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Background: Heart valve replacement (HVR) surgery represents a significant life event that can potentially impact the well-being (WB) of patients; however, there is a shortage of research on the understanding of WB in HVR patients. This study aims to elucidate the WB experiences of patients who have undergone HVR surgery.Methods: A qualitative directed content analysis approach was employed, focusing on patients who had undergone HVR surgery at hospitals affiliated with Mashhad University of Medical Sciences in Iran from March 2021 to June 2022. Data collection involved conducting 23 face-to-face, semi-structured, in-depth interviews with HVR patients until data saturation was reached. Data analysis was performed using the Elo and Kyngäs approach in MAXQDA software version 10.Results: The analysis revealed 11 generic categories based on the Biopsychosocial-Spiritual (BPSS) model, encompassing the WB experiences of HVR patients. These categories included physical improvements, facilitated treatment compliance, personal and environmental mastery, optimism in life, resilience, healing therapeutic communication of medical staff, a positive supportive atmosphere, job and financial assurance, faith in a higher power, optimism regarding a purposeful future, and gratitude mixed with generosity.Conclusion: The findings of the current study revealed that the experience of WB in HVR patients was influenced by various conditions. By recognizing these conditions, healthcare providers can develop targeted interventions to improve the WB experience in these patients. Also, the findings provide a foundation for future research on WB in medical contexts.

Objectives Grief is a human, universal, personal and multidimensional experience. Although studies have been conducted to describe grief, there is no consensus among scholars about its theoretical or empirical definition in older adults. This study aims to analyze the concept of grief in old age. Methods & Materials This is a review study that was conducted in eight steps using Walker and Avant’s concept analysis method. To find studies related to grief in the elderly, a search in online databases including ScienceDirect, Scopus, PsychInfo, PubMed, Web of Science, and EMBASE using keywords: Grief, mourn, bereavement, old, geriatric, aging, age, later life, seniors, nonagenarian, octogenarian and centenarian. Also, articles were examined without considering the time limit published until January 30, 2023. The search strategy, screening, and data reporting were done based the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Results Of 5963 articles, 34 were included. According to the findings, grief had five features, “a unique phenomenon”, “negative emotional experience”, “physiological irritation”, “experience of loneliness”, and “loss of previous meanings”. Three antecedents of grief included: Loss of loved ones, loss of pets, spouse divorce, and loss of health. Four consequences of grief included health consequences, social consequences, financial consequences, and resiliency. Conclusion The provided definition of grief in older adults can help the health team understand the concept better and carry out investigations, interventions, and evaluations to improve the health of the elderly.

Abstract Background Providing safe care in a sensitive and high-risk unit such as the ICU is one of the most crucial tasks for nurses. One way to establish the criteria for safe care is by creating a instrument to assess it. Therefore, this study was conducted with the aim of designing and psychometrically evaluating an instrument for safe nursing care in the ICU. Methods The current study employed a sequential-exploratory mixed-method approach with two qualitative and quantitative phases. Based on the results of qualitative phase and the literature review, the primary instrument was designed. In the quantitative phase, the designed instrument underwent psychometric evaluation. Face, content and construct validity were assessed. Face validity was assessed by 20 nurses, and content validity was assessed by 26 experts. In the construct validity stage, the sample size for the exploratory factor analysis (EFA) included 300 nurses, and for the confirmatory factor analysis (CFA) included 200 nurses who work full-time in the ICUs of hospitals affiliated with Kermanshah University of Medical Sciences in western Iran. EFA sampling was conducted in three hospitals, encompassing six ICUs, while CFA sampling was carried out in two hospitals, covering four ICUs. Sampling was done using the convenience method. The reliability of the instrument was also assessed. Finally, the interpretability, feasibility, weighting, and scoring of the instrument were evaluated. Results The qualitative phase identified three themes, including professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). The primary instrument was designed with 107 items rated on a five-point Likert scale. In the quantitative phase, the psychometrics of the instrument were conducted. First, the face and content validity were assessed, and the average scale content validity index (S-CVI) was 0.94. Then, a preliminary test was conducted to assess the initial reliability (α = 0.92) and the correlation of each item with the total score. After completing these steps, the number of items in the instrument was reduced to 52. The results of the EFA explained 58% of the total variance, with 4 factors identified: professional behavior by following guidelines, comprehensive care, accurate documentation, and pressure ulcer care. At the CFA stage, the results of the calculation of indices and goodness of fit showed that the model had a good fit. The reliability of the relative stability by examining the intraclass correlation coefficient (ICC) for the whole instrument in 20 samples was 0.92 with a confidence interval of 0.97 − 0.81. To measure absolute stability and determine the responsiveness of the instrument, the standard error of measurement (SEM) was 4.39 and the minimum detectable change (MDC) was 12.13. Conclusion The instrument for safe nursing care in the ICU has favorable psychometric properties.

