The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial.

BACKGROUND: Ethical decision­making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity. METHODS: In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. RESULTS: Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009). CONCLUSIONS: The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. REGISTRATION: This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.

Effect of Spiritual Care Based on the Sound Heart Model on Spiritual Experiences of Hemodialysis Patients.

Hemodialysis patients require spiritual care due to their spiritual distress. This study aimed to investigate the effect of spiritual care on spiritual experiences of hemodialysis patients. This randomized controlled trial was conducted in 2017 at hemodialysis departments of Baqiyatallah and Cham ran hospitals in Tehran. The volunteer patients were selected by available sampling according to the inclusion criteria. Participants were randomly assigned to intervention and control groups. Interventions were performed in the educational-supportive nursing system according to the patients' self-care ability. Eight individual counseling sessions, 15-45 min, face-to-face, during dialysis, once a week were implemented for intervention group. Developing the relationship with God, self, people and nature were the main goals of care. Daily spiritual experience questionnaire was completed by patients before and three months after the intervention. There was no significant difference in the spiritual experience score of the intervention (75.20 ± 9.14) and control group (76.63 ± 10.03), before the intervention (P = 0.523). There was a statistically significant difference between the intervention (82.93 ± 5.69) and the control group score (77.24 ± 12.09) three months after the intervention (P < 0.0001). Due to the need for holistic and community-oriented care and the positive effect of this study, the use of the Sound Heart Model is recommended for Muslim patients.

Design and Psychometrics of the Mentoring Questionnaire among Bachelor's Degree Students in Nursing.

BACKGROUND: Regarding the importance of mentoring in nursing and lack of attention to this issue, as well as the lack of a suitable questionnaire to assess mentoring, this study was carried out to design and analyze psychometric properties of mentoring among bachelor's degree students in nursing. MATERIALS AND METHODS: In a mixed method study, the validity and reliability of the Mentoring Questionnaire were measured after designing it. The study sample included all undergraduate nursing students of one of the nursing schools in Tehran, Iran. In the qualitative phase, item generation, face, and content validity were performed. In the quantitative phase, construct validity and reliability were performed. The Cronbach's alpha coefficient and Interclass Correlation Coefficient (ICC) test were exploited for data analysis and reliability assessment, respectively. RESULTS: The number of items designed for the Mentoring questionnaire was twenty. Finally, the Mentoring Questionnaire was designed with 16 items. The Cronbach's alpha coefficient of the Mentoring Questionnaire was 0.96. In addition, the results of the ICC showed the high reliability of the Mentoring Questionnaire (ICC = 0.99). The indices derived from Exploratory Factor Analysis (EFA) revealed that the Mentoring Questionnaire had appropriate construct validity. CONCLUSIONS: Given the results of this study, as well as the importance of mentoring measurement among nursing students and the lack of access to a valid questionnaire, it can be concluded that the Mentoring Questionnaire is a useful tool for bachelor's degree nursing students.

Palliative Care in the Health System of Iran: A Review of the Present Status and the Future Challenges.

OBJECTIVES: In the near future, the health system of Iran will face serious public health challenges means increase in the elderly population and the rate of chronic diseases. Therefore, it is anticipated that providing palliative care for chronic diseases will be one of the priorities of the country's health system. The purpose of the present study was to explain the present status and the future challenges of providing palliative care in the health system of Iran and help policy-makers to create a future roadmap by presenting a picture of the present status.  Methods: In this qualitative study, 17 semi-structured interviews were conducted with policy-makers, researchers, and managers of the centers providing palliative care in 2018-2019. Interviews were analyzed using directed content analysis based on the Public Health Strategy and framework analysis. RESULTS: According to the WHO Public Health Strategy, palliative care challenges categorized in 13 subcategory and four main category include policy-making, program implementation, comprehensive education and drug availability. CONCLUSION: Providing palliative care that is currently dispersed in some centers does not meet the needs of chronic diseases. Establishing the palliative care system as one of the major goals of the health system of Iran is possible through reforming the fourfold structure of policy-making, implementation, education and drug availability. Therefore, it is suggested that authorities perform comprehensive and systematic management of challenges using foresight methods.
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Stressors experienced by the family members of brain-dead people during the process of organ donation: A qualitative study.

More is known about organ donor recipients than donor families. We explored the stressors experienced by family members of brain-dead people during the process of organ donation. Seventeen family members and five organ procurers were interviewed and the data analyzed through conventional qualitative content analysis. Stressors experienced by family members fell into six themes-perceived threat of loss, decision making under conflict, painful corrosive farewell, feeling of insecurity, complexity of grief, and seeking relief. Findings highlight the necessity of developing and using standard protocols for supporting brain-dead people's family members throughout the process of organ donation and following bereavement.

