Design and Evaluation of Reform Plan for Local Academic Nursing Challenges Using Action Research

PURPOSE: This study identifies challenges to the first nurse training program for undergraduate nursing students at a nursing and midwifery school in Iran using a collaborative approach in order to improve the program. METHODS: Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. The participants were 148 individuals from nursing academic and clinical settings, including administrators, faculty members, students, and staff nurses. We obtained approval from the research deputy and ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran for this study. RESULTS: Lack of coherence in the educational program and implementation of the program, inadequate communication between management inside and outside the organization, insufficient understanding of situations by students, and improper control of inhibitors and use of facilitators in teaching and in practice were among the major challenges in the first training process in the context of this study. After classification of problems, the educational decision-making authorities of the school developed an operational program with stakeholder cooperation to plan initial reforms, implementation of reforms, reflection about the actions, and evaluation. Comparison of student satisfaction with the collaborative learning process versus the traditional method showed that except for the atmosphere in the clinical learning environment (p > .05), the mean differences for all dimensions were statistically significant. CONCLUSIONS: The results confirm the overall success of the revised partnership program, but stressed the need for further modification of some details for its implementation in future rounds.

Problems of Clinical Nurse Performance Appraisal System: A Qualitative Study

PURPOSE: The purpose of this study is to explore problems of clinical nurse performance appraisal system. METHODS: This study employed a descriptive qualitative approach. The participants were purposively selected from clinical nurses working across all of the hospital units in a large metropolitan teaching hospital in Tehran, Iran in 2012. Data were collected using five focus group interviews, which were audio taped. The number of participants in each group ranged from 7 to 10. The semi-structured interviews were guided by a set of nondirective questions, and continued until the data reached saturation. Data were analyzed using framework analysis. RESULTS: Four major themes regarding the problems of clinical nurse performance appraisal system emerged from the analysis of textual data. These themes were contextual problems, problems related to performance appraisal structure, problems related to performance appraisal process and those related to performance appraisal results. CONCLUSION: The findings of this study reveal that the nurse performance appraisal system confronts with various problems. Some of these problems are related to organizational context while the others concerned structure, process and results of the performance appraisal system. In order to achieve high quality of patient care as the final goal of performance appraisal, changing and revision of this system is necessary.

Developing a scale for quality self assessment in pre-hospital emergency services

Establishing of total quality management in any organization including emergency medical services need to an appropriate tool to help developing, implementing and evaluating of quality programs. The objective of this study was to develop a valid and reliable tool for self assessing enabler criteria of Iran EMS centers according to European Foundation for Quality Management [EFQM] model.The study was conducted using the Delphi method, and 43 participants as panelists were enrolled in 3 round modified Delphi technique. Initially, a rating scale was developed in response to main question of study; which items should be contained in self assessing tool of quality in Iran EMS area? This scale was judged by 5 experts primarily, and after some modification was entered in Delphi process. The comments of panelist were collected by E Mail and final scale was developed in the end of 3th rand.Pre-hospital Emergency Self assessing Rating Scale [PHESARS], Was main result of this study that developed in 190 items in 5 enabler criteria according to EFQM model including; Leadership [52], Policy and Strategy [21], staff [41], Resources and partnership [36] and Processes [40].Self assessing scale was developed by TQM and excellence perspective and because of experts' consensus in developing it, has content validity and can be used in self assessing of pre-hospital area and determining improvement opportunity and, can leads the Iran EMS centers to total quality management and organizational excellence

[Marital satisfaction and therapeutic regimen compliance in hemodialysis patients in hospitals of Shahid Beheshti University of Medical Sciences and Health Services in 1388- 89]

Therapeutic regimen non compliance is a common problem in hemodialysis patients. It is associated with many side effects. Marital satisfaction and conflictions in dyadic relationships have an important effect on compliance of a complex regimen. This study aims to determine the correlation between marital satisfaction and therapeutic regimen compliance in hemodialysis patients in hospitals of Shahid Beheshti University of Medical Sciences and Health Services in 1388-89. In this descriptive correlatiional study 100 hemodialysis patients were selected through the judgmental sampling method. Data gathering tool was a questionnaire consisting three parts: demographic data, disease and ENRICH Marital Satisfaction Inventory. The latter part is validated by content validity method. The reliability of ENRICH Marital Satisfaction Inventory was determined by Chronbach's=method. The questionnaires were completed by patients during hemodialysis. In order to determine the compliance of therapeutic regimen, the researcher recorded the mean of the last three months' values of P, K, interdialytic weight gain, and the numbers of missed dialysis sessions using patient's documents. Data were analyzed by SPSS statistical software While 56% of patients had compliance in therapeutic regimen. 59% had low and very low and 41% of patients had moderate and high marital satisfaction. There was a significant correlation between marital satisfaction and therapeutic regimen compliance and marital satisfaction in patients with therapeutic regimen compliance was high. Planning for counseling and supportive programs concerning marital satisfaction can be beneficial for patients and their families in order to increase their therapeutic regimen compliance

[ effects of group and individual education on the level of the knowledge, attitude and practice of self care in patients with diabetic foot ulcer]

The diabetic foot ulcer is one of the most common and devastating complications of diabetes mellitus. Patient education about the prevention of foot ulceration is among the most challenging issues. The purpose of this study was to examine the effects of group and individual patient education on the level of the knowledge, attitude and practice of self-care in patients with diabetic foot ulcer. In this quasi-experimental study, the samples consisted of 80 patients with type 2 diabetes randomly allocated to two groups to receive either individual or group education [40 patients in each group]. The patients received one day education program about foot care. The patients' knowledge, attitude and practice of self-care were assessed before and after the interventions and the data were compared between two groups. The authors declare that they have no conflict of interests. The finding showed that the level of knowledge about foot care was poor in most patients of both groups. The attitude was positive and the practice was moderate. The level of the knowledge [P=0.09], attitude [P=0.21], and practice [P=0.01] of both groups improved after educational program. There was not a statistically significant difference between two groups in terms of knowledge and practice improvement. There was a statistical significant difference between two groups in terms of attitude improvement. The effects of group and individual education on diabetic foot self-care are similar. Group education is more economical