Spiritual care competency and its relationship with clinical self-efficacy in nursing students.

BACKGROUND: Spiritual care occupies a special place in holistic care and improving the quality of services provided to patients. The component of clinical self-efficacy is recognized as a prerequisite for clinical capacity and competency. The current study determined the level of spiritual care competency and its relationship with clinical self-efficacy in nursing students. METHODS: This cross-sectional study was conducted on 194 nursing students studying in medical sciences universities in Yazd, Iran, who were selected by convenient sampling. Data collection tools were a spiritual care competency scale and nursing students' clinical self-efficacy questionnaire. The gleaned data were analyzed by SPSS20 using descriptive and inferential statistics. RESULTS: The mean scores of spiritual care competency and clinical self-efficacy of students were 70.29 ± 9.58 and 102.40 ± 21.57, respectively. The results of Pearson's correlation coefficient test showed that clinical self-efficacy had a positive significant correlation with spiritual care competency (p = 0.04, r = 0.14). The mean score of spiritual care competency was higher in female students (71.10 ± 9.81) than male students (67.50 ± 8.23) with a statistically significant difference (p < 0.05). The regression test results suggested that clinical self-efficacy can be considered as a predictor of spiritual care competency. CONCLUSION: The results revealed that spiritual care competency in nursing students was at an average level, and the higher the level of clinical self-efficacy is, the more developed the spiritual care competency will be. Thus, nursing educators and health system managers should pay special attention to improving the clinical self-efficacy of nursing students to develop their spiritual care competency.

Translation and psychometric evaluation of the reflective capacity scale in Iranian medical education.

BACKGROUND: Examining the reflective capacity in medical students is a principal step for the development of effective educational strategies to improve it. Reflection scales available in Iran are inadequate due to the lack of focus on students' willingness and tendency to participate in reflection. This study aimed at translation and psychometric evaluation of "Reflective Capacity Scale" in Iranian medical education. METHODS: This methodological research was completed in two parts: translation and psychometric evaluation. After getting permission from the main developer of the tool, the translation process was done based on Polit and Yang model in Persian language. Then, face validity and content validity of the tool were established using a qualitative method. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 320 medical students, who were selected using convenience sampling. The reliability of the tool was also checked with two methods of internal consistency and stability. The gleaned data were analyzed with SPSS20 and AMOS. RESULTS: "Reflective Capacity Scale" includes 16 items that were retained after cross-cultural translation. Face validity and content validity were acceptable. By performing exploratory factor analysis, four factors were identified that accounted for 63.79% of the total variance. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The internal consistency reliability of the whole tool was equal to 0.83 and the intra-class correlation coefficient was equal to 0.98. CONCLUSION: The translated and validated "Reflective Capacity Scale" provides a robust tool for assessing reflective capacity among Iranian medical students. Its validity and reliability underscore its potential for measuring the reflective capacity of medical students.

Translation and psychometric validation of the Persian version of palliative care attitudes scale in cancer patients.

INTRODUCTION: To improve cancer patients' quality of life, palliative care is necessary. The growth of palliative care, along with the assistance of the government and the collaboration of specialists, also relies on the knowledge and attitude of people. In Iran, there is no tool available to gauge patient attitudes about palliative treatment. The Persian version of the Palliative Care Attitude Scale (PCAS-9) was translated and psychometrically validated in this research among cancer patients. METHODS: This methodological study was conducted in two stages: translation stage and psychometric validation stage. The method of translation was based on that proposed by Polit and Yang. Utilizing a qualitative approach, the scale's face and content validity were investigated. 162 cancer patients who required palliative care based on expert diagnosis participated in the confirmatory factor analysis to establish construct validity. Stability and internal consistency provided evidence of reliability. The data was examined using SPSS18 and AMOS. RESULTS: The "Palliative Care Attitudes Scale" translated well across cultures. Validity on both the face and the content was acceptable. Confirmatory factor analysis (CFA) revealed a good fit for the original three-factor structure. The intra-class correlation coefficient (ICC) was equal to 0.89, while the internal consistency (Cronbach's alpha) reliability of the whole scale was equal to 0.77. CONCLUSIONS: Persian version of the "Palliative Care Attitudes Scale" was acceptable and adequate in cancer patients. Using this tool makes it easier to assess how patients feel about receiving palliative care and how well training sessions are working to change patients' views.

