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Nurses are at high risk of burnout, desire to leave the profession, and possibly missed nursing care due to the exhausting nature of caring. Missed nursing care may also affect nurses' burnout and desire to leave the profession. Therefore, the objective of this study was to determine the missed nursing care and its relationship with burnout and desire to leave the profession among intensive care unit nurses. The participants of this descriptive analytical study were 249 Iranian nurses working in intensive care units in 2022. The data were collected using a Demographic Information Questionnaire, Kalish's Missed Nursing Care Questionnaire, Maslach Burnout Inventory, and desire to leave the profession questionnaire. The majority of nurses (71%) were females. The generalized linear regression model showed that there was a significant relationship between missed care with gender (B = 5.55, P < .001), marital status (B = -7.37, P = .04), working shift (B = 7.80, P < .001), and employment status (B = -2.87, P = .02). Using structural equation modeling, it was found that the effect of missed care on burnout was significant. Considering the effect of missed care on burnout among nurses working in intensive care units, it seems that creating better working conditions, providing sufficient resources for nurses, supporting them, and changing the factors affecting missed care in order to improve the conditions can reduce the possibility of missing nursing care and, finally, burnout., Competing Interests: The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The present study aimed to determine the prevalence and severity of moral distress (MD) and its associated factors among emergency department nurses., Methods: This cross-sectional study was conducted in 2023 on 172 nurses from the emergency departments of medical training centers affiliated with Mazandaran University of Medical Sciences. The census method was used to collect the data, which included demographic variables and Corley's MD questionnaire. The Data were analyzed using SPSS software (version 22), using an independent T-test, analysis of variance (ANOVA), and multiple regressions., Results: Out of 172 nurses, 60.5% were women, with an average age of 32.52±6.88 years. The results demonstrated an average MD score of 69.73±25.68. In terms of frequency and intensity, around 53.5% of the participants experienced MD at a low level (0-72), while the remaining 46.5% reported experiencing it at a medium level (14-73). A significant association was found between MD and age ( p =0.037), workplace hospital ( p =0.005), and history of mental disorders ( p =0.005). Furthermore, linear regression analysis revealed a statistically significant association between MD, marital status, and occupational type ( p <0.05)., Conclusion: The results showed that nurses had low to moderate levels of MD. Several factors, including age, history of mental disorders, marital status, employment type, workplace hospital, and education, were associated with the overall MD score. To reduce MD and its negative effects on nurses, it is necessary to address these factors and develop an effective strategy for identifying and managing MD to improve nursing care quality., Competing Interests: The authors declared no conflict of interest. Consent for publication: All authors have expressed their consent to the publication of this study.

Competing Interests: Conflict of interest: None declared.

Background: and purpose: This study aimed to investigate the effect of melatonin on sleep quality and cognitive function of individuals undergoing hemodialysis., Materials and Methods: In this randomized controlled clinical trial, 102 eligible individuals were assigned to two equal intervention and control groups. The intervention group received melatonin 3 mg tablets half an hour before going to bed for six weeks, while the control group was given a placebo with similar conditions., Results: This study had 102 participants who were divided into intervention and control groups. The mean age of the participants was 58.30 (SD = 12.10). Among the participants, 54.90% were female. Moreover, 33.33% of the individuals received dialysis for four years or longer. After the intervention, the mean and standard deviation of the Pittsburgh Sleep Quality Index (PSQI) was 12.66 (SD = 3.09) in the intervention group and 18.86 (SD = 3.8) in the control group (P < 0.001). Moreover, the mean sleep quality index in the intervention group showed a statistically significant difference before and after the intervention (P < 0.001); the PSQI score declined from 20.21 to 12.66. Likewise, there was a statistically significant difference between the two groups after intervention in the mean Montreal Cognitive Assessment (MoCA) index (P = 0.002); it was 24.27 (SD = 3.42) in the intervention group and 22.15 (SD = 2.3) in the control group. The mean MoCA score in the intervention group showed a significant difference before and after the intervention (P < 0.001), increasing from 21.19 to 24.27., Conclusion: According to the study's findings, melatonin can improve individuals undergoing hemodialysis' cognitive function and sleep quality., Competing Interests: Declaration of competing interest We certify that there is no conflict of interest for each author., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Burn patients feel a lot of physiological and mental stress during treatment and rehabilitation which often cause anxiety and body image dissatisfaction. This study aimed to compare the effects of the Benson relaxation technique and nature sounds on pain anxiety and body image in burn-injured patients admitted to a burn intensive care unit (BICU)., Methods: This single-blind randomized clinical trial studied 60 burn patients allocated into three groups (Benson relaxation, nature sounds, and control) from September 2021 to February 2022. The patients received the intervention for seven consecutive days in person. Burn Specific Pain Anxiety Scale (BSPAS), was completed on the 1st, 4th, and 7th days. The intervention continued for four weeks measuring body image using the Satisfaction with Appearance Scale (SWAP) at the end of the 1st, 3rd, and 5th weeks. Finally, the data were statistically analyzed using the Shapiro-Wilk test, chi-square test, Fisher's exact test, Bonferroni post hoc test, repeated measures ANOVA, Kruskal Wallis test, and Generalize Estimating Equations (GEE)., Results: The mean pain anxiety and dissatisfaction with the appearance were high in the three groups in the pretest. On the 7th day after the intervention, the ANOVA showed that the mean pain anxiety decreased significantly in Benson's relaxation and nature sounds groups in three stages (before intervention (S1), after intervention (S2) and immediately after dressing change (S3) (P < 0.001). Correspondingly, the Kruskal Wallis test revealed that the body image dissatisfaction decreased significantly in the three groups at the end of the 3rd and 5th weeks (P < 0.001). The mean scores of pain anxiety showed that the nature sounds group proved more effective than the Benson relaxation technique. Also, the means scores of body image satisfaction showed that the Benson relaxation technique proved more effective than nature sounds., Conclusion: The study findings suggested that the Benson relaxation technique and nature sounds effectively reduces pain, anxiety, and improves body image satisfaction in patients with burn injuries., (Copyright © 2022 Elsevier Ltd and ISBI. All rights reserved.)

Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergency nurses as well as the associations between these variables., Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated with Ardebil University of Medical Sciences (Ardebil, Iran), in 2020. Data were collected via socio-demographic, Spiritual Well-Being Scale (SWBS), and Maslach Burnout Inventory (MBI) questionnaires., Results: This study included 239 emergency department nurses. The mean age of the participants was 34.4±6.4 years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. The results indicated that moderate (P=0.007) and severe (P<0.001) personal accomplishment was a positive and significant predictor of the SWB in emergency department nurses., Conclusion: Proper planning and provision of suitable educational programs in the dimension of the SWB of nurses prevent the creation and continuation of OB and increase the self-efficacy and job satisfaction of emergency medical staff, resulting in better patient care., Competing Interests: None declared.

Aim: This study aimed to determine the effects of acupressure on the intestinal function of patients undergoing Coronary Artery Bypass Graft (CABG) surgery., Background: Studies indicated that cardiovascular patients are prone to constipation. Acupressure is one of the therapeutic and palliative approaches that can be used by doctors, nurses, and even patients themselves., Methods: The present three-group randomized clinical trial study was conducted on 90 patients undergoing CABG surgery. In the intervention group, 48 hours after surgery the patients received acupressure points LI4 and ST25 twice a day (10 am and 6 pm) for three sequential days. In the sham group, the patients received acupressure at a 1.5 cm distance from the LI4-ST25 points, and the patients in the control group received only the usual care. This research used a demographic and medical information questionnaire, Rome IV scale, Bristol stool scale, symptom registration checklist, and daily excretion assessment checklist. The intestinal function indices were completed 24 hours after surgery (before intervention), 48, 72, 96, and 120 hours after surgery., Results: All three intervention, sham, and control groups were without defecation in 24 hours (before intervention) and 48 hours after surgery. There was a significant difference between the three intervention, sham, and control groups in the number of stools after 72 hours, 96 hours, and 120 hours after the intervention (p<0.001). Also, a significant difference was observed among the three groups in terms of stool consistency 96 hours after the start of the intervention (p=0.032) and 120 hours after the start of the intervention (p<0.001)., Conclusion: The results showed that patients had a significant improvement in the number of bowel movements and stool consistency in the intervention group. In acute conditions, acupressure on LI4-ST25 points can positively affect intestinal function when patients are hospitalized in the intensive care unit., Competing Interests: The authors declare no conflict of interest., (© 2023, Gastroenterology and Hepatology From Bed to Bench (GHFBB).)

