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Abstract Background Moral reasoning in nursing is crucial in delivering high-quality patient care and fostering increased job satisfaction among nurses. Adhering to professional values is vital to this profession, and nurses must modify their actions to align with these values. Objective This study aimed to examine the correlation between moral reasoning and professional values among undergraduate nursing students. Research design A descriptive correlational design was recruited. Participants and research context The research was conducted at three nursing schools located in Tehran, Iran. The sample was recruited through random stratified sampling, specifically targeting undergraduate nursing students. The data collection tool comprised a three-part questionnaire, including a demographic information form, the Nursing Dilemma Test, and the Nurses Professional Values Scale Revised Questionnaire. The distribution of questionnaires encompassed both face-to-face and electronic methods. The analysis of data was conducted using SPSS 16 software. The data was analyzed using the independent samples t-test, Pearson’s correlation coefficient, and linear regression analysis. The P value of 0.05 was considered significant. Ethical considerations The Ethics Research Center of Shahid Beheshti University of Medical Sciences approved the study. Findings Data analysis showed that moral reasoning was directly correlated to professional values (r = 0.528, p

Abstract Introduction Assessing critical thinking disposition is crucial in nursing education to foster analytical skills essential for effective healthcare practice. This study aimed to evaluate the cross-cultural adaptation and validation of the Persian version of the Critical Thinking Disposition Scale among Iranian nursing students. Method A total of 390 nursing students (mean age = 21.74 (2.1) years; 64% female) participated in the study. Face and content validity were established through feedback from nursing students and expert specialists, respectively. Construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA was used to explore the number of factors and the items that were loading on them. The CFA was used to confirmed the fidnings of the EFA on the same sample. Convergent and discriminant validity were examined, along with reliability through internal consistency and test-retest reliability. Results EFA revealed a two-factor structure, comprising “Critical Openness” and “Reflective Skepticism,” explaining 55% of the total variance. CFA confirmed the model’s fit (χ² = 117.37, df = 43, χ²/df = 2.73, p

Background: Due to the nature of their work, prehospital personnel face various ethical challenges that can lead to moral distress. Compared to hospital nurses, the interaction of personnel in the pre-hospital environment is closer, and the ethical climate can affect the reaction of pre-hospital personnel in the face of moral challenges and distress. This study determines the relationship between moral distress and ethical climate among prehospital personnel. Materials and Methods: This cross-sectional correlational study was conducted on 136 emergency medical services personnel selected via census sampling. To collect the data, two instruments were used, namely the revised moral distress and Victor and Cullen’s standard ethical climate. The data were analyzed using descriptive statistics and Pearson correlation in the SPSS software, version 23. Results: According to the results, the mean score of moral distress intensity (MDI) was high (3.65±1.14) and the mean score of moral distress frequency (MDF) was moderate (1.83±0.53) among emergency medical services personnel. The mean ethical climate was moderate (2.96±1.02). The study found a negative and significant relationship between ethical climate and MDI among emergency medical services staff (r=-0.34, P0.05). This study also found a significant relationship between MDI and personal characteristics, such as age, work experience, and history of referral to the board of inquiry (P0.05). Conclusion: Considering the positive effect of the ethical climate on reducing emergency medical services providers’ moral distress, more attention is essential to the factors affecting moral distress.

Abstract Aim and Objectives This study aimed to develop and examine psychometric properties of the safety feeling scale (SFS) in adult patients to assess their sense of safety during a hospital stay. Design Mixed methods design. A SQUIRE checklist was used. Methods This is a study with two phases of scale development and evaluation of the psychometric properties of the scale. In the first phase, the concept of ‘safety feeling’ was analysed using a hybrid model. Thus, a systematic review and then a qualitative study with hospitalized patients (n = 31) were conducted by conventional content analysis. In the psychometric phase, factorial validity, reliability, feasibility, and responsiveness of the scale were evaluated by different tests in various samples. Results After integrating the results of the systematic review and qualitative study, a scale item pool with 84 items was developed. In the psychometric phase, 12 items with four factors were specified; ‘effective care,’ ‘confidence in the healthcare team,’ ‘emotional enrichment’ and ‘hygienic facilities,’ explaining 51% of the total variance of the scale. They were confirmed by confirmatory factor analysis. Internal consistency and stability of the scale were satisfactory. Feasibility and responsiveness were also acceptable.

Islamic thinkers including philosophers and theologians, have presented various proofs to reject the belief in reincarnation which some of them have been challenged by other thinkers. Among them, two proofs have special importance and status, one attributed to Sheikh Al-Raees Ibn Sina and the other to Mulla Sadra. İn this paper after criticizing and investigating the above two proofs and stating their problems, it is atempted to present new version of Sadr al-Motaalehin proof which is based on time concept. Considering that the concept of time is common between philosphy and science, another aspect of Sadr al-Motaalehin's proof is paid attention to and its validity is examined from this point of view. Also, this descriptive and analytical article shows that Sadr al-Motaalehin's proof which is rooted in the substance theory, is the most convincing proof in reject the reincarnation. It should be noted that this goal can be achieved by using the concept of time in this proof and presenting an interpretation based on the concept of time.

Background: Incivility is a kind of disrespect to people. Students and faculty members agree on the growing trend of incivility. Uncivil behaviors in online nursing classes are a serious global issue that can influence the learning-teaching process and threaten patient safety in the clinical setting. This study aimed to identify incivility in the online learning environment from the perspective of nursing faculty members and students.Methods: This descriptive qualitative study was conducted in 2021. A total of 20 participants were selected from among nursing students and faculty through purposive sampling. Data were collected using in-depth semi-structured interviews and analyzed via a qualitative content analysis approach.Results: Data analysis revealed five categories including ghost students, unconditional freedom, disruptive learning behaviors, academic dishonesty, and ignoring the rules of the online learning environment.Conclusion: Incivility in the online learning environment disrupts the teaching-learning process and undermines instructor-student relationships. Given that disrespectful and threatening behaviors, even to a small degree, can significantly affect the learning environment, it is essential to recognize such behaviors. As uncivil behaviors in virtual nursing education can affect education by developing inappropriate behavioral and communication patterns in students, leading to the violation of professional ethics and patients’ rights, it is necessary to pay attention to this critical issue by conducting further studies and designing interventions to correct it.

