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Background: Failure to fulfill the physical and psychological needs of breast cancer patients and their partners can result in anxiety, depression, and marital problems. Aim: The present study was performed with aim to elucidate the experiences of breast cancer women regarding partner's unsupportive behaviors. Method: This qualitative study was conducted with a Dickelman descriptive phenomenological approach in the chemotherapy and oncology department of Shahid Ghazi Tabatabai and Shahid Madani hospitals of Tabriz city in 2021. A total of 9 female breast cancer patients were included. Individual in-depth interviews and note-taking were used to collect data using MAXQDA Software. The semi-structured interviews were used to collect data. Interviews were analyzed using the Dickelman, Allen, and Turner method. Results: A total of 1500 primary codes were obtained, and finally 3 main categories were extracted including financial inadequacy, emotional impoverishment and breakdown of shared life, and existential devaluation as a woman. Implications for Practice: The results showed need for the husband to pay more attention to the impact of his behavior on his wife; also talking about the problem on the part of the couple is the biggest factor in understanding the support that can be expressed. Also, men and women do not think the same in understanding the needs of their sick partner. Male caregivers are usually less understanding of their spouses. Therefore, health professionals should pay more attention and help men cope with this problem and bear the suffering of their wives.

Background: Understanding the experiences of patients’ family members witnessing resuscitation helps develop care plans. Accordingly, this study aimed to explore the experiences of witnessing resuscitation among the patients’ family members.Methods: A total of 15 patients’ family members were interviewed over a 4-month period (from April to July 2019). The participants were recruited through purposive sampling, and they were enlisted from three educational hospitals in Tabriz. Data were analyzed using Smith’s interpretative phenomenological analysis (IPA) via the MAXQDA12 software.Results: Data analysis led to the identification of four main themes and nine subthemes. The main themes included “the insistence on being present”, “achieving calmness”, “partnership and collaboration” and “hindrance”.Conclusion: Although family members reported feelings of agitation towards the health professionals, there was also strong evidence of the benefits of witnessing resuscitation such as open communication, psychological support, and facilitating acceptance of the patient’s prognosis. The study highlighted the importance of developing formal policies based on a family-centered care (FCC) approach to observe family presence during resuscitation while maintaining the patient’s and family’s rights.

Abstract Background Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care. Aim This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period. Methods A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis. Results Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses’ roles. Additionally, nurses expressed a negative attitude towards resuscitated patients. Conclusion Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses’ roles in the post-resuscitation period and increasing support from nursing managers.

Abstract Aim This study aimed to explore nurses' experiences of providing family‐centred care in the postresuscitation period. Design An exploratory‐descriptive qualitative design was used. Methods In this qualitative study, in‐depth, semi‐structured interviews were conducted with 22 nurses in three educational hospitals. There were six participants who completed follow‐up interviews to resolve questions generated during initial interviews. Data were analysed using conventional content analysis. Results Five main categories were extracted: continuous monitoring, facilitation of attendance, involvement in care, informing and emotional support. Despite the lack of organizational policies and guidelines, nurses explained how they work to provide family‐centred care for families, especially those they assessed as having less possibility of aggressive behaviour and those with a better understanding of their loved one's condition. To provide postresuscitation family‐centred care, nurses facilitated family attendance, involved them in some basic nursing care, and provided information and emotional support to the family members. Conclusion Nurses attempted to follow the basic principles of family‐centred care in the postresuscitation period. However, to improve the provision of care by nurses, it is necessary to embed family‐centred care principles in institutional policies and guidelines and to conduct training for nurses. Implications for the Profession Iranian nurses are interested in engaged families in the postresuscitation period. Correct implementations of such care that include all families need institutional policies and guidelines. Patient or Public Contribution No patient or public contribution.

