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Abstract Aim The aim of this study was to explore the process of error recovery (ER) by nurses in intensive care unit (ICU). Design This qualitative study was conducted in 2018–2020 using the grounded theory methodology. Methods Participants were 20 staff nurses, head nurses and nursing managers recruited from the ICUs. Sampling was started purposively and continued theoretically. Data were collected using semi‐structured interviews and were analysed using the approach proposed by Corbin and Strauss. Results The findings indicated that nurses' primary concern was for the patient and their own personal/professional identity. Five strategies were found including evaluating situation, identifying error, analysing error and situation, determining the agent for error correction, and reducing error effects. Contextual factors were also highlighted as being important in the error recovery. “Attempting to protect self and patient” was the core category of the study. Nurses' concern about protecting patient life and their own personal/professional identity make them use unprofessional approaches for ER.

Abstract Background Characteristics of nursing care in the oncology ward depend on this ward’s specific context. This study aimed to investigate the nursing care in the oncology ward regarding the culture of this ward. Methods This qualitative study was conducted in an oncology ward using a focused ethnographic approach. The whole nursing team of the selected ward (N = 16) participated in the study through purposeful sampling. Three methods of observation, interview, and field documents were used for data collection. Data were analyzed by Spradley’s (1980) ethnographic method. Results ‘Nursing in the oncology ward with intertwined roles’ emerged as the main theme. This theme included the following subthemes: ‘Robin Hood nurse,’ ‘a secretive nurse,’ ‘a negligent nurse,’ ‘a snitching nurse,’ ‘a complaining nurse,’ ‘an apathetic senior nurse,’ ‘a stigmatized training nurse,’ ‘a brazen-bodied nurse,’ ‘a compassionate nurse,’ ‘a moonlighting nurse,’ and ‘a drug bartender.’ Conclusion This study provided a deep cultural insight into nursing care in the oncology ward, considering the particular culture of this ward and emphasizing the nurses’ intertwined roles. These roles are on a spectrum, with positive roles, such as compassion, on one side and negative roles, such as negligence, on the other. The results of this study can be provided to nursing managers; therefore, by being aware of nurses’ roles considering the specific subculture of the oncology ward, they can provide psychological interventions to improve the mental health of reluctant and complaining nurses and ethics-based training for secretive, negligent, and snitching nurses to provide quality care to the patient.

Abstract Background Caring for patients during a pandemic can be difficult for healthcare workers, the patients themselves, and healthcare systems. Nurses are expected to recognize ethical dilemmas and make sound judgments when confronted with them. Sensitizing nurses to ethical issues strengthen their ability to identify ethical dilemmas and make ethical choices. As a result, this study aimed to determine a relationship between moral sensitivity and caring behavior among nurses during the coronavirus (COVID-19) pandemic. Method The current study is a cross-sectional study of 406 nurses who worked in a single hospital during the COVID-19 epidemic. We used a demographic questionnaire and the caring behavior inventory (CBI) tool to collect data online. The data were analyzed using descriptive and correlational statistics. Findings Eighty-three point seven percent of participants in this study were female, and 71.9% were married. 47.5% reported caring for a COVID-19 patient for longer than a month; their average work experience was 13.1 years. Additionally, Moral Sensitivity correlated positively with caring behavior and its dimensions (r = 0.164, P = 0.001). However, a significant and inverse link existed between the dimension "following the rules" and the nurse's caring conduct (r = -0.117, P = 0.019). Conclusion During the pandemic, nurses' moral sensitivity was moderate and significantly connected with their caring behavior. Because nurses encounter numerous obstacles while caring for patients in critical conditions, they require ethical empowerment to perform correctly, as caring behavior improves with increased moral sensitivity.

Abstract Aim To determine the psychometric properties of the Persian version of the MUSIC Inventory in nursing students. Design Cross‐sectional psychometric study. Methods Transcultural adaptation of the MUSIC Model of Academic Motivation Inventory was carried out using translation to Persian and back‐translation. Then, the qualitative and quantitative face and content validity of the inventory were evaluated. Construct validity was assessed by exploratory factor analysis. To perform construct validity and reliability, a convenience sample of 360 undergraduate nursing students was recruited. Cronbach's alpha was used to assess internal consistency reliability. Results Cronbach's alpha for all items of the MUSIC inventory was .94, and each factor was between .72–.93. Exploratory factor analysis supported the 5‐factor structure of the MUSIC inventory. These 5 factors explain 66.59% of the overall extracted variance. Three items of the MUSIC inventory, which were related to the empowerment component, were deleted. Conclusion Based on the findings of this study, the Persian version of the MUSIC Model of Academic Motivation Inventory is a valid and reliable tool for Persian language nursing students.