Background and Objective: Today, due to advances in science and technology and dealing with various moral issues, nurses experience more distress. Therefore, the behavioral framework of nurses and the quality of services provided to patients can be influenced by the ethical climate in the hospital. Moreover, the moral distress and moral climate in the hospital can influence the nurses' job involvement. Therefore, this study was conducted to investigate the relationship between moral climate and moral distress with the job involvement of nurses working in hospitals affiliated with Hamadan University of Medical Sciences, Hamedan, Iran. Materials and Methods: This descriptive-correlational study was conducted on 140 nurses working in hospitals affiliated with Hamadan University of Medical Sciences. Data collection tools included a demographic information form, Hospital Ethical Climate Survey, Revised Moral Distress Scale, and Kanungo Job Involvement Questionnaire. Data were analyzed using descriptive and inferential statistics in SPSS 23 software. Results: The mean score of the intensity of moral distress was 3.81±1.25 and the frequency of moral distress was 2.6±1.3. The mean scores of moral climate and job involvement were 3.91±1.68 and 2.71±1.1, respectively. There was a significant positive relationship between moral climate and nurses' job involvement (r=0.41, P

In the context of geo-infrastructures and specifically tunneling projects, analyzing the large-scale sensor-based measurement-while-drilling (MWD) data plays a pivotal role in assessing rock engineering conditions. However, handling the big MWD data due to multiform stacking is a time-consuming and challenging task. Extracting valuable insights and improving the accuracy of geoengineering interpretations from MWD data necessitates a combination of domain expertise and data science skills in an iterative process. To address these challenges and efficiently normalize and filter out noisy data, an automated processing approach integrating the stepwise technique, mode, and percentile gate bands for both single and peer group-based holes was developed. Subsequently, the mathematical concept of a novel normalizing index for classifying such big datasets was also presented. The visualized results from different geo-infrastructure datasets in Sweden indicated that outliers and noisy data can more efficiently be eliminated using single hole-based normalizing. Additionally, a relational unified PostgreSQL database was created to store and automatically transfer the processed and raw MWD as well as real time grouting data that offers a cost effective and efficient data extraction tool. The generated database is expected to facilitate in-depth investigations and enable application of the artificial intelligence (AI) techniques to predict rock quality conditions and design appropriate support systems based on MWD data.

Objective: Considering the importance of out-of-hospital services, the emergence of home care nursing, and the need for an ethical framework in nursing practice, the present study aimed to explore the nurses’ experience of ethical values of home care nursing. Methods: The data of the study was collected using face-to-face individual interviews. Through purposive sampling, 20 nurses who worked in the home care centers in four cities of Iran in 2020 were interviewed. They shared their experiences of the ethical values of home care nursing. Then, the interviews were analyzed based on the content analysis approach and using Graneheim and Lundman method. Results: In the present study, 416 codes were extracted. Merging these codes based on the similarity, seven main themes, and 16 sub-themes were extracted. The themes included perception of the professional identity, respect for the client’s autonomy, respecting privacy, establishing human interaction, maintaining mutual safety, observance of justice, and cultural-religious competence. The sub-themes included responsibility, development of professional and inter-professional interactions, maintaining the professional status at home, providing the holistic artistic care, patient’s privacy, nurse’s privacy, and maintaining the confidentiality of information, respect for the client’s choice, honestly informing, empathetic interaction, adjusting the power positions, client's safety, nurse’s safety, establishing justice, respect for the religious beliefs at home and cultural sensitivity. Conclusion: The participants stated that due to entering the patient’s privacy in the home care cases, the ethical values such as perception of the professional identity, privacy, family interactions’ management, mutual security, and cultural-religious competence became doubly important compared to the hospital caring.

Background: Respect for human dignity has been the focus of various studies on patients’ health and treatment. Despite the increasing number of cancer patients, to date, the dimensions of dignity have not been fully identified for this group. This study was conducted with the aim of the development and psychometrics evaluation of a dignity assessment questionnaire for Iranian cancer patients. Method: This mixed-method design with a sequential exploratory approach was conducted in Iran. In the first phase, a purposive sampling method was used to recruit the participants and the sampling continued until data saturation. The data were collected through individual semi-structured interviews. In the second phase, the validity and reliability of this instrument were assessed among 300 cancer patients. Results: The dignity assessment questionnaire for cancer patients included four domains and 27 items. The domains of the questionnaire were “the performance of the treatment team”, “respect for patients’ personal space”, “family support”, and “adequate equipment and facilities”. The internal consistency of the questionnaire was assessed using Cronbach’s alpha coefficient and the split-half method. To confirm the stability, test-retest was utilized and the result of the interclass correlation coefficient for the entire questionnaire was 0.94. Conclusion: A dignity assessment questionnaire has been developed based on the perception and understanding of cancer patients, their family caregivers, and oncology nurses. The findings of the present study could help healthcare providers to implement a scheme with the aim of strengthening support for and better treatment and care of cancer patients.

Due to associated uncertainties, modelling the spatial distribution of depth to bedrock (DTB) is an important and challenging concern in many geo-engineering applications. The association between DTB, the safety and economy of design structures implies that generating more precise predictive models can be of vital interest. In the present study, the challenge of applying an optimally predictive three-dimensional (3D) spatial DTB model for an area in Stockholm, Sweden was addressed using an automated intelligent computing design procedure. The process was developed and programmed in both C++ and Python to track their performance in specified tasks and also to cover a wide variety of different internal characteristics and libraries. In comparison to the ordinary Kriging (OK) geostatistical tool, the superiority of the developed automated intelligence system was demonstrated through the analysis of confusion matrices and the ranked accuracies of different statistical errors. The results showed that in the absence of measured data, the intelligence models as a flexible and efficient alternative approach can account for associated uncertainties, thus creating more accurate spatial 3D models and providing an appropriate prediction at any point in the subsurface of the study area.

Introduction: Collaborative learning encourages students to work with peers and leads to the development of problem-solving and communication skills, and the transfer of knowledge learned in the classroom to be used in the clinical setting. This study aims to explain the role of collaborative learning experiences of nursing students in the field of clinical training. Methods: In this qualitative study, 20 nursing students who experienced specialist clinical training were selected using object-based sampling. The data were collected using semi-structured and focus group interviews. The interviews were transcribed verbatim and the relevant themes were extracted and categorized using content analysis. Results: The results revealed that group interactions lead to useful experiences in clinical works. It was also shown that collaborative learning affects the clinical success of nursing students. The participants stated that group work in clinical settings is the most important learning experience in the training course. While contributing to learning development, group participation helps the students to deal with the assigned tasks more efficiently and support each other by sharing their knowledge and establishing friendly relations. The themes derived from the data included 1) peer support, 2) clinical reasoning, and 3) group capabilities. Conclusion: Collaborative learning is an important factor in improving clinical work. The results of the present study underlined the weakness of educational programs in terms of collaborative learning. Therefore, educators and education professionals are recommended to support the development of a suitable context for active and collaborative education and learning.

Abstract Background The process of learning the professional values is started from the student’s entering to the university and to the workplace. This study compared the importance of professional values from the perspectives of nurses and nursing students. Methods This descriptive-analytical study was conducted on 250 nurses and 100 nursing students. Data were collected using the Nursing Professional Values Scale-Revised. Results According to the findings, the mean scores of nurses (3.68 ± 0.16) and nursing students’ (3.86 ± 0.17) perspective toward professional values were at an important level. Furthermore, the students’ perspective toward the professional values’ importance was significantly more favorable than those of nurses. The highest mean scores of professional values in the two groups were related to the caring and justice domains. Both groups considered activism and professionalism as the least important domains among the others. Conclusions As the findings suggest, we need to pay more attention to values training, especially professionalism and activism, during undergraduate education for preparing the nurses to work in today’s complex healthcare context. It is necessary to conduct more comprehensive studies for exploring the gap between theory and practice in different cultures and contexts.

