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Considering the importance of family caregivers in pressure injury prevention, it is necessary to clearly define their role in pressure injury prevention guidelines. We reviewed the contents of pressure injury prevention guidelines with the aim of defining the role of family caregivers. PubMed, Web of Science, Scopus, and Proquest were searched, as well as the internet, as some pressure injury guidelines may not be published in professional journals. Literature published between 2000 and 2020 was searched using the keywords "pressure injury," "pressure ulcer," "bed sore," and "prevention guideline." Ten guidelines related to pressure injury prevention were found. Of these, five guidelines mentioned the role of family caregivers in relation to pressure injury, referring only to the training and empowerment of family caregivers. Of the five guidelines that mentioned caregiver training, only three determined the training content in detail. According to these guidelines, family caregivers should be trained on the risk factors of pressure injuries, characteristics of pressure injuries, intervention to prevent pressure injuries, nutrition, sign and symptoms of pressure injuries, complication such as infection and using protective equipment and devices. In the guidelines that focused on family caregivers, the attention is sometimes limited and vague. Limited attention to the role of family caregivers can lead to lack of awareness and reduced ability of family caregivers to prevent pressure injury and ultimately increase the patient's risk of developing pressure injury.

Introduction : Le cancer du sein provoque une crise multidimensionnelle qui ébranle non seulement la patiente, mais aussi le conjoint et les autres membres de sa famille. Il convient donc d’étudier l’adaptation à ce phénomène, qui constitue l’une des principales difficultés pour les proches. En comprenant mieux comment les conjoints de femmes atteintes d’un cancer du sein font face à cette crise, ces derniers pourraient mieux prendre soin de leurs épouses et améliorer leur qualité de vie. But de l’étude : L’étude visait à explorer le concept d’adaptation à partir d’expériences vécues par les conjoints de femmes souffrant d’un cancer du sein. Méthodologie : Cette étude qualitative a été réalisée en 2019 selon une approche phénoménologique dans les villes de Hamadan et Rasht, en Iran. Le groupe de participants comptait 20 conjoints de femmes atteintes du cancer du sein, recrutés grâce à une méthode d’échantillonnage par choix raisonné. Les données ont été recueillies au moyen d’entretiens non structurés en personne; elles ont été analysées à l’aide de la méthode phénoménologique en six étapes de van Manen. Résultats : Les expériences vécues par les participants ont montré que le phénomène d’adaptation des conjoints au cancer du sein de leur femme se décline en cinq thèmes : souffrance émotionnelle, fardeau des soins, maintien de la cohésion familial, incertitude de l’avenir et sentiment de perte du concept de soi. La compréhension du concept d’adaptation chez les conjoints de femmes atteintes du cancer du sein dans les stratégies de santé peut aider les femmes à bien s’adapter, tout en aidant les professionnels à adopter des mesures efficaces dans le domaine des soins médicaux, pour les patientes et leurs conjoints.

Background: Nursing students experience many challenges in their life when entering adolescents and confronting nursing responsibilities. This study aimed to explore the undergraduate nursing students’ strategies in confronting with living challenges. Materials and methods: A conventional content analysis approach used. Nursing students were selected in a purposeful sampling method from universities in Khoy and Tabriz (Iran) and qualitative unstructured interviews were held with 18 undergraduate nursing students. Results: nine strategies were emerged: “Applying the problem-solving process”, “Self-controlling in stressful pressures”, “Maintaining interpersonal relationships”, “Ask for help to remove obstacles”, “Relying on own abilities and beliefs”, “Organizing the financial situations”, “Avoid from unpleasant situations”, “Impulsive behavior with adverse conditions”, and “Rule-based problem solving”. Conclusions: A deeper understanding of life management strategies can be a useful guide for the educational system and can help students and families to overcome stressful situations.

Most parents consider adolescence to be the most difficult stage of parenting. Parental practice is a determining factor in adolescents' outcomes. Mothers play the main role of parenting in Iran. Coinciding the transition of adolescence with the transition of middle-aged mothers can affect the mothers' parenting practice. The present study aimed at explaining the Iranian mothers' practice in parenting an adolescent child.This qualitative conventional content analysis was conducted from July 2018 to November 2019 in Kashan. 21 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. The data were analyzed through conventional content analysis. Data collection and analysis were performed simultaneously using MAXQDAv10 software.Regarding the study objectives, two themes and six main categories were identified. The theme of 'laying the groundwork for upbringing' was detected by two main categories: 'meeting the needs and 'effective interaction with the adolescent'; also, the theme of 'individual-social capacity building' was explained by four main categories: 'helping to gain independence', 'modeling individual-social behavior', 'socializing the adolescent', and 'preparing to accept future roles'.Mothers' practice was mainly focused on adolescents' independence, college education, career prospects, and marriage preparation and respect for older adults. Consistent with this transition to modernity, and contrary to the collectivist values of Iranian society, mothers' practice was in line with developing adolescents' independence and building their self-confidence, which is close to the authoritative parenting style.