Background & Aims: Epidemiological changes have made chronic diseases increasingly important. Hypertension is also known as a chronic disease. The high prevalence of hypertension has made the disease a significant health problem in communities. Spiritual health has been proposed as one of the health indicators and predictors of self-care in chronic diseases. This study aimed to determine the relationship between spiritual health and adherence to the treatment regimen in patients with hypertension. Materials & Methods: In this descriptive correlational study, 121 patients with hypertension were selected by continuous sampling method from cardiac clinics affiliated with Iran University of Medical Sciences, Iran, in 2020. The study data were collected through demographic information form and validated Ellison and Paloutzian spiritual health and Hil-Bone diet adherence questionnaires. For data analysis, we performed the statistical tests of the Spearman, independent t test, Chi-square, and analysis of variance in SPSS version 16. Results: This study shows a significant and negative relationship between spiritual health and adherence to the treatment regimen in patients with hypertension (P=0.001, r=-0.05). Conclusion: As spiritual health increases, adherence to the treatment regimen in patients with hypertension decreases. Spiritual health in this group of patients leads to less adherence to the treatment regimen.

Abstract Background Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients. Methods This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance. Results Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η2 = 0.305, P

Background: Readmission of patients with Acute Coronary Syndrome (ACS) causes many problems for them and their family. This study aimed to improve the quality of care provided to patients with ACS and discover solutions to reduce the rate of readmission among them. Materials and Method: This participatory action research study was done based on Streubert and Carpenter approach. This study included 45 participants (31 patients and 14 stakeholders) and carried out in a hospital affiliated to Isfahan University of Medical Sciences, Iran, from 2013 to 2014. Solutions with high and moderate feasibility, flexibility, and suitability were implemented in each cycle until reaching

Patient safety is a major health concern throughout the world, and medical errors are the most important factor threatening patient safety, especially in the Intensive Care Unit (ICU). To prevent errors and improve patient safety, it is necessary to identify the underlying causes of error from the perspective of nurses working in ICUs. This study aimed to explore nurses’ experiences of factors contributing to medical errors in the Intensive Care Unit. The present qualitative study was conducted using conventional content analysis. The participants included 17 nurses working in ICUs in two educational hospitals affiliated with the Iran University of Medical Sciences in Tehran. Data were collected using in-depth semi-structured interviews and were analyzed through the conventional content analysis approach based on Graneheim and Lundman's model. Four main categories (a) extra-organizational challenges; (b) Organizational position; (c) The specificity of the care environment, (d) Individual reason and nine subcategories: (accreditation problems, non-native care standards, organizational management, organizational Features, critical condition of patients, physical structure of unit, neglect in the process of care, lack of clinical knowledge and experience, and physical and psychological problems) were identified. From the nurses' perspective, a series of factors associated with the health system, the organization, the ICUs, and the individual play a role in the occurrence of errors; therefore, it is necessary for planners, policy-makers, nursing managers to think about these underlying factors and with in-service training, and a positive, supportive atmosphere; lead nurses to support the patient and improve patient safety.

Background & Aim: Iranian elderly population is increasing, and a high percentage of this population suffers from diabetes. Considering that the concept of active aging has not been developed in the context of chronic diseases that are common in aging (such as diabetes), the purpose of this study was to analyze the concept of active aging in diabetic elderly patients based on a hybrid model. Methods & Materials: Three stages of hybrid model (theoretical, field work and final analysis) were used in this study. In the theoretical phase, 35 articles (published in 1990-2016) from scientific databases were analyzed. In the field work phase, 10 participants were interviewed and then a qualitative content analysis was performed. In the final phase, the findings of the two previous stages were merged and analyzed. Results: The definition of active aging for the diabetic elderly is a comprehensive, dynamic, multidimensional and culturally dependent process that requires a sense of satisfaction, happiness, well-being, security, and physical and mental health, that is achieved through social participation, providence of appropriate health and employment services, awareness of diabetes, and financial, emotional, family, and governmental support that brings subjective and objective benefits to the international, national and individual levels (such as adaptation to illness, a sense of worth and self-esteem). In order to achieve this, paying attention to the whole life span from childhood to old age is needed. Conclusion: The results of this study suggest that health, security, satisfaction, participation, access to health services, support and knowledge of diabetes play an important role in activating elderly people with diabetes in Iran.

