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   Table of Contents - Current issue
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March-April 2021
Volume 26 | Issue 2
Page Nos. 89-188

Online since Friday, March 5, 2021

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ORIGINAL ARTICLES  

Adjustment to a new heart: Concept analysis using a hybrid model Highly accessed article p. 89
Parvaneh Asgari, Alun C Jackson, Fatemeh Bahramnezhad
DOI:10.4103/ijnmr.IJNMR_9_20  
Background: Although the phenomenon of adjustment to a new heart in transplant recipients is very complex, very few studies have been conducted on this important issue. Therefore, no careful and clear definition exists for this concept. Materials and Methods: This concept analysis was conducted in Iran in 2018 on 13 patients undergoing heart transplantation. In the theoretical phase, a conceptual framework was created according to the existing data in the literature about the phenomenon. In this study, 13 participants were selected using purposive sampling with maximum diversity.-Ž In the fieldwork phase, 20 deep and semistructured interviews were conducted with patients undergoing heart transplantation over 4 months. After data saturation, interviews were analyzed using the qualitative content analysis method proposed by Granheim and Lundman (2009). At the final analytical phase, the results of the two previous phases were integrated using a hybrid model. Results: Adjustment to a new heart is a unique multiphase process in patients undergoing heart transplantation. The antecedents include the transplantation time, physical conditions, social and family support, relationship with congeners, and spiritual beliefs. The desirable consequences of adjustment to a new heart may include a new life, inner peace, and spiritual excellence, and the undesirable consequences may include psychological abuse and emotional stagnation. Conclusions: According to the results, the health-care team should consider the patient as a unique client and initiate discussions before and following heart transplantation that address patients' adjustment to a new heart in all their physical, sexual, and emotional aspects.
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Termination of pregnancy for fetal anomalies: A qualitative study of the informational and educational needs of women p. 97
Bahareh Kamranpour, Mahnaz Noroozi, Masoud Bahrami
DOI:10.4103/ijnmr.IJNMR_94_20  
Background: Diagnosing congenital fetal anomalies before birth is considered an emotionally devastating experience. To facilitate the process of compatibility with this event, healthcare providers should determine various needs of these women. The present study was conducted to explore the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies. Materials and Methods: The present study was a qualitative content analysis. Forty participants (women, their spouses, and healthcare providers) in Rasht city, Iran, were selected using purposive sampling method with maximum variety and their data were gathered using in-depth interviews and field notes. Data were analyzed using conventional qualitative content analysis with Graneheim and Lundman approach. Results: After analyzing the text of the interviews, the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies were categorized in three main categories of “receiving information tailored to the client's circumstances,” “learning life skills to cope,” and “getting prepared for the next pregnancy.” Conclusions: The results, by exploring and magnifying the informational and educational needs of these women, could present an appropriate context for providing principal care and cultural-based interventions with an emphasis on comprehensive education and counseling. Also, proper implementation of the process of obtaining informed consent from the women to terminate the pregnancy is essential. These could facilitate the conditions for their return to normal life and ultimately promote their health.
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The process of promoting spiritual health in iranian muslim adults: A grounded theory p. 104
Azita Jaberi, Marzieh Momennasab
DOI:10.4103/ijnmr.IJNMR_92_19  
Background: Spiritual health is a complex concept and it is important to review its promotion and evolution from a Muslim point of view in Iran. So, the present study was designed to explore the process of spiritual health promotion among Iranian Muslims. Materials and Methods: This study is a grounded theory in which the continuous comparative analysis method Strauss & Corbin (1998) was used to analyze data. This study's sampling method was purposive in trying to select participants with the maximum variation. Results: The “striving effort to promote spiritual health” was the core category which was the participants' strategy of the participants to confront their main concern, “to achieve transcendence”. The essential spiritual process in this study was “the journey in the transcendence path”. People would find the purpose and meaning of life by interconnecting and relying on their inner forces, and by establishing the moderation between the dimensions of existence. In this way, individuals will become closer to human perfection with the help of these components. They will achieve immersive wellbeing and moral maturity through the consolidation of spiritual health. Such a person lives to serve among the people. Conclusions: Adult promotion of spiritual health is dynamic and complex. The main process in this path is spiritual growth, which begins and continues as a result of the striving to advance spiritual health and refinement. Considering these findings has become a concern for holistic care within the scope of nursing care.
