code of ethics for nurses

Nurses are ever-increasingly confronted with complex concerns in their practice. Codes of ethics are fundamental guidance for nursing as many other professions. Although there are authentic international codes of ethics for nurses, the national code would be the additional assistance provided for clinical nurses in their complex roles in care of patients, education, research and management of some parts of health care system in the country. A national code can provide nurses with culturally-adapted guidance and help them to make ethical decisions more closely to the Iranian-Islamic background. Given the general acknowledgement of the need, the National Code of Ethics for Nurses was compiled as a joint project [2009-2011]. The Code was approved by the Health Policy Council of the Ministry of Health and Medical Education and communicated to all universities, healthcare centers, hospitals and research centers early in 2011. The focus of this article is on the course of action through which the Code was compiled, amended and approved. The main concepts of the code will be also presented here. No doubt, development of the codes should be considered as an ongoing process. This is an overall responsibility to keep the codes current, updated with the new progresses of science and emerging challenges, and pertinent to the nursing practice

Coronary artery disease risk factors in an urban and peri-urban setting, Kerman, Southeastern Iran [KERCADR study]: methodology and preliminary report

This article was to present the sampling and measurements methods and the main preliminary findings of the KERCADR cohort study [first round] in an urban and peri-urban setting, Kerman, southeastern Iran2009-11. 5900 [3238 female] people aged between 15 to 75 years were recruited in the household survey by non-proportional to size one-stage cluster sampling. Trained internal specialists, general practitioners, clinical psychologists and dentists have assessed the study subjects by person-assisted questionnaires regarding different NCD risk factors including cigarette and opium smoking, physical activity, nutrition habits, anxiety, depression, obesity, hypertension and oral health. Blood samples were also collected for determining FBS, HbA1c, cholesterol and triglyceride. Weighted standardized prevalence estimates were calculated by STATA 10 survey analysis package. The participation rate was more than 95% in all subgroups. Cigarette smoking [18.4% vs. 1.2%], opium use [17.8% vs. 3.0%] and triglyceridemia [16.1% vs. 12.0%] were significantly higher among men than women. In contrast, women were presented with higher level of sever anxiety [29.1% vs. 16.7%], obesity [16.8% vs. 9.2%], low-physical activity [45.1% vs. 39.2%] and uncontrolled diabetes [60.2% vs. 31.0%]. More than 68% of all subjects have presented with moderate to severe gingival index scores. The first round of the KERCADR cohort with sufficient sample size and response rate provided precise estimates for the main clinical and para-clinical NCD risk factors. These evidences need to be translated into public health interventions and monitored in the next rounds of the cohort

[Comparison of the frequency of recurrent laryngeal nerve injury with and without exploration of the nerve in thyroidectomy]

Surgeons are not willing to participate in thyroid surgeries due to dangerous, although rare, complications of the procedure. Post thyroidectomy complications are divided in early and late onset; hypocalcemia, bleeding, thyroid storm and recurrent laryngeal nerve [RLN] injury are the most important ones. This study was performed to compare the frequency of recurrent laryngeal nerve injury with and without nerve exploration in the thyroidectomy operation. In this Cohort study, we evaluated 566 cases underwent thyroidectomy during about 6 years [2005-2011] in two centers, Bahonar and Afzalipour hospitals, in Kerman, Iran. A total of 566 patients, 124 men [21.9%] and 442 women [78.1%] with the mean age of 40.26 years and the mean hospitalization period of 3.35 days were evaluated. 382 patients [67.5%] underwent total or subtotal thyroidectomy and 184 [32.5%] underwent lobectomy and isthmectomy. 124 patients [21.9%] had malignant and 442 [78.1%] had benign lesions. The most common found malignancy was papillary thyroid carcinoma [PTC], where as the most found benign lesion was multinodular guiter [MNG]. Recurrent laryngeal nerve exploration was done for 337 patients [59/5%]. Totally, 6 cases [1.1%] showed Recurrent laryngeal nerve injury [1 in exploration and 5 in non exploration group] from which, 4 had permanent hoarseness and 2 had permanent dysphonia. Also, malignancy and radical neck dissection had significant effect on nerve injury but re-operation and unilateral or bilateral surgery had not. Recurrent laryngeal nerve identification and exploration decreased the incidence of nerve injury significantly. We believe that recurrent laryngeal nerve identification and exploration during thyroidectomy is the best procedure to decrease the risk of nerve injury

