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November 2017 -
Volume 15, Issue 9

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From the Editor

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Original contribution/Clinical Investigation
Diabetes Mellitus - Knowledge, Management and Complications: Survey report from Faisalabad-Pakistan
Ijaz Anwer, Ahmad Shahzad, Kashmira Nanji, Farah Haider, Muhammad Masood Ahmad

Alanine aminotransferase indicates excess weight and dyslipidemia
Mehmet Rami Helvaci, Orhan Ayyildiz* Mustafa Cem Algin, Yusuf Aydin, Abdulrazak Abyad, Lesley Pocock

Comparative Analysis of Antimicrobial Peptides Gene Expression in Susceptible/Resistant Mice Macrophages to Leishmania major Infection

Hamid Daneshvar, Iraj Sharifi, Alireza Kyhani, Amir Tavakoli Kareshk, Arash Asadi

Does socio-economic status of the patients have effect on clinical outcomes after coronary artery bypass grafting surgery?
Forough Razmjooei, Afshin Mansourian, Saeed Kouhpyma

Comparison of the uterine artery Doppler indices during pregnancy between gestational diabetes and diabetes mellitus and healthy pregnant women
Nazanin Farshchian, Farhad Naleini, Amir Masoud Jaafarnejhad,
Parisa Bahrami Kamangar

Survey single dose Gentamicin in treatment of UTI in children with range of 1 month to 13 years old in Jahrom during 2015
Ehsan Rahmanian, Farideh Mogharab,
Vahid Mogharab

Evaluation of control of bleeding by electro cauterization of bleeding points of amplatz sheath tract after percutaneous nephrolithotomy (PCNL) in Jahrom Peymanieh hospital during year 2015-2016
Ali Reza Yousefi , Reza Inaloo

Comparison of the three-finger tracheal palpation technique with triple ID formula to determine endotracheal tube depth in children 2-8 years in 2016-2017
Anahid Maleki, Alireza Ebrahim Soltani, Alireza Takzare, Ebrahim Espahbodi,
Mehrdad Goodarzi , Roya Noori

Effect of Sevoflurane and Propofol on pulmonary arterial pressure during cardiac catheterization in children with congenital heart diseases
Faranak Behnaz, Mahshid Ghasemi , Gholamreza Mohseni, Azim Zaraki
Population and Community Studies

Prevalence and risk factors of obesity in children aged 2-12 years in the Abu Dhabi Islands
Eideh Al-Shehhi, Hessa Al-Dhefairi, Kholoud Abuasi, Noora Al Ali, Mona Al Tunaiji, Ebtihal Darwish

Study and comparison of psychological disorders in normal students and students with multiple sclerosis in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Comparative study of self-concept, physical self-concept, and time perspective between the students with multiple sclerosis and healthy students in Shahrekord
Neda Ardestani-Samani, Mohammad Rabiei, Mohammad Ghasemi-Pirbalooti, Asghar Bayati, Saeid Heidari-Soureshjani

Relationship between Coping Styles and Religious Orientation with Mental Health in the Students of the Nursing-Midwifery Faculty of Zabol
Nasim Dastras, Mohsen Heidari Mokarrar, Majid Dastras, Shirzad Arianmehr

Tuberculosis in Abadan, Iran (2012-2016): An Epidemiological Study
Ali-Asghar ValiPour, Azimeh Karimyan, Mahmood Banarimehr, Marzieh Ghassemi, Maryam Robeyhavi, Rahil Hojjati,
Parvin Gholizadeh

Family Stability and Conflict of Spiritual Beliefs and Superstitions among Yazdi People in Iran: A Qualitative Study
Zahra Pourmovahed , Seyed Saied Mazloomy Mahmoodabad ; Hassan Zareei Mahmoodabadi ; Hossein Tavangar ; Seyed Mojtaba Yassini Ardekani ; Ali Akbar Vaezi

A comparative study of the self-actualization in psychology and Islam
Simin Afrasibi, Zakieh Fattahi

The effectiveness of cognitive - behavioral therapy in reducing the post-traumatic stress symptoms in male students survivors of earthquake in the central district of Varzeghan
Sakineh Salamat, Dr.Ahad Ahangar, Robab Farajzadeh

Reviews

Effects and mechanisms of medicinal plants on stress hormone (cortisol): A systematic review
Kamal Solati, Saeid Heidari-Soureshjani, Lesley Pocock

Comparing Traditional and medical treatments for constipation : A Review Article
Mohammad Yaqub Rajput

A review of anti-measles and anti-rubella antibodies in 15- 25 year old women in Jahrom City in 2011
Ehsan Rahmania , Farideh Mogharab, Vahid Mogharab

