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Background: Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process. Objectives: This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran. Research design: This was a mixed-methods study with an exploratory sequential design. Participants and research context: A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively. Ethical considerations: The ethical committee (...) of Kerman University of Medical Sciences, Iran, approved the protocol of the study. Findings: Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale. Discussion: The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges. Conclusion: Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences. (shrink)

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Background The enhancement of nursing care quality is closely related to the clinical competence of nurses, making it a crucial component within health systems. Objective The present study investigated the relationship between nurses’ clinical competence, moral identity, and moral injury during the COVID-19 outbreak. Research design This cross-sectional study was carried out among frontline nurses, using the Moral Identity Questionnaire (MIQ), the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP), and the Competency Inventory for Registered Nurse (CIRN) as data collection tools. (...) Participants and research context: The research population for this study consisted of all frontline nurses ( n = 251) employed in a hospital in southern Iran. Sampling was conducted between May 1, 2021 and September 30, 2021, during the COVID-19 outbreak. Ethical considerations The present study received approval from the research ethics committee of Rafsanjan University of Medical Sciences, with project No. 99267 and code of ethics ID No. IR. RUMS.REC.1399.262, dated 15.02.2021. Results According to the study findings, 42.2% of the nurses demonstrated high clinical competence, while 51.4% exhibited moderate clinical competence. The results indicated a positive correlation between moral identity and clinical competence but a negative correlation between moral injury and clinical competence. Furthermore, the variables of moral identity and moral injury were found to predict 10% of the variance in clinical competence. Conclusion According to the results, moral identity and moral injury had an impact on the clinical competence of nurses. Therefore, implementing a program aimed at enhancing moral identity and providing training strategies to address moral injury during crises like the COVID-19 pandemic can lead to improvements in nurses’ clinical competence and the overall quality of care they provide. (shrink)

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IntroductionAn individual’s level of mindfulness can predict his/her level of general health, anxiety, and anger. If we have a valuable tool for measuring mindfulness, we can predict such factors more concisely. Therefore, the aim of this study was to compare a narrowband and a broadband mindfulness scale in predicting the level of general health, anxiety, and anger in a general population.Materials and MethodsThis was a cross-sectional study on an Iranian general population from September 22, 2020 to April 14, 2021. The (...) convenience sampling method was used. Data were collated via electronic and paper forms of the Relaxation/Meditation/Mindfulness Tracker t-Persian version, the Freiburg Mindfulness Inventory- Short-Form-Persian version, the General Health Questionnaire, the trait anxiety section of the State–Trait Anxiety Inventory, and the trait anger section of the State–Trait Anger Expression Inventory-2.ResultsThe FMI-P predicted 0.05% of GHQ variance while the first and third levels of RMMt-P predicted 0.145%. The FMI-P predicted 0.19% of anxiety variance, while the first and third levels of RMMt-P predicted 0.195%. The FMI-P predicted 0.0% of anger variance, while the first, second, and third levels of RMMt-P predicted 0.08%. RMMt-P Level 1 was a better predictor of general health, anger, and anxiety.ConclusionThe current study found that the RMMt-P was a better predictor of general health and anger than the FMI-P. These findings suggest that the type of questionnaire used in the study of mindfulness is important, but more research is needed to determine the extent of these relationships. (shrink)