Abstract Background Patient safety is a global health issue that affects patients worldwide. Providing safe care in the intensive care units (ICUs) is one of the most crucial tasks for nurses. Numerous factors can impact the capacity of nurses to deliver safe care within ICUs. Consequently, this study was undertaken with the aim of identifying the components of safe nursing care in ICUs. Methods The current research constitutes a qualitative conventional content analysis study conducted from January 2022 to June 2022. The study participants comprised nurses, intensivists, nurse responsible for patient safety, paramedic, patients, and patients’ family member, totaling 21 individuals selected through purposive sampling. Data collection involved individual, in-depth, and semi-structured interviews. Subsequently, data analysis was performed utilizing the approach outlined by Graneheim and Lundman (Nurse Educ Today 24(2):105–12, 2004), leading to the identification of participants’ perspectives. Results Three themes were identified as components of safe nursing care in ICUs. These themes include professional behavior (with categories: Implementation of policies, organizing communication, professional ethics), holistic care (with categories: systematic care, comprehensive care of all systems), and safety-oriented organization (with categories: human resource management and safe environment). Conclusions The findings of this study underscore the significance of advocating for safe nursing practices in ICUs by emphasizing professional conduct, holistic care, and safety-focused organizational structures. These results align with existing research, suggesting that by introducing tailored interventions and tactics informed by these elements, a safer environment for nursing care can be established for ICUs patients.

Background: Adaptation to complications of hysterectomy is one of the topics of concern for women and health care providers. There is no instrument for evaluating adaptation to hysterectomy. This study aimed to design the Hysterectomy Adaptation Scale (HAS) and assess its psychometric properties. Materials and Methods: This methodological study was conducted from 2018 to 2020 in Mashhad, Iran. To develop the item pool, qualitative data from directed content analysis and data from the review of adaptation and coping instruments were used. The face, content, construct validity, internal consistency, and stability were used to evaluate the psychometric properties of HAS. Results: The final version of the HAS consisted of 24 items with a reported content validity index of 0.9. Six factors were extracted from the principal component analysis, which explained 60.3 of the observed variance. Model fit indices in confirmatory factor analysis showed that the model was well fitted. The values of the alpha coefficient and intra-class coefficient were 0.86 and 0.95, respectively. Conclusions: The HAS is a valid and reliable scale for evaluating the adaptation level of hysterectomized Iranian women. HAS can distinguish between hysterectomized women who have adapted to hysterectomy and those who have not. It can be used to assess the adaptation of hysterectomized women in research and clinical practice.

Background & aim: Spirituality is among prominent strategies to minimize negative emotions in different circumstances. Clarifying the concept of spiritual well-being in high-risk pregnancies enables healthcare providers to address and support their patients' spiritual needs. This study aimed to explore the perceptions and experiences of spiritual well-being among women with high-risk pregnancy.Methods: This qualitative content analysis was conducted from December 2017 to March 2019 in public and private hospitals and health centers in Mashhad, Iran. The participants included 26 women with high-risk pregnancy, who selected using a purposive sampling. Data was collected through semi-structured and face-to-face individual interviews using the interview guide. The data analysis was carried out concurrently with the data collection, using the conventional content analysis based on the Graneheim and Lundman's method. Results: Following data analysis, "Spiritual well-being in high-risk pregnancies” was characterized by two main categories including “Meaning-seeking and belief in purposeful pregnancy” and" Relying on spirituality in achieving health."Conclusion: Searching for meaning and purposefulness in pregnancy and relying on spirituality to achieve health are among the components of spiritual well-being in high-risk pregnancy; hence, understanding women’s spiritual well-being could help tailoring strategies to reduce their tensions and discomforts caused by high-risk pregnancy. Thus, it is highly recommended that women with high-risk pregnancy receive spiritual care as part of their comprehensive care.

Abstract Background The concept of sexual satisfaction in menopausal women is very different from that in premenopausal women, and this difference is due to aging and physical, hormonal, cultural, and psychological changes. Therefore, the first step in discovering methods for assessing sexual satisfaction in postmenopausal women is to develop a measurement instrument. This study was conducted to develop and evaluate the psychometric properties of a sexual satisfaction instrument for postmenopausal women. Methods The current study is an exploratory-sequential mixed-methods research project that will be divided into two parts: qualitative and quantitative. Aligned with the primary objective of the research, which is to elucidate the concept of sexual satisfaction in postmenopausal women, the hybrid concept analysis model developed by Schwartz and Kim will be employed. This model comprises three key phases: the theoretical phase, the fieldwork phase, and the final analytical phase. Those who met the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, and menopausal duration were recruited. The conventional content analysis will be carried out following the steps proposed by Graneheim and Lundman. Second, in the quantitative phase, the psychometric properties of the instrument were evaluated, including the content, face and construct validity and reliability via internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument. Discussion A valid and reliable scale for evaluating the sexual satisfaction of postmenopausal women should be developed, and educational content should be designed to improve the sexual satisfaction of this group of women.