Review of percutaneous nephrolithotomy in children below 12 years old in Jahrom hospital, during 2010-2014
Ali Reza Yousefi , Reza Inaloo

Physical and mental health in Islam
Bahador Mehraki, Abdollah Gholami

International Health Affairs

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses
Saeedeh Elhami, Kambiz Saberi, Maryam Ban, Sajedeh Mousaviasl, Nasim Hatefi Moadab, Marzieh Ghassemi

Cognitive Determinants of Physical Activity Intention among Iranian Nurses: An Application of Integrative Model of Behavior Prediction
Arsalan Ghaderi, Firoozeh Mostafavi, Behzad Mahaki, Abdorrahim Afkhamzadeh,
Yadolah Zarezadeh , Erfan Sadeghi

Effect of resilience-based intervention on occupational stress among nurses
Hossein Jafarizadeh, Ebrahim Zhiyani, Nader Aghakhani, Vahid Alinejad, Yaser Moradi

Education and Training

Calculation of Salaries and Benefits of Faculty Members in the Ministry of Health and Medical Education of Iran
Abdolreza Gilavand

The effect of education on self-care behaviors of gastrointestinal side effects on patients undergoing chemotherapy
Shokoh Varaei, Ehsan Abadi Pishe, Shadan Pedram Razie, Lila Nezam Abadi Farahani

Creating and Validating the Faith Inventory for Students at Islamic Azad University of Ahvaz
Solmaz Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Creating and Validating the Adjustment Inventory for the Students of Islamic Azad University of Ahvaz
Homa Choheili, Reza Pasha, Gholam Hossein Maktabi, Ehsan Moheb

Evaluating the Quality of Educational Services from the Viewpoints of Radiology Students of Ahvaz Jundishapur University of Medical Sciences
Abdolreza Gilavand, Jafar Fatahiasl

An Investigation of Psychosocial aspect of Iranian Nursing Students' Clinical Setting
Mahsa Boozaripour , Zanyar Karimi, Sima Zohari Anbohi, Amir Almasi-Hashiani, Fariba Borhani

Clinical Research and Methods

Comparison of the Antibacterial Effects of Chlorhexidine Mouth washes with Jaftex Mouth wash on Some Common Oral Microorganisms (An in Vitro Study)
Ebrahim Babadi, Zahra Bamzadeh, Fatemeh Babadi

Study of the effect of plasma jet on Fusarium isolates with ability to produce DON toxins
Elham Galin Abbasian, Mansour Bayat, Arash chaichi Nosrati, Seyed Jamal Hashemi, Mahmood Ghoranneviss

The comparison of anti-inflammatory effect in two methods of topical dexamethasone injection and topical application of ginger alcoholic extract after removing mandibular wisdom teeth
Sahar Zandi, Seyyed Muhammadreza Alavi, Kamran Mirzaie, Ramin Seyedian, Narges Aria, Saman Jokar

The effect of curcumin on growth and adherence of major microorganisms causing tooth decay
Leila Helalat, Ahmad Zarejavid, Alireza Ekrami, Mohammd Hosein Haghighizadeh, Mehdi Shiri Nasab


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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November 2017 - Volume 15, Issue 9

The Challenges of Implementation of Professional Ethics Standards in Clinical Care from the viewpoint of Nursing Students and Nurses


Saeedeh Elhami (1)
Kambiz Saberi
(1)
Maryam Ban
(2)
Sajedeh Mousaviasl
(2)
Nasim Hatefi Moadab
(3)
Marzieh Ghassemi
(2)

(1) Student research committee, Abadan school of medical sciences, Abadan, Iran
(2) Abadan school of medical sciences, Abadan, Iran
(3) Student research committee, Kermanshah university of medical sciences, Kermanshah, Iran


Corresponding author:
Marzieh Ghassemi
Abadan School of Medical Sciences,
Abadan, Iran

Abstract

Background and Objectives:
Observing the professional ethics in providing nursing care is an inseparable part of this profession as overstepping it influences patient satisfaction and recovery, quality of care, standards of nursing care and promotion of occupation. Therefore, this study was conducted aiming to determine the barriers of observance of professional ethics standards in clinical care from the viewpoint of nursing students and nurses.

Methods: In this descriptive cross-sectional study, viewpoints of 180 nurses and nursing students of Abadan Faculty of Medical Sciences regarding the barriers of observance of professional ethics standards in clinical environment were collected using demographic information questionnaire and barriers of observance of professional ethics criteria in three domains including Managerial, environmental and individual care were collected and analyzed using SPSS software.

