آموزش و اخلاق در پرستاری

تأثیر روایت گویی از طریق شبیه سازی بر استدلال و حساسیت اخلاقی دانشجویان پرستاری دانشگاه علوم پزشکی تهران

نویسندگان

1 کارشناس ارشد کودکان،دانشکده پرستاری و مامایی،دانشگاه علوم پزشکی تهران، تهران، ایران

2 دانشیاردانشگاه علوم پزشکی تهران،دانشکده پرستاری و مامایی دانشگاه علوم پزشکی تهران،عضو مرکز تحقیقات قرآن، حدیث و طب دانشگاه علوم پزشکی تهران، ایران

3 استاد آمار زیستی دانشگاه تربیت مدرس، دانشکده علوم پزشکی، دانشگاه تربیت مدرس، تهران، ایران

چکیده

مقدمه: حساسیت پرستاران به موضوعات اخلاقی و نحوه استدلال آنان در بالین، یکی از اصول حرفه ­ای در پرستاری است که نیازمند توجه ویژه است. بنابراین پژوهش حاضر با هدف تعیین تأثیر روش روایت گویی توسط شبیه سازی بر استدلال و حساسیت اخلاقی دانشجویان پرستاری انجام شده است.  
روش کار: تحقیق حاضر به شیوۀ کارآزمایی بالینی، بر روی 60 نفر از دانشجویان مقطع کارشناسی، در حیطۀ پرستاری است که با پرتاب تاس، به 2 گروه مداخله و کنترل تقسیم و بررسی شدند. پرسشنامه های جمعیت شناختی، استدلال اخلاقی کوهلبرگ و حساسیت اخلاقی لاتزن برای جمع آوری داده ها، در 3 نوبت قبل و بعد مداخله و یک ماه بعد تکمیل شدند. مداخله طی 4 جلسۀ 3 ساعته بر اساس   10سناریوی روایی شده، با مضمون چالش های اخلاقی در پرستاری و 2 جلسه به صورت بیان تجربه های دانشجویان، در محیط بالین انجام گشت. داده ­ها توسط نرم افزار SPSS نسخه 16 و با استفاده از آزمون ­های آماری کای دو، دقیق فیشر و ANOVA مورد تجزیه و قرار گرفت.
یافته‌ها:  نتایج بررسی نشان داد که دو گروه از نظر متغیرهای دموگرافیک، میزان استدلال و حساسیت اخلاقی تفاوت معناداری قبل از مداخله نداشتند و هماهنگ بودند. بعد از مداخله، گروه کنترل استدلال اخلاقی 6.88±39.23 و مداخله 7.55±49.03 بود که به 0.001>P تفاوت معناداری بین دو گروه مشاهده شد که نشان دهنده آن بود که در پیگیری نیز تفاوت معناداری وجود دارد. حساسیت اخلاقی بعد از مداخله در گروه کنترل 24.03±32.56 و مداخله 14.14±84.36 بود که با 0.001>P تفاوت معناداری بین دو گروه مشاهده شد.
نتیجه‌گیری: روایت گویی از طریق شبیه سازی می­ تواند، یک روش موثر در جهـت افزایش حساسیت و استدلال اخلاقی دانشجویان پرستاری باشد. بنابراین نتایج نشان داد که تحول در روش های آموزش اخلاق، باعث افزایش توانمندی های اخلاقی دانشجویان پرستاری خواهد شد.
 

کلیدواژه‌ها

عنوان مقاله [English]

The Effect of Storytelling through Simulation on Moral Reasoning and Moral Sensitivity of Nursing Students in Tehran University of medical sciences

نویسندگان [English]

  • Arezo Fard 1
  • Akram Sadat Sadat Hoseini 2
  • Anoshirvan Kazemnejad 3

1 Instructor of Pediatric Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2 Associate Professor, Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

چکیده [English]

Introduction: Nurses' sensitivity to ethical issues and their way of reasoning at the bedside is one of the professional
principles in nursing that needs special attention. Therefore, the current research was conducted with the aim of determining the effect of the narrative method on the reasoning and moral sensitivity of nursing students through simulation.
Materials and Methods: The present research is a clinical trial on 60 undergraduate students in the field of nursing who were divided into 2 intervention and control groups by throwing dice. Demographic questionnaires, Kohlberg's moral reasoning and Latzen's moral sensitivity were completed for data collection in 3 times before and after the intervention and one month later. The intervention was conducted during 4 sessions of 3 hours based on 10 narrated scenarios, with the theme of ethical challenges in nursing and 2 sessions in the form of expressing students' experiences, in the clinical environment. The data were analyzed by SPSS version 16 software and using chi-square, Fisher's exact and ANOVA statistical tests.
Results: The results of the study showed that the group had no significant difference before the intervention and were harmonious in terms of demographic variables, the level of reasoning and moral sensitivity. After the intervention, the moral reasoning of the control group was 39.23±6.88 and the intervention was 49.03±7.55, which showed a significant difference between the two groups at P<0.001, which indicated that there is a significant difference in the follow-up. Moral sensitivity after the intervention was 32.56±24.03 in the control group and 84.36±14.14 in the intervention group, with P<0.001, a significant difference was observed between the two groups.
Conclusion: Storytelling through simulation can be an effective method to increase the sensitivity and moral reasoning of nursing students. Therefore, the results showed that the evolution in ethics education methods will increase the moral capabilities of nursing students.