Abstract Background The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. Methods This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. Results The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. Conclusion Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.

Abstract Introduction Clinical education is a fundamental part of nursing professional education. One method of education is the implementation of the preceptorship program, in which clinical nurses are responsible for educating nursing students. The present study aimed to determine the effectiveness of the preceptorship training program for the participation of clinical nurses in the education of nursing students. Methods This quasi-experimental study was conducted in 2023 at the teaching hospital in Tehran, Iran. The sample consisted of 66 nurses from a teaching hospital selected using the accessible method and randomly were put into two groups. The workshop addressed the educational needs of preceptors and students, their readiness for their role, and strategies to effectively support students. Prior to the study, the nurses’ level of participation was assessed utilizing a valid IMSOC questionnaire that gauged their involvement in guiding nursing students. The participation rate was reassessed after one month using the same questionnaire. The data were analyzed using SPSS version 19. Findings The two groups were homogeneous in terms of demographic characteristics. The average score for nurses’ participation in the education of students before the intervention was 101.84 ± 15.42 in the test group and 107.24 ± 10.53 in the control group; these two groups were not significantly different (P = 0.10). After the intervention, the scores reached 118.90 ± 15.11 in the test group and 106.21 ± 11.96 in the control group, indicating a significant difference (P

Objective: The purpose of the present study was to design the Farsi Scale of Sexual-Reproductive Needs and Concerns of never-married women over 35 and to assess its psychometric properties. Materials and methods: This mixed method research had two phases. The first phase was qualitative (Conventional Content Analysis). We interviewed never-married Iranian women over 35; from their responses, we extracted specific statements which to be used as questionnaire items. To validate the questionnaire psychometrically, we tested its validity (face, content, and structure) and reliability (internal consistency and stability). For qualitative face validity, 15 never-married women and 5 experts commented on the style of sentences. For quantitative face validity, we used the impact score. For qualitative content validity, 15 experts commented on the items based on their appropriateness, and for quantitative content validity, we performed the Content Validity Ratio and Content Validity Index. Exploratory Factor Analysis was used to Construct Validity. To evaluate structural validity, a cross-sectional sample of 240 never-married women over the age of 35 completed the questionnaire. Cronbach’s Alpha was used for internal consistency. In addition, the test-retest method and Intraclass Correlation Coefficient were used to ensure stability. Results: The Sexual-Reproductive Needs and Concerns Scale of Iranian Never-Married Women over 35 was developed with 15 items and three dimensions (Emotional burden; Sexual needs; Stigma). Cronbach's alpha for the instrument was 0.81 and the Intraclass Correlation Coefficient was 0.98. Conclusion: The results of the study showed that the developed scale has acceptable validity and reliability, and thus can be used to assess the sexual-reproductive needs and concerns of never-married Iranian women of 35 and over.

Abstract Aim The present study aimed to assess professional autonomy among clinical nurses and identify its predictors using a native and contemporary tool, which is in line with the recent advancement in nursing professionalism in Iran. Design The study used an analytical cross‐sectional design. Methods A total of 1601 nurses working in medical centres nationwide under the Ministry of Health participated in the study. The research instrument consisted of two parts, including individual and organizational characteristics and a questionnaire on clinical nurses' professional autonomy. Data analysis involved descriptive and inferential statistics as well as multiple logistic regression analysis using SPSS software. Results The results indicated that the total professional autonomy score among clinical nurses was 75.86 ± 12.03, with the majority (n = 1262, 78.9%) reporting high professional autonomy. Multiple logistic regression analysis revealed that nurses with 5–15 years of experience had 1.82 times higher odds (95% confidence interval: 2.47–1.35) of having high professional autonomy compared to those with less than 5 years of experience. Similarly, nurses with over 15 years of experience had 2.25 times higher odds (95% confidence interval: 1.56–3.26). Head nurses had 4.56 times higher odds (95% confidence interval: 2.60–7.99) of having high professional autonomy compared to clinical nurses. Conclusion Educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended. Additionally, measures such as supporting nurses, providing effective communication training and empowering nurses are essential to promote professional mutual respect among nurses. No Patient or Public Contribution This study explored professional autonomy in clinical nurses in Iran. No patient or public contribution was investigated.