Background: Despite the decisive role of nurses in patient’s education, they have limited ability to carry out this responsibility. One of the reasons for this incompetence is insufficient nursing education programs. This study aimed to compare and contrast the effects of multiple teaching methods and conventional methods on knowledge, satisfaction, and performance of bachelorette nursing students. Methods: We conducted a quasi-experimental study with pre-test, post-test design. A sample of 154 nursing students from Tehran University of Medical Sciences was selected and then randomized into experimental (77) and control groups (77). The control group received conventional teaching, and the experimental group received multiple teaching methods, including scenario writing, role playing, videotaping, and analyzing, in 12 weekly sessions. The obtained data were analyzed by the Chi-square and Mann-Whitney tests in SPSS V. 18. Results: Multiple teaching methods did not affect nursing students’ knowledge. However, it resulted in higher student satisfaction (P=0.001) and improved performance with regard to patient’s education (P=0.001). Conclusion: Multiple teaching methods may help students to educate, interact, communicate, and cooperate with patients more effectively.

Background: Patients with degenerative knee joint disease may ultimately undergo Total Knee Replacement (TKR) surgery. However, they need enough knowledge about self-care. The current study aimed at determining the knowledge score of patients undergoing TKR. Methods: The current descriptive, cross sectional study was conducted on 140 patients underwent TKR referring to selected hospitals affiliated to Iran University of Medical Sciences by convenience sampling. Data were collected by Received Knowledge of Hospital Patients (RKHP) and analyzed by descriptive statistics with SPSS V. 19. Results: The mean total knowledge score was 2.09±0.28 that was close to the average level. Patients got the highest score in financial dimension and the lowest score in ethical dimension. Conclusion: Knowledge score was higher than average showing inadequate knowledge of patients; however, a comprehensive educational program should be tailored for patients undergoing total knee joint replacement.

Background: The rights of patients admitted to the Intensive Care Units (ICUs) are threatened more than the ones admitted to other hospital wards due to the nature of ICU and special health conditions of the patients admitted such as lower consciousness and their need for invasive and noninvasive care practices. Awareness of obstacles and observance of patients’ rights are of particular importance. Therefore, the current study aimed at determining the observance of patients’ rights and the organizational facilitators and deterrents influence them from the viewpoint of nurses working in ICUs of educational and therapeutic centers affiliated to Iran University of Medical Sciences, Tehran, Iran. Methods: The current descriptive, cross sectional study included 160 nurses working in ICU, surgery and general wards selected by the census method. Data collection instruments included the 3-section demographic characteristics questionnaire, the Client Observation Checklist (COC) as well as patient safety culture questionnaire. Data were analyzed using SPSS V. 21. Results: Based on the results of COC, the client observation was 76.16% in the current study. The highest amount of satisfaction and desirable observance belonged to the information receipt axis (78.34%) and the lowest observance belonged to the selection and decision making axes (67.17%). The most important facilitating organizational and deterrent factors to observe the client’s rights were identified as reduction of working hours of nurses (96%), handling nurses’ amenities (94.6%), inappropriate nurse/patient ratio (92.6%), and lack of job security and mental safety in nurses (90.6%). Conclusion: Several factors, such as inappropriate nurse/patient ratio, socioeconomic problems, working hours, and heavy workload in a limited time were among the factors influencing the quality of nursing practices, based on the charter of patients’ rights.