Results: In both groups of nursing students and nurses, the highest average of management, environmental, and personal care services area are related to the environmental domain (p <0.005).

Conclusion: Observance of the professional ethics standards in nursing practice, especially factors related to environmental dimension which is one of the most important barriers to professional ethics, can play an important role in improving and restoring the health of patients. Therefore, the management system and health system managers can play effective roles in observance of the best criteria of professional ethics through accurate planning and providing human resources and improving the conditions of service for medical personnel, including improving the conditions of sectors and satisfying their expectations in different fields.

Key words: Nursing Ethics, Clinical Care, Nursing Students, Nurses


RESEARCH QUESTIONS

Adherence to professional ethics in the provision of nursing care has always been emphasized. But it seems that due to the changing viewpoints on health and changes in the health system, the ethical approach in healthcare professions has changed from a request and recommendation to an undeniable necessity (1). Nursing ethics is the observance of professional ethics in the provision of nursing care and also the inseparable part of the nursing profession (2). Any nursing ethical impairment can affect the most scientific and best nursing care (3). Nurses are responsible for caring for the patients as members of the healthcare team. Members of this team spend a lot of time with the clients and have a lot of contact with them due to the nature of their work. Therefore, care involves human and moral relationships as the central concept of nursing. Caring for the clients in all its dimensions has an ethical nature, so that the subject of ethics and nursing are thought to be two basic elements, and historically, nursing is one of the first professions that have addressed ethical issues (4).

Many years have passed from establishment of the codes of ethics for the nursing profession, which shows the importance of ethics as one of the main elements of this field (4). However, the issue of ethics and ethical competence of nurses still maintains its importance in various educational, management and research dimensions. In other words, the establishment of codes of ethics alone cannot provide the necessary moral excellence in the various dimensions of nursing services. Many nurses consider ethical codes of professional ethics in regard to ethical issues, but do nothing about it.

In many cases, they do not have enough power and support to show their reaction, and sometimes they do not know what to do (6). The results of studies in the field of ethics indicate weakness in the ethical decision-making of nurses (7). Zirak et al. in their research stated that only about half of the students are at an acceptable level of moral development (8). According to the studies, the average score of moral reasoning in nurses abroad was 51.74 and in Iran was 42/16 (9). Sokhanvar states that “The rate of observance of ethical principles in clinical decision making is not desirable, and nurses have no ability to apply ethical knowledge in the real environment.” Therefore, it is necessary to monitor the rate of observance of nursing ethics codes from the source of nursing ethics education, that is, nursing schools, in order to determine the extent to which students have weaknesses so that nursing managers provide more complete education in that dimension. The importance of nursing schools in nursing ethics education is as extent as Kelly in his research concluded that colleges are the most influential force in shaping ethics in nursing students (10). The results of a study in 2007 on the study of nursing ethics training in Turkey revealed that inappropriateness of the trained teaching methods of ethics and ethical content is one of the most important barriers to the development of nursing students’ abilities to deal with ethical issues (11).

Borhani et al, reviewed the perception of nursing students about the barriers to professional ethics. In their results, they referred to eight themes: lack of motivation and interest in nursing profession, inadequate self-awareness, lack of ethics teachers, lack of curriculum, using inappropriate methods in ethics training, ethical evaluation problems, weakness of interpersonal communication, and constraints of clinical environment (12).

Most nurses agree with each other and their viewpoint is that they have some barriers to ethical performance in their work environment that disturbs their ability to provide competent and quality care [13]. Lack of observance of the professional ethics in the health system by nurses affects patient satisfaction and recovery, quality of care, nursing care standards and promotion of care (14). Researchers have also considered moral sensitivity to be influenced by the education, culture, religion, education, and life experiences of individuals (15). Naturally, cultural contexts influence the crucial issues of moral sensitivity. Accordingly, barriers are no exception to this rule. Therefore, multiple studies in different societies have led to the recognition of different aspects of moral sensitivity (16). However, due to the lack of studies on the barriers of professional ethics in nursing performance and since one of the important achievements of codes of ethics is the facilitation of the implementation of clinical governance, which involves taking actions to minimize the risk for employees and patients, paying attention to patient complaints and using the best evidence available in clinical decision making (17), and also, identification of ethical barriers and appropriate ethical decision making leads to positive psychological responses such as satisfaction, increased motivation and sense of competence in nurses and patients (18). The aim of this study was to determine the barriers of observance of professional ethics standards in clinical care from the viewpoint of nursing students and nurses. It seems that a comprehensive view of this important issue can be valuable.