Introduction: The present systematic review was conducted to examine self-esteem and related factors in burns patients., Methods: A comprehensive search was conducted from the first to the April 1, 2022 at the international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Burns", "Self-confidence", "Self-perception", "Self-esteem", and "Self-concept"., Results: A total of 762 burn patients were included in this review from ten cross-sectional studies. The mean score of self-esteem in burn patients based on Rosenberg Self-Esteem Scale, State Self-Esteem Scale, Cooper Smith's self-esteem questionnaire, and Rifai's self-esteem scale were 17.77 (SD = 5.55) out of 30, 65.91 (SD = 5.49) out of 100, 56.68 (SD = 5.49) out of 100, and 109.77 (SD = 9.55) out of 145, respectively. Factors associated with self-esteem in burns patients were gender, occupation, the location of the burn, type of burn, site of burn, burn scar, and quality of life had a significant relationship with burn patients' self-esteem. Factors such as social support, family support, friends support, and supporting others, had a significant positive relationship with self-esteem of burns patient. However, self-esteem in patients with burn had a significant negative relationship with grade of burn injury, percentage of burn, depth of burn, facial burn, post-traumatic stress disorder, psychiatric morbidity, major depressive, and suicidality factors., Conclusion: Overall, patients with burns had moderate levels of self-esteem. Therefore, it is recommended that health professionals use interdisciplinary approaches to better manage burn patients., Competing Interests: None., (© 2022 The Authors.)

In this study, Antimicrobial, Antifungal and Antibiofilm activity tests on 16 bacteria and 2 fungi of Salvia marashica İlçim, Celep & Doğan and Salvia caespitosa Montbret & Aucher ex Benth species were performed by Agar Well Diffusion and Microdilution methods. Salvia species showed sensitivity with a zone diameter of 12-16 mm. Concentrations of 0.5 mg/ml to 16 mg/ml by the dilution method were used to determine the Minimum inhibited concentration (MIC) and Minimum bactericidal concentration (MBK). The MIC values of the plants are mostly 0.5 mg/ml - 4 mg/ml and MBC values are between 0.5 mg/ml - 8 mg/ml. Antifungal activity findings are remarkable on the species and it has been observed to have very high effects especially on Candida parapsilosis. When the antioxidant research findings are examined; It was observed that Salvia marashica and Salvia caespitosa plants have approximately 75% antioxidant activity at 1 mg/ml, and findings mostly directly proportional between concentrations and antioxidant activity capacity were recorded. MCF-7 and HUVEC cell lines were used to investigate anticancer activity properties. In line with the findings, while the IC50 value of Salvia marashica on the MCF-7 Cell line was 0.125 mg/ml, it was 1.65 mg/ml in the HUVEC cell line, while the IC50 value of Salvia caespitosa on the MCF-7 Cell line was 0.115 mg/ml in the HUVEC Cell line. It was found to be 9.87 mg/ml. It has been proven that both Salvia species have a cytotoxic effect on the MCF-7 Cell line., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: Forensic nursing is a specialty in the nursing profession based on legal procedures. This study aimed to assess the effect of a forensic nursing virtual education course on knowledge and clinical decision-making among master’s nursing students., Methods: In a quasi-experimental study with a pre- and post-test, 106 master’s nursing students at Guilan (n=65) and Mazandaran (n=41) Universities of Medical Sciences, Iran were enrolled. Data were collected using census sampling from March to April 2021. Participants in the intervention group received a forensic nursing virtual education course in three 90-minute sessions for 2 days., Results: A total of 88 out of 106 master’s nursing students were enrolled in this study. The mean post-education score for knowledge in the intervention group was significantly higher than in the control group (12.52 vs. 7.67, P<0.001). The mean post-education score for clinical decision-making in the intervention group was significantly higher than in the control group (16.96 vs. 13.64, P<0.001)., Conclusion: The level of knowledge and clinical decision-making of master’s nursing students regarding forensic evidence improved after the forensic nursing virtual education course in the intervention group compared to the control group. Nursing managers and policymakers can develop appropriate strategies to improve the knowledge and clinical decision-making of nursing students by using forensic nursing education courses in the curricula of nursing programs, especially in postgraduate education as an elective or mandatory course.

