Background and Aim: The present study was carried out aiming to determine the relationship between moral distress and moral sensitivity among nurses. Materials and Methods: This descriptive analytical study was conducted on 257 nurses employed in teaching hospitals affiliated to Birjand University of Medical Sciences (South Khorasan) in 2015. Available sampling was done among the nurses working in intensive care units (ICU, CCU, NICU and dialysis) in the whole province meeting the inclusion criteria. The data collection tool was a three-part questionnaire consisting of the demographic information questionnaire, Corly moral distress questionnaire, and the Korean version of the Hun moral sensitivity questionnaire. The collected data were analyzed running SPSS statistical software version 16. Ethical Considerations: Written consent was obtained from all participants. Additionally, all of them were assured of anonymity of the questionnaires and confidentiality of the information. Findings: There was no significant relationship between moral distress and the nurses' moral sensitivity (P=0.2). The mean scores (out of 5) were 3.5±0.66 for the total moral distress, 3.5±0.75 for the intensity of moral distress, and 3.54±0.66 for the frequency of moral distress, respectively. The mean for moral sensitivity (out of 4) was 3.1±0.45. There was a statistically significant relationship between moral sensitivity and moral distress with age and years of work experience, and also between moral distress and the type of the ward (P<0.05). Conclusion:The findings indicates that nurses who do not have sufficient executive power for moral performance will experience moral distress, despite their high and low levels of moral sensitivity. Thus, it is necessary hospital administrators to take some specific measures to carry out periodic evaluation of this phenomenon, and hold some codified trainings in this regard.

Background:The long-term complications of hemodialysis deteriorate patients' quality of life and lead to physical and mental discomfort. Physiologically, sports activities can play an important role in reducing these side effects including muscle cramps. Objectives: The aim of this study was, to determine the impact of isotonic exercise on the frequency of muscle cramps. Methods: This clinical trial was carried out on 60 hemodialysis patients admitted to the dialysis units of Shahrekord and Borujen hospitals in 2014. The intervention included an isotonic exercise program that was implemented during 10 sessions of constant cycling (each lasting 10 minutes) immediately before dialysis. The outcome variable was the number of muscle cramps in patients during the hemodialysis session. The data were analyzed in SPSS-16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential tests (independent and paired t-tests). Results: The mean frequency of leg cramps before the intervention was not significantly different between the two groups (P = 0.10). However, it was significantly different between the groups after the intervention (P = 0.001). Moreover, the number of muscle cramps in the experimental group was significantly lower after the intervention than before implementing the program (P = 0.03). Conclusions:The isotonic exercise of constant cycling has a considerable effect on decreasing the number of muscle cramps in hemodialysis patients. Hence, it is suggested that dialysis units provide facilities for constant walking and cycling to accelerate patients' treatment.

Background: In order to achieve the goals of the healthcare system, nursing managers are required to comply with ethical principles in decision-making. In complex and challenging healthcare settings, it is shown that the managers’ mere awareness of ethics does not suffice and managers need to be sensitive toward making ethical decisions. Aim: To explore nursing managers and their sensitivity toward ethical decision-making by analyzing their related experiences. Method: The current study has been conducted in Iran in 2017 through a qualitative content analysis approach. Nineteen nurse managers were selected purposefully from different hospitals in Tehran. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method. Ethical considerations: The research was approved by the ethics committee of Tarbiat Modares University, Tehran, Iran. Participants were informed about the purpose of the study and submitted written informed consents regarding their participation. The principle of autonomy, confidentiality, and anonymity was taken into account in data collection. Results: Fifteen subcategories, three categories (assertiveness, commitment, and insight), and one theme of excellent decision-making were the results of data analysis. Discussion: Findings showed that nursing managers’ sensitivity to ethical decision-making allows them to make the best decision by insight, commitment, and assertiveness. Making a morally excellent decision ensures that ethical principles are followed in the healthcare system. Conclusion: Considering that most managers are committed to making ethical decisions, it is required to develop the scope of their insights even further using a professional management and ethical principles training program. Also, by addressing some of the ethical barriers at personal and organizational levels, the assertiveness in managers can be improved, which in turn can facilitate their ethical decision-making.

