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Background Nurse prescribing is a successful innovation in the role of nurses in the world. It is crucial to assess the challenges of nurse prescribing roles in the Intensive Care Units (ICU), due to the needs of the patients in these units. This qualitative study aimed was to explore the experts’ experiences regarding lack of the legality of nurse prescribing in ICU in the healthcare system of Iran. Methods Data were collected through semi structured face-to-face interviews with 33 experts chosen according to purposive and snowballing sampling with maximum variation. The interviews were analysed using Graneheim and Lundman's conventional content analysis method. After overviewing the interviews, semantic units, codes, subcategories, categories and themes were extracted. The qualitative data were analysed using MAXQDA software version 10. Results The main theme of the study was “The current challenges due to the illegality of nurse prescribing” with five categories and 12 subcategories. The five categories included the "current reality of illegal prescribing", "patient safety threat", "current conflicts", "physician as an autocratic group," and "prescribing demands." Conclusion Despite the nurse prescribing role has been legalized and implemented in many countries, there is still no law in the ICU and other places in Iran, and this lack of legality has led to the conflicts and challenges for the patients, nurses and healthcare system. The legality of nurse prescribing in the ICU can prevent medication errors and endangering patient safety.

BackgroundThe process of learning the professional values is started from the student’s entering to the university and to the workplace. This study compared the importance of professional values from the perspectives of nurses and nursing students.MethodsThis descriptive-analytical study was conducted on 250 nurses and 100 nursing students. Data were collected using the Nursing Professional Values Scale-Revised.ResultsAccording to the findings, the mean scores of nurses (3.68 ± 0.16) and nursing students’ (3.86 ± 0.17) perspective toward professional values were at an important level. Furthermore, the students’ perspective toward the professional values’ importance was significantly more favorable than those of nurses. The highest mean scores of professional values in the two groups were related to the caring and justice domains. Both groups considered activism and professionalism as the least important domains among the others.ConclusionsAs the findings suggest, we need to pay more attention to values training, especially professionalism and activism, during undergraduate education for preparing the nurses to work in today’s complex healthcare context. It is necessary to conduct more comprehensive studies for exploring the gap between theory and practice in different cultures and contexts.

Background Professional values of nursing students may be changed considerably by curricula. This highlights the importance of the integration of professional values into nursing students’ curricula. The present study aimed to investigate the importance of professional values from nursing students’ perspective. Methods This cross-sectional study was conducted at the Kerman University of Medical Sciences, Iran. Data were gathered by using a two-section questionnaire consisting of demographic data and Nursing Professional Values Scale-Revised (NPVS-R). By using the stratified random sampling method, 100 nursing students were included in the study. Results Results showed that the mean score of the students’ professional values was at high level of importance (101.79 ± 12.42). The most important values identified by the students were “maintaining confidentiality of patients” and “safeguarding patients’ right to privacy”. The values with less importance to the students were “participating in public policy decisions affecting distribution of resources” and “participating in peer review”. The professional value score had a statistically significant relationship with the students’ grade point average (P

Background: Since “dignity” is one of the fundamental rights of every patient, consideration for patients’ dignity is essential. Unfortunately, in many cases, especially in cancer patients, dignity is not fully respected. Dignity is an abstract concept, and there are only a few comprehensive studies on the dignity of cancer patients in Iran. Research objective: This study aimed to evaluate the perception of Iranian cancer patients on human dignity. Research design: A qualitative research approach was used as the study design. The data were collected through individual semi-structured interviews and analyzed using the qualitative content analysis method. Participants and research context: This study was conducted on cancer patients in internal medicine wards in Iran. The data were gathered through semi-structured interviews from May 2017 to February 2018. Ethical considerations: The study protocol was approved by the Research Ethics Committee of medical universities located in Southwest of Iran. The ethical principles were carefully followed throughout the study. Findings: Based on the results of the interviews, 3 main themes and 11 categories were determined. The main themes were identified as the “personal space and privacy,” “respect for human values,” and “moral support.” Discussion: The results of the present study showed the necessity of care for cancer patients in a respectful manner. The key elements in such care were the preservation of their personal space and privacy, respect for their values, and the provision of adequate moral support. These measures will have a positive effect on the perception of such patients on human dignity. Conclusion: Considering the special care required by cancer patients, the Iranian healthcare and hygiene managers should design and implement a care plan that includes the ethical principles related to human dignity.