Background: Studies suggest that family caregivers of hemodialysis patients experience a high level of burden, which could lead to numerous physical and psychological problems. Despite the need for adequate training and support, these caregivers are mostly neglected, and few studies have been performed in this regard. Aim: to evaluate the effect of educational programs on the home care of hemodialysis patients and burden of their family caregivers. Method: This randomized controlled clinical trial was conducted on 76 caregivers of hemodialysis patients referred to Shahid Hasheminejad Hemodialysis Center of Tehran, Iran in 2015.­ Subjects were divided into two groups of intervention and control (n=38). The intervention group received four training sessions on the home care of hemodialysis patients for two weeks, and the control group received routine care. Data were collected using the Caregiver Burden Inventory (CBI) at the beginning and six weeks after the intervention­. Data analysis was performed in SPSS V.21 using Chi-square, Fisher’s exact test, independent and paired T-test, and Mann-Whitney U test. Results: In this study, no significant difference was observed between the two groups in terms of demographic characteristics. At the baseline, mean score of caregiver burden in the intervention and control groups was 88.5±11.7 and 84.9±15.1, respectively, and no significant difference was observed between the groups in this regard (P=0.30). Six weeks after the intervention, the results of independent T-test revealed a significant difference between the mean scores of caregiver burden in the intervention (58.7±6.6) and control groups (87.8±11.7) ­(P

Background: The family caregivers of patients undergoing hemodialysis have a major role in the care of patients at home. The study results indicate that these caregivers face with multiple problems regarding responsibilities and issues arising from the care and treatment of the patients.These issues decrease their quality of lives. However, these caregivers are mostly neglected andno studies are available on the effectiveness of educational program on their quality of lives. Therefore, this study aimed to examine the effects of educational program on the quality of life of family caregivers of patients undergoing hemodialysis. Methods: This research was a randomized controlled clinical trial, conducted on 76 family caregivers of patients undergoing hemodialysis referred to Shahid Hasheminejad, a medical and educational center in Tehran, Iran. The subjects were equally allocated into 2 groups of 38 patients.The caregivers of the patients who referred in even or odd days of the week were randomly assigned into the intervention and control groups, respectively. The intervention group received 4 training sessions on home care training program during 2 weeks, but the control group just received the routine training at the center. Both groups answered demographic information and “quality of life” (SF-36)questionnaires before and 6 weeks after the intervention. Then, the obtained data were analyzed in SPSS, 21. Descriptive statistics, the Chi-square and Fisher exact tests, as well as independent samples t-test, t-couple, and Mann-Whitney U test were used to analyze the data. Results: The majority of caregivers (54%) were in the age range of 35-55 years. About 68.4% were female and 70% were married. No significant difference was found between the baseline mean scores of “quality of life” of the intervention and the control groups (45.95±14.94 vs. 45.08±11.02, P=0.775). However, the mean scores of quality of life of the intervention group increased at the end of the study and the 2 groups were significantly different in this regard (63.51±11.55 vs. 41.74±10.51, P

Background: The unplanned departure of endotracheal tube is one of the main complications for endotracheal intubation. In addition to endotracheal extubation, its movement can also lead to damage to the oral cavity. Stabilizing endotracheal tube is the most important factor that can prevent unplanned departure of endotracheal tube as well as its movement. The current study was done with the aim of determining and comparing the effect of stabilizing endotracheal tube by a holder with routine method on quality of airway care in patients hospitalized in ICU. Methods: This study was a clinical and quasi-experimental trial with a control group which was done on 100 patients having endotracheal tube attached to mechanical ventilation by a holder. The samples were selected randomly from patients hospitalized in ICU in Hazrat Rasoul Akram hospital. The samples were then divided into control group and test group. At the end of the study, the homogeneous samples were selected and studied. The endotracheal tube was stabilized by a holder in test group and by a routine method (gauze) in control group. The quality of managing airway was studied through 3 frequency indices: endotracheal tube extubation, frequency of linear movement of endotracheal tube, damage to oral mucosa. For the first two indices a self-designed tool was used and a modified version of Oral Assessment guide was used for the oral trauma assessment. The data were analyzed using descriptive statistics, qui square test and independent t-test by SPSS version 17. Results: The findings showed no significant statistical difference in frequency index of endotracheal extubation. Linear movement of endotracheal tube was lower in test group compared to control group. There was no significant difference regarding oral trauma in both groups. A difference was observed in both groups in comparing scores before and after using two methods in “lips” and “Gingiva”. Conclusion: According to the results of this study, it was indicated that using ETT holder for stabilizing endotracheal tube compared to routine method only has preference in movement of endotracheal tube on quality of airway management. While applying methods of stabilizing endotracheal tube, it should be noted that not only type of stabilizing, but also other nursing cares from patients in ICU can affect quality of airway management. Therefore, it is recommended to do further studies on other factors inflencing airway management.

