio of the expressions in 15 items in three factors: Acquiescence to patients' rights violations (6 items), Unethical conduct by caregivers (5 items), and low staffing (4 items) in the scale. The internal consistency of the instrument with Cronbach's alpha was higher than 7.0. CONCLUSION The Persian version of moral distress with 15 items of the three factors had validity and reliability. According to the present findings, this scale can be used to study moral distress among nurses working in psychiatric wards. Moral distress leads to burnout, increases risks to patient safety and reduces quality of care. Nurses need to be able to assess and manage moral distress. Therefore, considering the side effects, it is necessary to have a reliable and valid scale that can be studied. Considering that culture has an impact on nurses' moral distress, it is suggested that this instrument be studied in and tested in other languages and cultures.
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Affiliation(s)
- Raziyeh Ghafouri
- Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Lotfi-Bajestani
- Nursing Research Committee, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kayoko Ohnishi
- Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Hyogo, Japan
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bernuzzi C, Setti I, Maffoni M, Sommovigo V. From moral distress to burnout through work-family conflict: the protective role of resilience and positive refocusing. ETHICS & BEHAVIOR 2021. [DOI: 10.1080/10508422.2021.1955682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chiara Bernuzzi
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia
| | - Ilaria Setti
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia
| | - Marina Maffoni
- Psychology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCCS
| | - Valentina Sommovigo
- Department of Brain and Behavioural Sciences, Unit of Applied Psychology, University of Pavia
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Alemu AY, Endalamaw A, Belay DM, Mekonen DK, Birhan BM, Bayih WA. Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One 2020; 15:e0241073. [PMID: 33095807 PMCID: PMC7584210 DOI: 10.1371/journal.pone.0241073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background Healthcare-associated infection is a global threat in healthcare which increases the emergence of multiple drug-resistant microbial infections. Hence, continuous surveillance data is required before or after patient discharge from health institutions though such data is scarce in developing countries. Similarly, ongoing infection surveillance data are not available in Ethiopia. However, various primary studies conducted in the country showed different magnitude and determinants of healthcare-associated infection from 1983 to 2017. Therefore, this systematic review and meta-analysis aimed to estimate the national pooled prevalence and determinants of healthcare-associated infection in Ethiopia. Methods We searched PubMed, Science Direct, Google Scholar, and grey literature deposited at Addis Ababa University online repository. The quality of studies was checked using Joanna Brigg’s Institute quality assessment scale. Then, the funnel plot and Egger’s regression test were used to assess publication bias. The pooled prevalence of healthcare-associated infection was estimated using a weighted-inverse random-effects model meta-analysis. Finally, the subgroup analysis was done to resolve the cause of statistical heterogeneity. Results A total of 19 studies that satisfy the quality assessment criteria were considered in the final meta-analysis. The pooled prevalence of healthcare-associated infection in Ethiopia as estimated from 18 studies was 16.96% (95% CI: 14.10%-19.82%). In the subgroup analysis, the highest prevalence of healthcare-associated infection was in the intensive care unit 25.8% (95% CI: 3.55%-40.06%) followed by pediatrics ward 24.16% (95% CI: 12.76%-35.57%), surgical ward 23.78% (95% CI: 18.87%-29.69%) and obstetrics ward 22.25% (95% CI: 19.71%-24.80%). The pooled effect of two or more studies in this meta-analysis also showed that patients who had surgical procedures (AOR = 3.37; 95% CI: 1.85–4.89) and underlying non-communicable disease (AOR = 2.81; 95% CI: 1.39–4.22) were at increased risk of healthcare-associated infection. Conclusions The nationwide prevalence of healthcare-associated infection has remained a problem of public health importance in Ethiopia. The highest prevalence was observed in intensive care units followed by the pediatric ward, surgical ward and obstetrics ward. Thus, policymakers and program officers should give due emphasis on healthcare-associated infection preventive strategies at all levels. Essentially, the existing infection prevention and control practices in Ethiopia should be strengthened with special emphasis for patients admitted to intensive care units. Moreover, patients who had surgical procedures and underlying non-communicable diseases should be given more due attention.