Nursing students' and educators' views about nursing education in Iran

Educational systems in each country would be predicted capable of scholars in professional fields. Nurses are particular member of health care team and have pivotal role in health promotion in individual, family and community. This survey examined nursing students' and educators' views about nursing education in Iran. In a descriptive cross sectional study, researcher-developed questionnaires were completed by 700 students and 200 teachers of State and Azad School of nursing and midwifery. Probability sampling was done. Chis square were used for statistical analysis under SPSS v.14. Results showed that in students, greatest mean score were in educational setting but in teachers were contrary. Based on teachers' views, student-teacher ratio was not proper. Both students and teachers have the same opinion about lack of educational resources. According to students views, lowest mean score belong to educators. Also, there are significant correlations with some part of demographics. Educators and students evaluated several aspects of nursing educational system in Iran. These findings could be recovered instructive structure with the purpose of train talented and competent nurses

[ necessity for specialty education in nursing MS program: viewpoints of the faculty members of school of nursing and midwifery in Iran]

Academic specialty nursing courses are so limited in our country, being available just in a few schools. This study was performed in order to determine the necessity for having specialty education programs in MS level and the type of educational program needed. This descriptive cross-sectional study was performed through year 2008 in schools of nursing and midwifery of the country. The study population was faculty members of the schools of nursing and midwifery who were selected clustery and randomly [n=300]. A questionnaire was sent to schools of nursing and midwifery. Nursing faculty members were asked to send the completed questionnaires back to nursing organization. Data was analyzed by SPSS software using Chi[2]. 76.6% of participants believed that graduates of nursing MS are not efficient in clinical settings. 92.7% stated that presenting specialty clinical courses is necessary in MS level. From these persons' viewpoints, the reasons for establishing these specialized courses are prioritized as follows: promotion of service quality, the increasing requirement of society for specialized function of medical professions, establishing a desirable occupational position for nurses, and reducing the expenses of health services. MS graduates are not efficient enough in clinical settings, so it calls for making some revisions in educational courses of MS level. It is recommended to conduct more comprehensive researches on this area considering evaluation of educational programs

[Job satisfaction among iranian nurses]

Health systems are challenging with increased health demands and limited economic status; whilst, nurses shortages is a worldwide issue. Job dissatisfaction among nurses is a main cause for work leaves. The aim of this study was to assess job satisfaction among Iranian nurses and its related factors. In this cross-sectional study, 1058 nurses were selected randomly during 1384-5. A two-sectioned self-report questionnaire was used which included demographic data and job satisfaction scale. Data were analyzed in SPSS version 12.0. Findings showed that only about one third of nurses were satisfied [satisfied and very satisfied] with their jobs [34.30%]. In this study, main factors of job satisfaction were job safety [44.5%] as well as working environment and facilities [44.26%]. On the other hand, nurses were dissatisfied with their job because of the described job duties [74.75%], managers' way of communication [70%], and their social position [70.3%]. Increasing the salary and payment, job equity, modifying working time and shift plans, providing opportunities for the nurses to further their carriers, and continuing education are important issues in increasing job satisfaction

[Prevalence of Type 2 dioabetes mellitus in 3-19 age group in East of Tehran in 2001]

Type 2 Diabetes is fast increasing in adolescents various populations; there is a lack of related data in Iranian population. The aim of this study is to determine the prevalence of diabetes, its risk factors [such as family history, obesity, sedentary life, high caloric diet, birth weight, history of GDM in their mothers], associated disease [hypertension, dyslipidemia, obesity] and related complications [proteinuria and retinopathy]. This is a cross sectional study of 4480, 3 - 19 year old children from eastern Tehran selected by multiple stratified cluster random sampling; this study was done in 3 steps. In the first step, the children were screened by detecting FBS. Then 210 persons with FBS> 100 were selected and GTT [1.75 mg/kg glucose] was done for all of them and in the third step, we measured Anti GAD, ICA, serum insulin levels and C peptide in patients with Impaired Fasting Glucose. Questionnaires for history, physical examination and nutritional status and the results of tests were completed for each one, all the patients were evaluated for retinopathy and nephropathy. Overall, we detected one case of IFG, 6 cases of IGT and 5 cases of DM. Finally, the results were compared with those of 20 age sex matched controls. The prevalence of IFG was 22 in 105; for IGT it was 133 in 105 and 110 in 105 for DM. The prevalence of type 2 diabetes was 45 in 105 in adolescents in this population. Obesity and strong family history of diabetes mellitus was observed in most of them. None of them had complications of DM. In spite of the few cases of type 2 diabetes identified in Iranian adolescents, prevalence of this disease in our population is low. The probability of this disease should be considered in obese children with strong family history of DM. In order to prevent type 2 DM in adolescents; appropriate dietary and physical activity interventions are is recommended for the general population