کلیدواژه‌ها [English]

  • Storytelling
  • Moral Sensitivity
  • Moral Reasoning
  • Simulation
  • Nursing Students
  1. Mosadeghrad AM. Essentials of healthcare organization and management. 1 st Edition, Tehran: Dibagran; 2015
  2. Chiu W-T, Yang C-M, Lin H-W, Chu T-B. Development and implementation of a nationwide health care quality indicator system in Taiwan. International Journal for Quality in Health Care 2007; 19(1): 21-8.
  3. Raeisi A, Asefzadeh S, Yarmohammadian M. A Comparative Study on Accreditation Models in Europe and the USA. Health Information Management 2008; 3(2):1-9.
  4. Gloria NG, Leung GK, Johnston JM, Cowling BJ. Factors affecting implementation of accreditation programs and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis. Hong Kong Medical Journal 2013; 19(5): 434-46.
  5. Lutfiyya MN, Sikka A, Mehta S,et al. Comparison of US accreditedand non -accredited rural critical access hospitals. International Journal for Quality in Health Care 2009; 21:112.
  6. Schmaltz SP, Williams SC, Chassin MR,et al. Hospital performance trends on national quality measures and the association with Joint Commission accreditation. Journal of Hospital Medcine 2011; 6: 454 –61.
  7. Halasa YA, Zeng W, Chappy E,et al. Value and impact of international hospital accreditation: a case study from Jordan. Eastern Mediterrian Health Journal 2015; 21:90 –9
    1. Yıldız MS, Öztürk Z, Topal M,et al. Effect of accreditation and certification on the quality management system: analysis based on Turkish hospitals.International Journal of Health Planning and Management 2019; 34:e1675 –87.
    • Shaw C, Bruneau C, Kutryba B, De Jongh G, Suñol R. Towards hospital standardization in Europe. Int J Qual Health Care. 2010;22(4):244-9.
    1. Greenfield D, Braithwaite J, Pawsey M. Health care accreditation surveyor styles typology. Int J Health Care Qual Assur. 2008;21(5):435-43.
    2. Al-Assaf A, Akgün HS. Healthcare Accreditation in Kazakhstan: Methods and Impact. Health Care Academician Journal. 2016;3(2):57-63.
    3. Vanoli M, Traisci G, Franchini A, Benetti G, Serra P, Monti MA. A program of professional accreditation of hospital wards by the Italian Society of Internal Medicine (SIMI): self-versus peer-evaluation. Intern Emerg Med. 2012;7(1):27-32.
    4. Mosadeghrad AM. Hospital accreditation: The good, the bad, and the ugly, International Journal of Healthcare Management. 2020:1 -5.
    5. Baker, s. beitsch, L. Landrum, L. Head, R. (2008). The role of performance management ang quality improvement in a national voluntary public health accreditation. Public health managementpractice, 13 (4), 627-429.
    6. Bohigas L, Heaton C. Methods for external evaluation of health care institutions. International Journal for Quality in Health Care 2000; 12(3):231- 238.
    7. Mosadeghrad AM. Comments on Iran hospital accreditation System .Iranian Journal of Public Health 2016; 45: 837 -842.
    8. Mosadeghrad AM. Iran hospital accreditation: Future directions. 1 st Edition in J. Braithwaite, et al., (Eds.) Health Care Systems: Future Predictions for Global Care, Taylor & Francis 2018: 285 -291.
    9. Milner B. Implementing hospital accreditation: individual experiences of process and impacts: Waterford Institute of Technology; 2007.
    10. Alkhenizan A, Shaw C. Impact of accreditation on the quality of healthcare services: a systematic review of the literature. Ann Saudi Med 2011; 31: 407-416.
    11. Mahmoodian S, Safaei F, Meraji M, Kimiafar K, Farsinegar N, Ghasemi R. Challenges and Strengths of Implementing Accreditation Process from Health Information Management Staff Perspective. 2016.
    12. Salehi Z, Payravi H. Challenges in the Implementation Accreditation Process in the Hospitals: a Narrative Review. 2017; 30(106): 23-34.
    13. Yarmohammadian MH, Shokri A, Bahmanziari N, Kordi A. The blind spots on Accreditation program. J Health Syst Res 2013; 9(11):1158-1166.
    14. Kabir M-J, Heidari A, Jafari N, Honarvar M-R, Vakili M-A, Aghapour S-A, et al. Internal environment assessment of hospitals in Gorgan and Gonbad-e Qabus cities, Iran, according to Weisbord’s six-dimension model. Journal of Mazandaran University of Medical Sciences (JMUMS) 2014; 23(108): 123-132.
آموزش و اخلاق در پرستاری
دوره 11، 1-2
فروردین 1401
صفحه 55-64