Organizational Challenges: A Major Obstacle at End of Life Care in Iran.

Aims: End-of-life care is a significant part of nursing practice. The role of organizations at the end of life care cannot be ignored. Organization can act as a facilitator to improve the quality of care and provide a peaceful death at the end of life. The aim of this study was to illuminate oncology nurses’ organizational challenges of caring for dying patients in Iran. Study Design: Qualitative method with conventional content analysis approach, Data collected by interviewing nurses which worked in oncology units in hospitals supervised by Zahedan Medical University in Iran and were conducted during the late summer 2014 to spring 2015. Methodology: Was used to analyze the experiences of 18 oncology nurses in relation to caring for dying patients. The mean age of participants was 32 years old, and had a minimum of 9 months and up to 12 years (mean = 6 years) of working experience in the oncology sector. 75% of nurses were married; all of them had a bachelor's degree in nursing. Findings: Three themes emerged from the text including: 1) environment structural challenges, 2) cultural and structural challenges of the organization, and 3) educational challenges of end of life care. Conclusion: Considering the vital role of hospitals in providing holistic care for end of life patients, new technologies and methods of care can have a great impact on education, treatment and nursing practice, therefore, necessary organizational and cultural changes need to take place to improve nursing care which is fit to new condition.

Psychometric Properties of the Persian Version of the Morisky Medication Adherence Scale-8.

Background: Hypertension is a global public health crisis. Poorly controlled high blood pressure is one of the most important factors contributed to this crisis. Lack of medication adherence is often considered as the main reason for insufficient control of high blood pressure. Difficulty in measuring medication adherence is another problem in this field. To reduce this difficulty several medication adherence scales were developed. This study was performed to test reliability and validity of Morisky Medication Adherence Scale-8. Materials and Methods: A cross-sectional study was conducted to validate the Persian version of MMAS-8. The Persian version of MMAS-8 was generated by using a modified forward/backward translation procedure. Two hundred and fifty hypertensive patients were participated in the study. Construct and known-groups validity, Cronbach’s alpha and test-retest reliability were used to assess psychometric properties of Persian scale. Results: Data analysis showed that the scale did not have an acceptable internal consistency (Cronbach’s Alpha= 0.40) but had excellent stability (p= 0.89). The confirmatory factor analysis poorly fitted with one-dimensional model. Participants with controlled blood pressure had significantly higher MMAS-8 scores than uncontrolled blood pressure group. Conclusion: Totally some of the psychometric properties of the Persian version of the MMAS-8 did not meet the requirements of the standard level so it is not recommended to use in general. More studies are needed to establish a more appropriate scale in order to be used in the mentioned population.

Factors Hindering Organizational Learning: Perspectives of Iranian Nurses.

Background: Nurses can play a fundamental role in organizational learning being the largest group providing healthcare services; however, factors affecting their organizational learning are yet to be identified. Aims: To explore factors hindering organizational learning from the perspective of Iranian nurses. Study Design: Qualitative content analysis on in depth semi-structured interview texts. Place and Duration of Study: Kerman University of medical sciences hospitals, between February and December 2014. Methodology: We recruited 16 nurses (5 men, 11 women; with a mean age of 36.4 years) working in clinical wards of hospitals affiliated to Kerman University of Medical Sciences. All interviews were transcribed verbatim immediately after they were conducted. Data were analyzed subsequently. Results: The data analysis from 16 nurses included in the study, revealed 5 main themes, including undirected training, role ambiguity, unfavorable work conditions, inadequate professional capabilities and feelings of subordination. Conclusion: Identifying factors hindering organizational learning from the perspective of nurses allows healthcare managers and policymakers to promote the quality of their nursing services and achieve patient and personnel satisfaction while facilitating organizational learning through designing need-based training courses for nurses, redefining nurses’ job description, revising nursing students' selection processes and trusting in nurses' capabilities.