[Evaluation of ghrelin and leptin in patients with thyroid malfunction]

Leptin and Ghrelin are hormones that have been discovered in the last decade and were shown to be involved in appetite and metabolism regulation and body weight. Thyroid hormones are also involved in general metabolism and changes in their circulating levels bring about changes in appetite and body weight. Results of animal and human studies regarding Leptin level and its relation to thyroid hormones are opposing each other, and there is no data about Ghrelin level in thyroid malfunction. To determine the relation between thyroid function and circulating levels of Ghrelin and Leptin, we evaluated serum concentration of these hormones in patients with untreated thyroid malfunction. Thirty hyperthyroid and 30 hypothyroid females that were aged between 14-52 years and 30 healthy females with the same age range [control group] were randomly selected. From each participant 5 ml of fasting blood was collected and after processing, serum levels of T[4], T[3], T[3]-uptake, TSH, Leptin and Ghrelin were evaluated by radio-immunoassay or enzyme-link immunoassay methods. Evaluated results showed that neither Ghrelin nor Leptin levels show significant change in patients with thyroid malfunction. But there was a positive significant correlation between Leptin level and BMI of all participants [r=0.41, P<0.01]. In addition, there were negative significant correlations between Ghrelin and thyroid hormones [r=0.27, P<0.05].

The present results show that Leptin variation is due to BMI. Furthermore, negative and weak correlation between thyroid hormones and Ghrelin may indicate that increase in appetite of hyperthyroid patients and its decrease in hypothyroid patients are not due to circulating level of Ghrelin

[Normal exophthalmic values in children, teenagers, and adults of Tehran]

Purpose: to determine normal values of Hertel exophthalmometry in children, teenagers, and adults in Tehran

Methods: in a population-based epidemiological study, ocular protrusion was measured in 1063 randomly selected [stratified sampling method] normal subjects of Tehran. Hertel exophthalmometry was performed in all by a single oculoplastic surgeon. Subjects were divided into 3 age groups: children [6-12 years], teenagers [13- 19 years], and adults [20-70 years]. Data were analyzed using two-tailed paired t-test, independent sample t-test and linear regression test

Results: the age range was 6 to 70 years [mean 20.3 +/- 10 .9] and 601 [56.5%] were male. Mean absolute exophthalmic value was 14.2 +/- 1.8 mm in children, 15.2 +/- 1.9 mm in teenagers, and 14.7 +/- 2.3 mm in adults. Increase in age had a statistically significant effect on the exophthalmic value [r = +0.32 for children, +0.01 for teenagers, and -0.30 for adults; P<0.01]. Relative exophthalmic value was less than 2 mm in all subjects

Conclusion: the normal exophthalmic value had positive correlation with increase in age up to 20 years old and negative correlation thereafter. There was a positive correlation between the base and increase in age of all age groups

[Peripapillary staphyloma: a case report]

Purpose: to report two cases of peripapillary staphyloma presented to the Rassoul Akram Hospital

Patients and findings: the first case was a 2.5-year-old boy with a large peripapillary staphyloma. Size of staphyloma was 4 disc diameter with a depth of 8 mm. The second case was a 4-year-old girl with a staphyloma measuring 2.5 disc diameter in width and 3 mm in depth in her right eye. There were also multiple cilioretinal vessels and a little glial tissue over the disc in the second case

Conclusion: peripapillary staphyloma is a rare congenital anomaly of the optic disc. Amblyopia-therapy and wearing protective glasses are recommended in unilateral cases