Background: One of the results of burn injuries is the appearance of scars and deformities in various organs of the body, which can cause many physical and psychological challenges to burn patients. Lack of proper communication between nurse and patient leads to inaccurate identification of psychological and social needs of these patients and thus affects the quality of care., Aim: This study aimed to investigate the effect of seeing the patient's pre-burn face photo on the quality of care and empathy of nurses with patients admitted to the burn intensive care unit., Methods: The present study is a quasi-experimental interventional study conducted on 26 Burn Intensive Care Unit (BICU) nurses who were selected by census sampling method in 2018. Data were collected through QUALPAC Nursing Care Quality Questionnaire, Lumonica Empathy Questionnaire and Demographic Questionnaire, which were completed by nurses before and after the intervention. Pre-burn photos of patients with facial burns were displayed at the nursing station for one month and the data were compared before and after the intervention. Descriptive statistics and paired t-test and independent t-test, Mann-Whitney and Pearson correlation tests were used to analyze the data., Findings: The results of present study showed that there was a statistically significant difference between the quality of nursing care (p = 0.001) and its psychological dimension (p < 0.001) before and after the intervention in the group of nurses. However, no significant relationship was found between nurses' empathy with patients before (p = 0.901) and after intervention (p = 0.001)., Conclusion: Seeing the photo of the patient's pre-burn face and establishing a relationship between the nurse and the patient had an effect on the quality of nursing care and especially its psychological dimension. However, in order to generalize the results and implement this low-cost, convenient and low-complication intervention for all patients admitted to the intensive care unit, more studies are needed in this field., (Copyright © 2021 Elsevier Ltd and ISBI. All rights reserved.)

Aim: The present study aimed to evaluate the effect of an empowerment program on the moral sensitivity and caring behaviors of nurses in emergency departments in Iran., Background: Emergency department is often a high stress environment. Nurses who worked in the emergency departments are expected to work under pressure to many standards, guidelines and protocols related to patient care. It will expose emergency department nurses to psychological pressures and moral conflicts. A nurse's sensitivity to ethical issues is necessary to provide humane care; it is considered to be a professional competence for nurses., Methods: This study had a controlled quasi-experimental design. Data were collected before, immediately after, and 1 month after the intervention using a moral sensitivity questionnaire and a caring behavior questionnaire. A total of 131 emergency department nurses from 4 teaching hospitals were divided into an intervention group and a control group. The intervention group received six 60-minute training sessions; the control group did not receive the training., Results: The mean moral sensitivity and caring behavior scores for both groups increased significantly immediately and 1 month after the intervention. However, the significance was higher in the intervention group than in the control group. A comparison of the mean moral sensitivity and caring behavior scores between the groups immediately and 1 month after the intervention did not show a statistically significant difference., Conclusions: Implementing a training program on ethical issues could thus have a significant impact on the clinical performance of nurses, which could be maintained through follow-up., (Copyright © 2021. Published by Elsevier Ltd.)

Depression can lead to increased medical costs, impaired individual and social functioning, nonadherence to therapeutic proceeding, and even suicide and ultimately affect quality of life. It is important to know the extent of its prevalence for successful planning in this regard. This study was conducted to determine the prevalence of depression in the Iranian elderly. This systematic review and meta-analysis study was done through Medline via PubMed, SCOPUS, Web of Science, ProQuest, SID, Embase, and Magiran with determined keywords. Screening was done on the basis of relevance to the purpose of the study, titles, abstracts, full text, and inclusion and exclusion criteria. The quality of the articles was assessed using the Newcastle-Ottawa standard scale. After primary and secondary screening, 30 articles were finally included in the study. According to the 30 articles reviewed, the prevalence of depression in the Iranian elderly was 52 percent based on the random-effects model (CI 95%: 46-58). According to the results of the present study, depression in the Iranian elderly was moderate to high. Therefore, more exact assessment in terms of depression screening in elderly people seems necessary. Coherent and systematic programs, including psychosocial empowerment counselling for the elderly and workshops for their families, are also needed. Researchers can also use the results of this study for future research., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Hedayat Jafari et al.)

Background: The knowledge level of caregivers and their support for patients can affect the self-care of patients with heart failure (HF). The present study was conducted to compare the effects of teach-back, multimedia, and blended training methods on self-care and social support in patients with HF and on knowledge in their caregivers., Materials and Methods: In a randomized clinical trial, a total of 150 HF patient-caregiver dyads were randomly allocated into three equally sized training groups, using a simple number table ( n = 50). The study was conducted between May to October 2018 in Sari, northern Iran. In the teach-back, multimedia and blended training groups, patient-caregiver dyads participated in 20-30-min training sessions held face-to-face, using digital video disc (DVD) and combination of teach-back and DVD on 4 consecutive days at the bedside of hospitalized patients in coronary care unit, respectively. Data were collected using the European Heart Failure Self-Care Behaviour Scale and the multidimensional scale of perceived social support for patients. Caregivers' level of knowledge was measured using the HF Knowledge Scale. Data were measured on the first day of hospitalization, 1 day before discharge and 4 and 8 weeks after patients' discharge. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA)., Results: All three educational methods improved self-care behaviors in patients. The comparison of self-care behavior scores in patients with HF among the three groups at different time points showed no statistically significant differences ( P > 0.05), except 1 day before discharge ( P = 0.04). There were no statistically-significant differences between the teach-back, multimedia and the blended training group in terms of perceived social support at any of the four-time points ( P > 0.05). All three training methods improved the level of knowledge of caregivers. However, the score in the blended training groups was higher than the other groups ( P < 0.001)., Conclusion: According to the results of the present study, it seems that all three educational interventions can improve self-care behaviors in HF patients and increase knowledge in their caregivers. However, using the blended training method was associated with better outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