Background Errors are among the factors threatening patient safety. It is essential to understand how to deal with nursing errors in the emergency department. Thus, the present study aimed to explain the process of dealing with nursing errors in the emergency department. Method This qualitative study adopted Corbin and Strauss's (2008) grounded theory method. The data were collected by in-depth semi-structured interviews and field notes. Eighteen nurses, two doctors, and one patient companion participated in this study. The research setting was the emergency departments of five teaching hospitals in down tone of Tehran, Iran. The participants were selected by purposive sampling at first, and then by theoretical sampling. Results Following the data analysis, four main categories of “reality shock”, “formulating a situational response”, “reactive measure”, and “progress or regress” were extracted. The data analysis showed that “formulating a situational response” is the core category of the process of dealing with errors among nurses in the study emergency departments. The first step in the process of dealing with errors in ED was the reality shock, then nurses entered the stage of formulating a situational response, after that they entered the stage of “reactive measure” and finally they entered the stage of progress or regress. Discussion and conclusion After an error occurs in the emergency department, nurses experience four stages during the process of dealing with nursing errors. When dealing with an error, nurses think about protecting the patients. However, some contextual factors direct the nurses towards protecting themselves rather than the patient. The decision-makers in the healthcare system can modify these contextual factors, provide in-service training, develop anonymous reporting systems, and establish a positive support environment, thus directing the nurses towards supporting the patients (in addition to trying to protect oneself).

Background and Aim : Nurses suffer from burnout due to frequent and daily exposure to stressful situations more than those in other occupations. Nurses in ICUs are more exposed to burnout compared to the nurses of other parts due to exposure to various stresses such as high pressure, decision making in urgent situations and responsiveness to the results of each decision, permanent attempt to prevent mistakes, especially exposure to death and disability of patients. For this reason, job burnout in nurses working in ICUs is more than other nurses and can affect the role of nursing professionals, especially patient advocacy. The aim of this study was to determine the correlation between attitude towards the role of patient advocacy and job burnout among nurses in ICUs. Materials and Methods: This descriptive-analytic study was conducted on nurses working in three educational hospitals affiliated to Kerman University of Medical Sciences in 2013. Of the 250 nurses working in adult and child ICUs (ICU, NICU, CCU, dialysis), 183 subjects who had inclusion criteria were selected using the available method. The criteria for entering the study include having at least undergraduate degree in nursing, a 6-month work history in clinical settings, and full-time clinical work. A three-part demographic questionnaire, "Maslach Burnout Inventory", and a nurses' attitude survey questionnaire on the role of patient advocacy were used to collect the data. The first part examines demographic characteristics, including age, gender, marital status, education level, employment area and years of work experience. The second part is a 22-item questionnaire that covers all three areas of occupational burnout; nine items are related to the emotional exhaustion of nurses against the clients and the workplace; five items are related to depersonalization (nurses' disinterest and indifference to clients); and eight items are related to the lack of individual's success that helps the nurse to express the degree of satisfaction and achievement of success in patient care. The frequency of questionnaire items is from zero to six as never, several times a year, once a month, several times a month, once a week, several times a week, and every day. The Persian translation of the Maslach Burnout Inventory has been reviewed by Akbari et al (2011) and has been approved by three English language instructors in terms of accuracy of translation and