Communication is the basis of nursing care and can have a significant effect on patient and community health. This study aimed to optimize the professional and interprofessional relationships of nurses. This participatory action research was conducted with 288 patients and 23 staff of one of the Reference Hospitals in Tehran, Iran, from 2019 to 2020. Interviews were simultaneously analyzed using the conventional content analysis method, and in the quantitative section, the communication skills checklist and a researcher-made questionnaire were used. Participants gave oral and written consent, and their confidentiality and anonymity were respected. Participants’ experiences showed that the implemented programs changed the work environment. The acquired basic concepts were improving the nurse’s responsibility and accountability, improving the quality of care and respecting the patient and the family. Quantitative data obtained before and after the implementation of change programs showed that patient satisfaction increased from 41.57±7.03 to 94.34±4.67 and patient and family training from 113.73±19.77 to 245.99±36.61. The length of hospital stay decreased from 5.52±2.47 to 3.57±2.35 days, nosocomial infections from 32.1±2.8 to 17.4±2.4 and readmission from 4.8±1.2 to 2.3±1.1. The results indicated that patients’ quality of care and safety was increased by optimizing the nurse’s professional and interprofessional relationship. Patients reported greater respect, and nurses had higher job satisfaction.

Background Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. Method For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman’s method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. Results From content analysis, 3 main categories; considering patient’s spirituality, maintaining patient’s dignity during care, and reducing patient’s suffering, were found. The essence of these categories reflect on the care-providers’ consideration and effort in “inducing a sense of worthiness” in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. Conclusion For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.

Background Most parents consider adolescence to be the most difficult stage of parenting. The parental practice is a determining factor in adolescents’ academic achievement, self-esteem, independence attainment, social adjustment, and risky behaviors reduction. The main role of parenting in many societies is played by mothers. The present study aimed at explaining the Iranian mothers’ practice in parenting an adolescent child. Methods This qualitative conventional content analysis was conducted in 2019 in Kashan, in the central part of Iran. Totally, 20 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. Interviews continued until data saturation was reached. Data collection and analysis were performed simultaneously using MAXQDA10 software. Results Regarding the study purpose, six main categories and two themes were identified. The theme of ‘laying the groundwork for upbringing’ was detected by two main categories: ‘meeting the needs’ and ‘effective interaction with the adolescent’ and the theme of ‘individual-social capacity building’ was explained by four main categories: ‘helping to gain independence’, ‘modeling individual-social behavior’, ‘socializing the adolescent’, and ‘preparing to accept future roles’. Conclusions A deeper understanding of maternal practice can help health professionals, especially family nurses, develop parenting programs to promote maternal literacy and adolescent health.

Background Over the past hundred years, licensed practical nurses (LPN) have faced several challenges because of the changing situations in health care system. The current study addresses the role changing of LPNs in accordance with the context and new needs. Aims This aim of situation analysis is to access what changes have occurred in the role of LPNs in the wake of changes in role of RNs over the past century and What factors and variables have influenced this process? Methods This study used a Grounded Theory methodology called Situational Analysis. Data were collected through semistructured and in-depth interviews with 33 nurse. Findings Researchers identify six themes that focus on how the role of LPNs has been changing and variables have influenced this process. Conclusions In Iran, as in other countries of the world, the role of LPNs comes to fore when there are pressing needs and nursing shortage. Iranian policymakers have decided to eliminate LPNs, Although LPNs in other countries are working in community-based settings. Treatment-oriented and self-monitoring structure of the Iranian health care system, new nursing organizations and lack of clear role classification at the caring levels have made the nursing roles ambiguous.

Aim and objectives To explore Iranian hospital nurses' lived experiences of intelligent resilience. Background Nurses do high levels of emotional work when fulfilling patients' and their family members' complex needs. Intelligent resilience can alleviate nurses' stress and enhance their endurance. Design This study was based on the Husserlian descriptive phenomenology. Methods A purposive sample of ten hospital nurses was drawn from hospitals affiliated with Hamadan University of Medical Sciences, Hamadan, Iran. In-depth semi-structured interviews were held to collect data. The seven-step data analysis approach proposed by Colaizzi was used for the data analysis. In this study, the adherence to consolidated criteria for reporting qualitative guidelines has been followed. Results The participating hospital nurses' lived experiences of intelligent resilience came into four main themes of patience and wisdom, reverence, situational self-control and appealing to religiosity. Each of the four main themes included two subthemes which were having peace and wise quietness, reverence for the patients, physicians and nurses, distancing themselves from stressful situations and displacing staff who cause stress, and the nurse's trust in God as well as the patient and his family`s trust in God, respectively. Conclusion Nurses with intelligent resilience are able to bring peace, reverence for others and situational self-control to stressors thereby providing higher quality of care to their patients. Relevance to clinical practice Nurses work in unstable and stressful conditions. The findings of this study provide better understanding about the concept of nurses' intelligent resilience and its indicators and attributes.