Correlation between moral distress and clinical competence in COVID-19 ICU nurses.

BACKGROUND: Nurses' clinical competence is one of the fundamental necessities for providing safe and effective care. Moral distress, as one type of occupational stressors, can affect various aspects of clinical competence, especially under conditions of complicated medical settings such as the coronavirus disease 2019 (COVID-19) epidemic. This study was conducted with the aim of determining the relationship between moral distress and clinical competence in nurses working in COVID-19 intensive care units (ICUs). METHODS: The study was a cross-sectional study. A total of 194 nurses working in COVID-19 ICU affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, central Iran, participated in the study. Data were collected using Demographic Information Questionnaire, Moral Distress Scale, and Clinical Competence Checklist. Data were analyzed with SPSS20 using descriptive and analytical statistics. RESULTS: The mean score of moral distress, clinical competence, and skills application were 1.79 ± 0/68, 65.16 ± 15.38, and 145.10 ± 38.20, respectively. Based on Pearson correlation coefficient, there was an inverse and significant relationship between the moral distress score and its dimensions with clinical competence and skills application (P < 0.001). Moral distress was a significant negative predictor that accounted for 17.9% of the variance in clinical competence (R2 = 0.179, P < 0.001) and 16% of the variance in utilization of clinical competence (R2 = 0.160, P < 0.001). CONCLUSION: Considering the relationship between moral distress, clinical competence and skills application, to maintain the quality of nursing services, nursing managers can strengthen clinical competence and skills application by using strategies to deal with and reduce moral distress in nurses, especially in critical situations.

Medical students' reflective capacity and its role in their critical thinking disposition.

BACKGROUND: Developing reflective capacity and critical thinking is one of the prerequisites of education in health professions, especially medicine. This study aimed to determine the reflective capacity of medical students and its role in their critical thinking disposition. METHODS: In this cross-sectional descriptive research, conducted in 2022, a total of 240 medical intern students were selected using the convenient sampling method. Data were collected using a reflective capacity questionnaire and critical thinking disposition questionnaire and analyzed with descriptive and inferential statistics using SPSS20. RESULTS: The mean reflective capacity was 4.53 ± 0.50, and mean critical thinking disposition was 127.52 ± 10.85. Among the dimensions of reflection, "active self-appraisal (SA)" and "reflective with others (RO)" had the highest and lowest means, respectively. The dimensions of critical thinking disposition with the highest and lowest means were related to innovation and intellectual maturity, respectively. Reflective capacity and its dimensions were found to have a direct and statistically significant relationship with critical thinking disposition and its dimensions. Regression analysis results showed that reflective capacity accounts for 28% of students' critical thinking disposition. CONCLUSION: The relationship between students' reflective capacity and their critical thinking disposition has rendered reflection as one of the necessary components of medical education. Thus, determining the learning activities by considering the reflection process and models will be very effective in creating and strengthening critical thinking disposition.

Translation and psychometric evaluation of the persian version of the "Nursing Profession Self-Efficacy Scale".