compliance with its English Principles. In this study, the validity of this questionnaire was evaluated by 10 faculty members, and the CVI was calculated as 88%. Cronbach's alpha was calculated as 0.89 with a sample size of 30. The third part, the 19-item questionnaire, was selected from the questionnaires used in the Barrett-Sheridan and Hanks study, which evaluates nurses' attitude towards the role of patient advocacy. Two-way translation of English to Farsi and vice versa, and validity and reliability, and factor analysis of this questionnaire were done by Motamed et al. (2012) and CVI is estimated as 86% and Cronbach's alpha is 0.77. All items of the present questionnaire are ranked using the 5-point Likert scale. Attitudinal questions were divided into two subscales of the cognitive aspect (10 items) and the behavioral aspect (9 items) (5). For data analysis, descriptive statistics and inferential tests (Pearson correlation coefficient, independent t-test and one-way ANOVA) were used in SPSS 18 software. Ethical considerations: After acquisition of the code of ethics committee approval of number K / 93/30 from the Vice-Chancellor for Research, Kerman University of Medical Sciences and obtaining other necessary permits, and explaining the objectives of the research, the informed consent of the participants was obtained and it was assured about the confidentiality of information. The response rate to the questionnaires was 96.3% (183 out of 190 questionnaires). The median age of participants was 35 ± 1/34 years in the range of 22 to 48 years old. Findings: The majority of them were female (90.3%) and had undergraduate education (9.1%). More than half of the nurses had a work experience of between 6 months and 10 years. In terms of type of division, the majority of participants were engaged in adult ICUs. The average burnout rate of participants was 4.02 ± 0.26 and the mean of attitude towards the role of patient advocacy was 3.72 ± 0.50. There was a significant negative relationship between attitude towards the role of patient advocacy and job burnout (r = -0.07, p = 0.035). There was a significant negative relationship between cognitive factors of attitude towards the role of patient advocacy with dimensions of emotional exhaustion (r = -0.81, p = 0.03) and lack of personal success and burnout (r = -0.12, p=0.04). But this relationship was not meaningful with the dimension of burnout. (r=0.10, p=0.15). Also, there was a significant negative relationship between attitudinal behavioral factor towards the role of patient advocacy with the dimension of the lack of personal success and burnout (r = -0.21, p = 0.03). But this relationship was not significant with the dimensions of emotional exhaustion and depersonalization of burnout (r = 0.03, p = 0.65). There was no statistically significant correlation between mean of burnout and demographic characteristics of participants (p = 0.86). But there was a significant statistical relationship between the mean attitude towards the role of patient advocacy and education level of the participants (p = 0.04). Conclusion: Regarding the existence of a significant negative correlation between attitude towards the role of patient advocacy and job burnout among nurses working in ICUs, providing the necessary conditions to support patients causes the improvement of nurses' attitudes towards patient advocacy, competence and their efficiency and thus reduces their burnout. Also, considering the significant relationship between the attitude towards the role of patient advocacy and the education level of the participants, it is suggested to include training the role of patient advocacy, the ability to identify patient advocacy situations, how they are correctly expressed to others and manage it, in the nursing program so as to help nurses become professional and increase their efficiency and competency which will ultimately increase job satisfaction and reduce burnout. Among the limitations of this study are available sampling and the absolute use of a questionnaire to measure variables. In order to generalize the findings, the study is proposed in both quantitative and qualitative methods in a wider geographical range with larger sample size. Please cite this article as: Motamed-Jahromi M, Abbaszadeh A, Jalali T. Correlation between Burnout and Role of Patient Advocacy in ICU Nurses. Med Ethics J 2017; 11(40): 29-37.