Background One of the main challenges of nursing student education is the lack of clinical competence that reduces the quality of patients care. Measuring the clinical competency of undergraduate nursing students is effective in curriculum developing, planning, and learning evaluation. Objective To validate self-assessment clinical competence questionnaire of undergraduate nursing students. Methods This was a cross-sectional study at Baqiyatallah University of Medical Sciences in Tehran, Iran, 2015-2016. The original version of the self-assessment questionnaire for baccalaureate nursing graduates was translated to Persian by the World Health Organization's (WHO) method. The psychometric evaluation of the questionnaire was conducted on 300 nursing students. The participants were selected by convenience sampling. The tool validity was confirmed by exploratory factor analyses. The reliability was investigated by internal consistency and test-retest. Results Cronbach's alpha coefficient was 0.96 (0.82-0.91). Intraclass correlation coefficient (ICC) was 0.98 (0.88-0.99). Five factors were extracted by analysis of clinical competency tool of undergraduate nursing students. The factors included technical competence, advanced competence, ethical competence, care management and safety competence. Conclusions The Persian version of the clinical competence assessment tool has acceptable psychometric characteristics in the Iranian nursing students' community. This questionnaire can be used as a valid tool in planning and research management areas.

Background: The health system in Iran faces specific challenges as the managerial role of head nurses have changed. The importance of this role cannot be underestimated for the healthcare organizations’ success. The present study was conducted to explore the meaning of managerial competence of head nurses in intensive care units (ICU) in Iran. Materials and Methods: This study used a qualitative approach. We extracted the lived experience of ten Iranian ICU head nurses. Data were collected through unstructured in‑depth interviews from 2014 to 2015. Interviews were recorded and transcribed verbatim and were interpreted using Van Manen’s six‑step approach. Results: The expansion and clustering of 442 initial themes led to the emergence of 35 secondary themes, nine subthemes, and three main themes. Managerial competence – theme included “self‑excellence,” “ward excellence,” and “intensive care excellence.” Conclusions: The “managerial competence of ICU head nurses” is a dynamic concept that reflects the psychological and functional capability of head nurses in contributing towards excellence in their own critical care practice as well as that of the ward. A competent head nurse has outstanding personal and nursing attributes and holistic knowledge, and is also committed to the ongoing professional improvement of him/herself. Using their ability to facilitate interpersonal and interprofessional communication effectively, a head nurse seeks the psychological, physical, and human optimization of the ward in which he/she works. Therefore, the goal of providing insightful critical care through smart organization and planning of nurses and other personnel can be achieved.

Background: Nurses have always been known as an advocate for the rights of patients. The recognition of what is perceived as the violation of patients’ rights can help nurses to understand patients’ concerns and priorities. Thus, it helps nurses play their supportive roles more effectively. Objective: The aim of this study was to explore different dimensions of the violation of patients’ rights. Research design: Data were collected utilizing unstructured interviews and field notes. Data analysis was conducted using the qualitative content analysis approach. Prolonged engagement, maximum variation sampling, and member check were among the factors which enriched the research. Participants and research context: The sample consisted of 18 patients and 11 members of their families. They were purposively selected from two hospitals in Tehran during 2009–2012. Ethical considerations: The research was approved by the Ethics Committee of the university and hospitals. Finding: The patients’ rights were violated in a variety of ways. There were three main dimensions to this issue: (a) care recession including deprivation of the caregiver’s presence and the delay/lack of needed responses; (b) receiving mechanical care including superficiality, lack of emotion, and failure to understand the situation; and (c) being disrespected including humility and aggression. Conclusion: The patients and their families consider any shortcomings in relation to the patient and the quality of care as the violation of the rights. The findings of the study imply sensitizing managers toward providing appropriate conditions as well as educating nurses to observe patients’ rights. It is suggested that the processes leading to the violation of patients’ rights be discovered and prevented in the future.

The present study examined how infertile Iranian clients confront infertility. Research on infertility has confirmed the significance of a socio-cultural context in the formation of responses to infertility. This study used the grounded theory approach to explore the experiences of infertile individuals presenting at the Royan Institute in Iran from October 2013 to September 2014. Clients with infertility of at least two years in duration were recruited using purposive sampling followed by theoretical sampling. A total of 41 interviews were conducted with 36 people. Data were collected through in-depth unstructured interviews and field notes. Data analysis was performed using MAXQDA 2007. A sense of 'insecurity about personal and family identity' shaped in the context of 'facing the cultural-economic dilemmas' was identified as the main concern of infertile clients. The clients dealt with this concern through a series of strategies that included gradual acceptance of infertility, seeking information and consultation, pursuing treatment, focusing on saving the marriage, self-control and resilience and fighting inner turmoil. All these approaches suggest 'protecting personal and family identity' as the core concept. The findings highlight the need for the health care system to treat infertility as a broad concept than mere individual and biological dysfunction.