This descriptive correlational study was aimed at determining the relationship of hemodialysis shift with sleep quality and depression in 310 hemodialysis patients. Demographic and Clinical Questionnaires, the Pittsburgh sleep quality index, and Beck's Depression Inventory were used to ascertain the aforementioned relationship. Among the patients, 59.6% reported poor sleep quality and 44.8% reported experiencing depression. Results show that these conditions were significantly related to many factors. Although dialysis shift was not significantly related to sleep quality and depression, sleep quality was found significantly associated with age, female gender, illiteracy, unemployment, residence in rural areas, diabetes, addiction to sedatives, and phosphorus levels. A significant relationship was also found between depression and phosphorus levels. Logistic regression predicted age, gender, illiteracy, unemployment, residence in rural areas, and addiction to sedatives as factors for poor sleep quality. A body mass index (BMI) above 30, decreased urea, and increased phosphorus were predicted as factors for increased depression.

Objectives:: Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units., Method:: This correlation, analytical study was conducted with 181 nursing staff of the intensive care units of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. The data collection tool included a three-part questionnaire containing demographic characteristics form, perception of futile care questionnaire, and caring behaviors inventory. To analyze the data, statistical tests and central indices of tendency and dispersion were investigated using SPSS, version 19. Pearson's correlation coefficient, partial correlation, t-test, and analysis of variance tests were performed to assess the relationship between the variables., Ethical Considerations:: The study was reviewed by the ethics committee of the Mazandaran University of Medical Sciences. Informed consent was obtained from participants., Results:: Our findings illustrated that the majority of nurses (65.7%) had a moderate perception of futile care, and most of them (98.9%) had desirable caring behaviors in taking care of patients in the final stages of life. The nurses believed that psychosocial aspects of care were of utmost importance. There was a significant negative relationship between perception of futile care and caring behavior., Conclusion:: Given the moderate perception of nurses concerning futile care, and its negative impact on caring behaviors toward patients, implementing suitable interventions for minimizing the frequency of futile care and its resulting tension seems to be mandatory. It is imperative to train nurses on adjustment mechanisms and raise their awareness as to situations resulting in futile care.

Background: Patients on hemodialysis can experience thirst distress. However, there is no valid and reliable Persian instrument to measure this condition in such patients. The present study aims to determine the psychometric properties of the Persian version of the thirst distress scale (TDS) for patients on hemodialysis., Materials and Methods: Our sample consisted of 142 hemodialysis patients completed the TDS Persian version. The face, content, and construct validity of the scale were ascertained. Reliability was also assessed using internal consistency, construct reliability, and intra-class correlation coefficient (ICC)., Results: Construct validity determined one factor with an eigenvalue greater than 0.7. The model revealed good fitness (χ 2 (121, N = 142) = 269.32, p < 0.001; χ 2 df = 2.225, goodness of fit index (GFI) = 0.912, normed fit index (NFI) = 0.866, comparative fit index (CFI) = 0.926, incremental fit index (IFI) = 0.961, and root mean square error of approximation (RMSEA) = 0.089 (90% confidence interval = 0.069 - 0.109)). The internal consistency, construct reliability, and ICC were greater than 0.70. The scale's convergent validity was demonstrated., Conclusion: This study confirmed the acceptable psychometric properties and the factor structure of the TDS in Iranian patients on hemodialysis.
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Background: Many patients undergoing hematopoietic stem cell transplant (HSCT) experience fatigue due to their disease process and its long period of treatment. Using nonpharmacological methods to help reduce their fatigue is a reasonable endeavor. The present study was conducted to investigate the effect of Benson's relaxation technique on fatigue levels in patients after HSCT., Materials and Methods: Thirty-seven patients were randomly selected to the intervention ( n = 19) and control group ( n = 18). In the intervention group, the participants performed Benson's relaxation exercises for 20 min twice per day over a period of 15 days. The data collection tools used included a demographic and medical information form and the Brief Fatigue Inventory, completed by both groups on three different occasions (upon admission and days 8 and 14 after the HSCT). The data obtained were analyzed in Statistical Package for the Social Sciences version-20 using statistical tests., Results: The results of the independent t -test showed no significant preintervention differences in fatigue levels between the two groups. On days 8 ( t = 11.21, p < 0.001) and 14 after the transplant ( t = 15.62, p < 0.001), a significant difference was observed in the mean level of fatigue between the two groups., Conclusions: These findings indicate that Benson's relaxation technique would improve fatigue in HSCT patients., Competing Interests: Nothing to declare.