Abstract Aim The aim of the study was to examine the experiences of nursing students in internship during the COVID‐19 pandemic. Design A qualitative study. Methods Purposeful sampling was conducted among undergraduate nursing students at Tabriz School of Nursing in November 2021. Students participated in 14 in‐depth open‐ended interviews and stated their experiences and opinions on internships during the COVID epidemic until full data saturation. Data analysis was performed using the conventional content analysis method. This study followed the Standards for Reporting Qualitative Research (SRQR) checklist. Results Findings were extracted and classified into five main categories, including a lack of facilities and equipment, psychological disturbances, physical risk, disturbances in education and learning activities and movement to continue clinical learning in the situation. Conclusion Nursing students in clinical training during the COVID epidemic have experienced physical and mental health issues, as well as educational challenges. During an infectious disease epidemic period, education administrators should adopt appropriate strategies to protect students' health and facilitate their educational and learning activities.

Background & Aims One of the concerns of nurses and physicians is the adherence to treatment in patients with heart diseases. In Iran, there are no accurate statistics on the treatment adherence of patients with coronary artery stents, and the risk of cardiovascular diseases (CVDs) in these patients has not been investigated. Therefore, this study aims to determine the relationship between treatment adherence and the risk of CVDs in patients with coronary artery stents. Materials & Methods This descriptive cross-sectional study was conducted from June to August 2021 in Shahid Madani Hospital in Tabriz, Iran. Participants were 200 patients who underwent coronary angioplasty in the past year and had coronary artery stents. They were selected by a simple random sampling method. To collect data, a demographic form, the treatment adherence questionnaire, and the Framingham risk score (FRS) were used. The collected data were analyzed in SPSS software, version 22 using descriptive statistics, Pearson correlation test, t-test, and one-way analysis of variance. Results The mean age of the patients was 61.6±10.62 years. Most of them were male (60.5%) and married (68%). The overall mean score of treatment adherence was 41.50±8.48, indicating moderate adherence. Patients had poor adherence in domains of dietary regimen and regular physical activity such that most of them used high-fat food (87%) and had the least amount of physical activity per week (92.4%), but they used prescribed medicines on time (70.3%). Based on the FRS, men were twice as likely to have CVDs as women. There was a significant association between treatment adherence and the risk of CVDs, such that the risk of CVDs in the next 10 years among patients decreased with increasing their adherence to treatment (r=-0.25, P

Background: Patient handover in the emergency department (ED) is a 2-way communication process between the paramedics and in-hospital emergency personnel, which can result in miscommunication and delivery challenges. This study aimed to explore the lived experience of paramedics on patient handover to the ED. Methods: Over a period of 5 months, an interpretative phenomenological analysis (IPA) was used to explore the lived experiences of 15 paramedics in Tabriz, Iran. Semi-structured interviews were conducted in the emergency medical stations using the Smith approach for data collection and analysis. The researcher used 4 criteria to ensure rigor, including credibility, dependability, confirmability, and transferability, according to Lincoln and Guba. Results: Three main themes emerged from the data analysis, including “the hole of hope,” “the boring issues,” and “paramedics are only a driver.” A further 11 sub-themes emerged under the main themes. Conclusion: The highlighted issues that need to be considered during the process are the presence of staff in front of the ED's door to welcome the patient, removal of structural defects and defective hospital equipment, the presence of medical supplies in emergency triage to prevent the paramedics from stumbling, and listening to paramedics by physicians and nurses to obtain the patients’ history.

Abstract Background Ethics-based nursing practice can transform health care practices. As the biggest human capital in the health care system, nurses are obliged to follow ethical principles in this field. One of these ethical principles; is beneficence, which is considered the core of nursing care. This study aimed to investigate clarification of the principle of beneficence in nursing care and its related challenges. Methods This integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, and Scopus were searched using the keywords; “beneficence”, “ethic”, “nursing” and “care” in English and Persian in the time range of 2010 to 10 February, 2023. After applying inclusion criteria and assessing the articles using Bowling’s Quality Assessment Tool, finally, 16 papers were included from 984. Results After reviewing and evaluating the qualified articles, the findings were classified into four main categories: (1) nature, (2) applicability, (3) Relevant and influential factors, and (4) challenges related to the ethical principle of beneficence in nursing care. Conclusion Based on the results of this review it seems that paying attention to clarification the principle of beneficence in nursing care can provide positive outcomes for patients to benefit from this principle and finally, it leads to increasing the well-being and health of patients, reducing their mortality rate, increasing satisfaction and maintaining the respect and human dignity of patients.