Abstract Introduction Advanced age is associated with life-threatening conditions at the end of life. Many of these persons at the end of their lives cannot make decisions because of the variable consciousness. They are able to make decisions and identify their care priorities, in a process called advanced care planning. So, an instrument is required for investigating ACP of the elderly population. This study was performed to determine the psychometric properties of the Persian version of the advanced care planning questionnaire(ACPQ) in elderly population referring to Tehran. Method This methodological study was performed in five hospitals in 2021–2022. A total of 390 eligible elderlies were included. The psychometric assessment including translation, face validity, content validity were performed Alsothe exploratory factor analysis and confirmatory factor analysis were assessed. Reliability were done by internal consistency by assessing Cronbach alpha and stability was performed using test-retest. Results The face validity of the instrument was performed with minor changes. The content validity index for all of the items was above 0.79. In EFA four factors was extracted also CFA showed that the four-factor model has a good fit of the data (RMSEA: 0.04; NFI: 0.97 CFI: 0.99; IFI: 0.99; RFI: 0.96; AGFI: 0.87; GFI 0/90; standardized RMR: 0.02). Cronbach alpha and ICC were 0.72–0.94 and 0.85–0.96, respectively. Conclusion The Persian version of the advance care planning questionnaire has desirable psychometric properties for measuring the advanced care planning of the elderly population. In addition, healthcare providers in Iran can employ this questionnaire in their practice and research.

Abstract Background Caring ability is one of the most important indicators regarding care outcomes. A valid and reliable scale for the evaluation of caring ability in mothers with preterm infants is lacking. Objective The present study was conducted with the aim of designing and psychometric evaluation of the tool for assessing caring ability in mothers with preterm infants. Method A mixed-method exploratory design was conducted from 2021 to 2023. First the concept of caring ability of mothers with preterm infants was clarified using literature review and comparative content analysis, and a pool of items was created. Then, in the quantitative study, the psychometric properties of the scale were evaluated using validity and reliability tests. A maximum likelihood extraction with promax rotation was performed on 401 mothers with the mean age of 31.67 ± 6.14 years to assess the construct validity. Result Initial caring ability of mother with preterm infant scale (CAMPIS) was developed with 64 items by findings of the literature review, comparative content analysis, and other related questionnaire items, on a 5-point Likert scale to be psychometrically evaluated. Face, content, and construct validity, as well as reliability, were measured to evaluate the psychometric properties of CAMPIS. So, the initial survey yielded 201 valid responses. The three components: 'cognitive ability'; knowledge and skills abilities'; and 'psychological ability'; explained 47.44% of the total observed variance for CAMPIS with 21 items. A subsequent survey garnered 200 valid responses. The confirmatory factor analysis results indicated: χ2/df = 1.972, comparative fit index (CFI) = 0.933, and incremental fit index (IFI) = 0.933. These results demonstrate good structural, convergent, discriminant validity and reliability. OMEGA, average inter-item correlation (AIC), intraclass correlation coefficients (ICC) for the entire scale were at 0.900, 0.27 and 0.91 respectively. Conclusion Based on the results of the psychometric evaluation of CAMPIS, it was found that the concept of caring ability in the Iranian mothers with preterm infants is a multi-dimensional concept, which mainly focuses on cognitive ability, technical ability, and psychological ability. The designed scale has acceptable validity and reliability characteristics that can be used in future studies to assess this concept in the mothers of preterm infants.

Abstract Background Menstruation is a natural occurrence that women experience during their reproductive years and may encounter many years throughout their lifespan. Many adolescent females lack accurate knowledge about menstruation, so they may face issues from receiving incorrect information from unreliable sources. Our study aimed to investigate the practices and beliefs surrounding menstruation among Iranian adolescent females. Methods This qualitative study was conducted using conventional content analysis. A purposeful sampling method was used to select 18 adolescent females from secondary and high schools located in the three regions of Neyshabur City-Iran. Data were collected through in-depth, semi-structured interviews. Results Three main themes were extracted, consisting of lifestyle and related beliefs, lake of support, and awareness and information. Conclusions misconceptions and wrong behaviors during menstruation indicate that the lake of knowledge an traditional factors influence adolescent girls’ health. The study provides the basis for intervention planning in this regard and different levels (individual, intrapersonal, health systems, and community).

Background: The concept of resilience has emerged in recent years in association with disaster risk reduction. In assessing adolescents’ resilience, it is important to consider resilience as a multi-factorial construct and context-based issue. Currently, there is a short resilience questionnaire to assess this construct among Iranian adolescents. Given the importance of using a short and valid questionnaire to assess resilience, this study investigates psychometric properties and the underlying structure of the Iranian translation of the child and youth resilience measure 12 (CYRM-12). Materials and Methods: After obtaining permission, the CYRM-12 was translated into Persian and then back-translated based on the Wild (2005) process. The final version was distributed among 653 high school adolescents in the age range of 14 to 18 years. The reliability scale was evaluated by using the Cronbach α and test re-test reliability among 35 adolescents. Subsequently, the intra-class correlation coefficients were assessed. Confirmatory factor analysis was evaluated as the validity. Results: The Cronbach α coefficient for the CYRM-12 was 0.71 and the test re-test reliability was excellent (ICC=0.88, 95% confidence interval, 0.78–0.94). Confirmatory factor analysis showed that the root mean square error of approximation was significant (0.043) and all items were indicated with a high correlation with scales, including the comparative fit index (CFI), non-normed fit index (NNFI), normed fit index (NFI), incremental fit index (IFI), and relative fit index (RFI) that were more than 0.9 and only parsimony normed fixed index was 0.7 that would be acceptable as well. Moreover, the correlation between total anxiety and resilience is significant. This is the first study that used the Persian version of the CYRM-12 questionnaire in Iran. In disasters, time is important; therefore, this short version would be more appropriate to help measure children’s resilience more quickly. Moreover, the short version of the CYRM-12 questionnaire is suitable for measuring resilience. Conclusion: This study determined good fitness, reliability, and test re-test reliability of the Persian CYRM-12 for Iranian adolescents.