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Affiliation(s)
- Abebaw Yeshambel Alemu
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- * E-mail:
| | - Aklilu Endalamaw
- Department of Paediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Demeke Mesfin Belay
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale Mekonen
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biniam Minuye Birhan
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Paediatrics and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Alemu AY, Endalamaw A, Bayih WA. The burden of healthcare-associated infection in Ethiopia: a systematic review and meta-analysis. Trop Med Health 2020; 48:77. [PMID: 32939151 PMCID: PMC7487565 DOI: 10.1186/s41182-020-00263-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/24/2020] [Indexed: 01/18/2023] Open
Abstract
Background Different primary studies in Ethiopia showed the burden of nosocomial infection across geographical setting and variant period. However, the national level of burden and types of healthcare-associated infections were unknown. Hence, this systematic review and meta-analysis estimated the overall nationwide burden and types of healthcare-associated infections in Ethiopia. Methods We searched PubMed, Science Direct, Google Scholar, African Journal Online, and Addis Ababa University repository by date April 7, 2020. To assess publication bias, Egger’s test regression analysis was applied. Weight-inverse random-effect model meta-analysis was used. Subgroup analysis was conducted based on ward type, study region, study design, sample size and diagnostic method, ward type, and study participants. Results A total of 18 studies with 13,821 patients participated in the overall prevalence estimation. The pooled prevalence of healthcare-associated infection was 16.96% (95% CI 14.10–19.82). Specifically, surgical site infection (39.66%), urinary tract infection (27.69%), bloodstream infection (19.9%), dual infections (SSI and UTI) (14.01%), and respiratory tract (13.51%) were the commonest types of healthcare-associated infection. In subgroup analysis, the highest overall prevalence was observed as surgical, gynecology, and obstetrics ward (22.42%). Conclusions The national prevalence of healthcare-associated infection remains high. The most common type of HCAI was surgical site infection, followed by urinary tract infection, bloodstream infection, SSI and UTI, and respiratory tract infection. The overall prevalence was highest in surgical, gynecology, and obstetrics ward. Hence, infection prevention and control should be a priority agenda in healthcare with due emphasis for surgical patients.
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Affiliation(s)
- Abebaw Yeshambel Alemu
- Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Aklilu Endalamaw
- Department of Paediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Paediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Sedaghati A, Assarroudi A, Akrami R, Rad M. Moral Distress and its Influential Factors in the Nurses of the Nursing Homes in Khorasan Provinces in 2019: A Descriptive-Correlational Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:319-324. [PMID: 33014744 PMCID: PMC7494168 DOI: 10.4103/ijnmr.ijnmr_158_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/09/2019] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
Background: Nurses in nursing homes are constantly faced with various moral decisions in terms of elderly care, which in turn causes moral distress. This study aimed to evaluate the moral distress status and its influential factors in the nursing homes in Khorasan provinces, Iran. Materials and Methods: This descriptive-correlational study was conducted on 227 nurses engaged in the nursing homes of Khorasan provinces in 2019. The subjects were selected via census sampling. Data were collected using demographic, occupational, and care center characteristics questionnaire and a moral distress questionnaire. Data analysis was performed in SPSS version 16 using the Mann–Whitney U and Kruskal–Wallis test. Results: The mean (SD) score of moral distress was 28.68 (19.19), and 93.83% of the subjects reported low levels of moral distress. Significant correlations were observed between moral distress and age, work experience, workplace, nurse–physician relations, motivation of the nurses, care facilities, and medical equipment. Furthermore, the highest mean (SD) score of moral distress belonged to the items regarding the lack of work experience 12.19 (3.12). Conclusions: According to the results, moral distress in the nurses of the studied nursing home was relatively low. Despite the favorable outcome of the study, the age discrimination of nurses by nursing homes should not be overlooked.
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Affiliation(s)
- Ali Sedaghati
- Student Research Committee, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Abdolghader Assarroudi
- Iranian Research Center on Healthy Aging, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Rahim Akrami
- Department of Biostatistics and Epidemiology, School of Health, Medicine and Quran Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mostafa Rad
- Assistant Professor in Nursing, Iranian Research Center on Healthy Aging, Department of Nursing, Nursing and Midwifery School, Sabzevar University of Medical Sciences, Sabzevar, Iran
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