Introduction: Acceptance and commitment therapy tries to increase one's psychological acceptance regarding subjective experiences (thoughts, feelings, etc.,) and in turn, decrease ineffective control actions., Aim: The current study was conducted with the aim to investigate the effect of acceptance and commitment therapy (ACT) on the amount of life expectancy and anxiety among bereaved patients., Material and Methods: This research was a quasi-experimental study with pretest-post-test control group design. The statistical population included all bereaved patients aged between 20-40 who referred to counseling and treatment centers and psychiatric clinics in Tehran in 2015. Bereaved patients were identified through convenient random sampling method amongst patients and based on clinical diagnosis of psychiatrist treating patients. Thirty four persons were chosen and were randomly assigned in two 17- persons experimental and control groups. Both groups were evaluated at two stages of pre-test and post-test through anxiety scale (Spielberger STAI-y 1970) and life expectancy (Schneider, 1991)., Findings: Conducted investigation shows that the average life expectancy in the experimental group has increased from 12.40 to 23.30 after acceptance and commitment therapy. Moreover, the average of anxiety scores in the experimental group has decreased in post-test from 121.20 to 79.10 after acceptance and commitment therapy. Results of covariance analysis revealed that the experimental group subjects experienced a significant lower level of anxiety than those in control group (p<0.001). Furthermore, the life expectancy has significantly increased in the experimental group (p<0.001)., Conclusion: Inefficient beliefs (illogical), intellectual faults and cognitive distortions have reduced, and these in turn cause a reduction in anxiety. In this way bereaved patients' life expectancy has increased., Conclusion: The acceptance and commitment therapy has led to the anxiety reduction and caused an increase in bereaved patients' life expectancy., Competing Interests: • Conflict of interest: No Conflict.

Fatigue is one of the main complaints of patients undergoing allogeneic and autologous hematopoietic stem cell transplantation (HSCT). Since nonpharmacological interventions are cost-effective and causes fewer complications, this study aimed to review the studies performed on the effects of nonpharmacological interventions on fatigue in patients undergoing HSCT during September 2016. MEDLINE, CINAHL, Scientific Information Database, IranMedex, PubMed, ScienceDirect, Scopus, Magiran, and IRANDOC databases were searched using Persian and English keywords. A total of 1217 articles were retrieved, 21 of which were used in this study. Exercise is known as an effective intervention in alleviating physical and mental problems of patients undergoing stem cell transplant. This review-based study showed that nonpharmacological methods such as exercise might be effective in decreasing fatigue in patients undergoing stem cell transplant. There is a multitude of studies on some of the complementary and alternative therapy methods, such as music therapy, yoga, relaxation, and therapeutic massage. These studies demonstrated the positive effects of the aforementioned therapies on reduction of fatigue in patients undergoing stem cell transplantation. All the investigated methods in this study were nonaggressive, safe, and cost-effective and could be used along with common treatments or even as an alternative for pharmacological treatments for the reduction, or elimination of fatigue in patients undergoing stem cell transplantation. Given the advantages of complementary and alternative medicine, conducting further studies on this issue is recommended to reduce fatigue in patients after stem cell transplantation., Competing Interests: There are no conflicts of interest.

Purpose: Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran., Materials and Methods: All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria 21 studies were identified. The results were analyzed using Stata software version 11., Results: A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and confidence interval were 36.3% and 46.2-26.4, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 43.3-14.4., Conclusion: KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy.&nbsp.

Background: Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients., Method: This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model., Results: Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035)., Conclusion: Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.