Aim Little knowledge is available about the experiences of the commissioning mothers during the process of surrogacy; thus, the present study was conducted in order to explore and analyze this process. Methods This study was conducted in a referral institute in Tehran with a qualitative approach and using grounded theory methodology. The data were collected through 39 unstructured, in-depth interviews that were conducted with 15 gestational commissioning mothers, two of their husbands, four surrogates, and five of the personnel at centers for assisted reproduction (some participants were interviewed more than once). Sampling started purposively and then continued theoretically. Results The analysis revealed the main concern of these mothers to be the feeling of “insecurity about becoming a mother” and their predominant strategy for dealing with it to be “seeking security about becoming a mother,” which emerged as a core concept. The consequences of the mothers' adopted strategies and the effects of the intervening factors included “reaching a state of relative peace,” “a continuing threat to one's identity,” and “mental and physical exhaustion.” Conclusion Identifying the demands of this group of mothers can help medical personnel, particularly nurses, adopt better plans for the future and to optimize the care they provide to these patients.

BackgroundIn order to achieve the goals of the healthcare system, nursing managers are required to comply with ethical principles in decision-making. In complex and challenging healthcare settings, it is shown that the managers’ mere awareness of ethics does not suffice and managers need to be sensitive toward making ethical decisions.AimTo explore nursing managers and their sensitivity toward ethical decision-making by analyzing their related experiences.MethodThe current study has been conducted in Iran in 2017 through a qualitative content analysis approach. Nineteen nurse managers were selected purposefully from different hospitals in Tehran. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method.Ethical considerationsThe research was approved by the ethics committee of Tarbiat Modares University, Tehran, Iran. Participants were informed about the purpose of the study and submitted written informed consents regarding their participation. The principle of autonomy, confidentiality, and anonymity was taken into account in data collection.ResultsFifteen subcategories, three categories (assertiveness, commitment, and insight), and one theme of excellent decision-making were the results of data analysis.DiscussionFindings showed that nursing managers’ sensitivity to ethical decision-making allows them to make the best decision by insight, commitment, and assertiveness. Making a morally excellent decision ensures that ethical principles are followed in the healthcare system.ConclusionConsidering that most managers are committed to making ethical decisions, it is required to develop the scope of their insights even further using a professional management and ethical principles training program. Also, by addressing some of the ethical barriers at personal and organizational levels, the assertiveness in managers can be improved, which in turn can facilitate their ethical decision-making.

Purpose This research was performed to compare Islamic and Western ethical values in health services management. Approach Whittemore and Knafl's integrative review was employed. Findings Eight final categories of Islamic values (i.e., honesty, piety, foresight, dignity, justice, good temperament, widened heart, and certainty to God) and nine final categories of Western values in health services management (i.e., honesty, freedom, forgiveness, altruism, justice, dignity, responsibility, tolerance, and wisdom) were extracted in this study. Conclusions The results showed some discrepancy between Islamic and Western ethical values, which are partially due to a different definition of values in Islam and the West. Implications The comparison of ethical values can facilitate the exchange of intellectual, cultural, and experimental ideas between Islamic and Western healthcare management.

Introduction: Nursing students require highly specialized competencies to accurately determine patients' states and to predict and cope with problems that may occur during nursing care. This study explores the definition, domains, and levels of nursing students' competency. Methods: This study was a systematic review of nursing students’ competencies in English (ISI, SCOPUS, Ovid, Proquest, Iranmedex, Google scholar, PubMed) and Persian (Scientific Information Database) databases (1985–2015), according to the University of York Center for Reviewers and Dissemination Guidance approach, 2008. Results: From a total of 13,115 articles, 20 were retrieved in the final step. The individual experiences, dynamic process, and positive interactive social and beneficial changes in the equality of one’s professional life that cause meta-cognitive abilities, touch reality, motivation, decision making, job involvement, professional authority, self-confidence, knowledge and professional skills formulated the definition of nursing students' competency. Educational, cultural, individual, professional and inter-professional, research, clinical and practical domains were defined as belonging to nursing students' competency. Seven nursing student competency levels were identified. Conclusion: Although the definitions of competency, its domains, and its levels vary by profession and country, this systematic review demonstrated the comprehensive ones in three scopes. However, more research is needed to examine the three scopes in the nursing student competency concept.