Abstract Objectives: Understanding the nature of errors and the way errors are detected by nurses has a major role in preventing and reducing complications of errors. The present study aims to investigate the nature of errors and identify factors detecting errors in the emergency department. Methods: The present qualitative study was conducted with participation of 20 emergency department nurses according to Elo & Kyngas (2008) content analysis method. Data were collected through semi-structured in-depth interviews. Sampling began purposively and continued until data saturation was reached. Results: Analysis of data led to the extraction of two main categories, including nature of errors and error detectors. The nature of errors consisted of two subcategories, namely, lurking errors and indistinguishable of errors. Error detectors comprised four subcategories, namely, personal detectors, team detectors, client detectors, and organizational detectors. Conclusion: The present study results showed that errors in the emergency department are vague in nature and difficult to detect. Nurses use various sources to identify errors. In the context of the present study, human sources, especially nurses and patients have a key role in identifying and detecting errors. These sources of error detection should be reinforced by health organizations.

Abstract Background Professional values of nursing students may be changed considerably by curricula. This highlights the importance of the integration of professional values into nursing students’ curricula. The present study aimed to investigate the importance of professional values from nursing students’ perspective. Methods This cross-sectional study was conducted at the Kerman University of Medical Sciences, Iran. Data were gathered by using a two-section questionnaire consisting of demographic data and Nursing Professional Values Scale-Revised (NPVS-R). By using the stratified random sampling method, 100 nursing students were included in the study. Results Results showed that the mean score of the students’ professional values was at high level of importance (101.79 ± 12.42). The most important values identified by the students were “maintaining confidentiality of patients” and “safeguarding patients’ right to privacy”. The values with less importance to the students were “participating in public policy decisions affecting distribution of resources” and “participating in peer review”. The professional value score had a statistically significant relationship with the students’ grade point average (P

Background & Aim: Cancer as one of the most common illnesses in the world is associated with mental, physical, social and financial problems, which affects not only the patients, but also the family caregivers and creates a burden of care. Some studies have shown that spiritual well-being is effective in reducing the burden of care. Therefore, this research was conducted to determine the correlation between spiritual well-being and burden of care in family caregivers of cancer patients. Methods & Materials: In this cross-sectional correlational study, 150 family caregivers of cancer patients referred to Taleghani, Shohadaye Tajrish, Masih Daneshvari and Imam Hossein hospitals in Tehran were selected by the convenience sampling method from August to November 2017. The data gathering tool was a questionnaire, and data were analyzed using descriptive statistics, Pearson and Spearman correlation coefficients, independent t-test, analysis of variance and multiple regression analysis at a significance level of 0.05. Results: The mean and standard deviation of spiritual well-being score and burden of care were 90.36±17.70 and 25.54±11.79, respectively. There was a significant relationship between spiritual well-being (and its components including religious well-being and existential well-being) and burden of care (r=-0.421, P˂0.001). The result of regression test showed that spiritual well-being significantly predicted the burden of care. Conclusion: The burden of care is experienced by family caregivers during caring for cancer patients, which is related to their spiritual well-being. Therefore, paying attention to the spiritual well-being of these caregivers is emphasized.

Background: Quality assessment and service delivery processes for cancer patients are the major components of palliative care. This study intends to explore stakeholder’s perceptions of palliative care process challenges for cancer patients in Iran. Method: In this qualitative study, we conducted 22 semi-structured interviews from February 2016 to August 2017 in hospitals located in Tehran, Iran. Participants were selected through purposive sampling and included cancer patients, their family caregivers, healthcare providers, and policy-makers. The interviews were analyzed by qualitative directed content analysis based on the Donabedian model. In order to assess the accuracy and validity of the study, we used Lincoln and Guba’s four criteria. Results: After analysis of the interviews, we categorized the codes into a main category, “process”, and three identified subcategories – “weakness of stakeholders’ engagement policies”, “standardized care”, and “applying educational and research approaches”. Conclusion: Palliative care in Iran is a recent discipline. The results have shown that the process of providing services requires the attention of the health system to the standard models for providing palliative care services. In addition, it is necessary to train human resources in generalist and specialist palliative care groups, design palliative medicine curricula, inform general public about cancer, and empower patients and caregivers.

Mapping the subsurface temperatures can efficiently lead to identifying the geothermal distribution heat flow and potential hot spots at different depths. In this paper, an advanced adaptive multitask deep learning procedure for 3D spatial mapping of the subsurface temperature was proposed. As a result, predictive 3D spatial subsurface temperatures at different depths were successfully generated using geolocation of 494 exploratory boreholes data in Catalonia (Spain). To increase the accuracy of the achieved results, hybridization with a new modified firefly algorithm was carried out. Subsequently, uncertainty analysis using a novel automated ensemble deep learning approach for the predicted temperatures and generated spatial 3D maps were executed. Comparing the accuracy performances in terms of correct classification rate (CCR) and the area under the precision–recall curves for validation and whole datasets with at least 4.93% and 2.76% improvement indicated for superiority of the hybridized model. According to the results, the efficiency of the proposed hybrid multitask deep learning in 3D geothermal characterization to enhance the understanding and predictability of subsurface spatial distribution of temperatures is inferred. This implies that the applicability and cost effectiveness of the adaptive procedure in producing 3D high resolution depth dependent temperatures can lead to locate prospective geothermally hotspot active regions.

Abstract Background Emergency care providers regularly deal with ethical dilemmas that must be addressed. In comparison with in-hospital nurses, emergency medical service (EMS) personnel are faced with more problems such as distance to resources including personnel, medico-technical aids, and information; the unpredictable atmosphere at the scene; arriving at the crime scene and providing emergency care for accident victims and patients at home. As a result of stressfulness, unpredictability, and often the life threatening nature of tasks that ambulance professionals have to deal with every day, ethical decision-making (EDM) has become an inevitable challenge. Methods The content analysis approach was used to conduct the present qualitative study in Iran. The participants consisted of 14 EMS personnel selected through purposive sampling, which continued until the data became saturated. Data were collected using semi-structured interviews and analyzed concurrently with their collection through the constant comparison method. Results The process of data analysis resulted in the emergence of 3 main categories “respecting client’s values”, “performing tasks within the professional manner”, “personal characteristic”, and the emergence of eight (8) sub-categories signifying participants’ experiences with regard to EDM. Conclusion According to the results, when EMS personnel are faced with ethical dilemmas, they consider the client’s values and professional dignity, and perform the assigned tasks within the framework of the regulation. The findings also suggest that pre-hospital care providers assess legal consequences before making any decision. Further studies should be conducted regarding the experiences of the subordinates and other related parties.