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Investigating the effect of family-centered self-care program based on home visits regarding dietary and medication regimen adherence of discharged patients with acute coronary syndrome p. 113
Maryam Montazami, Asghar Khalifehzadeh-Esfahani, Mahrokh Keshvari
DOI:10.4103/ijnmr.IJNMR_105_19  
Background: Dietary and medication regimen adherence in patients with history of Acute Coronary Syndrome (ACS) is very important in preventing readmission and reducing the complications of the disease. The objective of the present study was to investigate the effect of the family-centered self-care program based on home visits dietary and medication regimen adherence in patients with ACS discharged from Shahid Chamran Hospital during 2017-2018. Materials and Methods: This clinical trial was conducted on 80 ACS patients. The samples by using the random numbers table, were randomly divided into control and experimental groups. The routine interventions were administered for the control group, and family-centered self-care was conducted on patients of the experiment group. In order to obtain the quantitative data of this study, three questionnaires were used including demographic characteristics, Morisky questionnaire, and dietary adherence. Results: The difference between the mean score of medication and diet regimen adherence in both groups before the intervention was not significant (p > 0.05). data was demonstrated that scores of medication and diet regimen adherence were significantly higher immediately and 6 weeks after the intervention; (f = 64.06, p < 0.001). Conclusions: Family-centered self-care program based on home visits can be used as an effective method to increase the dietary and medication regimen adherence in ACS patients.
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Investigating reproductive life plan in pregnant women referred to teaching hospitals of Mashhad, Iran p. 120
Fatemeh Ghaffari Sardasht, Afsaneh Keramat, Zahra Motaghi
DOI:10.4103/ijnmr.IJNMR_13_20  
Background: Reproductive Life Planning (RLP) is a person-centered approach that investigates the reproductive needs, values, and priorities of each person and not only reduces the risk of unwanted pregnancies but also improves pregnancy outcomes and childbirth by investigating the health behaviors and underlying diseases of each individual. Therefore, the present study was conducted to assess RLP in pregnant women. Materials and Methods: This descriptive cross-sectional study was carried out on 1019 pregnant women who were referred to outpatient clinics of teaching hospitals in Mashhad, Iran, during May–August 2019. The participants were selected using a convenience sampling method. The data collection tool used was a questionnaire. Data analysis was performed in SPSS software. Results: The results of this study showed that about two-thirds of the participants had a plan for their reproductive years. The age range of the participants was 13–47 years. Among the women, 38.60' had experienced failure of contraceptive method, and 32.20' had an unmet need for family planning-Ž. Moreover, only one-third of the women had been referred for preconception care, but 88.70' of the pregnant women had their initial prenatal care visit in their first trimester. Conclusions: Given the considerable number of unwanted pregnancies and unmet needs for family planning in the present study, the modification of family planning policies seems necessary. Various strategies have been proposed to prevent unintended pregnancies such as RLP. The long-term goals of RLP are to plan pregnancies and improve maternal and infant outcomes.
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The predictive power of sleep quality by morning-evening chronotypes, job satisfaction, and shift schedule in nurses: A cross-sectional study p. 127
Masumeh Hemmati-Maslakpak, Farzin Mollazadeh, Hossein Jamshidi
DOI:10.4103/ijnmr.IJNMR_301_19  
Background: Among nurses, sleep quality is an important factor which can be associated with many other factors, including job satisfaction, Morning-Evening (ME) chronotypes, and shift schedule. Besides, poor sleep quality can cause some problems for nurses and negatively affect the quality of nursing care. Therefore, the present study aimed to determine the predictive power of sleep quality by ME chronotypes, job satisfaction, and shift schedule in nurses working in Urmia teaching hospitals in 2019. Materials and Methods: A total of 327 nurses working in teaching hospitals affiliated to Urmia University of Medical Sciences were recruited using stratified sampling. Data were collected using the demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Minnesota Satisfaction Questionnaire (MSQ), and the Composite Scale of Morningness (CSM). Data were analyzed using linear regression analysis and Pearson correlation coefficient. Results: The results of the Pearson correlation coefficient and linear regression analysis showed that the ME chronotypes (R2 = 0.51, p = 0.006), job satisfaction (R2 = 0.51, p = 0.001), and shift schedule (R2 = 0.51, p = 0.005) are significantly correlated with the sleep quality among nurses. Conclusions: We concluded that the sleep quality was correlated with ME chronotypes, job satisfaction, and shift schedule, so that increased job satisfaction was associated with improved sleep quality, and the shift to the morning chronotype was associated with decreased sleep quality. Rotating shifts were also associated with higher sleep quality.