Aim Despite the increasing use of surrogacy, there are no caring theories/models that serve as the basis for nursing care to surrogacy commissioning mothers. This study has designed a model for caring of surrogacy commissioning mothers in 2013. Methods The theory synthesis of Walker and Avant's strategies of theory construction (2011) was used to design a caring model/theory. The theory synthesis includes three stages: (i) selection of focal concept (the concept of “security giving in motherhood” was selected); (ii) review of studies in order to identify factors related to focal concept relevant studies (42 articles and 13 books) were reviewed, statements and concepts related to focal concept were then extracted and classified, and their relations were specified; and (iii) organization of concepts and statements within a relevant general and effective manifestation of the phenomenon under study which led to developing of a model. Results In this caring model/theory, entitled “security giving in surrogacy motherhood”, nurses roles were conceptualized within the conceptual framework that includes three main roles: (i) coordination; (ii) participation; and (iii) security giving (physical, emotional, and legal support; empowerment; presence; relationship management between both parties and advocacy). Training surrogacy specialist nurses and establishment of surrogacy care centers are important factors for implementation of the model. Conclusion This model could help to provided better caring for surrogacy clients, especially for commissioning mothers.

Background and Purpose: Colorectal cancer (CRC) is one of the most highly prevalent and life-threatening digestive tract cancers. CRC and its treatment are associated with numerous complications in the patients. Orem's self-care model is a theory on clinical improvement and reducing fatigue in patients with CRC. This study aimed to investigate the effects of Orem's self-care theory on the nutrition status and fatigue of CRC patients. Methods: This quasi-experimental study was conducted on 70 patients diagnosed with CRC in the teaching hospital of Imam Reza in Kermanshah, Iran in 2014. Samples were randomly divided into two groups of experimental and control. Data were collected using the food frequency questionnaire (FFQ) and Brief Fatigue Inventory (BFI). After data collection, a self-care training program was implemented based on Orem's self-care theory. Results: Self-care training intervention in the experimental group improved the consumption patterns of fruits (P=0.002), vegetables (P=0.001), and dairy products (P=0.001). Moreover, general fatigue of CRC patients in the experimental group decreased after the intervention (P=0.0001). Conclusion: According to the results of this study, Orem's self-care model could reduce the clinical symptoms and fatigue of patients with CRC. Therefore, it is recommended that this model be applied to enhance the self-care behaviors and clinical conditions of CRC patients.

Introduction: Considering that patients in the special units have critical conditions and require the best possible specialized care, having appropriate professional relationship in these units is of great importance. Taking care of patients under critical conditions requires occupational safety and sense of satisfaction in the nurses. Indeed, nursing managers should provide an appropriate organizational environment with emphasis on establishing an effective relationship. Aim and objective: Explaining nurses’ perception of professional relationship in the coronary care unit. Materials and methods: The present study was a qualitative study conducted through conventional content analysis method. The participants were 37 nurses working in the coronary care unit who were selected purposively. Data were gathered through 25 in-depth interviews and 3 focus groups Results: After analyzing the data, the main theme of “ineffective relationship between the senior managers, head nurses, and the personnel of the coronary care unit” and two subthemes of “ineffective relationship between the head nurse and the personnel and “ineffective organizational environment” were extracted. Conclusions: The results of the present study provided an image of real experiences of participating nurses about the relationships that exist between different levels of nursing profession. so, by establishing a professional relationship in the coronary care unit, specialized cares would be performed. The main theme obtained in the study, “ineffective relationship between the managers, head nurses, and personnel of the coronary care unit” suggested different aspects of the outcomes of ineffective relationship between nurses, head nurses, and nursing managers. Therefore, it is necessary that professional relationships be improved at different levels of nursing and emphasized seriously.

Context: Different types of peer education have been used in nursing. There is not a formal peer education in Iranian nursing curriculum. Aim: The present study was conducted to identify and contextualize nursing students' perception of clinical training by planned peer assistant education. Setting and Design: This study was conducted using conventional qualitative content analysis by a descriptive explorative method in Mazandaran University of Medical Sciences. Materials and Methods: Participants included 24 trainees who received intensive care unit training by eight peer assistant. Data saturation was achieved through semi-structured in-depth individual interviews with 14 students and three focus group sessions. Statistical Analysis Used: Data were analyzed using conventional qualitative content analysis with MaxQData. Results: Participants' experiences were categorized into two main themes including (1) “Clinical differentiation” with three subthemes of clinical independence, courage, and sincere clinical experience, and (2) “facilitating interactive directed clinical learning” with two subthemes of facilitating clinical learning, and interactive directed learning were extracted from the qualitative content analysis of data. Conclusions: Students participating in planned peer-assistant education had a positive perception of the program and considered “clinical differentiation” as its most important achievement.