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BackgroundHealth care professionals face a number of problems during crises, such as the COVID-19. Studies addressed the prevalence of moral injury among healthcare professionals during the COVID-19 outbreak. Lack of a valid standard of moral injury among health care professionals is one of the factors that has made it difficult to identify and treat this complication. This study aimed to evaluate the psychometric properties of the Moral Injury Symptoms Scale-Health Care Professionals among health care professionals in Iran.MethodsThis study was conducted (...) to evaluate the validity and reliability of the MISS-HP. The sample included 455 healthcare professionals working in four teaching hospitals in Kerman, who were in direct contact with patients. In this study, face validity, content validity, construct validity, and internal reliability of the MISS-HP were evaluated. Demographic information questionnaire, the Moral Injury Symptoms Scale-HealthCare Professionals, General Health Questionnaire, and Impact of Event Scale were administered to study participants.ResultsThe MISS-HP was evaluated using translation-back translation technique. The content validity index of the items and the scale were 0.9 and 0.99, respectively. Exploratory factor analysis showed a three-factor structure in the MISS-HP that explained 57.49% of the variance. Confirmatory factor analysis indices were acceptable. The cut-off point of the questionnaire was 36.5. There was a positive and moderate correlation between the Persian version of MISS-HP, GHQ, and IES-R. The Cronbach’s alpha coefficient of the Persian version of MISS-HP was 0.70.ConclusionThis study found that the MISS-HP is a concise, comprehensive, valid and reliable scale for assessing moral injury among health care professionals in clinical or research settings. This scale will be helpful for managers and researchers to identify and plan health policies and improve the psychological state of health care professionals. (shrink)

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BackgroundNurses provide the majority of health-care services and face numerous health challenges during an epidemic. During the COVID-19 epidemic, nurses are subjected to physical, mental, and social disorders that impair their quality of life and hardiness. Therefore, it is important to be aware of the situation of nurses. The current study aimed to compare the compassion satisfaction, compassion fatigue and hardiness among nurses before and during the COVID-19 outbreak.Materials and MethodsThis cross-sectional study included 508 clinical nurses from one public hospital (...) in southern Iran. The subjects were recruited using census sampling methods in 2019–2020. Sampling was performed before and during the COVID-19 with a 1-year interval. Although, the study setting was the same before and during the COVID-19, questionnaires were completed by different nurses before and during the COVID-19. Demographic questionnaire, professional quality of life questionnaire and Occupational Hardiness Questionnaire were used to collect data.ResultsThe scores of compassion satisfaction, compassion fatigue and hardiness did not differ significantly during the COVID-19 compared with before the COVID-19. Before COVID-19, hardiness and work experience predicted 11% of the variance of compassion satisfaction, whereas during COVID-19, hardiness and gender predicted 26% of the variance of compassion satisfaction. Before COVID-19, hardiness and work experience predicted 3% of the variance of compassion fatigue, whereas during COVID-19, hardiness, type of employment and gender predicted 6% of the variance of compassion fatigue.ConclusionThe current study found that compassion satisfaction, compassion fatigue and hardiness did not change during the COVID-19 outbreak compared with before the COVID-19 outbreak. However, during the COVID-19, the hardiness was a significant predictor of compassion satisfaction and compassion fatigue. The study results showed that it was possible to increase the compassion satisfaction and reduce the compassion fatigue by strengthening the hardiness of nurses. However, these results need to be considered in future studies, especially in crises such as COVID-19 disease. (shrink)

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BackgroundSexual harassment in the workplace has many negative consequences for nurses and the delivery of patient care. Appropriate policies and strategies can help to create a safe work environment for nurses. Therefore, the present study aimed to investigate Iranian nurses’ strategies for preventing sexual harassment in the workplace.Materials and methodsThis qualitative descriptive-explorative study used conventional content analysis to investigate how Iranian nurses cope with sexual harassment. Participants were selected using a purposeful sampling method. Data was collected through in-depth, semi-structured interviews (...) from September 2020 to April 2021. In order to obtain rich information, maximum variation was considered. The Guba and Lincoln criteria were used to increase the study’s trustworthiness, while the Graneheim and Lundman approach was used to analyze the content.ResultsOne hundred and twelve codes, one main category, four categories, and 12 subcategories were extracted. The main category, strategies to prevent sexual harassment among nurses in the workplace, includes four categories: behavioral response, working conditions adjustment, informing, and performance of hospital security guards. The most common strategy used by nurses was behavioral response.ConclusionBasic measures are required to prevent sexual misconduct against nurses, which is an obvious part of the professional organizational culture. Managers and policymakers should develop workplace ethics, legal accountability, and safety. They should also develop training programs and prevention strategies to help nurses improve their coping skills. Further quantitative and qualitative research in other healthcare groups is required to confirm the findings of this study. (shrink)

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