Nurse leaders’ Attitudes, Self-Efficacy and training Needs for Implementing Evidence-Based Practice: Is It Time for a Change toward Safe Care.

Introduction: Evidence-based practice (EBP) has been recognized as the gold standard for safe and high quality care. Nurse leaders have a strategic position in terms of initiating changes in clinical settings for successfully implementing EBP. Therefore, the factors that influence implementing EBP must be measured. Aims: To examine nurse leaders’ attitudes, self-efficacy, and training needs for implementing evidence-based practice. Place and Duration of Study: Four teaching hospitals affiliated to Kerman University of Medical Sciences in the southeast of Iran from January to April 2014. Methods: A cross-sectional study was conducted on 70 nurse leaders from four teaching hospitals. After using a modified forward/backward translation procedure to create a Persian version of "perceptions of nurses of evidence-based practice questionnaire", data were collected from the participants and analyzed using SPSS (version 20), descriptive statistics, Student’s t-test, analysis of variance (ANOVA), and Pearson’s correlation. Results: Most (82.86%) of the participants had not attended any specific training course on the implementation of EBP and 80% had not been involved in any research activities. Nurse leaders’ attitudes toward EBP were unfavorable (mean=2.55±0.88), their levels of self-efficacy in EBP skills were weak (mean=2.64±1.31), and their demand for training in all of the EBP areas was moderate (3.89±.97). Conclusion: Current practice of nurse leaders is not evidence-based, which is worrisome and can result in serious deficiencies in the quality and safety of nursing care. Nurse leaders must attempt to equip themselves with the attitudes and skills required to change in practice using EBP.

Validating the Persian Version of the Hill-Bone's Scale of "Compliance to High Blood Pressure Therapy".

Introduction: Hypertension is a global public health concern. Among the factors that contribute to this crisis, the poor control of hypertensive patients is a major concern. Patients’ lack of adherence to the medication regimen is often considered to be the main reason for this failure. Several medication-adherence scales were designed to measure the extent to which patients adhere to their medication and treatment regimens. Since these scales must be very reliable and have strong validity if they are to be used in clinics and research, this study was performed to test the reliability and validity of the Hill-Bone’s scale of “Compliance to High Blood Pressure Therapy.” Methods: After using a modified forward/backward translation procedure to create a Persian version of the Hill-Bone’s scale, we conducted a cross-sectional study in which two hundred and eighty hypertensive patients participated to validate the Persian version. Exploratory and confirmatory factor analysis, criterion validity, Cronbach’s alpha, and test-retest reliability were used to determine the validity and reliability of the Persian scales’ psychometric properties. Results: The analysis of the data showed that the scale had excellent stability (Intraclass Correlation Coefficient = 0.97) and low acceptability of internal consistency (Cronbach’s Alpha = 0.44). The exploratory factor analysis did not clarify meaningful patterns among the subscales. The confirmatory factor analysis failed to fit the observed items with the latent subscales. The scale scores were not correlated with blood pressure (P > 0.05). Conclusion: Although some of the psychometric properties of the Persian version of the Hill- Bone’s scale and its modified version were acceptable, they were not sufficient to recommend the Persian version for general use. More studies are needed to revise and develop a more comprehensive scale that is appropriate for use in the context of the mentioned population.

Patient advocacy practice among Iranian nurses.

This cross-sectional study among nurses at the hospitals of the Tehran University of Medical Sciences aimed to investigate the extent of involvement in patient advocacy practice among nurses. Participants (n=330) were selected using proportionate systematic random sampling. Data were gathered through patient advocacy questionnaires and analysed using descriptive/inferential statistics. The average of nurses’ patient advocacy practice was 3.848+ 0.304 (possible range 1-5). One third of the participant nurses had high scores in practising patient advocacy, two thirds of them had scores in the medium range and 0.6% of nurses had low scores. The majority of nurses (83.5%) declared their commitment to patient advocacy as high, and 42.5% believed they had enough ability to practise advocacy.