Background: Understanding nurse managers' supportive strategies for managing nursing errors can facilitate the improvement of nursing care quality and patient safety. Objectives: This study aimed to explore nurse managers' supportive strategies for nursing error management (NEM). Methods: This descriptive qualitative study was conducted on twenty nurse managers and two nurses purposively recruited from teaching hospitals affiliated to Urmia University of Medical Sciences, Urmia, Iran. The data were collected via in-depth semistructured interviews and concurrently analyzed via conventional content analysis. Results: Nurse managers' supportive strategies for NEM were overlooking nurses' errors to promote their obedience, prioritizing nursing care measures to reduce errors, error prevention training rounds during shift handover instead of error reporting, and alternative disciplinary measures instead of error reporting. These strategies were conceptualized as protective disciplinary exchange. Conclusion: Protective disciplinary exchange denotes that nurse managers prefer to manage nursing errors with flexibility. This situational communicative strategy helps nurse managers protect their staff resources and maintain their positions.

Aim: Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients. Methods: In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted. Results: Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach. Conclusion: Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.

Sharareh Zeighami Mohammadi, Sima Mohammadkhan Kermanshahi, Zohreh Vanaki Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Background: Women with breast cancer (BC) are commonly confronted with others’ pity. However, there is limited information about pity in Iranian women with BC. The aim of this study was to explore perceptions, reactions, coping strategies, and consequences of pity among Iranian women with BC. Methods: This qualitative study was carried out from March 2016 till October 2017. A purposive sample of 36 women with BC was selected with maximum variation from three health care centers in Alborz Province, Iran. Data were collected using semistructured interviews and analyzed using a conventional content-analysis approach. Results: Our findings indicated that Iranian women with BC experienced received pity and perceived unusual attention from others as due to certain reasons. Others’ pity caused negative emotional reactions in them. They used self-protection strategies against others’ pity. The consequences of self-protection against pity were normalizing the patient’s flow of life and/or social isolation. Conclusion: Pity is a serious psychosocial challenge in Iranian women with BC, with negative effects on quality of life. Therefore, pity should be considered in counseling and psychosocial screening of patients. Keywords: breast cancer, pity, qualitative study, conventional content analysis

Sharareh Zeighami Mohammadi, Sima Mohammad Khan Kermanshahi, Zohreh Vanaki Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Background: Body image altered is the most important psychosocial concern associated with breast cancer. Yet, there is a paucity of information regarding strategies for coping with this problem. This study aimed to explore Iranian breast cancer women’s strategies for coping with body image altered. Methods: This qualitative study was conducted in 2016–2017. A purposive sample of 36 women with breast cancer was selected with maximum variation from three health care centers in Alborz Province, Iran. Data were collected by semi-structured interviews and analyzed by performing conventional qualitative content analysis. Results: The main theme of the study was “reconstruction of feminine identity” with the six main categories of physical appearance improvement, active information seeking, self-care for managing limits, psychological self-empowerment, maintaining maternal role, and maintaining wife role. Conclusion: Iranian breast cancer women’s strategies for coping with body image altered are multidimensional and are mainly based on personal resources. Breast cancer women use these strategies to reconstruction of their feminine identity. Health policy-makers can use the findings of the present study to develop interventions and programs for improving breast cancer women’s body image care. Keywords: breast cancer, body image altered, coping, feminine identity, qualitative study

Background: The performance of nurses, which is rooted in personal motivation, determines the quality of care. Therefore, it is important that nurses are motivated to provide high-quality care. Purpose: The purpose of this study was to explore the factors that affect caring motivation from the perspectives of nurses in Iran. Methods: This was a qualitative study. Seventeen nurses were interviewed using a semistructured, in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Results: Data analysis led to the identification of the two themes of (a) self-valuation and (b) providing beneficial care. Conclusions/Implications for Practice: The findings of this study increase scholarly understanding of the caring motivations of nurses. These motivations may be used in related programs by senior nursing managers to improve the quality of nursing care.

Emotional intelligence can help nurses improve their clients' satisfaction and health. The aim of this hermeneutic phenomenological study was to explore Iranian hospital nurses' lived experiences of emotional intelligence. Data collection was done through holding ten in-depth semi-structured interviews with ten hospital nurses. Participants were recruited from hospitals affiliated with Hamedan University of Medical Sciences, Hamedan, Iran. Data analysis was done using Van Manen's ( 1997 ) six-step approach and resulted in the development of the main theme of normative interactive management and the following three subthemes of resorting to spiritualities, self-protection, and intelligent resilience.