Abstract Background Patients with a stroke often cannot care for themselves after hospital discharge. Assessment of their self-care ability is the first step in planning post-discharge home care. This study aimed to design and validate a measure of perceived self-care ability (PSCA) in stroke patients. Methods A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2020–2021. The qualitative phase involved in-depth semi-structured interviews with 12 participants. Transcripts were content analyzed. The results guided the development of 81 items. psychometric properties such as face validity (Impact Score > 1.5), content validity ratio (CVR > 0.63), content validity index (Item Content Validity Index: ICVI > 0.78, Scale Content Validity Index/Average: SCVI/Ave > 0.8) and Kappa value (Kappa > 0.7), internal consistency (Cronbach’s alpha > 0.7), relative reliability (ICC: inter class correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4–0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assessed. Results Content analysis of the qualitative interviews yielded 5 major categories and 9 subcategories that reflected "Perceptual stability", "Cognitive fluctuations", "Sensory, Motor and Physical health",” The subjective nature" and "The dynamic nature” of PSCA. Results of face and content validity reduced the number of items to 32, capturing three dimensions of PSCA in chronic stroke patients; these dimensions included perceptual ability, threatened health status, and sensory, motor, and cognitive ability. The findings supported the reliability and validity of the measure. Conclusions The PSCA questionnaire was developed and validated within the Iranian culture. It is useful in assessing the self-care of patients with stroke and in informing practice.

Background Improving the quality of life (QoL) is a significant healthcare priority, and it is an important health outcome for elderly individuals with Alzheimer’s disease. Quality of Life in Late-Stage Dementia (QUALID) is a specific scale used to measure the QoL in elderly individuals with Alzheimer’s. So far, limited quantitative research has been conducted on the psychometric properties of this scale.Aims This study was conducted to translate the QUALID Scale into Persian and evaluate its psychometric properties among family and professional caregivers of elderly individuals with Alzheimer’s disease in Tehran.Methods A cross-sectional methodological study was conducted among family and professional caregivers of elderly individuals with Alzheimer’s in Tehran, Iran in 2022. The questionnaire was translated into Persian using the forward–backward method. Face and content validity were assessed. Additionally, construct validity was examined using exploratory factor analysis (EFA) with Equamax rotation (n=210) and confirmatory factor analysis (CFA) (n=155). Cronbach’s alpha and interclass correlation coefficient (ICC) were estimated to determine reliability.Results A total of 365 caregivers with a mean age of 14.18±42.60 years participated in this study. In the face and content validity phase, all 11 items were retained. To determine the construct validity, two factors were extracted in the EFA phase, including behavioural signs of discomfort and behavioural signs of social interaction. The findings of the CFA also indicated that all goodness of fit indices supported the final model. The Cronbach’s alpha was excellent for both factors (0.814), and the ICC was calculated as 0.98.Conclusion Based on the findings of this study, it can be concluded that the Persian version of the QUALID Scale has sufficient validity and reliability for measuring the QoL in elderly Iranian individuals with Alzheimer’s.

Abstract Introduction Advance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive regarding a person’s future medical care. It is used when a person is unable to participate in the decision-making process about their own care. Therefore, the present systematic review investigated the factors related to ADs from the perspective of cancer patients. Methods A systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior. Results Out of 5900 research papers found, 22 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients’ age was 62.04 ± 6.44. According to TPB, factors affecting ADs were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: “Lack of knowledge of the ADs concept” and “Previous experience of the disease”, the subjective norm category includes three subcategories: “Social support and interaction with family”, “Respecting the patient’s wishes” and “EOL care choices”. Also, the category of perceived control behavior was categorized into two sub-categories: “Decision-making” and “Access to the healthcare system”, as well as external factors affecting the model, including “socio-demographic characteristics”. Conclusion The studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the palliative care practice, promoting the participation of health care professionals in ADs activities and creating an AD-positive attitude should be strongly encouraged.