MATERIALS AND METHODS

The present study is a cross-sectional descriptive study. The research population includes full-time nurses occupied in Abadan Faculty of Medical Sciences and nursing students of Abadan Faculty of Medical Sciences who have inclusion criteria such as the baccalaureate degree in nursing, employment in one of the Internal surgical departments, at least six months of working experience, lack of responsibility at managerial posts, for nurses and students who have at least the first year of study. Sampling was conducted as a convenience sample from a total of 180 students and nurses participating in the study. After obtaining the necessary permission, the questionnaires were distributed by the researcher through the expression of the goals of the research and obtaining informed consent and frequent attendance at the appropriate time. It should be noted that the subjects completed the questionnaire freely and without direct supervision, and then the completed questionnaires were collected simultaneously by the researcher.

The questionnaire consisted of two sections: demographic information and barriers to observance of the professional ethics criteria in three areas of management, environment and personal care. Demographic data including age, gender, place name and work experience, and questionnaire of evaluation of the barriers of the observance of professional ethics criteria including 33 questions (14 questions related to the management domain, 5 questions related to environmental domain, 14 questions related to the field of care). Items were answered with a five-point scale. Selection of the options of “I totally agree” or “I agree” indicates that the raised item is a barrier to the observance of professional ethics standards. Selection of “I am opposite” option indicates that the raised item does not impede the observance of professional ethics standards from nurses’ viewpoint. Selection of the “I have no idea” option indicates that the lack of knowledge of the effect of the variable (question) in question is inadequate to professional ethics. Cronbach’s alpha coefficient for the reliability and internal consistency of the questionnaire has been calculated by Dehghani et al. (19) (89).

RESULTS

The demographic variables included: age, gender, and work record, and the results are presented in Table 1. The average age was 377/4 227/24.

Table 1: Descriptive statistics of demographic variables


Comparison of the barriers of the observance of the standards of professional ethics in clinical care from the viewpoint of nursing students with nurses of the Faculty of Medical Sciences of Abadan are presented in Table 2. Due to the normal or non-normal distribution of the sample, the appropriate test was used.

Click here for Table 2: Comparison of the barriers of observance of the Professional Ethics Standards in General and on the basis of the areas (Managerial, Environmental, Individual Behaviors) in Clinical Care from the viewpoint of nursing students of the Faculty of Medical Sciences of Abadan

Comparison of the viewpoints of nursing students and nurses on three areas including managerial, environmental, and individual with regard to the non-normal distribution of managerial and environmental domains was conducted using Kruskal-Wallis test and the results are presented in Table 3.

Click here for Table 3: Comparison of Managerial, Environmental, and Individual Behaviors Barriers Observing Professional Ethics Standards in Clinical Care from the Viewpoint of nursing students and nurses of the Faculty of Medical Sciences of Abadan

DISCUSSION

The findings of this study provide a view of barriers of observance of the professional ethics standards from the viewpoint of nursing students and nurses in three areas of managerial, environmental and individual care.

In both groups of nursing students and nurses, the highest average was related to the environmental area. The lack of proper facilities and equipment in the department, biological changes in the body during night shift, crowding, shift work, unexpected expectations of patients and their companions from nursing staff are involved among the factors related to this area. Naturally, an environment organized in accordance with the standards of care provides the initial conditions for ethical work. Although, for most nurses, care for patients is not very important, sometimes clinical environments that do not have standards of care have a negative effect on their performance and their care of the patient (21, 20). Meanwhile, Schluter also emphasized the role of these factors as barriers of achievement of professional ethics standards (22). Bennet et al. (2008) point out crowding as the main barrier for nurses in applying research evidence and observance of the professional ethics in care (23). Dierckx in a study on the management of the American Nurses Association pointed to the environmental factors such as lack of nursing staff, high workload, insufficient time, and financial and organizational constraints from nurses’ viewpoints as important barriers of the lack of observance of professional ethics.

One of the other important barriers of observance of professional ethics in this study is the lack of experience of educators in ethical and legal issues in nursing education, which is one of the management factors. Borhani et al in a qualitative study on the students revealed the role of these factors as the top barriers to achieving professional ethics standards (12). The results of a study in 2007 in nursing ethics in Turkey also suggest the inappropriateness of teaching methods of ethics and ethical content as one of the most important barriers to develop abilities of nursing students to deal with ethical issues (11) while Nasiriani and his colleagues have also confirmed this (22). Health care organizations can familiarize the nurses with the principles and standards of care, the importance of observance of professional ethics in improving patients’ conditions and disadvantages of lack of observance of the ethics in therapeutic systems using appropriate and practical training. Applicable training and expressing concrete examples in this field as well as teaching time management, along with direct monitoring of clinical interventions, can help remove the barriers.

From the viewpoint of nurses, they