BACKGROUND: Self-efficacy demonstrates the general competence of nurses in providing nursing care. Evaluation of nurses' self-efficacy is of particular importance to improve nursing care. The existing self-efficacy scales in Iran are insufficient due to lack of focus on the specific issues of the nursing profession. This study was conducted with the aim of translating and psychometrically evaluating the Persian version of "Nursing Profession Self-Efficacy Scale" (NPSES). MATERIALS AND METHOD: This cross-sectional study was conducted in two parts: translation and psychometric evaluation. After getting permission from the original developer of the scale, the process of translating the questionnaire into Persian was done based on the Polit and Yang model. Then, the face validity was explored using a qualitative method with the participation of 10 nurses. The content validity was investigated using a qualitative and quantitative method (content validity index) with the participation of 15 experts. Construct validity was surveyed with exploratory and confirmatory factor analysis via completing the questionnaire by 550 nurses worked in different wards of hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd/Iran, who were selected using convenience sampling. The reliability of the tool was also established with internal consistency and stability methods, with the participation of 30 nurses. SPSS20 and AMOS were used for data analysis. RESULTS: "Nursing Profession Self-Efficacy Scale" includes 19 items for which the translation and cultural compatibility of the Persian version were confirmed. Face validity and content validity (SCVI/Ave = 0.9) were acceptable. By conducting exploratory factor analysis, three factors (professional situation, care situation, and support situation) were identified, which accounted for 62.38% of the variance of the scores. In the confirmatory factor analysis, the values of the fit indices confirmed the appropriate fit of the model. The reliability was established using Cronbach's α method (α = 0.86) and an ICC of 0.83, indicating that the scale was reliable. CONCLUSION: The translation, validity, and reliability of the Persian version of "Nursing Profession Self-Efficacy Scale" suggested that this tool has a clear and legitimate translation. Also, this tool has good validity and reliability and can be used as one of the tools to measure the self-efficacy of Iranian nurses.

Comparison of the effect of incentive spirometry and deep breathing exercises on hemodynamic parameters of patients undergoing coronary artery bypass graft surgery: A Clinical Trial.

BACKGROUND AND OBJECTIVE: Hemodynamic changes are among the common complications after coronary artery bypass graft (CABG) surgery. Incentive spirometry (IS) and deep breathing exercises (DBEs) are widely used in patients undergoing CABG surgery. The aim of the present study was to compare the effect of IS and DBEs on hemodynamic and oxygenation parameters of patients undergoing CABG surgery. METHODS: This is a clinical trial that was performed on 40 patients with heart disease who were candidates for coronary artery bypass graft surgery. Participants were selected using convenience sampling and then randomly divided into two groups. One day before surgery, one group was taught how to perform DBE and the other group was taught how to use IS in practice. Hemodynamic and oxygenation indices were measured and recorded before the intervention, the first, second, and the third day after the intervention. Data analysis was carried out using SPSS ver.16 and descriptive and inferential statistical tests. RESULTS: The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) on the first day after the intervention in patients undergoing the IS group was significantly higher than the DBE group (p<0.05). On the third day after the intervention, the mean arterial oxygen saturation (SaO2) in patients of the IS group was significantly higher than the DBE group and the mean respiratory rate (RR) in patients in the IS group was significantly lower than the DBE group (p <0.05). However, there was no significant difference between the two groups in terms of other indices (p> 0.05). CONCLUSION: The results showed that IS has a greater effect on hemodynamic and oxygenation indices of patients undergoing CABG compared to DBE, so, it is recommended to use IS to improve hemodynamic and oxygenation indices in these patients.

The relationship between ethical leadership, conscientiousness, and moral courage from nurses' perspective.

BACKGROUND: Nurses' conscientiousness and moral courage are essential to providing high quality care. Leadership is one of the factors that may be very effective in strengthening these characteristics in nurses. Among leadership styles, the ethical leadership has a special value. This study investigated the relationship between ethical leadership of nursing managers, conscientiousness, and moral courage from the nurses' perspective. METHODS: In this cross-sectional descriptive study, 180 nurses working in hospitals of Yazd, central Iran, were selected through simple random sampling. Three questionnaires: the "Ethical Leadership", "Conscientiousness", and "Moral Courage" were used to collect data. Data were analyzed with SPSS20 using descriptive and analytical statistics. RESULTS: There was a positive and significant relationship between conscientiousness and moral courage with ethical leadership from the nurses' perspective (P < 0.05). The relationship between conscientiousness and moral courage was also significant (P < 0.05). The regression analysis showed that ethical leadership can be considered as a predictor of conscientiousness and moral courage. CONCLUSION: The relationship between ethical leadership and conscientiousness and moral courage suggests that nursing managers, by adopting such an approach in leadership, can increase conscientiousness and moral courage in nurses.