Background: The professionalization of nursing is one of the goals of academic education, which needs to be nurtured during education, so this research was conducted to study the views and experiences of nursing students and instructors regarding professional growth through role mode nursing instructors. Materials and Methods: This was a qualitative study with directed content analysis based on the growing up and role modeling theory in nursing students' education, which was conducted at two universities in Iran from April to September 2021. The participants included 16 undergraduate, master's, and PhD students, and nursing instructors selected using purposeful sampling with maximum diversity. The data were collected through in-depth interviews. Results: From the data analysis, 689 unrefined primary codes and 76 integrated codes were extracted. The three subcategories of the previous study included “effort to improve educational quality,” “clinical effectiveness,” and “promotion of professional status.” Generic categories were formed based on the grouping of codes. “Effort to improve educational quality” included the six generic categories of educational effectiveness, effective classroom management, comprehensive evaluation, adherence to educational rules, application of knowledge, and efforts to promote research. “Clinical effectiveness” included the generic category of effective clinical training. “Promotion of professional status” included the two generic categories of effective professional interactions and striving for professional independence. Conclusions: It can be concluded that role model nursing instructors can increase the students' abilities, and thus, facilitate their professional growth through a combination of strategies based on the generic categories mentioned.

Abstract Aims Nurses who care for patients with infectious disease may experince significant stress and negative psychological reactions. The intention of nurses to care is a complex and multifaceted concept that is influenced by a range of factors. Therefore, this study was conducted to explain the concept of nurses’ intention to care for patients with infectious disease and then develop a reliable and valid scale to measure this concept accurately in Iranian nurses. Design This study is a cross-sectional study with a sequential-exploratory mixed-method approach from May 2022 to July 2023. The concept of nurses’ intent to care for patients with infectious disease was explain using deductive content analysis, and item pools were generated. In the sconed step the samples were 455 nurses. Data was collected by an online form questionnaire using a convenience sampling technique. In this step to determine the psychometric properties of nurse’s intention to care for patients with infectious disease scale (NICPS), face and content validity performed. Then construct validity was determined and confirmed using exploratory and confirmatory factor analysis followed by convergent and divergent validity respectively. Finally, scale reliability including stability and internal consistency were evaluated. Results The finding showed that NICPS with seventeen items were classified into three factors namely “Social support” with seven items, “Spiritual motivation” with six items and “Job satisfaction” with four items. These three factors explained 56.14% of the total variance. The fit indices showed that the model has a fit and acceptable (TLI, CFI, IFI > 0.9; PNFI, PCFI > 0.5, REMSEA > 0.049, CMIN/DF = 2.477). Reliability revealed acceptable internal consistency and stability (> 0.7). Conclusion The finding showed that NICPS has three factors in Iranian nurses. Nursing managers can use these results to provide training and support intervention for nurses in order to increase their intention to care for this patient. Also, the NICPS is a reliable and valid for evaluating this concept in future studies.

Objective Stuttering is one of the speech disorders that appears in childhood. Many studies emphasize early interventions for its treatment. Circumstances such as a lack of therapists and the COVID-19 pandemic have limited the access to face-to-face therapy. Studies show some problems with this type of treatment. A detailed understanding of these problems in a cultural context can help increase the quality of providing telepractice. This study was conducted to discover the telepractice treatment of stuttering in preschool children. Materials & Methods This qualitative study was conducted in Iran from November 2020 to February 2022 using the grounded theory method. In this study, in-depth, free, and individual interviews were conducted with 9 therapists and 5 parents of children who stutter. The data were analyzed using the Corbin and Strauss method, version 2015. Results After analyzing the data of this study, 6 main categories, 17 subcategories, and 63 primary categories were extracted. The main categories include “hesitation in choosing telepractice”, “characteristics of family and clients”, “technology and the knowledge to apply it”, “therapist skills for telepractice”, “payment system for telepractice fees”, and “efficiency of telepractice”. Conclusion In this study, “efficiency of telepractice” was chosen as the central concept that all participants were concerned about in some way. According to this model, “hesitation in choosing telepractice”, “characteristics of family and clients”, and “technology and the knowledge to apply it” as the context have effects on the processes that are taking place in relation to the telepractice in preschool children who stutter. These processes include “therapist skills for telepractice” and “ payment system for telepractice fees”. In the end, all these things increase the efficiency of telepractice.

BACKGROUND: Nursing students are at risk of violence. When nursing students encounter violence in clinical environments, their functional abilities and their desire to stay in this profession are impressed. This research determines the relationship between violence in the workplace and the attitude towards the nursing profession (NP) among Iranian nursing students in 2021. MATERIALS AND METHODS: This cross-sectional research was conducted as an online survey in 2021, and 512 nursing students were selected using the convenience method. Data collection tools included a demographic information form, a professional attitude questionnaire, and a workplace violence questionnaire. Chi-square tests, one-way analysis of variance (ANOVA), sample t-test, and multiple regression were used to analyze the data. RESULTS: The average age was 23.19 ± 4.58 years. Students with high violence experiences had a more negative attitude towards the profession (P = 0.000). The perpetrators of violence were mainly hospital employees (52.42). It was followed by patients and companions (45.86) and instructors (43.95). A significant relationship was found between gender (P = 0.03), age (P = 0.00), academic year (P = 0.005), and marital status (P = 0.008) with attitude towards profession. The findings of this research showed that the variables of gender (boy) and age have an inverse effect on the attitude with a predictive power of 37%; however, the attitude towards the profession becomes positive by increasing the academic year. CONCLUSION: This research provides data to nursing schools to develop intervention and prevention strategies to support students in dealing with the experience of violence. Holding related training courses in violence prevention techniques reduces the other party’s anger and can help improve the situation.