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Designing virtual patients for education of nursing students in cancer course p. 133
Masoud Bahrami, Arash Hadadgar, Masoumeh Fuladvandi
DOI:10.4103/ijnmr.IJNMR_327_20  
Background: One of the best approaches to promote clinical reasoning in nursing education is Virtual Patient (VP). The purpose of this study was to design and implement VPs for nursing student's education in caring for cancer patients. Materials and Methods: In the first stage, through a descriptive-exploratory qualitative study using a focus group method, topics with higher priority in cancer nursing were identified. Then, based on the VP Nursing Design Model (VPNDM) for each of these topics, a scenario and then an interactive VP was designed and implemented in the Open Labyrinth application. The content validity of VPs was evaluated by eight experts and then the face validity was examined in the pilot group including 15 nursing students. Results: Topics with higher priority in cancer nursing courses were mastectomy, chemotherapy, radiotherapy, hypercalcemia, spinal cord compression, cardiac tamponade, and superior vena cava syndrome. For five scenarios based on the nursing process in three sequences (signs and symptoms, diagnosis and interventions) the VPs were designed. In this process, learning objectives, determining the critical path, adding branches at the decision point, adding feedback, completing the clinical course and related data, and adding multimedia were considered. VPs were revised based on the proposed modifications following face and content validity. Conclusions: This article presents VP design steps for use in a nursing student training course. The researchers were able to provide and validate five VPs to care for cancer patients based on the VPNDM.
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Gaining experience over time: The family caregivers' perception of patients with a tracheostomy in home care p. 137
Saied Daraie, Shirin Hasanvand, Fateme Goudarzi, Maryam Rassouli
DOI:10.4103/ijnmr.IJNMR_173_20  
Background: The transition of tracheostomy patients to the home poses many challenges for both the patient and the family. Identifying and understanding the experiences of family caregivers pave the road for discovering and meeting care needs. This study has been aimed to explain the experiences of family caregivers of patients with a tracheostomy about patient care at home. Materials and Methods: This qualitative study was conducted using a conventional content analysis approach from September 2018 to January 2019. Participants included nine family caregivers and one professional caregiver who were selected through purposive sampling method. The in-depth interviews were conducted at home or in health centers using field notes. Data were recorded manually and analyzed using the five-step method proposed by Granehim and Lundman. Results: The data led to the emergence of 1591 initial codes, 23 subcategories, and 6 categories. Categories include the need for training, the need for receiving care support, care challenges, care burden, gaining experience, hope, and inner satisfaction. Conclusions: In this study, the family caregivers faced with lots of challenges in caring patients with tracheostomy so that they were in needs of training and support from professionals. Although they got skillful in care and endure burden, they were so hopeful and satisfied with their attempts. Hence, there is a need for official nongovernmental organizations with the aim of maintaining care and protecting their families.
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Androgen deficiency in aging males: Translation and validation study of the iranian version p. 144
Mansoureh Ashghali-Farahani, Alice Khachian, Parya Vakilian, Mokhtar Mahmoudi
DOI:10.4103/ijnmr.IJNMR_209_20  
Background: Considering the importance of psychometric evaluation of the male sex hormone deficiency questionnaire by Iranian nurses, this study aimed to determine the translation and validation of the Iranian version of the Androgen Deficiency in Aging Males (ADAM) questionnaire. Materials and Methods: This study was cross-sectional. After obtaining permission from the instrument maker, translating it into Farsi, retranslated it into English, and determining validity and reliability. The study population was 200 Iranian men who admitted to hospitals affiliated with Iran University of medical science and were older than 50 years and selected by convenience sampling method. They were evaluated and monitored based on the Iranian version of the ADAM questionnaire. Sensitivity and specificity were assessed and analyzed by Rock Chart analysis. Descriptive and analytical statistical tests were used at a significant level of 0.05. Results: Findings showed that the Iranian version of the ADAM questionnaire had good face validity. Results showed that Cronbach's alpha in this questionnaire was 0.93, which indicates high reliability, and all the valid questionnaires were reported for the Scale-Content Validity Index (SCVI) calculation. Hence, the questionnaire has good content validity. The Iranian version of the ADAM questionnaire has a sensitivity of 93.85' and a specificity of 77.14' at the cut-off point of 2.2, indicating high sensitivity and specificity. Conclusions: The Iranian version of the ADAM questionnaire is valid and reliable and has high sensitivity and specificity. Nurses can also use it as an adjunctive scale to screen andropause men over 50 years of age.