Introduction Pain self-management is crucial in reducing pain intensity and improving the quality of life for cancer patients. By acquiring self-management skills, patients can actively participate in managing their pain. Objective The objective of this study was to develop a grounded theory-based model to assist cancer patients in enhancing their pain self-management. Methods This qualitative research was conducted in two stages from 2019 to 2021. The initial phase utilized a grounded theory approach to explore the process of pain self-management in cancer patients. Following Corbin and Strauss’ analytical method, a grounded theory of pain management in cancer patients was identified. Subsequently, Walker and Avant’s theory synthesis strategy was employed to construct a practical model that provides support for patients in managing their pain. Results Within the conceptual framework, this study developed the “Holistic Supporting from Pain Self-Management” model. This supportive model consists of three main components: (1) enhancing pain self-management skills in cancer patients and their families, (2) empowering physicians and nurses in pain management for cancer patients, and (3) improving the organizational structure for pain management in cancer patients. Conclusion The Holistic Supporting from Pain Self-Management model emphasizes the importance of addressing all dimensions of cancer pain, including physical, functional, psychosocial, cultural, and spiritual aspects, to effectively manage pain in cancer patients. This model addresses the needs of patients, healthcare providers, and the healthcare system, aiming to enhance and support pain self-management.

Background & Aim: Cancer is a disease that affects the quality of life of the patient, and palliative care is a solution that can improve it. However, home palliative care program has not developed in most countries of the world. The aim of this study is to improve a home palliative care program for cancer patients. Methods & Materials: This research is an action research study that was conducted through quantitative and qualitative approaches in Tabriz over 2018-2020. Eighteen home care nurses were selected for interviews using purposive sampling in order to identify the care needs of cancer patients and the barriers to palliative care at home. In addition, a questionnaire to determine the attitude and knowledge was distributed among 60 home care nurses before and after the action stage. The qualitative data were analyzed using conventional content analysis method, and the SPSS software version 14 was used to analyze the quantitative data. Results: The care needs of cancer patients were determined in five categories and barriers to palliative care in three categories. Cancer patients have physical, psychological, educational, financial and spiritual needs, and barriers to palliative care include poor instruction, families' desperation, and unprofessional caregivers. In the quantitative phase, nurses had average knowledge and negative attitude towards palliative care. Training through virtual space improved the knowledge and attitude of nurses, and the paired t-test showed that the mean score of nurses' knowledge after the action stage was significant. Conclusion: according to the findings, to improve palliative care at home, the physical, psychological, educational, financial and spiritual needs of cancer patients should be considered. Removing barriers to palliative care including developing guidelines, supporting the families of cancer patients and training special nurses for palliative care at home can improve care in these patients.

Abstract Background One of the roles that nurses have acquired in recent years is the role of prescribing. This study aimed to investigate the knowledge and attitudes of critical care nurses, physicians and patients about nurse prescribing. Methods A descriptive cross-sectional study with the participation of 152 nurses, 53 physicians and 75 patients was carried out. Participants were selected by stratified random sampling from the critical care units of six hospitals in Tabriz, Iran. Demographics and participants’ knowledge and attitudes about nurse prescribing questionnaires were used to collect data. The collected data were analyzed using SPSS-22 software. Results The mean scores of total knowledge about nurse prescribing in nurses, patients and physicians’ were 15.41 ± 1.85,16.45 ± 2.31, 14.74 ± 1.7 respectively (from a range of 10 -20), and the mean score of knowledge by physicians was significantly higher than others (P = 0.000) and they had more knowledge about nurse prescribing. The mean scores of the attitudes towards nurse prescribing in nurses, physicians and patients were 40.62 ± 3.68, 37.98 ± 5.92 and 39.38 ± 4.39 respectively (from a range of 10 -50). However, the total mean score of attitudes among nurses was significantly higher than others (P = 0.000) and nurses had more positive attitudes toward prescribing. Conclusion The results showed that the participants have a good understanding and attitudes toward nurse prescribing. Nurse prescribing as a new duty and authority can be considered in providing more effective care by specialist nurses. The results of this study can also be used in the future planning of health policy for nurses to have the right to prescribe and ultimately improve the quality of patient care.