Introduction: To follow the progress of technology and increasing domain of nurses’ duties, ethical challenges can be observed more than ever. Therefore, the growing and dynamic system of nursing requires nurses with professional and ethical competence who can provide optimal care. The aim of the present study was to define and explain dimensions of moral competency among the clinical nurses of Iran. Methods: This qualitative content analysis study was carried out in the years 2014 and 2015 in Iran. Data were collected through in-depth semistructured interviews and field notes. The resulting data were analyzed by Graneheim and Lundman’s method of conventional content analysis. The participants were 12 clinical nurses who were selected using purposive convenient sampling and continued interviews until data saturation. Results: Themes obtained in the present study were posited in three main categories of “moral character,” with subcategories of altruism, search for meaning, be pioneering, perfectionism, self-control, honesty, and forgiveness; “moral care” with subcategories of dignified care, safe care, fair care, and holistic care; and “moral decision-making” with subcategories of moral sensitivity, moral thinking, moral reasoning, and moral courage. Conclusions: Findings of the present study suggest that nurses’ moral competency is an adorable character with a wide range that includes moral virtues and character, moral decision-making, and ultimately providing moral care; therefore, moral competency is a meta-competence in the field of nursing. Because there are many competencies in different fields.

Introduction: Clinical education is the core component of nursing education. PhD graduated nurses who are faculty members can play a main role in clinical instruction. However, there is not clear understanding about the challenges which they may encounter for accepting their role as clinical educator. The aim of this study was to explore the challenges of role acceptance by PhD aduated nurses who are faculty members. Methods: In this qualitative exploratory study a total of 13 participants (8 PhD graduated in nursing, 3 head of departments of nursing, one educational vice chancellor of nursing school, and one nurse) were selected by purposive sampling method. Data were collected by semi-structured, face to face interview and analyzed by conventional content analysis approach developed by Graneheim and Lundman. Results: The main theme emerged from data analysis was "identity threat". This theme had five categories including expectations beyond ability, lack of staff’s rely on the performance of PhD graduated nurses, poor clinical competencies, doubtfulness, and obligation. Conclusion: PhD graduated nurses experienced some worries about their role as clinical educators and argued that they have not been prepared for their role. Therefore, policy makers and authorities of nursing schools should support PhD graduated nurses for accepting their new roles as clinical educators. Moreover, some changes in nursing PhD curriculum is needed to improve the clinical competencies of PhD graduated and prepare them for their role as a clinical educator.

Background:Considering that many nursing actions affect other people’s health and life, sensitivity to ethics in nursing practice is highly important to ethical leaders as a role model.Objective:The study aims to explore ethical sensitivity in ethical nursing leaders in Iran.Method:This was a qualitative study based on the conventional content analysis in 2015. Data were collected using deep and semi-structured interviews with 20 Iranian nurses. The participants were chosen using purposive sampling. Data were analyzed using conventional content analysis. In order to increase the accuracy and integrity of the data, Lincoln and Guba's criteria were considered.Results:Fourteen sub-categories and five main categories emerged. Main categories consisted of sensitivity to care, sensitivity to errors, sensitivity to communication, sensitivity in decision making and sensitivity to ethical practice.Conclusion:Ethical sensitivity appears to be a valuable attribute for ethical nurse leaders, having an important effect on various aspects of professional practice and help the development of ethics in nursing practice.

Background: Ethical care is a core value in nursing. Pediatric nurses are in direct and continuous contact with children and their parents. They manage their lives and health. As part of the pediatric nurses' daily work, ethical issues play an important role in making decisions, are important to make decisions, and this capability is only achieved by ethical practice. This study aimed to explore the factors facilitating the learning of ethical practice among Iranian pediatric nurses. Materials and Methods: This study is a conventional qualitative content analysis based on the Graneheim and Lundman method. It was conducted through semi-structured interviews with two focus groups, incorporating 28 nurses working in pediatric wards. Unstructured observation and field notes were other methods of data collection. Purposive sampling continued until data saturation was ensured. All interviews were tape recorded and transcribed in verbatim. Results: Three main categories and 12 subcategories emerged from this study. The facilitating factors include (1) individual competencies (knowledge, experience, emotional intelligence, and loving children), (2) ethical imprinting (responsibility, reflection, empathy, and ethical beliefs), and (3) an environment that nurtures moral values (organizational, spiritual, family, and cultural environments) as facilitating factors. Conclusions: The promotion of nurses' competencies, ethical virtues, and imprinting, as well as improvement of the quality of nursing care must be the top priority of the health team. Undoubtedly, the success of the health care system is not possible without ensuring that pediatric nurses learn ethical practices.

One of the key concepts in nursing ethics, is patient advocacy that can bring benefi ts to patients, nurses and nurse treatment system to be followed, but for various reasons are not able to play a full role. Thus, knowing their attitudes towards their role as patient advocate can be a way to improve the performance of nurses in this role. This study aimed to investigate nurses’ attitudes about their role as patient advocate in intensive care units of teaching hospitals depended to medical universities in Tehran. This cross-sectional study on 259 adult ICU nurses working in hospitals dependent medical universities in Tehran was conducted in 2015. The questionnaire was used to collect data. Data signifi cance level of 5% with independent t test, Pearson correlation coeffi cient and ANOVA were analyzed. Regression analysis also combined effect of demographic variables on nurses’ attitude of defense was used. This study showed that the overall attitude of critical care nurses to patient advocacy role was relatively positive (3.68). between attitude advocacy mark and some demographic characteristics such as age, economic status, general work experience, educational experience and a special section there was a signifi cant relationship (p