Background: By acceptance of palliative care as a part of health system of each country and due to increasing prevalence of cancer, special focus on stakeholder’s educational needs is of vital importance so that palliative care services are improved and the quality of life of patients is enhanced. This study was conducted to explore the educational needs of stakeholders of palliative care for cancer patients in Iran. Methods: This qualitative study with 20 semi-structured interviews was conducted from August 2016 to February 2017 in Shohadaye Tajrish and Emam Khomeini Hospitals of Tehran. Participants were selected through purposive sampling and included cancer patients and their family caregivers as well as healthcare providers, experts and policy-makers. The data were analyzed through Conventional Content Analysis of Landman and Graneheim using MAXQDA10 software. Statements of each main category of the study were summarized in SWOT categorizes. Result: A total of 546 codes were extracted from the analysis of the interviews and four main categories and four subcategories were identified. The four main identified categories included:”academic education planning”, “workforce education”, “public awareness”, and “patient and caregiver empowerment” that contained our subcategories as follows: “strengths”, “weaknesses”, “opportunities” and “threats” (SWOT). Conclusion: Meeting the educational needs of the stakeholders of palliative care requires policy-makers to identify the factors leading to strategies that are based on the use of opportunities, the removal of weaknesses, and coping with the threats to which the organization is faced.

Introduction: There is a growing trend in online education courses in higher education institutes. Previous studies have shown that high levels of self-direction are essential for successful online learning. The present study aims to investigate challenges of and barriers to self-directed virtual-learning among postgraduate students of medical sciences. Methods: 23 postgraduate virtual students of medical sciences in Iran, collected through maximum variation purposive sampling and semi-structured interviews, served as the sample of this study. The collected data were analyzed using the inductive content analysis method. Results: Three themes and six sub-themes were identified as barriers to self-directed learning in virtual education, including cognitive barriers (information overload and lack of focus on learning or mind wondering), communication barriers (inadequate coping skills and inadequate writing skills) and educational environment barriers (heavy workload and role ambiguity). Conclusion: By the importance of self-direction in online education, the present study results can be used by virtual education planners in the review and design of courses, so as to adequately equip students, obviate barriers to self-directed virtual education, and ultimately train highly self-directed learners in online medical education.

Background: Power in nursing is a broad concept that has a determining effect on the achievement of professional goals. Gaining power is essential for promoting the roles of nurses, improving their professional image and the consistent improvement of healthcare systems. Objectives: This study was conducted to identify and clarify strategies for gaining power in the nursing profession through the experiences of Iranian nurses. Methods: The present qualitative grounded theory study was conducted on fifteen participants selected through purposive sampling. Data were collected through individual, in-depth, semi-structured interviews. The data obtained were analyzed using the guidelines provided by Corbin and Strauss, (2008 edition). This study was carried out in Qazvin city of Iran and lasted fourteen months (2015-2016). Results: The analysis of the data were classified under the main theme of gaining human-professional power based on individual and organizational capacities, divided into four main categories, including respecting human values and ethical principles (with two subcategories, keeping the human symbols of power and commitment to moral obligations of power), promoting professional interactions (with two subcategories, paying attention to intraprofessional communication and paying attention to interprofessional communication), attempting professional endurance (with two subcategories, raising self-confidence and having professional commitment), and valuing potential capacities (with two subcategories, regard for individual capacities and regard for organizational capacities). Conclusion: The findings obtained suggest that success in gaining power in nursing, requires a cumulative focus on human, ethical, professional, individual and organizational capacities.

Introduction: Clinical education is the core component of nursing education. PhD graduated nurses who are faculty members can play a main role in clinical instruction. However, there is not clear understanding about the challenges which they may encounter for accepting their role as clinical educator. The aim of this study was to explore the challenges of role acceptance by PhD aduated nurses who are faculty members. Methods: In this qualitative exploratory study a total of 13 participants (8 PhD graduated in nursing, 3 head of departments of nursing, one educational vice chancellor of nursing school, and one nurse) were selected by purposive sampling method. Data were collected by semi-structured, face to face interview and analyzed by conventional content analysis approach developed by Graneheim and Lundman. Results: The main theme emerged from data analysis was "identity threat". This theme had five categories including expectations beyond ability, lack of staff’s rely on the performance of PhD graduated nurses, poor clinical competencies, doubtfulness, and obligation. Conclusion: PhD graduated nurses experienced some worries about their role as clinical educators and argued that they have not been prepared for their role. Therefore, policy makers and authorities of nursing schools should support PhD graduated nurses for accepting their new roles as clinical educators. Moreover, some changes in nursing PhD curriculum is needed to improve the clinical competencies of PhD graduated and prepare them for their role as a clinical educator.

Introduction: To follow the progress of technology and increasing domain of nurses’ duties, ethical challenges can be observed more than ever. Therefore, the growing and dynamic system of nursing requires nurses with professional and ethical competence who can provide optimal care. The aim of the present study was to define and explain dimensions of moral competency among the clinical nurses of Iran. Methods: This qualitative content analysis study was carried out in the years 2014 and 2015 in Iran. Data were collected through in-depth semistructured interviews and field notes. The resulting data were analyzed by Graneheim and Lundman’s method of conventional content analysis. The participants were 12 clinical nurses who were selected using purposive convenient sampling and continued interviews until data saturation. Results: Themes obtained in the present study were posited in three main categories of “moral character,” with subcategories of altruism, search for meaning, be pioneering, perfectionism, self-control, honesty, and forgiveness; “moral care” with subcategories of dignified care, safe care, fair care, and holistic care; and “moral decision-making” with subcategories of moral sensitivity, moral thinking, moral reasoning, and moral courage. Conclusions: Findings of the present study suggest that nurses’ moral competency is an adorable character with a wide range that includes moral virtues and character, moral decision-making, and ultimately providing moral care; therefore, moral competency is a meta-competence in the field of nursing. Because there are many competencies in different fields.

Background: Nurses' health is often accompanied by various dangers due to the nature of their career. Therefore, it is required to monitor their health. Based on designing any system, users' views should be investigated relative to the usefulness, necessity and acceptance of the system. Then, a designing and implementing process is conducted. Objective: To investigate nurses' views on accepting the creation of a Nurses' Health Monitoring System. Methods: This cross-sectional study was conducted in 2015. Sample size was 586 nurses of Shahid Beheshti University of Medical Sciences. Sampling was conducted using multi-stage random sampling method. Research tool was a two-section researcher-made questionnaire. In the first section, demographic data were studied and in the second section, a twelve-item questionnaire was presented based on technology acceptance model. Five-item questions were regulated on perceived usefulness (PU) and perceived ease of use (PEU) and views towards creating this system. Validity of the questionnaire was approved by content validity and content validity index and its reliability was approved by Cronbach's alpha. Data were analyzed using SPSS16 and descriptive statistics (frequency distribution, percentage, mean). Results: The majority of participants (75.3%) were females between 25-35 years of age (44.4%) and (58.2%) were married. Mean work experience was 11.5±8.19. Mean perceived usefulness (PU) (17.36±2.66) and perceived ease of use (PEU) (16.75±2.65) and views towards using a Nurses' Health Monitoring System was (16.220±3.05). Conclusion: Over two-thirds of nurses demonstrated perceived usefulness and perceived ease of use as well as positive views towards creating a nurses' health monitoring system. It is recommended to design and implement a nurses' health monitoring system based on local culture of Iranian nurses using IT in the health sector.