Burnout among Iranian nurses: a national survey.

BACKGROUND: Nurses, particularly critical care nurses, are exposed to high levels of stress and burnout. Burnout is associated with many deleterious consequences affecting health care outcomes. The present study is intended to determine the dimensions of burnout in nurses on surgical, medical and critical care units and its relationship with demographic characteristics. METHODS: In this descriptive research study, performed at critical and non- critical care units, 743 nurses were randomly selected by quota sampling from medical sciences universities in Iran. Data collection instruments included a "demographic questionnaire" and the "Persian version of the Copenhagen Burnout Inventory. Data were analyzed using SPSS20. RESULTS: The findings showed that regarding all dimensions, the lowest level of burnout belonged to surgical wards whereas the highest level pertained to critical care wards indicating a significant difference among various aspects of burnout in different wards, i.e., surgery, medical, and critical care. There was no significant difference in gender, academic degree, and marital status in any of the aspects of burnout in critical care units; yet, the difference was significant between surgical and medical wards (P < 0.05). There were a negative significant correlation between some dimensions of burnout with age and nursing experience in critical care and medical wards (P < 0.05). Whereas in surgical wards, there were a positive significant correlation between some aspects of burnout with nursing experience and age (P < 0.05). CONCLUSION: This study found that the critical care nurses have significantly higher level of burnout compared to the medical-surgical nurses. These results should be considered when planning burnout prevention schedules for nurses.

Moral courage and psychological empowerment among nurses.

BACKGROUND: Moral courage is one of the fundamental values of nursing profession and a powerful method of coping with ethical problems. Psychological empowerment is a suitable method of enabling individuals to coping mental pressures of the work environment. This study determined the correlation between moral courage and psychological empowerment of nurses. METHODS: This was a descriptive cross-sectional study. A total of 180 nurses employed in different wards were selected randomly. Data were collected by Demographics Questionnaire, Sekerka's Moral Courage Scale, and Spreitzer's psychological empowerment Scale and analyzed with SPSS16 using descriptive and inferential statistics. FINDINGS: The results indicated that the mean score of moral courage was 21.11 ± 69.90 and the greatest amount of moral courage was in the dimension of "going beyond compliance". The mean score of "psychological empowerment" was 30.9 ± 73.58 and the greatest mean belonged to "competence". There was a positive significant correlation between "psychological empowerment" and "moral courage and its dimensions" (P < 0.05). CONCLUSION: The findings suggested a correlation between moral courage and psychological empowerment. Thus, nurses' moral courage could be enhanced by reinforcing their psychological empowerment leading to increased patient satisfaction and quality care.

Effect of palliative care training on perceived self-efficacy of the nurses.

BACKGROUND: Nurses are involved in providing end-of-life care for end stage individuals and their self-efficacy is one of the key factors bearing on such care. The purpose of this study was to determine the effect of palliative care on perceived self-efficacy of the nurses. METHODS: This is a quasi-experimental study with pretest-posttest design. Sampling was randomized and included 40 individuals. The intervention consisted of palliative care training for four sessions, each lasting 45 min. Data were collected using demographic and perceived self-efficacy questionnaires completed before and after the intervention. Data were then analyzed by SPSS 16 software using descriptive and inferential statistics. RESULTS: The mean age of the participants was 38.6 and their work experience was 14.25 years. The majority of the participants were female (85%) and had a bachelor level of education (92.5%). The findings showed that "perceived self-efficacy", "psychosocial support" and "symptom management" improved significantly after intervention (p < 0.05). CONCLUSION: Based on the results, palliative care education has the potential to increase nurses' perceived self-efficacy. Since all members of the health care team Including nurses play an important role in providing palliative care, nursing managers can take an effective step to maximize the capacity of nurses by planning and supporting training in this regard.