Introduction Dysphagia is a common issue in patients with head and neck cancer (HNC) and is known to negatively impact their quality of life. To evaluate the impact of dysphagia on the quality of life of HNC patients, the M. D. Anderson Dysphagia Inventory (MDADI) questionnaire was developed.

Background: Protein-energy malnutrition is an important problem for hemodialysis patients due to decreased quality of life, increased hospitalization, and mortality. The present study aimed to investigate the effect of nutritional supplement programs on the malnutrition and biochemical indicators of patients undergoing hemodialysis.Methods: In this Randomized Controlled Trial study, 66 patients undergoing hemodialysis were allocated to three groups according to the random allocation methods. Groups A and B received nutritional supplements IsoWhey protein powder (one cup or 24 grams’ powder) and BCAA Muscle Guard Tablet (6 tablets per day: 2 tablets every 8 hours), respectively, along with a schedule of nutrition counseling, nephrology visits, and telephone follow-up for two months. The control group (group C) received a routine diet without supplementation. Biochemical indicators (Hemoglobin, BUN before and after dialysis, creatinine, cholesterol, triglyceride, TIBC, total protein, albumin, ferritin) were measured for all three groups before, one and two months after the intervention, and nutritional status based on SGA was assessed before and after the intervention.Results: Before the intervention, three groups were homogeneous in demographic variables, biochemical indicators, and nutritional status (P>0.05). But, after the intervention, there was a statistically significant difference between groups in means of TIBC, total protein, and albumin (P

Abstract Background In recent years, one of the concepts that has received attention in the nursing profession is professional dignity. On the other hand, there was no proper scale to evaluate this concept. This study aimed to develop and evaluate the psychometric properties of perceived clinical nurses’ professional dignity scale (PCNPDS). Methods This exploratory sequential mixed method was developed and implemented in Iran. The study was conducted in two phases; (a) item generation by hybrid concept analysis and (b) item reduction by psychometric evaluation including validity and reliability of the developed scale. Also, the interpretability (ceiling and floor effect), stability (intraclass correlation coefficient), and absolute stability (standard error of measurement) were calculated. Results 68 items in the primary item pool were finally reduced to 22 items after evaluating the validity (face, content, and construct validity) and reliability. Exploratory factor analysis revealed three factors (organizational dignity, dignity-based competency, and dignity-based appreciation) and explained 47.55% of the total extracted variance. Confirmatory factor analysis showed that the model had a good fit. Finally, Cronbach’s alpha coefficient, McDonald’s omega, ICC, and SEM were calculated as 0.90, 0.89, 0.96, and 1.91, respectively. Conclusion The 22-item developed scale is valid and reliable for professional dignity measurement among Iranian clinical nurses.

Abstract Objective This present study was designed to explain the concept of nurses intention to care of patients with infectious diseases. Methods This study is a deductive content analysis study that was performed from May 2022 to Jun 2022 in three hospitals in Iran. In total 21 nurses were chosen by purposive sampling and for deta collection used semi-structured interviews. Data analysis was done using Elo and Kingas method. Results This study have revealed the formation of seven distinct themes, namely Job satisfaction, Professional ethics, Personal values, Standard precautions, Preserving health, Support, and Attitude of patients and their families. These themes are comprised of 17 categories and 59 subcategories. Conclusion By comprehending the dimensions of nurses’ intentions to care for patients with infectious diseases, it is possible to develop suitable planning and strategies to meet the healthcare requirements of such patients. Managers can take action by examining the issues and demands of nurses, and by providing job security, they can establish a Healthcare service systems with high security that can effectively respond during an outbreak of infectious diseases. Additionally, Nursing managers can prevent nurses from leaving their jobs by taking appropriate intervention, increasing their motivation, and enhancing their satisfaction.

