Background: Moral distress is a very common experience in the nursing profession, and it is one of the main reasons for job dissatisfaction, burnout, and quitting among nurses. For instance, morally difficult situations in taking care of child patients who are severely ill may lead to moral distress for nurses. However, most of the studies about moral distress have been conducted on nurses of special wards and adult medical centers with much focus on developed countries. Subsequently, little has been researched (...) on this topic among nurses in other nations such as Iran, and most certainly, there has been hardly any such research involving Iranian pediatric nurses. Aim/objectives: This study was conducted to evaluate moral distress among nurses in selected pediatric hospitals in Tehran, Iran. Research design: This cross-sectional study was conducted on eligible nurses who were selected through proportional stratified sampling and who completed demographic characteristics and the pediatric version of Moral Distress Scale-Revised questionnaires. Data were analyzed using descriptive statistics, t test, one-way analysis of variance, and Pearson correlation coefficient. Participants and research context: In total, 195 pediatric nurses working at three selected children’s specialized university hospitals in Tehran participated in this study. Ethical considerations: This study was evaluated and approved by the institutional review board of Tehran University of Medical Sciences. Findings: The mean and standard deviation of total score of moral distress was 106.41 ± 61.64 within a range of 10–257. Also, the difference between the mean score of moral distress of the group who had not quitted their position and those who have quit in the past was statistically significant (p = 0.043). The situation that was associated with the highest moral distress was “observing medical students performing painful procedures on patients just to gain some skill.” Total score of moral distress was significantly higher among male nurses (p = 0.014), while nurses with a master’s degree experienced just a higher intensity of moral distress compared to those who had a bachelor’s degree (p = 0.006). Conclusion: Since many pediatric nurses clearly face moral distress while taking care of children, it is necessary to consider measures for preventing or decreasing situations that would lead to this distress. (shrink)

Background and aimThe nature of pediatric settings may encounter nurses with more complicated ethical issues. A code of ethics guides nurses to act and decide ethically as a profession. Also, there is always a need to evaluate amount nurses adhere to this code of ethics, using valid and reliable instruments. This study aimed to develop a questionnaire and assess its psychometric properties to measure pediatric nurses' adherence to the code of ethics. MethodsIn this methodological research study, firstly, the questionnaire was (...) developed based on an extensive review of the related literature and the theoretical framework of nursing ethics. A panel of experts (n = 12) reviewed the preliminary questionnaire qualitatively and quantitatively (using CVI and CVR). A conveniently selected sample of 156 nurses working in pediatric wards in three hospitals filled out the questionnaire. The psychometric process included determining sample size and data adequacy using KMO and Bartlette's test of sphericity; exploratory factor analysis (principal component method with Promax rotation); item analysis; and Cronbach's alpha coefficient. Also, the Interclass Correlation Index (ICC) value was determined using a two-week interval test–retest method on 30 eligible nurses.ResultsThe CVI and CVR for the entire questionnaire were 0.85 and 0.78, respectively. The CVI and CVR of all items were reported higher than 0.59 and 0.8, respectively. Cronbach's alpha of the 28-items instrument was 0.92. Extracted six factors explained 65.31% of the total variance, and the values of the item correlations with the total questionnaire showed good internal consistency (0.52 to 0.90). The items of each factor were evaluated to determine the values they represent. Accordingly, the factors were named beneficence, nonmaleficence, human dignity, autonomy, informed consent, and honesty. The ICC value was 0.99.ConclusionsThe developed instrument is acceptable and has good reliability and validity. It can be used to assess the amount of pediatric nurses' adherence to the code of ethics by managers, teachers, and researchers. (shrink)

Patient advocacy has been a topic of much discussion in the nursing literature for a number of decades. Ambiguities remain, however, concerning definitions of advocacy in nursing. This qualitative grounded theory-type study aimed to inquire into the meaning of patient advocacy from Iranian nurses' perspective. A purposive sample of 24 nurses (staff nurses, head nurses and supervisors) working in a large university hospital in Tehran was used. Data were collected using in-depth semistructured interviews and reflective diaries kept by the participants. (...) The data were analyzed using elements of Strauss and Corbin's' approach. Advocacy was defined by the participants as: informing and educating; valuing and respecting; supporting; protecting; and promoting continuity of care for patients. The participants also believed that advocacy could take place only if there was respect for patients' individuality and their inherent human dignity. Many of the descriptions given by the participants are consistent with previous research in this area and represent a comprehensive account of their perceptions of patient advocacy. (shrink)

Background: Ethical studies in nursing are very important topics, and it is particularly crucial with vulnerable populations such as new graduated nurses. Neglecting ethical principles and violence toward graduates can lead to their occupational burnout, job dissatisfaction, and leaving the nursing profession. Objective: This study was designed with the aim of understanding the experience of Iranian experienced nurses’ use of lateral and horizontal violence against new graduated nurses. Research design: This qualitative study used a conventional content analysis approach; it was (...) conducted with 18 experienced nurses. Data were collected through unstructured and semi-structured interviews of various general hospital departments in northwest of Iran and analyzed using methods as described by Graneheim and Lundman. Ethical considerations: This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered. Findings: “Psychological violence,” “Verbal violence,” “Physical violence,” and “Source of violence” were four categories extracted through data analysis. Discussion: Violence behaviors are instances of workplace maltreatment that damage individual nurses, quality of care, and the ethical climate of the healthcare settings. The lateral and hierarchical violence in nursing were explained by oppressed group model. Conclusion: This study provided the context for identifying details of various types of workplace violence against new graduated nurses. It should be approached as a health system priority that requires specific multi-dimensional methods to manage consisting of identification, strategic planning, policymaking, prevention, education, and research. (shrink)

Background: Providing information to patients is an essential aspect of care. The way in which such information is transmitted is also important and is affected by different variables. The perceptions of dishonest nursing staff have not been sufficiently discussed to date. Aim: The purpose is to explore the reasons for dishonesty in transmitting information to patients. Design and Method: In this qualitative content analysis study, data were collected using semi-structured interviews with Twelve Iranian Critical Care Nurses from January 2020 till (...) August 2020. Data were analyzed according to Graneheim and Lundman approach. Ethical consideration: The research protocol was authorized by the Ethics Committee of the Medical Sciences University of Tehran (Register number: 95-04-99-33485). Results: The findings indicated that dishonesty in giving information to the patients has many reasons. Although lying is not compatible with ethical care, working conditions sometimes forced nurses to hide the truth. Discussion and conclusion: Nurses believed honesty was an integral aspect of professional practice, but situational specifics have an effect on whether the truth is told or withheld. Finally, the nurses noticed a big gap between what they want to tell and what they were doing in practice. (shrink)