Background & Aim: Error always occurs in the health system and it can lead to irreparable consequences. Therefore, error prevention must be taken into account by the health systems. Detection of factors contributing to error is a key factor for the prevention of error. Hence, the aim of this study was to explore factors contributing to nursing error in emergency department. Methods & Materials: This study was conducted using a qualitative approach. 17 emergency nurses participated in this study. Semi-structured interview was used to collect the data. Sampling was started as the purposive sampling and continued until the saturation of data was reached. Data were analyzed using the Elo & Kyngas (2008) qualitative content analysis approach. To achieve trustworthiness, participants were selected with maximum variation in terms of age, gender, work experience, and educational background. Results: The analysis of data led to the emergence of 500 open codes and four categories including the predisposing factors of nurse-related error, predisposing factors of organization-related error, predisposing factors of error related to the culture of emergency department and predisposing factors of patient-related error. Conclusion: Factors contributing to nursing errors in emergency department were very wide and multifactorial. Identifying the factors contributing to error is a first step to prevent errors. For reducing nursing error, nursing managers should pay special attention to the contributing factors of error identified by this study and implement interventions to reduce and mitigate these factors.

Background & Aim: Moral courage is a virtue that helps people overcome their fears and limitations and make the right decision and take the right action when encountering any situations. Due to the nature of their profession, nurses daily face many moral issues, and their correct decisions and performances require moral courage. The aim of this study was to determine the moral courage of nurses employed in hospitals affiliated to Shahid Beheshti University of Medical Sciences. Methods & Materials: This descriptive, cross-sectional study was conducted in 2015. The research population was composed of nurses employed in hospitals affiliated to Shahid Beheshti University of Medical Sciences. The study samples were 155 people. The moral courage questionnaire of Sekerka and colleagues (2009) was used to collect the data. Data were analyzed using descriptive statistics, Pearson correlation coefficient, independent t-test and one-way ANOVA on the SPSS software v.22. Results: The mean score of moral courage of nurses was 63.72±5.91 (15-75). The highest and lowest mean scores were for the dimensions of moral agency (13.73±1.22) and endures threats (11.40±1.80) respectively. The work experiences of nurses had a significant positive relationship with moral courage and beyond compliance (P

Background: Ethical care is a core value in nursing. Pediatric nurses are in direct and continuous contact with children and their parents. They manage their lives and health. As part of the pediatric nurses' daily work, ethical issues play an important role in making decisions, are important to make decisions, and this capability is only achieved by ethical practice. This study aimed to explore the factors facilitating the learning of ethical practice among Iranian pediatric nurses. Materials and Methods: This study is a conventional qualitative content analysis based on the Graneheim and Lundman method. It was conducted through semi-structured interviews with two focus groups, incorporating 28 nurses working in pediatric wards. Unstructured observation and field notes were other methods of data collection. Purposive sampling continued until data saturation was ensured. All interviews were tape recorded and transcribed in verbatim. Results: Three main categories and 12 subcategories emerged from this study. The facilitating factors include (1) individual competencies (knowledge, experience, emotional intelligence, and loving children), (2) ethical imprinting (responsibility, reflection, empathy, and ethical beliefs), and (3) an environment that nurtures moral values (organizational, spiritual, family, and cultural environments) as facilitating factors. Conclusions: The promotion of nurses' competencies, ethical virtues, and imprinting, as well as improvement of the quality of nursing care must be the top priority of the health team. Undoubtedly, the success of the health care system is not possible without ensuring that pediatric nurses learn ethical practices.

Ethical values have gained much interest in health care. They are the basis of the behaviour and performance of professional care staff. This article aimed to explain ethical values in aged care. In this content analysis, major databases including PubMed, Scopus, Ovid, ProQuest, Web of Science, Psych Info, and Google Scholar were searched from January 2000 to June 2018 using specific keywords, and a total of 43 articles were included considering the inclusion criteria of the study. The texts of the results of the articles were studied repeatedly and the data were coded and classified using the method presented by Graneheim and Lundman. Five main themes of ethical values including preserving dignity, preserving integrity, establishing human relationships, justice, and providing professional care, along with 19 subcategories, were identified. Ethical values in aged care include providing professional care, and paying more attention to human aspects of care. Providing ethical care requires better understanding of older adults, awareness of their needs, and efforts to solve their problems.

Introduction: Hospital ethical climate is a kind of organisational climate consisting of interpersonal relationships between treatment personnel and personnel communication with patients and their families. Collaboration between physician and nurse is a prominent and important aspect of professional ethics and designed to achieve a common goal of patient care. Ethical climate that reflects persons’ perceptions of their organisation and is one of the important and influential factors affecting the attitudes and behaviours of employees in the workplace, can be influenced by the interprofessional collaboration between physicians and nurses. Aim: To investigate the correlation of hospital ethics with nurses’ attitude towards the interprofessional collaboration between physicians and nurses. Materials and Methods: In this descriptive study, 196 nurses working in the intensive care units of selected hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran, who were eligible to enter the research, were selected by available method. To collect data, Olson’s ethical climate questionnaire and attitude toward the collaboration of physicians and nurses Jefferson scale were used. Due to the fact that the validity of the questionnaire was verified and confirmed in numerous domestic researches in Iran, it was not re-examined. Cronbach’s alpha coefficient was used to verify their reliability. Results: The average score of the ethical climate of the hospital from the nurses’ viewpoint was 3.26±0.56, which indicates an unfavourable level of understanding of the ethical climate among the nurses. The mean score of nurses’ attitude towards the collaboration of physician and nurse was 51.17±4.98, which is in the positive level. The results of statistical analysis showed that there was no statistically significant relationship between the dimensions of nurses ‘perception of the ethical climate of the hospital and the nurses’ attitude toward the collaboration between the physician and the nurse (r=-0.26, p-value=0.695). Conclusion: Considering that collaboration between physician and nurses is one of the important features in providing care, it is suggested that training be provided to develop the morale of participation and cooperation in educational and clinical settings. Also, considering the importance of nurses’ perception of the ethical climate of the hospital, it is suggested that ethical workshops with the aim of familiarising all employees with the importance of the concept of organisational ethics in hospitals should be held.