Background & Aims: Mothers of children with autism face many problems that can affect their life. On the other hand, spirituality, as one of the essential aspects of man’s life, has a significant relationship with human health. This study seeks to determine the spiritual well-being of mothers of children with autism. Materials & Methods: The type of present study was descriptive-cross-sectional. In this study, mothers were identified among the 7 schools for children with autism, and 200 people participated in the survey in stages, according to the inclusion criteria. The collected data were used using descriptive statistical methods such as setting frequency distribution tables, calculating numerical indices, and independent chi-square and t-test. The paired t-test was used to achieve the goals under SPSS software v. 16. Results: The Mean±SD spiritual well-being of mothers was 77.17±10.51. Mean±SD spiritual well-being (41.11±5.61) had the highest, and Mean±SD existential well-being (36.06±5.67) had the lowest score. Conclusion: In this study, the spiritual well-being dimension of spiritual well-being was in a better position compared to its Existential Dimension of Health. It can be said that the mothers participating in the present study are richer in spiritual well-being compared to existential health.

Abstract Aim The aim of this study was to explore the barriers to effective pain management in Iranian people with cancer. Design A qualitative descriptive design was used. Methods This qualitative descriptive study was performed on 14 people with cancer. Data were collected using semi‐structured interviews and analysed by Graneheim and Lundman's content analysis method. Results Four main categories emerged in relation to barriers to pain management from the perspective of people with cancer. Categories included 1) accepting and enduring divine pain, 2) negative attitudes towards the effectiveness of analgesics, 3) patients’ low knowledge of pain self‐management methods and 4) neglected pain management. Barriers to pain management are multidimensional in nature consisting of patients, healthcare providers and system components. Therefore, attempts should be focused on the education of patients and healthcare providers about pain management and eliminating the shortcomings of the healthcare system.

Background: Along with the recent healthcare reform, intraprofessional collaboration in nursing is considered an essential factor for managing the challenges related to diverse roles and tasks of nurses in providing high quality care. There is lack of knowledge on how the nursing work environment could influence nurse-nurse collaboration. Purpose: The study aimed to assess the relationship between nursing work environment and nurses’ intraprofessional collaboration. Methods: A total of 300 nurses working in four teaching hospitals participated in this multicenter cross-sectional study. Data were collected using the Nurse-Nurse Collaboration Scale (NNCS) and the Practice Environment Scale of the Nursing Work Index (PES–NWI). The Pearson correlation test was used to analyze the data. Results: The results showed that the mean score of the PES–NWI was 2.65±0.32 out of 4. The highest and lowest scores belonged to the subscales of the nursing foundations for quality of care (2.86±0.31) and staffing and resource adequacy (2.24±0.49), respectively. The mean total score of nurse-nurse collaboration was 2.94±0.21 out of a score of 4. The results showed a significant positive relationship between nursing work environment and nurses’ intraprofessional collaboration (r=0.49, p

Background: Chronic and cancer diseases are expected to rise with the growing population of the elderly in the world. Home palliative care might be a possible solution for improving these patients' quality of life; therefore, the present study sets out to investigate home care nurses' attitude towards and knowledge of home palliative care. Materials and Methods: This is a descriptive cross-sectional study (2018-19), in which 168 home care nurses and nursing assistants in East Azerbaijan Province (Iran) were included (2018). The questionnaire used was specifically designed by Shimizu et al. in 2016 for determining the nurses' attitude towards and knowledge of home care. Data analysis was carried out using descriptive and inferential statistics (T-test and ANOVA). Results: In this study, 95 (56.60%) and 113 (67.90%) of the participants were found to have negative attitudes and limited knowledge, respectively. The other participants seemed to have neutral attitudes towards and average knowledge of home palliative care. The Mean (SD) attitude score on terminal home care was estimated 2.33 (0.83), and the knowledge score on dying care was calculated 41.76%, which were the lowest in comparison with the scores of other dimensions. Conclusions: The home care nurses' attitude towards and knowledge of home palliative care were found to be negative and limited, respectively, which underscores the need to endeavor to improve the attitude towards home care and the knowledge of dying care.