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The effect of non-verbal music on posttraumatic stress disorder in mothers of premature neonates p. 150
Zahra Pourmovahed, Seyed Mojtaba Yassini Ardekani, Behzad Roozbeh, Akram Raie Ezabad
DOI:10.4103/ijnmr.IJNMR_37_20  
Background: Hospitalization of a premature neonate in the Neonatal Intensive Care Unit (NICU) is stressful for mothers. They show symptoms of Post-Traumatic Stress Disorder (PTSD). It is important to use the proper strategy to manage PTSD. This study was designed to investigate the effect of non-verbal music on the PTSD in mothers of premature neonates hospitalized in NICU. Materials and Methods: In this clinical trial study, the convenience sampling method was applied and 45 mothers of premature neonates were selected and categorized randomly into the intervention (N = 23) and control (N = 22) groups in 2018. The babies were hospitalized in one of the NICUs in Yazd (Iran). The intervention group were supposed to listen to the non-verbal music for 20 minutes daily for two weeks using MP3 player and headphones. All participants completed the Perinatal PTSD Questionnaire (PPQ). The data were analyzed by SPSS 21 using paired t-test, independent t-test, and Chi-square test. Results: The PTSD mean (SD) scores before and after the intervention was 9.39 (1.67) and 4.39 (1.49), respectively, in experimental group. It was 8.54 (1.59) and 5.31 (1.71) in control group. The severity of PTSD decreased in the intervention (p = 0.003) and control (p < 0.001) groups after the intervention. The difference between the two groups was significant (F1,07 = 1058, p < 0.03), which confirmed the significant effect of the non-verbal music on decreasing the PTSD severity (0.92). Conclusions: Non-verbal music can be used as an effective and low-cost intervention for managing PTSD in mothers of premature neonates hospitalized in the NICU.
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Exploring facilitators of regaining autonomy in people with spinal cord injury: A qualitative study p. 154
Moloud Farmahini Farahani, HamidReza Khankeh, Mohammadali Hosseini, Asghar Dalvandi, Kian NorouziTabrizi
DOI:10.4103/ijnmr.IJNMR_25_20  
Background: One of the most important aims of rehabilitation in Spinal Cord Injuries (SCI) is regaining autonomy, which can affect individuals' Quality of Life (QOL). This study was conducted to understand the experiences of individuals with SCI in terms of regaining autonomy during transition from hospital to community. Materials and Methods: The present study was conducted using a qualitative research design. In this study, 15 semi-structured, in-depth interviews were conducted with individuals with SCI in Spinal Cord Injury (SCI) Association of Arak, Iran, from June 2018 to May 2019. The interviews were analyzed using the conventional content analysis method. Results: Data analysis emerged four core categories of “self-management” (adaptation to a new life, self-care, responsibility, and seeking information), “social support” (family and friends' support, health care providers' support, and peer support), “access to facilities and resources” (home modification, use of various rehabilitation techniques, and use of mobility equipment), and “spiritual and religious beliefs” (believing in divine destiny and performance of religious rites). Conclusions: The present study showed that several factors influenced the regaining of autonomy in individuals with SCI. It is important to consider the impact of these factors during transition from hospital to community. Health service providers can use the findings of this research to help these individuals regain their autonomy.
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The effect of peers support on fear of hypoglycemia in iranian patients with type 1 diabetes: A clinical trial study p. 162
Leila Dehghankar, Peyman Namdar, Leili Yekefallah, Narges Hosseini, Mahnaz Moradi
DOI:10.4103/ijnmr.IJNMR_277_19  
Background: Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes. Materials and Methods: This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test. Results: The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t53 = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t53 = -2.13, p = 0.03). Conclusions: Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.
