Analytical study of care quality and moral distress in clinical situations and patient care

Objective: Nursing profession conventionally meets a high standard of ethical behavior and action. One of the ethical challenges in nursing profession is moral distress. Nurses frequently expose to this phenomenon which leads to different consequences such as being bored by delivering patient care that decline care quality and make it challenging to achieve health purposes. This study was conducted to investigate the association between the aspects of moral distress and care quality.Methods: In this descriptive–analytical study, 545 nurses of intensive and cardiac care units and dialysis and psychiatric wards were recruited by census sampling. Three questionnaires, Sociodemographics, Moral Distress Scale, and Quality Patient Care Scale, were distributed among the participants and collected within 9 months. Data analysis was conducted by descriptive statistics, analysis of variance, and the least significant difference in SPSS 13.Results: Investigating moral distress domains(ignoring patient, decision-making power, and professional competence) and care quality domains(psychosocial, physical, and communicational) demonstrated that in being exposed to moral distress, ignoring patient had no effect on psychosocial domain(P=0.056), but decision-making and professional competence of moral distress had positive effect on psychosocial, physical(bodily), and communication domains of care quality.Conclusions: Because moral distress domains are effective on patient care quality, it is recommended to enhance the knowledge of nurses, especially beginners, about moral distress, increase their strength alongside standardizing nursing services in decisionmaking domains, improve the professional competence, and pay attention to patients.

Investigation on Relationship between Test Anxiety and Academic Performance of Nursing and Midwifery Students in Tabriz and Maragheh—Iran

Background and Aim: Given the dramatic decline in the ability of test due to test anxiety, the goal of this study was to evaluate the relationship between test anxiety and academic performances in students. Materials and Methods: This descriptive-analytical study was performed on 216 Iranian nursing and midwifery students in 2011-2012, utilizing Sarason Anxiety Inventory, demographic checklist and the average mark of students in the period of midterm and final exam. Multinomial logistic regression analyses by reporting odds ratios and their 95% confidence intervals were performed by SPSS17 software to assess the relationship between test anxiety and academic performances. Results: Mild, moderate and sever test anxiety was observed in 30.6, 43.1 and 26.4 percent of students respectively. Test anxiety was significantly related to academic performance (average), major and city. Also, there was 52.9% decrease for odds of having sever anxiety (compared to mild anxiety) with 1 point increase in average (OR = 0.471, 95% CI = (0.298 - 0.745) and p = 0.001). Conclusions: Due to inverse relationship between test anxiety and academic performance, performing preventive programs such as in time treatment of anxiety, empowering the students to deal with anxiety and conducting consulting services for how to studying are very important. Consequently it would be a big step in decreasing the test anxiety and therefore in improving the academic performance.

Transcutaneous bilirubin nomogram for evaluating the risk of hyperbilirubinemia in Iranian healthy newborns

Background Hyperbilirubinemia,which is mostly benign,is one of the most common problems in neonates.This study was conducted to draw a skin bilirubin nomogram for evaluating the risk of hyperbilirubinemia requiring treatment.Methods This cross-sectional study recruited 1066 healthy infants.The first transcutaneous bilirubin(TcB)measurement was performed before hospital discharge and within 12-48 h of birth.The neonates were followed up for 6 days after discharge based on their age at the time of discharge.The neonates were divided into four groups based on the TcB values before discharge and age in hours,including the low-risk,medium-low-risk,medium-high-risk and high-risk groups.The percentage of neonates who progressed toward severe hyperbilirubinemia was then calculated in each percentile based on the follow-up TcB measurement.Stata software was used to draw the nomogram.Based on the TcB values at discharge and the neonate's age in hours,the skin bilirubin nomogram was drawn in 40,75 and 95 percentiles.Results A total of 4.9%of the neonates were in the high-risk group,18.9%in the medium-high-risk group,34.8%in the medium-low-risk group and 41.2%in the low-risk group.The risk of severe jaundice in the follow-up of the neonates in the highest-risk to the lowest-risk groups was 48.9,14.5,9.7 and 3.3%,respectively.Conclusion The skin bilirubin nomogram can be used to predict severe hyperbilirubinemia in Iranian infants.