Background: Patient safety, which is a patient’s right, can be threatened by nursing errors. Furthermore, nurses’ feeling of “being a wrongdoer” in response to nursing errors can influence the quality of care they deliver. Research objectives: To explore the meaning of Iranian nurses’ experience of “being a wrongdoer.” Research design: A phenomenological approach was used to explore nurses’ lived experiences. Nurses were recruited purposively to take part in semistructured interviews, and the data collected from these interviews were analyzed using Van Manen’s thematic analysis. Participants and research context: Eight nurses working in three private or governmental hospitals in Tehran, Iran. Ethical consideration: The research design was approved in each participating hospital, and all interviews were carried out at a predetermined time in a private place. Findings: Five themes were extracted from the data: “wandering in unpleasant feelings” (with two subthemes: “unpleasant physical feelings” and “unpleasant emotions”), “wandering in the conscience court” (with three subthemes: “being the accused,” “being the victim,” and “being the judge”), “being arrested in time,” “time for change” (with three subthemes: “promoting accountability,” “promoting learning,” and “strengthening supportive relationships”), and “spiritual exercise.” Discussion: Some of our results are supported by the model of self-reconciliation and the recovery trajectory of “second victims” theory. Conclusion: The meaning of “being a wrongdoer” has positive and negative aspects. Feelings of wandering provide nurses the opportunity to reflect on and re-embrace the professional and moral responsibility of nursing. Nursing managers can convert their “defeats” into a prelude to learning, increase their accountability, and improve the quality of nursing care.

The purpose of this study was to develop codes of ethics for Iranian nurses. Researchers used mixed methods in four stages during 2009-2010 to develop a series of ethical codes for Iranian nurses in Isfahan, Iran. 55 ethical codes in 12 categories were extracted and listed as (1) believe in human dignity, (2) respect for patients’ privacy, (3) empathy for patient, (4) autonomy in decision making, (5) accurate and precise nursing care, (6) being conscience, (7) human relationship, (8) professional commitment, (9) promoting justice, (10) preventing harm and/or injury, (11) honesty and confidentiality, and (12) maintaining and promoting professional values. Study findings serve to the global nursing community on the Islamic view of ethics.

Rationale MS is one of the most common chronic diseases of the nervous system. Apart from disease progression, other complications such as unemployment, separation and divorce could potentially threat patients’ dignity. Most of the previous studies have been done of maintaining patients’ dignity in interaction with healthcare team, but studies on affecting factors of dignity in chronic patients in the society and in interaction with usual people are scarce. Aim We aimed to investigate factors affecting dignity of Iranian patients with MS in daily living and in interaction of them with the society. Methods In this qualitative study, 13 patients with multiple sclerosis were chosen by purposive sampling and semi-structured interviews were conducted until data saturation. The study was done in Tehran, the capital city of Iran. Results Factors affecting dignity were classified as ‘personal factors’ and ‘social factors’. Personal factors consist of the following subcategories: patients’ communication with self, patients’ knowledge, patients’ values and beliefs and patients’ resources. Social factors include others’ communication with patients, social knowledge, social values and beliefs and social resources. Conclusion Multiple personal and social factors interfere in perceived patient dignity. In fact, interaction between personal and social factors can be influential in final perceived dignity. By focusing on whole aspects of the patients’ lives, we can identify dignity-promoting or dignity-threatening factors and help patients maintain their dignity by taking appropriate measures for moderating threatening factors and improving dignity enhancing ones.

Background: Nursing students, during their study, experience significant changes on their journey to become nurses. A major change that they experience is the development of their moral competency. Objective: The purpose of this study is to explore the process of moral development in Iranian nursing students. Research design: A constructivist grounded theory method was adopted. Twenty-five in-depth, semi-structured, face-to-face intensive interviews with 22 participants were conducted from September 2013 to October 2014. All interviews were audio-taped, transcribed, and analyzed using writing memos and the constant comparative method. Participants and research context: The setting was three major nursing schools within Tehran, the capital of Iran. Nineteen nursing students and three lecturers participated in the study. Ethical considerations: The study was approved by the Tehran University of Medical Sciences Committee for Medical Research Ethics (92/D/130/1781). It was explained to all participants that their responses would be treated with confidentiality and that they would not be identified in any way in the research and any publication ensuing from the research. All participants agreed to be interviewed and signed written consent forms agreeing to the recording and analyses of the interview data gathered. Findings: Findings indicated three levels of moral development along with the formation of professional identity. The three levels of moral development, getting to know the identity of nursing (moral transition), accepting nursing identity (moral reconstruction), and professional identity internalization (professional morality), were connected to the levels of professional identity formation. Discussion: The proposed model added a new insight to professionalism in nursing. Conclusion: From the findings, it was concluded that to enhance higher moral practice, nursing instructors should promote the professional identity of nursing students. Reinforcement of moral characteristics and professional identity within registered nurses occurs over a series of phases and, once fully integrated into the identity of nursing students, the moral characteristics that they acquire become part of their both professional and personal identities.