Association between ethical leadership, ethical climate and organizational citizenship behavior from nurses' perspective: a descriptive correlational study.

BACKGROUND: Ethical leadership plays an important role in improving the organizational climate and may be have an effect on citizenship behavior. Despite the growing emphasis on ethics in organizations, little attention to has been given this issue. The purpose of this study was to identify ethical leadership, an ethical climate, and their relationship with organizational citizenship behavior from nurses' perspective. METHODS: In this descriptive correlational study, 250 nurses in twelve teaching hospitals in Tehran were selected by multistage sampling during 2016-2017. The data were collected using Ethical Leadership Questionnaire, Hospital Ethical Climate Survey, and Organizational Citizenship Behavior Scale. RESULTS: The findings showed a significant correlation between ethical leadership in managers, organizational citizenship behavior (P = 0.04, r = 0.09) and an ethical climate (P < 0.001, r = 0.65). There was a significant correlation between an ethical climate and nurses' organizational citizenship behavior (P < 0.001, r = 0.61). The regression analysis showed that ethical leadership and an ethical climate is a predictor of organizational citizenship behavior and confirms the relationship between the variables. CONCLUSION: Applying an ethical leadership style and creating the necessary conditions for a proper ethical climate in hospitals lead to increased organizational citizenship behavior by staff. To achieve organizational goals, nurse managers can use these concepts to enhance nurses' satisfaction and improve their performance.

The effect of teaching puberty health concepts on the basis of a health belief model for improving perceived body image of female adolescents: a quasi-experimental study.

BACKGROUND: As children approach adolescence, they focus increasingly on their appearance and physical attraction due to teenage body-image. Teaching the concepts of adolescent health changes an individual's attitudes towards parts of the body. The health belief model (HBM) is one of the significant pedagogic models in health education. According to this model, the individual's decision and motivation for adopting healthy behaviors depends on three separate categories "personal perception, adaptive behaviors, and probability of performing that action or behavior". This study investigated the effect of teaching puberty health concepts on the basis of a HBM on perceived body image in female adolescents. METHODS: A quasi-experimental research design was used in the study. This study was conducted with 60 sixth grade girls in state elementary schools in Yazd, Iran, that were selected with cluster sampling method and assigned randomly into experimental and control groups. The experimental group were educated in the school during eight 45-min sessions based on the HBM, whereas the control group were educated using the traditional lecturing method. The data were collected with demographic and self-body image questionnaires completed before and after intervention. The data were analyzed with SPSS16 using analysis of covariance (ANCOVA). RESULTS: The mean age of the participants was 12.16 ± 0.74 years. The findings showed that "perceived body image" and "students' self-attitude" improved significantly after intervention; yet, no significant difference was found between the subscales "attitudes towards weight" and "satisfaction with various parts of the body". CONCLUSION: The results of the study confirmed the efficacy and efficiency of teaching puberty health on the basis of the HBM on improving perceived body image in female adolescents.

The effect of education around ethical principles on nurses' perception to patient safety culture in an Iranian mental health inpatient unit: a pilot study.

BACKGROUND & OBJECTIVES: Patient safety is a crucial factor in the provision of quality healthcare and is therefore a global health concern. It is an area in which ethical concerns and high-quality clinical practice are inextricably linked. This study investigates the effect of education around ethical principles on nurses' perception of patient safety in a psychiatric unit. MATERIALS & METHODS: This pre- and post-test descriptive study was conducted in a mental health inpatient unit in a hospital in Tehran, capital of Iran, in 2018. A total of 33 nurses, selected by census sampling, participated in the study. Data was collected using a demographics questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC), and was analyzed with SPSS21. RESULTS: The mean score of patient safety was 116.85 ± 9.98 before the educational intervention, 143.58 ± 7.21 immediately after intervention, and 153.12 ± 9.47 1 month after intervention. The rate of error report by most participants over the past 12 months was 3-5 and 6-10 events before intervention, and 6-10 events immediately after and 1 month after intervention. Also, 42.4% of the participants assessed patient safety after intervention as very good and 36.4% assessed it as acceptable and very good 1 month after intervention whereas most of the participants (45.5%) assessed patient safety as acceptable before intervention. CONCLUSION: Education on ethical principles exerts a positive effect on nurses' perception of patient safety culture. Thus, it is recommended as an effective method of promoting nurses' perception of this variable. In this way, healthcare quality and enhanced patient safety can be achieved.

