Background Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses’ moral reasoning, moral distress and moral sensitivity. Methods In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. Results Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238–15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171–2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15–5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043–12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454–16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015–0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015–0.547, P = 0.009). Conclusions The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. Registration This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.
Background: Nurses, as health advocates and front-line fighters in the coronavirus disease 2019 (COVID-19) pandemic, experience severe professional stress and psychological crises. Objectives: The present study was conducted to explain the nurses’ perception of expected organizational and professional support during the COVID-19 pandemic. Methods: In this qualitative study, data collection was performed through semi-structured, individual, and in-depth interviews. A total of 20 nurses participated in the study through purposive sampling. The data were collected within June-October 2021. The collected data were analyzed based on Granheim and Lundman’s method. Results: The findings of the study were presented in the form of 4 main themes and 10 subthemes, including lack of physical support (i.e., lack of tools and equipment and problems concerning using personal protective equipment to care for COVID-19 patients), lack of psychological support (i.e., paying attention to nurses’ job stress and mutual understanding of managers and nurses), lack of welfare support (i.e., high workload, financial support, providing facilities for nurses for employment, and providing facilities to support staff in childcare), and weakness in efficient crisis management (i.e., insufficient attention of managers to the principles of crisis management and the lack of a standard infectious disease hospital for COVID-19 patients). Conclusions: Health system policymakers should provide comprehensive physical, psychological, and welfare support for nurses, effective professional and organizational context, and efficient crisis management to improve the quality of care.
Background: Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity.Methods: In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n=22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals.Results: In adjusted regression analysis after intervention, the nursing principled thinking (NPT) score was significantly increased in group discussions vs. lectures group (OR: 13.078, 95%CI: 3.238-15.954, P=0.008), lectures group vs. control group (OR: 14.329, 95%CI: 2.005-16.171, P<0.001) and group discussions vs. control group (OR: 18.01, 95%CI: 5.834-22.15, P<0.001). The moral sensitivity score was significantly increased in group discussions vs. lectures group (OR: 10.874, 95%CI: 6.043-12.886, P=0.005) and group discussions vs. control group (OR: 13.077, 95%CI: 8.454-16.774, P=0.002). However, the moral distress score was significantly decreased in lectures group vs. control group (OR: 0.105, 95%CI: 0.015-0.717, P=0.021) and group discussions vs. control group (OR: 0.089, 95%CI: 0.015-0.547, P=0.009). Conclusions: The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students.Registration: This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.
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