Background and Purpose: Initiating and adhering to self-care activities necessitate self-care motivation. This study was undertaken in Iran to explore self-care motivation among patients with heart failure (HF). Methods: This qualitative study was done in 2014 and 2015. Study participants were patients with HF and their family members who were purposively selected from Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. The study data were collected from December 2014 to May 2015 by doing in-depth semistructured face-to-face interviews and were analyzed via the directed content analysis approach. Results: Eleven primary codes were generated which reflected motivations for self-care among patients with HF in the Iranian sociocultural context. To enhance the clarity of the findings, these primarily codes were summarized and grouped into 7 subcategories including fear of death and love of life, returning to previous physical health status and preventing or alleviating symptoms, understanding the value of self-care behaviors and trusting them, having the desire for remaining independent, relying on God, reassuring and supporting family members, and preventing family members from feeling irritation. Implications for Practice: The findings of this study indicate that patients with HF have different motivations for doing self-care activities. Fear of death, love of life, wish to return to previous health status, and prevention or alleviation of HF symptoms were the participants’ strongest motivations for self-care. Understanding the motivations for self-care among patients with HF, based a holistic approach and evidence-based practice, can help nurses and physicians develop motivational programs for promoting self-care behaviors.

Background and Purpose: Surrogacy is a new assisted reproductive technology requiring to be perceived based on the real experiences of surrogacy patients regarding its legal issues so that legislators are able to enact appropriate laws for such patients' safety. This study pursues the goal to examine the experiences of commissioning mothers and surrogates confronting legal issues. Methods: This paper is part of the findings of a larger study conducted over 20 months from October 2011 to June 2013 using the grounded theory approach to explain the process of becoming a mother in commissioning mothers. The experiences of mothers using gestational surrogacy have been analyzed through the conventional content analysis method and then reported in terms of the legal issues of surrogacy. Overall there have been 20 participants including 11 commissioning mothers and 4 surrogates. For incorporating the resources, 5 fertility clinic personnel have also been interviewed. Totally 25 unstructured in-depth interviews have eventually been performed. Data have been collected via purposive sampling method within Royan Institute, and then due to the inadequate number of samples, sampling continued in other surrogacy treatment centers. Results: Commissioning mothers and surrogates suffer a great amount of stress at the time of childbirth, and lack of legal support imposes plenty of problems on them. Participants' experiences revealed a common theme of “legal constraints” with three dimensions as “inefficiency of current laws”, “receiving inadequate educational support services” and “stress and frustration”.s Conclusion: Results indicate disagreeable legal settings for surrogacy leading to a high level of stress imposed on the clients using these technologies. The treatment team should inform the families about the entire process ahead of them before they make their final decision so as to enable them to enter the process fully aware.

Objective To determine the competencies of charge nurses. Methods The systematic review and thematic synthesis study was done at Iran from1 Apr 2018 to 31 Jul 2018. Five electronic bibliographic database (Science Direct, Pro Quest, Scopus, Pub-Med, Scientific Information Database) were systematically searched for relevant literature published from 1980 to 2018. Content analysis was done to categorise competency of charge nurses. Results Of the 1285 articles, 24(1.86%) were reviewed. Through thematic synthesis, six themes identified were self-management, others' management, clinical competency, conceptual-cognitive competency, professional-legal competency and competency in communication. There is need to improve knowledge and skills in the domains of management, leadership, communication and perceptual/cognitive competency. Conclusions The findings may help nurse administrators and nurse directors in designing training programmes for charge nurses who could improve their competencies.

Without sufficient support, type 1 diabetes mellitus often disturbs patients' normal lives. This study describes and explores the support that Iranian adolescents with type 1 diabetes mellitus experienced. Semistructured interviews were conducted with ten adolescents, seven family members, one dietitian, one nurse, and one school nurse. Participants were chosen using purposive sampling from two teaching hospitals and one high school in two urban areas of Iran. Using standard procedures for content analysis, three main themes were identified: maintaining a normal life; receiving tangible, informational, and emotional support from the family and society; and advancement of life toward normalization. The cornerstone of maintaining a normal life for adolescents with type 1 diabetes mellitus is to adopt an active role in taking care of themselves within their systems of support.

Background : One of the indices of health care development is the use of HIS, but it is not supporting the nursing process as a scientific method. So, this study was done in order to optimize Hospital Information System (HIS) in cardiac care unit with the approach of “nursing care using scientific method”. Materials and Methods: This study is a part of a participatory action research which was done in CCU of Shahid Madani educational center of Khorramabad in four phases including assessment, planning, implementation and evaluation of change programs in 2010-2012. All individuals who were effective in HIS implementation were chosen as participants (44 people). Data gathering method included: open interview, group concentrated discussion, guiding group sessions and observing checklist of bedside nursing care. Nursing cares in SOAPIE method prepared and put in HIS with cooperation of IT unit, and plans implemented and evaluated. Reflection and sharing were used for accreditation. Data analysis was done by constant comparison method and the Wilcoxon test. Results: By HIS optimization, mean of bedside nursing care in different domains and totally increased from 177.40 to 273.06 (p=0.001). Also, the relationship of nurse with patient and care team improved that resulted in: Patient comfort, trust in received cares, trust in nurse, decrease in complaints and increase in patients and relatives, satisfaction. Conclusion: Optimized use of HIS prepared by easy availability to nursing care standards. It is recommended, by enhancing the HIS capabilities and interdisciplinary communication, safe and scientific cares, and accurate and fast record to be provided by technology.