Ethical leadership, nursing error and error reporting from the nurses' perspective.

BACKGROUND: Nursing errors endanger patient safety, and error reporting helps identify errors and system vulnerabilities. Nursing managers play a key role in preventing nursing errors by using leadership skills. One of the leadership approaches is ethical leadership. AIM: This study determined the level of ethical leadership from the nurses' perspective and its effect on nursing error and error reporting in teaching hospitals affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, Iran. RESEARCH DESIGN: This was a cross-sectional descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: A total of 171 nurses working in medical-surgical wards were selected through random sampling. Data collection was carried out using "ethical leadership in nursing, nursing errors and error reporting" questionnaires. Data were analyzed with SPSS20 using descriptive and analytical statistics. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee for Medical Research. Ethical considerations such as completing informed consent form, ensuring confidentiality of information, explaining research objectives, and voluntary participation were observed in the present study. FINDINGS: The results showed that the level of nursing managers' ethical leadership was moderate from the nurses' point of view. The highest and the lowest levels were related to the power-sharing and task-oriented dimensions, respectively. There was a significant relationship between nursing managers' level of ethical leadership with error rates and error reporting. CONCLUSION: The development of ethical leadership approach in nursing managers reduces error rate and increases error reporting. Programs designed to promote such approach in nursing managers at all levels can help reduce the level of error rate and maintain patient safety.

Relationship between perceived organizational justice and moral distress in intensive care unit nurses.

BACKGROUND:: The nature of the nursing profession pays more attention to ethics of healthcare than its therapeutic dimension. One of the prevalent moral issues in this profession is moral distress. Moral distress appears more in intensive care units due to the widespread need for moral decision-making regarding treatment and care in emergency situations. In this connection, organizational justice is of high importance and, as a significant motivational tool, leaves important impacts upon attitude and behavior of personnel. AIM/OBJECTIVE:: This study aimed at investigation of the relationship between perceived organizational justice and moral distress in intensive care unit nurses. RESEARCH DESIGN:: This is a descriptive-correlational research which examined the relationship between perceived organizational justice and moral distress in intensive care unit nurses. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 284 intensive care unit nurses were selected via census sampling. The data were collected through questionnaires and then were analyzed via SPSS-20 using Pearson and Spearman correlation tests. ETHICAL CONSIDERATIONS:: This study was approved by the Committee of Ethics in Medical Research. Completion of informed consent form, guarantee of the confidentiality of information, explanation on purposes of the research, and voluntary participation in the study were moral considerations observed in this study. FINDINGS:: There was a statistically significant negative correlation between the total perceived organizational justice and the total moral distress (p = 0.024, r = -0.137) and also between "procedural and interactional justice and errors" and "not respecting the ethics principles." Meanwhile, no relationship was found by the findings between distributive justice and dimensions of moral distress. CONCLUSION:: According to the results of the study, there was a reverse significant relationship between moral distress and perceived organizational justice; therefore, the head nurses are expected to contribute to reduce moral distress and to increase perceived organizational justice in nurses.

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.

Perceived organizational support and moral distress among nurses.