Background & Objective: Hospitals and healthcare centers, like any other organizations, have some common norms and beliefs called as organizational culture. Organizational culture plays a key role in organization&aposs and staffs&apos performances. Nurses&apos perspectives on the organizational culture affect the way they play their role in. This study aimed to investigate the role of organizational culture from perspectives of nurses working in selected hospitals at Tehran University of Medical Sciences. Methods & Materials: In this cross-sectional study, 230 nurses working in different wards of selected hospitals of Tehran University of Medical Sciences were recruited to the study. Data were collected using a demographic characteristics checklist as well as the nurse and organizational culture questionnaire extracted from the Robbins criteria. Data were analyzed using descriptive statistical indexes, independent t-test, Pearson correlation coefficient and regression in the SPSS v.17. Results: Results showed that the existing organizational culture in the selected hospitals was in a moderately good level from nurses&apos perspectives. From the scores obtained for various dimensions of the organizational culture, the highest and lowest scores were for control (44.2%) and conflict tolerance (31.8%), respectively. Conclusion: The level of the organizational culture from the nurses&apos perspectives might lead them to decrease the quality of their performance. Optimizing the organizational culture can improve nurses&apos performance and motivate them to increase their quality of work.

Background & Objective: Hospitals and healthcare centers, like any other organizations, have some common norms and beliefs called as organizational culture. Organizational culture plays a key role in organization's and staffs' performances. Nurses' perspectives on the organizational culture affect the way they play their role in. This study aimed to investigate the role of organizational culture from perspectives of nurses working in selected hospitals at Tehran University of Medical Sciences. Methods & Materials: In this cross-sectional study, 230 nurses working in different wards of selected hospitals of Tehran University of Medical Sciences were recruited to the study. Data were collected using a demographic characteristics checklist as well as the nurse and organizational culture questionnaire extracted from the Robbins criteria. Data were analyzed using descriptive statistical indexes, independent t-test, Pearson correlation coefficient and regression in the SPSS v.17. Results: Results showed that the existing organizational culture in the selected hospitals was in a moderately good level from nurses' perspectives. From the scores obtained for various dimensions of the organizational culture, the highest and lowest scores were for control (44.2%) and conflict tolerance (31.8%), respectively. Conclusion: The level of the organizational culture from the nurses' perspectives might lead them to decrease the quality of their performance. Optimizing the organizational culture can improve nurses' performance and motivate them to increase their quality of work.

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.

Background and Aim : Education is of the basic rights of the patients, and also, a main recognized role of the nurses. Education is an accrediting criterion of the organizations which provide health services . However, the results of the studies indicate that no effective patient education in different societies has been delivered, and this has had negative individual, family, and social consequences. Due to its interactional and cultural nature, patient education sounds to be vital and necessary to be investigated in specific societies and cultures. This study aims at identifying obstac les which leads to the lack of effective patient education. Material and Method: The qualitative research approach (grounded theory) was used in this study and open-ended interviews and field observations were used to gather the data. Eighteen nurses, 4 cardiovascular specialists, 9 patients with cardiovascular disease and 4 family members were interviewed at two educational hospitals in Tehran. Interviews were taped, transcribed and analyzed using constant comparative analysis . Results : More than 800 first level code, 26 categories, and three main variables were extracted as barriers to the effective patient education which are listed as follow: ineffective management, inappropriate organizational culture, and cultural obstructs. Each of these categories includes specific sub categories with specific features, functions, and conditions. Organizational culture played an important and central role in patient education. Conclusion: Although intervening main factors such as those extracted in this study, namely management, organizational culture, and cultural factors are also considered as patient education barriers in different societies, their nature and functions of each of three factors are totally different in societies. Therefore, precise identification and definition of their situation in planning and improving patient education seems to be very necessary.