Background: Tracheal intubation is an essential method of keeping the airway open in patients under general anesthesia. Sore throat is a prevalent complication after endotracheal intubation., Objectives: The aim of this study was to investigate the effect of green tea gargling on sore throat after coronary artery bypass grafting (CABG)., Patients and Methods: This was a single-blind, randomized clinical trial, in which 121 patients who had undergone CABG were divided into two groups: those who gargled distilled water and those who gargled a green tea solution. An hour after extubation, the patients of the intervention group were asked to gargle 30 cc of green tea, and the patients of the control group were asked to gargle 30 cc of distilled water, every 6 hours for up to 24 hours (four times per patient). A sore throat questionnaire was filled out 6, 12, and 24 hours after endotracheal extubation., Results: The results showed that there were no significant differences between the two groups with regard to patient age, sex, body mass index, smoking background, and duration of anesthesia. There was no significant difference between the two groups in terms of sore throat before the intervention (P = 0.461) and 6 hours after the intervention (P = 0.901). However, a significant difference was observed between the two groups in terms of sore throat 12 hours (P = 0.047) and 24 hours (P < 0.001) after removing the endotracheal tube., Conclusions: Gargling a green tea solution, an anti-inflammatory, natural, and harmless substance, can reduce the pain of sore throat in patients after endotracheal extubation.

The increasing progress in medical and health sciences has enhanced patient survival over the years. However, increased longevity without quality of life in terminally ill patients has been a challenging issue for care providers, especially nurses, since they are required to determine the futility or effectiveness of treatments. Futile care refers to the provision of medical care with futile therapeutic outcomes for the patient. Interest in this phenomenon has grown rapidly over the years. In this study, we aimed to review and identify nurses' perceptions of futile care, based on available scientific resources. In total, 135 articles were retrieved through searching scientific databases (with no time restrictions), using relevant English and Farsi keywords. Finally, 16 articles, which were aligned with the study objectives, were selected and evaluated in this study. Overlapping studies were excluded or integrated, based on the research team's opinion. According to the literature, futile care cannot be easily defined in medical sciences, and ethical dilemmas surrounding this phenomenon are very complex. Considering the key role of nurses in patient care and end-of-life decision-making and their great influence on the attitudes of patients and their families, support and counseling services on medical futility and the surrounding ethical issues are necessary for these members of healthcare teams.

Introduction: Spiritual health is of the basic elements in chronic patients. This concept can be considered as an important approach in promoting physical & spiritual health & life quality., Goal: The present study has been planned aiming to study life quality related to metastatic phase gastrointestinal (digestive) cancer referring to Mazandaran Medical Science University Educational Center in Iran., Material and Methods: This research has been done by descriptive-analytical method with 250 patients through available sampling method. The data has been collected via spiritual health & life quality questionnaire. The data analysis has been performed by calculating X², T Test, variance analysis and Pearson correlation coefficient., Results: The mean & standard deviation of the patients were 12.56 ±94/47. The highest relationship between age & spirituality was related to ages over 60. There was a meaningful statistical relationship between spirituality & life quality scale (p<0.001), between spirituality & respiratory disorder (p<0.047), anorexia (p<0.004), exhaustion (p<0.006), financial problems (p<0.006)., Conclusion: regarding the results, we can perceive the necessity behind improving spiritual health aspect as an influencing factor on the patients' life quality. Through enhancing spiritual beliefs, it is possible to help the patients' spiritual quality get promoted.

Background: Occlusion of central venous catheters is one of the limiting factors in using them. Heparinized saline solution is the standard solution used for keeping the catheters open., Objectives: This study aimed to determine the effect of heparin saline solution and normal saline in maintenance of patency of central venous catheters., Patients and Methods: This double-blind study was performed on 84 patients of intensive care unit who had central venous catheters. The patients were randomly divided into two groups of heparin saline receivers and normal saline receivers. In the heparin group after each drug injection into the lumen, 3 mL of heparin saline solution was injected in the catheter as well. The other group only received 10 mL of normal saline instead. The catheters were examined for blood return and flushing every eight hours for 21 days. Data was analyzed using SPSS software version 20 and descriptive and analytic statistics were studied., Results: There was no significant difference in the rate of flushing (P = 0.872) and possibility of taking blood samples from catheters (P = 0.745) in the two groups of heparin and normal saline receivers. Furthermore, using heparin had no effect on prolonging the survival of catheters., Conclusions: Considering possible side effects of heparin and the increase in treatment charges and the fact that using heparin did not have a significant effect on patency and survival of catheters in the studied patients, it is recommended to use normal saline solution to maintain the patency of central venous catheters.