BACKGROUND: Moral distress is prevalent in the health care environment at different levels. Nurses in all roles and positions are exposed to ethically challenging conditions. Development of supportive climates in organizations may drive nurses towards coping moral distress and other related factors. This study aimed at determining the level of perceived organizational support and moral distress among nurses and investigating the relationship between the two variables. METHODS: This was a correlational-descriptive study. A total of 120 nurses were selected using random quota sampling method. A demographic questionnaire, Survey of Perceived Organizational Support, and Moral Distress Scale were used to collect the data which were analyzed using descriptive and analytical tests in SPSS20. RESULTS: The mean perceived organizational support was low (2.63 ± 0.79). The mean moral distress was 2.19 ± 0.58, which shows a high level of moral distress. Moreover, Statistical analysis showed no significant relationship between perceived organizational support and moral distress (r = 0.01, p = 0.86). CONCLUSION: Given the low level of perceived organizational support and high moral distress among nurses in this study, it is necessary to provide a supportive environment in hospitals and to consider strategies for diminishing moral distress.

Ethical leadership outcomes in nursing: A qualitative study.

BACKGROUND:: Leadership style adopted by nursing managers is a key element in progress and development of nursing and quality of healthcare services received by the patients. In this regard, the role of ethical leadership is of utmost importance. OBJECTIVES:: The objective of the study was to elaborate on the ethical leadership and its role in professional progress and growth of nurses in the light of work condition in health providing institutes. METHODS:: The study was carried out as a qualitative study following conventional content analysis method. In total, 14 nursing faculty members and nursing managers at different levels were selected through purposive sampling method. Semi-structured interviews were used for data gathering. The data were analyzed using latent content analysis and constant comparison analysis. ETHICAL CONSIDERATIONS:: This study was conducted in accordance with ethical issues in research with human participants and national rules and regulations related to informed consent and confidentiality. The study was approved by the Committee of Ethics in Research at the Shahid Beheshti University of Medical Sciences in Tehran, Iran, under the code: sbmu.rec.1393.695 on 15 February 2015. FINDINGS:: Five subcategories were obtained based on the analysis, which constituted two main categories including "all-inclusive satisfaction" and "productivity." Nursing leaders highlighted the point that their ethical behavior creates "inner satisfaction of the leader," "employees' job satisfaction," and "patients' satisfaction." Improvement of productivity was another outcome of ethical behavior of the leaders. This kind of behavior resulted in "providing better services" and "inspiring ethical behavior in the employees." It has great influence on progress and growth of the nursing profession. CONCLUSION:: By creating an ethical climate, ethical leadership leads to positive and effective outcomes-for the patients as well as for the nurses and the leaders-and professional progress and development of the nursing profession. Therefore, an ethical work environment that supports nurses' progress and development can be developed by paying more attention to moralities in recruitment, teaching ethical values to the leaders, and using a systematic and objective approach to assess morality in the environment.

Ethical competency of nurse leaders: A qualitative study.

BACKGROUND: Ethics play an important role in activating the manpower and achieving the organizational goals. The nurse leaders' ethical behavior can promote the care quality by affecting the nurses' performance and bringing up several positive consequences for the organization. OBJECTIVES: The aim of this study was to identify and describe the ethical competency of nurse leaders in cultural domains and the working conditions of the Iranian healthcare setting to arrive at a more comprehensive and specific perspective. METHODS: This was a qualitative conventional content analysis study conducted with the participation of 14 nurse leaders at various levels. The participants were selected using the purposive sampling method, and the required data were collected using deep interview and also semi-structured interview. A deductive method of content analysis was applied in data analysis. Ethical considerations: This study was conducted in accord with the principles of research ethics and national rules and regulations relating to informed consent and confidentiality. FINDINGS: Data analysis resulted in 17 subcategories that were subsequently grouped into three major categories including empathetic interactions, ethical behavior, and exalted manners. DISCUSSION: Our findings are consistent with previous ones, yet presenting a more complete knowledge about aspects of ethical competency of nurse leaders. The nurse leaders can provide a proper behavioral model for the work environment through the use of new information. CONCLUSION: The nurse leaders introduced various aspects of ethical competency, so the leaders' ethical competency could be promoted via planning and managing some ethical development programs. More future research is needed regarding the experiences of the subordinates and other related parties.