Abstract Aim To investigate the barriers to home‐based palliative care for cancer patients from professional caregivers' experiences. Design A qualitative study. Method This is a descriptive‐qualitative study carried out in the community‐based care. Twenty‐three participants took part in this study. Data were collected through semi‐structured interviews. Results Data analysis led to the identification of three category of barriers including the lack of instructions (the lack of clinical practice guidelines, the ambiguity of tariffs and the lack of insurance coverage), family desperation (family views of prognosis, distrust and poverty) and lack of professionalism (limited knowledge, the use of amateur nurses and siloed care). Developing a care protocol and providing resources support contribute to the development of home‐based palliative care. Moreover, the education of families and training courses for nurses must be fostered.

Summary: Purpose: The aim of this study was to explain the experiences of Iranian nursing students regarding their clinical learning environment (CLE). Methods: Twenty-one nursing students participated in this qualitative study. Data were collected using semistructured interviews and analyzed using conventional content analysis. Results: Analysis of interviews identified six categories: educational confusion, absence of evaluation procedures, limited educational opportunities, inappropriate interactions with nursing staff, bullying culture, and discrimination. Systematic and consistent methods were not used in clinical education and evaluation of nursing students. In addition, there were inadequate interactions between nursing students and health-care staff, and most students experienced discrimination and bullying in clinical settings. Conclusion: Findings showed that the CLE of Iranian nursing students may be inadequate for high-level learning and safe and effective teaching. Addressing these challenges will require academic and practice partnerships to examine the systems affecting the CLE, and areas to be addressed are described in the six themes identified. Keywords: education, nursing, Iran, qualitative research, students, nursing

Objectives: Breastfeeding mothers returning to work undertake multiple conflicting roles at home and work that can result in high levels of stress. Exploring coping skills amongst these mothers can help in planning useful programmes to promote family wellbeing. This study aims to explore the experiences of working breastfeeding mothers and their coping mechanism against high levels of daily stress. Methods: In this qualitative study, we described the experiences of 20 Iranian breastfeeding mothers through in-depth and semi-structured interviews. All interviews were recorded, transcribed and analysed using thematic analysis. Results: Two main themes emerged as follows: 1) self-management with subthemes of a) attitude reconstruction, b) order and planning, c) creating a boundary between work and family and d) reprioritising life affairs; and 2) seeking help with subthemes of a) family member support, b) childcare facilities and c) spirituality. Conclusions: Findings suggest that women need support from family members and family-friendly policies at the workplace. Breastfeeding mothers may benefit from educational programmes that focus on effective coping strategies. Keywords: Breastfeeding, Coping, Employment, Iran, Stress, Women's health

Background: The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI) is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI. Materials and Methods: The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis), and homogeneity (internal consistency and intraclass correlation) on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran. Results: The 30 items loaded onto 4 factors explained 34.95–50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70–0.96. Conclusions: The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification.

Background & Aim: Heart failure is one of the most common cardiovascular diseases which decreases the quality of life. Most of the factors influencing quality of life can be modified with ongoing educational interventions. Inadequate teaching is one of the causes of low health outcomes. Therefore, this study examined the effects of a Roy’s Adaptation Model (RAM) based on quality of life of patients with heart failure. Methods & Materials: This randomized clinical trial study was conducted during May to August 2011. From patients with heart failure referred to Tabriz Shahid Madani policlinics, 44 subjects were conveniently selected and randomly allocated to two groups. The intervention group (n=22) received ongoing one-to-one teaching and counseling sessions and phone calls based on RAM over 3 months. The control group (n=22) received routine teaching. Data were collected using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), Interpersonal Support Evaluation List (ISEL) and the 6-Minute Walk Test (6MWT) at first as well as three months later, and analyzed through SPSS (v.13). Results: The statistical tests showed significant differences in the physical, emotional and total dimensions of quality of life (p