Introduction: Endotracheal intubation is a method necessary for controlling and maintaining airway during general anesthesia. Cough and hoarseness are common complications after endotracheal intubation. Inflammation has an important role in postoperative cough and hoarseness outbreak. Also it has been stated that green tea has anti-inflammatory properties. Therefore, the current study has been conducted to investigate green tea gargling solution effect on cough and hoarseness after coronary artery bypass graft (CABG) surgery., Methods: In this single-blind, randomized, & controlled clinical trial, we enrolled 121 patients undergoing CABG admitted to the ICU. The intervention group participants were asked to gargle 30 cc of green tea solution. The control group patients gargled 30 cc of distilled water. An hour after extubation, the intervention group patients were asked to gargle 30 cc of green tea and the control group patients were required to gargle 30 cc of distilled water every 6 hour up to 24 hour (each patient for 4 times). Moreover, the cough and hoarseness questionnaire was also filled in 6, 12, and 24 hours after endotracheal extubation., Results: The results showed no significant differences among the patients in both groups regarding age, gender, body mass index, smoking history, and anesthesia duration. There was a significant difference between the two groups in terms of cough 12 hours after removing the endotracheal tube. At other times, there was no significant difference between the two groups considering cough and hoarseness., Conclusion: The present study results showed that green tea gargling does not decrease hoarseness. Though, cough occurrence was less in the intervention group than the other group.

Background: One of the most important purposes of health-oriented educational centers is to train competent nurses. This study was intended to discover the meaning of "competency of nursing academic staff" among nursing students and instructors., Methodology & Methods: A qualitative study using the content analysis approach was conducted. The data was collected through in-depth interviews consisting of 30 individuals and a focus group., Results: Data analysis resulted in the extraction of 15 categories and 6 themes. The themes included 'providing effective education', 'increasing research capability of oneself and that of the students', 'promoting managerial competency', 'being a cultural and behavioral role model', 'motivating and nurturing the students', and 'boosting teaching values and disposition'., Conclusion: This study resulted in discovering the real meaning of professional competency among the nursing faculty staff. The findings could be utilized in designing assessment tools for professional competency of nursing academic staff in nursing schools and other medical fields.

Background: Pain is a common phenomenon after surgery. Cardiac surgeries are no exception and patients generally experience acute pain after these surgeries. Inadequate pain management after cardiac surgery predisposes patients to many complications. Therefore, the aim of this study was to determine the effects of listening to preferred music on pain intensity after open heart surgery., Materials and Methods: This study was a randomized clinical trial (RCT) conducted in open heart intensive care unit (ICU) of a university hospital in Sari, Iran. A total of 60 patients who were scheduled to undergo open heart surgery were randomly allocated in two groups. Patients in the intervention group (n = 30) listened to their preferred music by headphones for 30 minutes, whereas those in the control group (n = 30) did not listen to music. Using a Numerical Rating Scale (NRS), pain intensity was measured among the patients before the intervention, and immediately, 30 minutes and one hour after the intervention. Data was analyzed by Chi-square test, student's t-test and repeated measures analysis of variance (ANOVA)., Findings: Mean pain intensity in the intervention group before, immediately after, 30 minutes and one hour after the intervention were 5.8, 3.1, 2.5 and 2.4, respectively. Corresponding numbers in the control group were 4.7, 4.7, 4.8 and 4.9, respectively. Repeated measures ANOVA showed music to significantly reduce pain intensity (p = 0.0001)., Conclusions: Music can be effective as a non-pharmacological, inexpensive, non-invasive and side effect free method for pain management after open heart surgery.

The aim of this study was to determine the relationship between quality of life with stress in the haemodialysis patients. This descriptive correlation study was done on 100 haemodialysis patients selected by consent method from Imam Khomeini and Fatemeh Zahra Hospitals in Sari/Iran from March 2008 to February 2009. Data were collected in questionnaire consisting of 3 sections (demographic feature, quality of life and stress) in three months. In the questionnaire, first, quality of life then stress in the patients was studied and the variables described. Then the relation between them was determined by statistical analysis. From the total number of 100 patients (53 men and 47 women) under study, 42% with partial comfortable life had moderate tension. Pearson correlation coefficient showed that there is a significant linear relationship with quality of life and degree of tension, (r = 0.802). That is with increase of tension, quality of life declines (p < 0.001). Also Pearson correlation coefficient indicated that there is positive correlation between the number of hemodialysis per week and the history of dialysis (p = 0.001). History of dialysis in 69% of the patients was 1-5 years and 74% of them were dialyzed in the morning trice a week. Findings showed that, with increase of stress, quality of such patients' life decreases. Therefore, the nurses and the other members of medication team should know to reduce the patient's stress using the supportive procedures and adaptation techniques, help improve quality of life by proper intervention method.