Construction and validation of a mentoring questionnaire based on Islamic culture.

Education is considered to be a cultural and value-driven matter where any intervention in this field requires certain tools in order to describe the status quo. The current study, while taking into account the contextual texts related to Islamic mentoring, seeks to develop a tool to quantify this concept, as well as introduce the respective psychometric properties. A 113 items questionnaire was designed after reviewing the literature, the recommended guidelines concerning Islamic mentor and mentee, and reviewing available international tools. Content validity of the questionnaire was evaluated based on several criteria of clarity, fitness, and comprehensiveness by a survey of 10 experts and the necessary corrections were made. In the primary phase of this study, the psychometric properties of this questionnaire were evaluated by collecting the data from a random sample of 213 Iranian Ph.D. students in Tehran Universities of Medical Sciences. The factors analysis results show that 70 items, in the form of nine factors, construct the Islamic monitoring. Furthermore, The Cronbach's α coefficient was determined for each factor and the entire questionnaire. Total reliability of the scale was obtained at 0.97. Considering the confirmed validity and reliability of the questionnaire, this tool can be highly beneficial for the experts and education professionals, particularly in the field of medicine, for the assessment and establishment of mentoring.

The Portfolio as a Tool for Mentoring in Nursing Students: A Scoping Review.

BACKGROUND: One of the processes leading to education and evaluation promotion in nursing is mentoring. Moreover, using a portfolio leads to promotion of the mentoring process. Due to the importance of mentoring in nursing, its strengthening by the portfolio, the weakness of mentoring in nursing, and the lack of widespread use of portfolio in nursing education, the aim of this study was to determine portfolio content, which can help the mentoring performance. MATERIALS AND METHODS: The present scoping review study was conducted in 2017. Articles were searched using the keywords portfolio, mentoring, nursing education, logbook, teaching, learning, nursing, education, and evaluation. The search was conducted in SID, IranMedex, IranDoc, Magiran, PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect databases. Studies published in Persian and English from 1997 to 2017 were reviewed. The studies were extracted based on the inclusion and exclusion criteria. RESULTS: Of the 1070 articles searched, 6 were extracted for the final assessment. The results indicated that a portfolio consists of a title page, content list, introduction, record of experience, mentor's feedback and comments, self-evaluation, and educational activities. Furthermore, nursing process is required to help conduct mentoring among nursing students. CONCLUSIONS: Recording experiences, feedback, etc., in the portfolios of nursing students can be helpful in conducting mentoring for student's education. It is suggested that educational managers perform mentoring in educational environments using the contents suggested in this study.

Lifelong learning strategies in nursing: A systematic review.

BACKGROUND: Lifelong learning is an expectation in the professional performance of nurses, which is directly related to the success of students in nursing schools. In spite of the considerable attention paid to this issue, lifelong learning strategies are not fully understood. OBJECTIVE: The aim of this study was to clarify lifelong learning strategies of nursing students with respect to international experience. METHODS: In this systematic review, an extensive investigation was carried out using Persian and English studies in Pub Med, ProQuest, Cochrane, Ovid, Scopus, Web of Science, SID, and Iran Doc using the following keywords: lifelong learning, self-directed learning, lifelong learning model, continuing education, nursing education, and lifelong program. Finally, 22 articles published from 1994 to 2016 were selected for the final analysis. Data extracted from the selected articles was summarized and classified based on the research questions. RESULTS: In this study, 8 main themes, namely intellectual and practical independence, collaborative (cooperative) learning, researcher thinking, persistence in learning, need-based learning, learning management, suitable learning environment, and inclusive growth, were extracted from the article data. CONCLUSION: Having identified and clarified lifelong learning strategies in nursing, it is recommended to use the research findings in the programs and teaching systems of nursing schools. Use of strategies of lifelong learning will led to increased quality of education, development of nursing competency and finally, increased quality of patient care.

Experiences of Iranian Nursing Faculty Members on Working in Conflict Climate.

BACKGROUND: Few studies have been conducted on role conflict in nursing faculty in the world. This research reports the first study about this subject in Iran. OBJECTIVES: The purpose of this research was to explore the experiences of role conflict in Iranian nursing faculty members. MATERIALS AND METHODS: We conducted a qualitative study using a conventional content analysis approach. We used semi-structured and in-depth interviews by purposive sampling of 19 (15 instructors, three group managers and one educational assistant) participants to identify the influential factors of role conflict among nurse faculty members, working in seven nursing colleges in Iran. RESULTS: The three following categories emerged from data analysis: "roles Interference"; "role ambiguity", and "conflicting expectations". The main theme was "working in conflict climate". CONCLUSIONS: This study highlighted the influential factors that could produce role conflict for nursing faculty members. The results can help university leaders to improve nursing faculty working conditions.