Background and Aim: Phenomenon of moral distress in critical care environments, have different effects on the quality of care and good communication between members of caring team, especially Physician and nurses could to be effective in prevention of moral distress in nurses through creating desirable ethical atmosphere. This study aimed to determine the relationship between moral distresses with the Physiciannurses relationship in ICUs of the South Khorasan province. Materials and Methods: 215 nurses were recruited to the study by convenience method. Corly moral distress questionnaire and Shortell questionnaire of communication assessment between physician and nurses in ICUs were used for data collection. Data were analyzed by SPSS 16 software and using descriptive and inferential statistics. Ethical Considerations: Participants verbal consent was obtained and anonymously and confidentiality of the completing questionnaires was assured to them. Findings: The mean scores of moral distress severity, moral distress frequency and Physician-nurses relationship were 3±0/59, 3/66±0/5 and 3/2±1/1, respectively. There was significant direct correlation between mean score of communication between physician and nurses with moral distress frequency (r=-0/34, P<0/05). But there was not any correlation between Physician-nurses relationship moral distress severity. Conclusion: regarding undeniable role of good communication between physician and nurses in reducing the frequency of moral distress, it is necessary to determine the effective factors on this relationship and also provide strategies to promote desirable ethical atmosphere, in order to diminish of this phenomenon.

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Background & Aim: People with spiritual health are capable and strong individuals who have a higher power of control and social support and can adjust themselves to spirituals tensions and make the necessary interventions to deal with problems and crises. With regard to the holistic care approach, which focuses on all aspects of human beings, the spiritual health of healthcare team members, especially nurses, plays a key role in holistic care provision. Meanwhile, favorable spiritual health must be established in students who want to provide care to patients in the future. The formation of spiritual beliefs in the education period is extremely important in the spiritual attitude of students towards the spiritual issues of patients. The more the spiritual health of students, the higher the ability of these individuals to provide spiritual care, which is a component of the holistic care of patients. One of the factors affecting the promotion of spiritual health is spiritual intelligence. In fact, students with high spiritual intelligence have an accurate understanding of various health dimensions (e.g., spiritual health) and can effectively extend health by transferring this comprehension to clinical environments. With this background in mind, this study aimed to determine the relationship between spiritual intelligence and spiritual health in nursing students. Materials & Methods: This descriptive, analytical, and cross-sectional study was performed on nursing students in Boroujen, Iran in 2017. In total, 178 subjects were selected by the census method from three disciplines of nursing, emergency and operating room, and all four academic years. The exclusion criteria were being an employee and passing spiritual education courses or participating in spiritual education workshops. Data were collected using a demographic characteristics questionnaire, a spiritual intelligence questionnaire, and a spiritual health questionnaire. The demographic characteristics questionnaire included variables such as age, gender, academic year, the field of study, marital status, place of residence, and GPA. In addition, the spiritual intelligence questionnaire was formerly implemented and confirmed by Badi et al. using the content analysis method. The questionnaire contains 42 items in four areas of (general thinking and doctrinal dimension, the ability to deal with and interact with problems, addressing moral issues, self-awareness, love, and interest). The items of the questionnaire were scored based on a five-point Likert scale from completely disagree (one score) to completely agree (five scores). The total score of the questionnaire is in the range of 42-210, where a low, moderate, and high score is in the range of 42-97, 98-153, and 154-210, respectively. Furthermore, the Palutzian & Ellison spiritual health questionnaire (1998) includes two spiritual health and existential health dimensions and 20 items scored based on a six-point Likert scale from completely disagree (one score) to completely agree (six scores). The total spi...

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