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Perceived risk in women with high risk pregnancy: A qualitative study p. 168
Zahra Shojaeian, Talat Khadivzadeh, Ali Sahebi, Hossein Kareshki, Fatemeh Tara
DOI:10.4103/ijnmr.IJNMR_32_20  
Background: Risk perception in high-risk pregnancies influences the mothers' adherence to medical treatments and recommendations. Because of the lack of information about the women's perception of risk, the aim of this study was to explain perception of risk in high-risk pregnancies. Materials and Methods: This qualitative study was conducted on 25 women with a high-risk pregnancy in educational hospitals of Mashhad, Iran, from August 2017 to August 2018. Data were collected through semi-structured interviews and data saturation was reached after 29 interviews. Data collection and analysis were simultaneously carried out using the qualitative content analysis method adopted by Elo and Kyngäs in MAXQDA software. Results: Data analysis resulted in the four main categories of perception of risk control ability (risk controlling through experience, risk tolerance through relying on a higher power, and risk tolerance to reach family goals), wrong estimation of risk (wrong calculation of possible risks based on wrong beliefs and knowledge, and incorrect risk estimation caused by misunderstanding), possibility of mutual vulnerability of pregnancy and risk condition (possibility of vulnerability of the fetus to risk factors, and possibility of the mother's vulnerability to risk factors), and induced risk (risk induced by negative experiences, induced threat of unknown pregnancy outcome, and fear of ambiguous medical terms). Conclusions: The results of this study promoted our understanding of risk perception in women with high-risk pregnancies. Therefore, it will help to establish a-Ž better link between women with a high-risk pregnancy and the health team, enhance and improve maternal and fetal care.
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Internet dependency and its relation to sexual desire and satisfaction in married clients referred to healthcare centers in Tabriz, Iran p. 175
Jaizeh Karimi Johani, Mina Hosseinzadeh, Nader Mahdavi, Maryam Vahidi, Sevil Hakimi
DOI:10.4103/ijnmr.IJNMR_115_20  
Background: Internet dependency has become one of the 21st century dilemmas affecting different aspects of married life such as sexual relationships. Considering the importance of family in the Iranian society, this study aimed to determine how internet dependency is related to sexual desires and satisfaction among married clients of healthcare centers. Materials and Methods: This cross-sectional study was conducted on 326 married clients referred to healthcare centers in Tabriz City, Iran, between February and August 2019. Proportionate stratified random sampling was used based on the health complexes and the healthcare centers covered by them. One of the healthcare centers covered by each complex was selected randomly. The data collection tools included a demographic characteristics checklist, the Internet Addiction Test (IAT), the Index of Sexual Satisfaction (ISS), and the Hurlbert Index of Sexual Desire (HISD). The collected data were analyzed using the Pearson correlation coefficient test and multiple linear regression model. Results: The mean (SD) was 37.33 (15.37) for of internet dependency, 59.20 (17.27) for sexual desire, and 104.45 (22.81) for sexual satisfaction. There was a negative correlation between internet dependency and sexual satisfaction (r = -0.47, p < 0.001). This correlation remained significant (B = -0.41, df = 9, p < 0.001,) even when occupation (B = 3.66, p = 0.01), satisfaction with married life (B = 15.34, p < 0.001), and sexual desire (B = 0.60, p < 0.001) were adjusted as potential confounding factors. Conclusions: Internet dependency can cause a reduction in sexual desire and sexual satisfaction. Designing educational interventions in healthcare centers is recommended to manage the use of internet and to inform clients about the effects that internet dependency may have.
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The relationship between moral sensitivity, ethical climate, and job strain with patient privacy from viewpoint of operating room staffs p. 183
Elaheh Sepehrirad, Mehdi Heidarzadeh, Zahra Etebari Asl, Zeinab Abbasian, Saba Ashtari
DOI:10.4103/ijnmr.IJNMR_22_20  
Background: The privacy of patients in the operating room is in particular importance. The results of previous studies have shown that various factors are affecting in this context. The aim of this study is to evaluate the relationship between moral sensitivity, ethical climate, and job strain with respect to patients' privacy in operating rooms. Materials and Methods: All of operating rooms nurses of teaching hospitals affiliated to Ardabil University of Medical Sciences were entered into this descriptive-analytical study with census sampling method in 2019. To collect data, standard surveys of moral sensitivity, ethical climate, job strain, and privacy were used. Data were analyzed by SPSS15 software using descriptive and analytical statistics methods (independent t-test, ANOVA, Pearson correlation, and regression analysis). Results: There was a positive significant relationship between moral sensitivity and privacy (r = 0.56, p < 0.001) and ethical climate and privacy (r = 0.60, p < 0.001), too. But, there was an inverse and significant correlation between job strain and privacy (r = -0.69, p < 0.001). The results also showed that moral sensitivity is the best predictor of patients' privacy. Conclusions: Despite the predictability of all variables, results showed that moral sensitivity is the most important component in patients' privacy. In this regard, by increasing the moral sensitivity of nurses, the privacy of patients can be improved.
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LETTER TO EDITOR Top

Management of patients experiencing anxiety during the coronavirus disease: The main role of healthcare providers in a special crisis p. 188
Nader Aghakhani, Violeta Lopez
DOI:10.4103/ijnmr.IJNMR_306_20  
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