Background: Promoting hope, resulting in more positive health outcomes for patients with breast cancer and social support, is an important aspect of caring for people with this disease. Few studies have addressed how women with breast cancer to become hopeful with social support. Objectives: This study aimed at explaining the perception of Iranianwomen with breast cancer regarding the role of social support in promoting their hope. Methods: This qualitative study was conducted with conventional content analysis method through in-depth semi-structured interviews held with 17 breast cancer women selected through purposive sampling at Shohada-e Tajrish Hospital in Tehran (capital of Iran). The data were collected from July 2016 to December 2017. The Graneheim &Lundman method was used for analyzing and interpreting the data, while the criteria of the Guba and Lincoln method were used to ensure the trustworthiness of these data. Results: Supportive network as a theme and three major groups were obtained from the data analysis as follow. Family support (spousal support and first-degree relatives’ support), community support (peer support group and governmental/nongovernmental organizations support), and the healthcare provider’s support. Accordingly, received support from the three support networks leads to promoting hope in women with breast cancer. Conclusions: The promotion of hope in women with breast cancer requires the development of the supportive network. Nurses should design and implement appropriate programs based on this support network, which includes family support, community support, and the healthcare provider’s support

Background: Uncivil behavior is a serious issue in nursing education around the world, and is frequently faced by instructors and students. There is no study in relation to explain the concept and dimensions of uncivil behavior in nursing education of Iran. Aim: The aim of this study was to determine the perception of nursing educators about student incivility behavior. Methods: This was a qualitative study. Data from 11 semi-structured interviews were analyzed using conventional content analysis. Participants and research context: In all, 11 nursing educators of 5 various nursing schools in Tehran, capital of Iran, participated. Ethical considerations: Organizational approval by the Universities, and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process. Results: Three themes were found: disruptive behavior affecting communication climate, disruptive behavior affecting ethical climate, and disruptive behavior affecting learning climate. Discussion and final considerations: The results of this study demonstrated that uncivil behavior affects every ethical, communicational, and learning climate and threaten peace of the instructors, students, and the academic community. With the consideration of mutuality in incivility behaviors, the authors propose to examine students’ perceptions and identify dimensions of uncivil behavior of instructors for formulating strategies to minimize such behaviors in nursing educational society.

In this qualitative study, conducted with a grounded theory approach, 17 family members awaiting their relatives’ surgery, were interviewed. The interviews were semi-structured and the data from them was analysed using the constant comparative method suggested by Corbin and Strauss. The findings showed ‘attempt to reassure’ as the core category. The main theme of ‘assurance’, comprising patterns of ‘recourse to spirituality’, ‘communication’, ‘physical proximity’, and ‘coping’ indicated the processes used by participants to achieve their goals. These findings may help health care professionals, especially nurses, to better understand the subject and better facilitate the process of waiting whilst relatives have surgery.

Aim: Respect for human dignity right has been accepted as a fundamental human need in the world, but its meaning is complex. The present research aimed to understand the meaning of patient dignity in Iran. Study Design: The study was a qualitative study using content analysis. Place and Duration of Study: The study was performed in Kerman, Iran in 2014. Methodology: The study was conducted among patients with Heart diseases. The purposive sampling technique was used to select the participants. Participants were 16 heart patients admitted from two hospitals affiliated with the Kerman University of Medical Sciences. Twenty semi-structured interviews were constructed. Data were analyzed using qualitative content analysis Results: The analyzed data were made into two main themes and ten sub-themes. The two main themes that emerged were 1- Basic dignity with subthemes (Human security, Comprehensive care, Education and awareness, Respect, Effective communication and Privacy), 2- Transcendent dignity with subthemes (Trust, Gratitude, Satisfaction, Spiritual growth). In the basic dignity, the focus was on physical and psychological needs and in the transcendent dignity; the focus was on spiritual dimension. The results of this study may help health care professionals in understanding patient dignity in Iran.

Aims Ethical decision-making is a complex process that nurses perform daily. The aim of this study is to explain how ethical leaders in Iran strengthen ethical decision-making in their nursing teams. Method Data were collected using deep and semi-structured interviews with 20 Iranian nurses in 2015. Analysis was based on constant comparative analysis. Results Ethical leaders strengthen ethical decision-making by promoting ethical commitment, developing an ethical atmosphere and guiding ethical decision-making. Conclusion The development of ethical decision-making in nursing can improve ethics-based nursing care.