Infrastructures play an important role in urbanization and economic activities but are vulnerable. Due to unavailability of accurate subsurface infrastructure maps, ensuring the sustainability and resilience often are poorly recognized. In the current paper a 3D topographical predictive model using distributed geospatial data incorporated with evolutionary gene expression programming (GEP) was developed and applied on a concrete-face rockfill dam (CFRD) in Guilan province- northern to generate spatial variation of the subsurface bedrock topography. The compared proficiency of the GEP model with geostatistical ordinary kriging (OK) using different analytical indexes showed 82.53% accuracy performance and 9.61% improvement in precisely labeled data. The achievements imply that the retrieved GEP model efficiently can provide accurate enough prediction and consequently meliorate the visualization insights linking the natural and engineering concerns. Accordingly, the generated subsurface bedrock model dedicates great information on stability of structures and hydrogeological properties, thus adopting appropriate foundations.

BACKGROUND: Ethical decision-making and behavior of nurses are major factors, which can effect on the quality of nursing care. It seems that there is a correlation between demographic variables and ethical decision-making and moral behaviors of nurses. Promoting patients' health is one of the issues related to nurses' ethical behaviors. The aim of this study was to determine the role of judgment in promoting nurses' decisions and ethical behavior. MATERIALS AND METHODS: This was a descriptive, cross-sectional study in which 260 nurses were selected based on the inclusion criteria. Sampling method was available. The data collection tool was the Hospital Ethics Committee Survey Questionnaire. Data were analyzed by SPSS software version 20. RESULTS: In this study, judgments and ethical behaviors of nurses were evaluated at the moderate and good level. Gender, marriage status, education level, and nursing position were effective in judgments and ethical behavior of nurses. Age, job experience, and participation in the ethics workshop had no significant effect on ethical behavior and moral judgment. The mean score of moral belief of nurses participating in this study was 181.56 ± 17.60, and their mean moral practice in the real environment was 168.5 ± 17.77. CONCLUSION: The judgment competencies in ethical situation of nurses should be promoted to a higher level. It seems that more advanced educational methods are needed to achieve this goal. The findings from this study show the necessity of nurses' ability to improve their behavior and moral judgment. It also shows that nurses need more reinforcement based on the demographic variables.

Background: Students’ health and future health of the community are related to providing health care in schools and since in every society, different contextual factors affect this matter, the present study aims to recognize the factors influencing the health care elementary students are provided with. Methods: This qualitative content analysis was performed in 2014 in Isfahan. This study was conducted on school health instructors of elementary schools. Through targeted sampling, 15 health care providers, two mothers and 3 principals from 23 elementary schools were selected. Twenty-two semi-structured interviews were performed. Qualitative data analysis was done using qualitative content analysis. Results: In this study, 3 concepts were extracted: family umbrella over health (with two sub-categories of ‘family’s social status and its effect on health’ and ‘family and health’), functional resources (with two sub-categories of ‘opportunity’, ‘availability of resources for diagnosis’) and health components (with two sub-categories of ‘culture’, ‘the value of school health’). These contextual factors must be considered in providing health care for schools. Conclusions: Consideration of effective contextual factors on providing elementary students with health care can help improve health for this group.

Background: Participation of nurses in research studies is a requirement of achieving evidence-based nursing, but studies in this regard are limited. This study aimed to determine the viewpoints of nurses regarding the facilitating factors and obstacles of participating in research and utilization of its results in clinical practice. Methods: This descriptive study was done in 2013 at teaching hospitals affiliated to Kerman University of Medical Sciences. Study subjects included 210 clinical nurses with at least a bachelor's degree who were selected by stratified random sampling method. Data collection tools included a researcher-made 3-section questionnaire. The first section consisted demographic information and the second and third sections contained 21 questions each that evaluated the motivational factors and obstacles of research, respectively. Data were analyzed using descriptive statistics (mean and standard deviation). Results: Of all the participants, 87.6% were female with average age of 38.08 ± 4.93 years. Regarding the research facilitating factors, the highest score was given to the intrinsic interest for knowledge acquisition and increased practical work ability. In this section, the lowest scores were given to interaction with other colleagues and the existence of competitive conditions. In terms of the research obstacles, the highest scores were reported for problems at work including staff shortages and high workloads, while the lowest scores were reported for low self-confidence and lack of interest and unwillingness to do research. Conclusion: The results of this study can provide information for nursing policymakers to establish measures that constructively motivate nurses to do research and utilize its results by the managers.

Objective (s): This study aimed to explain the needs of family members awaiting patients, surgery. Methods: A qualitative design using content analysis approach was used to collect data and analyze the experience of 17 family members who were waiting for their patients’ surgery. Results: Data analysis led to the development of 3 categories and 6 subcategories. They included: Emotional need (need to consolation, need for hope(, Informational need )need to receive information about illness and surgery process, need to consulting and guidance (, Physical need )need to appropriate site, need to facilities and amenities). Conclusion: The finding might help healthcare professionals especially nurses to get a better understanding of the families, needs in this situation and as a result could be better planning and intervening for meeting of this needs.

Background: Patient’s dignity is an important issue which is highlighted in nursing It is an issue that is highly dependent on context and culture. Heart disease is the most common disease in Iran and the world. Identification of facilitator and threatening patient dignity in heart patients is vital. This study aimed to explore facilitator and threatening patient dignity in hospitalized patients with heart disease. Methods: This qualitative content analysis study was performed in 2014 in Kerman, Iran. 20 patients admitted to coronary care units and 5 personnel were selected using purposeful sampling in semi-structured and in depth interviews. Researchers also used documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneously with data collection Results: Three central themes emerged: a) Care context which includes human environment and physical environment, b) Holistic safe care including meeting the needs of patients both in the hospital and after discharge, c) Creating a sense of security and an effective relationship between patient and nurse, including a respectful relationship and account the family in health team. Conclusion: The results of this study showed that care context is important for patient dignity as well as physical environment and safe holistic care.

Background & Objective: The psychosocial climate of the classroom is a general concept for describing explaining and exposing the specific features of a class and has significant effects on students academic achievement This study was conducted for the first time in Iran It was performed to evaluate the relationship between the psychosocial climate of the classroom and academic achievement based on the views of faculty members and PhD students of Kerman University of Medical Sciences Iran Methods: The present study was performed using the census method It was conducted on 222 medicine dentistry and pharmacology students and 21 faculty members of Kerman University of Medical Sciences in 2013 using the psychosocial climate of class questionnaire Data were collected at the end of the second trimester when students received their academic records Data were analyzed using SPSS software independent and paired ttest ANOVA central and diffusion indicators and the Pierson correlation Results: Comparison of faculty members expectation score (3180 ± 477) and perception score (2920 ± 460) showed a significant difference (P < 0050) Based on ANOVA results faculty members expectation level was higher than their perception Comparison of the score of students expectation from (2903 ± 437) and perception of (24433 ± 510) the classroom climate showed a significant difference Expectation level was higher than perception level (P < 0001) There is a negative correlation between students average level and their perception level (P = 0042) Conclusion: The data indicated that there is a significant relationship between students and faculty members level of expectation and perception of psychosocial climate of the classroom The identification and development of conceptual models particularly an experimental model of academic performance based on cognitive features can be helpful in the improvement of the psychosocial climate of the classroom which results in students academic achievement