Background & Aim: Implementation of the motivational program by nurse managers can improve nurses&apos performance and behaviour, provide better care for patients, and promote patients&apos satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients&apos satisfaction. Methods & Materials: This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed (α=0.72). Fourty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1) determining nurse managers&apos expectancies from nurses, assessing nurses&apos attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses&apos performance 2) implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses&apos performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16. Results: There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention (P

Background: Nausea and vomiting are the worst and the most prevalent complications experienced by 70–80% of patients. Complementary treatments including therapeutic touch are cost-effective and low-risk, independent nursing interventions. Present research aims at investigating the effect of therapeutic touch on the intensity of acute chemotherapy-induced vomiting in these patients. Materials and Methods: As a single-blind, randomized clinical trial, the present research was carried out on women with breast cancer undergoing chemotherapy in Isfahan, Iran. The subjects were divided into three groups of control, placebo, and intervention. The intervention was applied to each patient once for 20 min on the aura (human energy field) focusing on solar chakra. Data gathering instruments included demographic questionnaire and acute vomiting intensity scale. Results: There was a significant difference among the three groups (and also after the intervention) (P < 0.0001). Paired comparisons among the groups using Mann–Whitney test showed that there was a statistically significant difference between the control group and the intervention group and between the control group and the placebo group (P < 0.0001). However, there was no significant difference between the placebo and intervention groups (P = 0.07). Conclusions: Therapeutic touch was effective in reducing vomiting in the intervention group. However, the patients experienced lower-intensity vomiting which may be because of presence of a therapist and probably the reduced anxiety related to an additional intervention. So, further research is recommended considering the placebo group and employing another person in addition to the therapist, who is not skilled for this technique.

Background: Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment. Objective: To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting. Research design: Data were collected from interviews and observations in 2009–2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred. Participants and research context: In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling. Ethical considerations: The research was approved by the Ethics Committee of the university and hospitals. Results: The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation–education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others’ needs, resulting in “success and accomplishment” of nurse/nursing manager and patient/family. Conclusion: This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses’ professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses’ rights are violated.

Dignity is a human right and a base for human health. This right must be observed in work environments as a moral obligation. This qualitative study aimed to understand nurses’ experiences of violation of their dignity at work and to explore its dimensions. The participants were 15 nurses working in two hospitals in Tehran. The data were collected through 26 unstructured interviews and analyzed using content analysis. The dimensions of violation were ‘irreverence’, including experiences of abuse and violence, humiliation, and being ignored; ‘coercion and violation of autonomy’, consisting of the control of relationships, lack of privacy, rigidness, and imposition; ‘ignoring professional and scientific ability’, indicating impossibilities in applying nurses’ knowledge; and ‘denying the value of nurse/care’, being the theme that verified the dominance of treatment/cure and lack of recognition of care value. Health systems should take the promotion of the nurses’ dignity into account through providing a dignified work environment.

The purpose of this qualitative study was to describe the experiences of Iranian nurses concerning their quality of work life. A purposive sample of nurses (n = 14) was recruited from two university hospitals. The data were collected through unstructured interviews and were analyzed by using qualitative content analysis. The results indicated that the participants discerned their quality of work life by assessing how favorable were their working conditions, the level of fulfilment of their personal needs, and the impact of their working conditions on their private life and their social life. Three main themes were identified: quality of work life, as experienced from a personal perspective; quality of work life, as experienced from a sociocultural perspective; and quality of work life, as experienced from an organizational-professional perspective. The results of the present study will help Iranian nurse administrators to adopt effective strategies in order to improve nurses' quality of work life. Future research can broaden the scope of the current results and offer a more comprehensive understanding of nurses' quality of work life.

Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU).Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P

This study aimed to evaluate the reliability and validity of the Iranian version of the Uncertainty In Illness Scale — Family form. For this purpose, the Uncertainty In Illness Scale — Family form was translated from English into Persian and tested for psychometric properties. The analyses were carried out with data from a sample of 310 patients’ family members at one general hospital in Birjand city, the center of the Southern Khorasan province. The Iranian version of the Uncertainty In Illness Scale — Family form demonstrated an acceptable level of content validity with a content validity index of 0.91. The Cronbach’s alpha of 0.83 showed that the scale had reasonable internal consistency. This preliminary validation study of the Iranian version of the Uncertainty In Illness Scale — Family form showed that it is an acceptable measure to be used with Iranian patients’ family members. Additional research is recommended for further evaluation of the psychometric properties of the scale.