Background: Education is considered the first function and mission of the university, and observing educational ethics guarantees the health of the teaching–learning process in the university. Aim: The aim of this study was to explore ethical values in nursing education from the perspective of Iranian nursing students and educators. Research design: This qualitative study was conducted using the Thematic Content Analyses method. The data were collected from seven semi-structured individual interviews and three focus group discussions from July to November 2015. Participants and research context: The participants were faculty educators of nursing and nursing students in Tehran, capital of Iran, who were selected through purposive sampling. They were recruited gradually. Sampling was continued until data saturation when no new codes were extracted. Ethical committee: This study was conducted after obtaining the approval of Shahid Beheshti University of Medical Sciences Ethics Committee, and informed consent were ensured before conducting the research. The principles of voluntariness, confidentiality, and anonymity were respected during the research process. Findings: Seven major themes emerged: human dignity, constructive human relations, educational justice, competency enhancement, excellence view, wisdom, and commitment and accountability. Conclusion: The results of this study indicated that although many of the values, as universal values, were similar to those of other countries—which can be a reflection of the globalization process in the nursing profession and the presence of humanistic and spiritual approaches at the roots of the discipline, some differences could be found in the content of values due to factors such as the people’s beliefs, culture, and religion. Iranian nursing students and educators revealed a unique and culture-based set of ethical values.

Background Today, nurses are required to have knowledge and awareness concerning professional values as standards to provide safe and high-quality ethical care. Nurses’ perspective on professional values affects decision-making and patient care. Therefore, the present study aimed to investigate the importance of professional values from clinical nurses’ perspective. Methods The present cross-sectional study was conducted in 2016 in four educational hospitals of Kerman University of Medical Sciences, Iran. Data were collected via the Persian version of Nursing Professional Values Scale-Revised (NPVS-R) by Weis and Schank. Sampling was conducted through the use of stratified random sampling method and 250 clinical nurses participated in the study. Results Results indicated that the total score of the nurses’ professional values was high. (102.57 ± 11.94). From nurses’ perspective items such as “Maintaining confidentiality of patients” and “Safeguarding patients’ right to privacy” had more importance; however, “Recognizing role of professional nursing associations in shaping healthcare policy” and “Participating in nursing research and/or implementing research findings appropriate to practice had less importance. A statistically significant relationship was observed between NPVS-R mean scores and nurses’ age, work experience as well as participation in professional ethical training (P

There are many nurses who are victims of errors in the hospital environment. It is quite essential to perceive the outcome of mistakes in nurses' profession. The aim of this scientific study was to interpret the causes that place nurses in danger of errors in emergency departments and also the consequences resulting from confronting the errors in the job environment. This research was designed to pursue a qualitative approach following content analysis. Through the purposeful sampling, 18 emergency nurses were selected to participate in this study. In-depth semi-structured interviews were used for data collection. Participants were selected by purposive sampling. Data collection continued until saturation was reached. The results of data analysis were presented in three different categories: the psychological reactions to error, learning from errors, and avoiding reactions. The current study revealed that errors could create positive and negative impacts on the emergency nurses' attitude. Confronting the errors through learning from the mistakes can result in the improvement of patients' safety whereas the negative outcomes can provoke destructive effects on nurses' career. Nurses are considered as victims of errors; therefore, they need support and protection to enhance their career.

Introduction: Parents who care for Thalassemia children tolerate a great burden. Understanding these sufferings seems necessary in order to provide appropriate care. This study was aimed to explore the experiences of parents who have children with thalassemia. Method: A qualitative approach was used to obtain rich data. Twenty-two parents were recruited purposefully from one charity clinic in South East of Iran. Semi-structured interviews were used. Data were analyzed by Lundman and Granheim's content analysis method. Results: Data analysis led to form one main theme including “Parents’ Burden of care”. Within this theme the following categories created: immersion in suffering, stigma and social death, uncertainty about future, and absence of a support network. Conclusion: The findings of this study showed that Caring for children with thalassemia have a significant impact on the lives of caregivers and alleviating caregivers’ burden is critical to managing parents. This research may be useful in terms of increasing information about thalassemia and raising consciousness of nurses and other health care providers.