Background & Objective: In order to achieve more success in the Bachelor of Science in the discipline of nursing education in Iran and identify its weaknesses and strengths comparative studies and utilization of successful universities strategies and experiences are necessary The present research compares the curricula of undergraduate nursing education in Iran and 8 selected universities from America Europe Australia and Asia The universities were compared in terms of student selection methods mission and objective general structure program length educational content teaching and learning methods educational strategies role of graduates and evaluation methodologies Methods: This was a descriptivecomparative study In the present study 8 renowned and innovative nursing schools were selected through purposeful sampling method The important components and indices of nursing curricula of the 8 nursing schools in America Europe Australia and Asia were analyzed Then each studied item was compared between the selected nursing schools and nursing schools of Iran Practical suggestions were made to improve the quality of the nursing curriculum in Iran in terms of improvement of each studied item The research model used in this study was the Beredy model that identified the 4 stages of description interpretation proximity and comparison in comparative studies Results: The general objectives and educational contents in all curricula of the examined nursing schools were to some extent similar However the establishment and development of the contents and the method extent and type of addressing them were different These differences created different contents Moreover despite the many similarities in training and evaluation techniques many differences depending on the level and purpose of the program were observed Conclusion: It seems that although the nursing curriculum in Iran does not hold a dissatisfactory position in comparison with the other studied curricula in order to resolve the flaws items like goals selection student selection methods research teaching and evaluation (theory and performance) methodologies need to be reviewed and revised

Background: One of the important aspects of hospital preparedness in disasters is its rapid early warning system. In this study, the activation of early warning system was evaluated under the monitoring of disasters workgroup of the Ministry of Health based on the national program of “hospitals preparedness in disasters” in Shahid Motahari Hospital. Materials and Methods: The sample was composed of 801 adults exposed to the earthquake. Two months after the earthquake, all subjects were surveyed with measures administrated in a standard order as follows: demographic data sheet, disaster experiences scale (DES), general health questionnaire (GHQ), and symptom checklist 90-revised (SCL-90-R). Results: The results revealed that 23% of the survivors in the exposed group had ASD, 10% had anxiety symptoms, 7.5% depression, 4% MADD, 5% psychosomatic disorders, 10% phobia, 7% aggressive behavior, and 10% insomnia. Conclusion: This article has summarized the current status of information on mental disorders caused by experiencing or witnessing a life threatening severe earthquake. The experience of fear, helplessness, and panic during the earthquake, and the appraisal by the victims of serious psychological, social, as well as demographical consequences after the earthquake, were positively related to the subscale scores and the total score of GHQ, SCL-90-R, and DES.

ABSTRACT Introduction: The importance of content validity in the instrument psychometric and its relevance with reliability, have made it an essential step in the instrument development. This article attempts to give an overview of the content validity process and to explain the complexity of this process by introducing an example. Methods: We carried out a methodological study conducted to examine the content validity of the patient-centered communication instrument through a two-step process (development and judgment). At the first step, domain determination, sampling (item generation) and instrument formation and at the second step, content validity ratio, content validity index and modified kappa statistic was performed. Suggestions of expert panel and item impact scores are used to examine the instrument face validity. Results: From a set of 188 items, content validity process identified seven dimensions includes trust building (eight items), informational support (seven items), emotional support (five items), problem solving (seven items), patient activation (10 items), intimacy/friendship (six items) and spirituality strengthening (14 items). Content validity study revealed that this instrument enjoys an appropriate level of content validity. The overall content validity index of the instrument using universal agreement approach was low; however, it can be advocated with respect to the high number of content experts that makes consensus difficult and high value of the S-CVI with the average approach, which was equal to 0.93. Conclusion: This article illustrates acceptable quantities indices for content validity a new instrument and outlines them during design and psychometrics of patient-centered communication measuring instrument.

Objective(s): To translate and validate the “Mishel’s Uncertainty in Illness Scale-Adult Form”(MUIS-A) in Iranian cancer patients. Methods: The scale was translated into Persian and back translated into English and revised according to the comments of the scale designers. Then, content and face validity, construct validity, internal consistency reliability and stability of the Persian version were measured. Data were analyzed using SPSS version 16 and LISREL 8.5. Results: In all 420 cancer patients completed the questionnaire. The mean score for the MUIS-A was 90.1(16.8). Confirmatory factor analysis showed satasfactory results for the whole instrument and its four subscales. The stabilty of the instrument with a three-week interval was 0.91. Cronbachchr('39')s alpha was 0.89 for the whole scale of 32 MUIS-A items and α ranged from 0.58 to 0.86 for its four factors. Conclusions: The Persian version of the MUIS-A has good validity and reliability indices. It can be used to assess uncertainty in illness in Iranian patients with cancer.

One of the main issues in nursing education that teachers and students frequently encounter is uncivil behaviors. This type of behavior is destructive for the teaching and learning environment. As teachers play an important role in nursing students' education and are ultimately their role models, the identification of these behaviors in nursing teachers appears to be essential. This study was conducted to determine nursing students' perceptions of their teachers' uncivil behaviors. The present study was conducted using a qualitative approach and content analysis. A total of 13 nursing students were selected through purposive sampling, and deep and semi-structured interviews were conducted with them. Content analysis was performed using an inductive approach. Three main categories were obtained through data analysis; disruptive behaviors affecting communication climate (subthemes: humiliation, the lack of supportiveness, and distrust), disruptive behaviors affecting ethical climate (subthemes: self-centeredness, coercion and aggression, and harassment), and disruptive behaviors affecting learning climate (subthemes: poor teaching skills, poor time management, and indiscipline). Given that human dignity takes precedence over education, any action causing humiliation and embarrassment can have inverse effects on the students and may harm them. These behaviors taint the educational role. Since students select their teachers as their role models, the impact of teachers' uncivil behaviors on students cannot be neglected. Neglecting these behaviors might lead to their persistence in the clinical setting and irreparable damage to patients, who are the ultimate recipients of care.

Introduction: The communication between nurses and patients' families is commun- ication significantly impacts patient well-being as well as the quality and outcome of nursing care, this study aimed to demonstrated the facilitators and barriers which influence the role of communication among Iranian nurses and families member in ICU. Methods: This study was conducted by the grounded theory method. Participants comprised eight registered nurses and ten families. Patients were admitted to the ICU of two large university hospitals in Kerman, Iran. We used non-structured interviews for data collection. All interviews were transcribed verbatim with a simultaneous, constant comparative analysis of the audio tapes performed according to the Strauss and Corbin method (1998). Results: According to data analysis, Facilitative factors between nurses and families' communication consisted of two categories, i) spiritual care, emotional support, Participation, notification and consultation and Barriers that were three categories: i) misunderstandings regarding treatment ii) job and iii) patient difficulties.Conclusion: The findings led into the recognition of the important barriers and facilitators in communication between ICU team and the family of the patients. By identification of the barriers and facilitators of communication, establishing new rules and using creative methods in education and establishing the communication of ICU team and rules and using patient-based approach we can have effective communication.