The time spent waiting through the surgery of a loved one is stressful for family members because of their worries regarding the procedure and potential outcomes. In Iran, the attention and support of healthcare professionals focus almost exclusively on the patient. No studies have explored the related support experiences of family members. Understanding these experiences may facilitate the development by healthcare professionals of support strategies to alleviate the surgery-related stresses of patients' family members.This study elucidates the support experiences of the Iranian families of patients undergoing surgery.A qualitative design using a content analysis approach was used to gather and analyze the support experiences of 16 Iranian families awaiting the conclusion of their relative's surgical operation. The study was conducted at a university medical center hospital in an urban area in Iran. After employing a purposive sampling method to select participants, semistructured interviews were used to collect data.Data analysis led to the development of two main themes: "interaction:" and "physical proximity." One significant finding was the role of productive interactions among family members to facilitate the passing of time and to provide a buffer. These interactions may take place among family members as well as among other companions.The findings of this study may be used to guide nursing practices and may help change nursing attitudes toward the family members of surgical patients. By better understanding the experience of families, nurses may improve their professional actions and reduce the stress experienced by family members while waiting for the conclusion of surgery.

Introduction:Courage is the ethical virtues that has special place in the nursing profession, whose role in patient support is highlighted. Courage virtues seems to grow with environmental reinforcement and social support. Hospital as a dynamic social institution has different forms of ethical climates. The purpose of this study was to determine the correlation between the ethical climate of the hospital and the moral courage of the nurses in one of the medical universities of Iran medical science’s selected hospitals.Method:This study is a descriptive-correlational study. The sample included 156 nurses who were selected by available method. A translated questionnaire of Olson’s ethical climate and Sekerka’s et al moral courage was used to collect data, in addition to demographic questions. The data were analyzed by SPSS software version 21 using descriptive and inferential statistics.Findings:Nurses’ perception of the ethical climates of the hospital was average (mean= 3.79, SD = 0.56) and their courage was moderate (mean 3.87, SD=0.86). There was a significant positive correlation between nurses’ ethical climates and their moral courage (r = 0.90, p

Background Currently, end-of-life care is a significant issue and a topic of debate in intensive care settings but understanding of nurses' perspectives about this within an Islamic context is surprisingly lacking. Aim The purpose of this study was to explore intensive care nurses' perspectives of the end-of-life care in South-east of Iran. Methods A descriptive qualitative research approach was used to engage 12 intensive care nurses from three intensive care units of teaching hospitals affiliated to Kerman University of Medical Science in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. Results Four major categories emerged from analysis of the interviews: commitment to care, awareness of dying patients, caring relationships, and dealing with barriers and ethical issues. The first category was emphasized and appeared dominant in all interviews. Limitation Because of specific socio-cultural and environmental factors, the findings of this study may not be applicable in other contexts, but enhance our knowledge about the topic in an Islamic context. Conclusions This study emphasizes the importance of looking at the end-of-life care for critical terminally ill patients within the context of spiritual milieu associated with commitment to a compassionate care until the last moment of their life. Intensive nurses, faced with various barriers and ethical issues, instead were focused on physical and spiritual care and believed that it should fulfil their role in the challenging process. Implications for nursing and health policy These findings indicate that there is a need for policies that help increase the quality of life of dying patients. It is imperative that nursing managers and policy makers in Iran consider these findings to improve end-of-life care in intensive setting. More training programmes, further education and research on the topic, should be implemented.

Summary Purpose Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. There is a lack of adequate attention for this problem. This study aims to explore the challenges of the health care process in rural Iran according to health care providers' experiences. Methods This was a qualitative study that used the content analysis method. We selected a total of 21 health care providers based on purposive sampling. Data collection consisted of semi-structured individual interviews that were analyzed by qualitative content analysis. Results Data analysis led to the formation of one main category, the challenges of process of health care in rural society. Within this main category, we created the following subcategories: change in characteristics of the rural society, increase in complexity of the health care process, decrease in workforce efficiency, and decrease in propensity of people's care. Conclusion The findings of this study indicate that the process of health care in Iranian rural society is changing rapidly with community health workers encountering new challenges. There is diminished efficiency in responding to the changing care process in Iran's rural society. Considering this change in process of care, therefore, the health care system should respond to these new challenges by establishing new health care models.