Family plays an important role in physical activity behaviors in children andadolescents although the procedure of this effect is not clear. This study wasdesigned to explore the family role in forming female adolescents’ physical activitybehavior. This study used a qualitative procedure and content analysis method. Tocollect data, semi–structured interviews were conducted with 25 participants (16female adolescents, 7 mothers, and 2 fathers). All interviews were recorded,transcribed and finally analyzed by qualitative content analysis method. Threemain themes emerged as the family role in forming female adolescents' physicalactivity behavior: starter (talent identification, interest arousal), strengthener(providing, companionship and encouraging), and maintainer (try to eliminatebarriers and try to acquire the agreement of the disagreed member in the family).This study provided a better understanding of how families influenced their girls'physical activity behavior. Identifying the role of family can help health authoritiesand physical education coaches to design more effective family–basedinterventions and also to identify more areas for further research.

Background & Objective: Identifying clinical education problems is a challenge in training staffs and professional role acceptance This study aimed to identify nursing faculty perception from student evaluation challenges in medical surgical wards Methods: This was a descriptive qualitative study Participants were 14 nursing faculty members and purposeful sampling was used until data saturation Interview was done for data collection All the interviews were recorded and then transcribed and analyzed Software One Note 2010 was used for documentation of interviews and extracted codes Manifest content analysis was used for data analysis Results: Four themes and 14 categories were emerged including superficial evaluation (face evaluation evaluation with invalid instrument modeless evaluation and detail center evaluation) unreal center evaluation (theory based evaluation unprofessional based evaluation tact based evaluation and help to average rise based evaluation) betbased evaluation (conservative evaluation student recompensebased evaluation of teacher and cliché type evaluation) and incomplete evaluation (unintegrated evaluation unclear evaluation and to digress of criterion reference evaluation) Conclusion: Modeless and noninstrumental evaluation was reported as important subjects that emphasized by faculty members Some interventions for fair evaluation were recommended as using valid instrument and proper approaches based on short and long goals for competent graduated to health care system entry

Background & Objective: There are two basic learning approaches in academic education deep and surface If educational assessment is designed based on deep understanding it will lead to deep learning This study aimed to investigate conventional methods of assessment in medical surgical courses and its relationship with learning approaches in nursing students of Kerman University of Medical Sciences Iran in 2010 Methods: This is a descriptive analytic study A questionnaire consisting of three sections including personal characteristics assessment methods and the revised twofactor study process questionnaire (RSPQ2F) was completed by 198 nursing students Data were analyzed using SPSS and by means standard deviation frequency Students ttest ANOVA Pearson correlation and Rho Results: The most used assessment methods were multiple choice question (MCQ) and Direct Observation Procedural Skills (DOPS) The mean score of deep learning approach was 3427 ± 5006 and of surface learning approach was 3121 ± 552 Regarding the relationship between learning approaches and assessment methods results showed a significant difference (P < 005) MCQ and DOPS alone resulted in the surface approach but a combination of tests and projects in written and DOPS tests lead to deep learning approach in clinical tests (P < 005) Conclusion: Using MCQ and DOPS without concentration on reflection and problem solving lead to surface approach As common assessment methods in this study led to surface approach using projects in written and clinical assessment for deep approach lifelong learning and student empowerment for their future responsibilities is suggested

Introduction: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran. Methods: In this qualitative study, 26 participants (21 rural health care providers and five rural patients) were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis.Results: One category, “ineffective referral system”, and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found. Conclusion: Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential.

Purpose: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. There is a lack of adequate attention for this problem. This study aims to explore the challenges of the health care process in rural Iran according to health care providers' experiences. Methods: This was a qualitative study that used the content analysis method. We selected a total of 21 health care providers based on purposive sampling. Data collection consisted of semi-structured individual interviews that were analyzed by qualitative content analysis. Results: Data analysis led to the formation of one main category, the challenges of process of health care in rural society. Within this main category, we created the following subcategories: change in characteristics of the rural society, increase in complexity of the health care process, decrease in workforce efficiency, and decrease in propensity of people's care. Conclusion: The findings of this study indicate that the process of health care in Iranian rural society is changing rapidly with community health workers encountering new challenges. There is diminished efficiency in responding to the changing care process in Iran's rural society. Considering this change in process of care, therefore, the health care system should respond to these new challenges by establishing new health care models.

As future providers of health services, nursing students should learn about ethical concepts over the course of their education. These concepts are currently taught in nursing schools, yet the degree of moral sensitivity in nursing students before entering clinical settings is a topic of controversy. This was a cross-sectional study on the nursing students studying for a bachelor’s degree in Qazvin University of Medical Sciences selected through census sampling (n = 205). Data were collected by Lutzen's Moral Sensitivity Questionnaire and analyzed through statistical tests using SPSS 16. The level of significance was P < 0.05. In order to conduct the study, permission was obtained from the Ethics Committee of Shahid Beheshti University of Medical Sciences.The mean of moral sensitivity was found to be 66.1 + 8.1, which is a moderate level. Of all the dimensions of moral sensitivity, "expressing benevolence" had the highest (16.9 ± 4.04) and "structuring moral sense" had the lowest (5.2 ± 1.45) mean scores. Among demographic variables, age was found to have a significant positive correlation with the score of moral sensitivity (r = 0.2, P = 0.01).Nursing students are relatively familiar with the ethical concepts of patient care, but that does not seem to be sufficed, as moral sensitivity is an extremely crucial factor in care. It is therefore recommended that the necessary training be provided to develop moral sensitivity in nursing students both in educational and practical environments.

Introduction: Power is a complex and extensive concept in nursing, which has a decisive impact on the accomplishment of duties, satisfaction and achievement of professional goals. Explaining the concept of power in nursing from the perspective of nurses and accessing its various dimensions may result in a better understanding of this issue. Aim: This study was aimed to explore the concept of power in nursing, using the views and experiences of Iranian nurses. Materials and Methods: This study was a qualitative research which used a content analysis approach. Participants were selected from among nurses active in clinical, management, and educational practices using the purposive sampling method. Data were collected using a semi-structured individual interview. The results were obtained by analysing the data using an inductive approach and the constant comparison method. Results: The participants of this study regarded the power of nursing as a positive concept and the issue of power in nursing consisted of three classes, the genesis with the subclasses of “being purposeful”, “being under the shadow of the profession nature”, “being dependent on the source”, strengthening with the subclasses of “being emotional and introverted”, “being formed in the context of professional communication”, “fluidity and flowing”, and the evolution with the subclasses “based on human values”, and “being a tool for professional excellence”. Conclusion: The concept of power in nursing can be considered a purposeful issue based on the nurses’ viewpoint which flourishes in the context of human, moral and caring nature of the nursing profession. According to its dependence on the nature of profession and on the basis of professional communication, Power of nursing grows with a fluidlike flowing structure, linked with human values, reaches maturity and results in outcomes such as improving the quality of care and professional excellence.