Introduction: As to the significance of clinical competency, the competency concept should be up-to-date periodically until clinical competency is evaluated based on it. This study aimed to develop and evaluate psychometric properties of a new tool to measure the postgraduate psychiatric nursing students’ competencies.Methods: The current study was conducted with a sequential exploratory mixed-method, in Iran, in 2019 -2022. The qualitative part was conventional content analysis, and the quantitative part was a methodology study. The questionnaire was developed by the item generation via individual semi-structured interviews with 21 participants sampled purposefully, and a literature systematic review. In the quantitative phase, psychometric analysis was performed based onconsensus-based standards for the selection of health status measurement instruments (COSMIN) criteria, and using face, content, and construct (i.e., convergent, known group, and exploratory factor analysis done on 199 postgraduate psychiatric nursing students by available sampling) validity. t-test analysis was used to compare the clinical competenceratings of two groups of experienced and inexperienced postgraduate psychiatric nursing students. Additionally, dependability was examined for internal consistency, stability over a one-month period, and measurement error. The sampling technique used for content validity was deliberate. Then, the responsiveness (through minimally detectablechanges), and interpretability (through minimal important changes) were calculated.Results: The questionnaire consisted of 43 items. Construct validity assessment via exploratory factor analysis (EFA) showed that 67.53% of the cumulative variance was explained by two factors: “Education and nursing care” (23 items) and “Evidence based psychiatric nursing interventions” (20 items). The convergent validity with one golden standard instrument was 0.49. The difference of the clinical competency scores of the two groups of experienced and novice was significant (P0.05).Conclusion: The 43-item postgraduate psychiatric nursing students’ clinical competency questionnaire is a valid and reliable newly developed instrument. Further studies are recommended to be conducted to assess competency with the largest sample size to promote instrument.

Objectives: Type 1 diabetes mellitus (T1DM) can profoundly influence different dimension of health such as sexual and reproductive health (SRH). The aim of this study is to develop and evaluate the psychometric properties of the Sexual and Reproductive Health Questionnaire for Women with Type 1 Diabetes Mellitus (SRHQ-WT1DM). Materials and Methods: This protocol for a sequential exploratory mixed-methods study has two phases. Conducting a literature review, the first phase of the study will develop the items of SRHQ-WT1DM. Data analysis in this phase will be performed using directed content analysis and according to the framework proposed by the United Nations Population Fund (UNFPA) and the World Health Organization (WHO) for SRH in women. The second phase will evaluate the psychometric properties of SRHQWT1DM through a methodological study. Face and content validity will be evaluated both qualitatively and quantitatively, and construct validity will be done by exploratory factor analysis and convergent validity. The questionnaire’s reliability and stability will be examined using internal consistency (by Cronbach’s alpha calculation) and test-retest method (by Intra class correlation coefficient calculation), respectively. Descriptive statistics, Pearson correlation coefficient, and independent t-test will also be used. Women with T1DM who are of childbearing age and have unknown mental disorders will be selected as participants in the study from the Iranian Diabetes Society. Discussion: Development and psychometric evaluation of a specific tool for SRH assessment in women will help identify and fulfill their SRH-related needs and improve dimensions of their SRH.

Background: Self-care is a fundamental principle in managing heart failure as it can improve quality of life, reduce hospitalizations, and minimize the adverse effects of the disease. Objectives: This study aimed to evaluate the psychometric properties of the Farsi version of the Self-care of Heart Failure Index (F-SCHFI). Methods: This cross-sectional study involved 420 patients referred to the Rajaie Cardiovascular Medical and Research Center in Tehran. The translation process followed the forward-backward method, which was approved by the designer. Exploratory factor analysis, using the maximum likelihood method and Promax rotation, was conducted on a sample of 210 patients. Confirmatory factor analysis was performed on another sample of 210 heart failure patients. Reliability was assessed by evaluating the internal consistency and composite reliability. Results: The study included 420 patients with an average age of 54.37±19.48 years. In the exploratory factor analysis, three factors of self-care management, symptom perception, and self-care maintenance were extracted. These factors accounted for 41.15% of the total variance. The reliability of these factors was more than 0.7. Confirmatory factor analysis demonstrated a good fit for the final model. Conclusion: The findings of this study indicate that the F-SCHFI has good validity and reliability in patients with heart failure, making it suitable for use in various research studies.

Abstract Introduction Achieving good death is among the objectives of palliative care in patients with cancer. There should be an instrument for evaluating the quality of palliative care provided by family members at the end of life. This study was done to assess the psychometric properties of good death inventory- short form according to the perspective of family of patients with cancer. Method This methodological study was done in 2022 at two hospitals in Tehran. The translation was done via forward-backward method. Face validity was examined through cognitive interviewing with 10 family members. The content validation, were used by assessment the opinions of 10 palliative care specialists. The construct validity was explored through exploratory factor analysis and examination of convergent validation with care evaluation scale 2.0, as well as inspection of correlation by answering two general questions of satisfaction with treatment and end of life quality of life. The scale’s reliability, internal consistency was calculated using Cronbach’s alpha coefficient and stability via test-retest. Results Overall, 204 family members of patients with cancer were included. In the exploratory factor analysis, three factors of peace, hope, and value as well as quality of care were extracted with cumulative variance of 41.8%.A significant and suitable correlation between the total scores of the participants Good death inventory-short form and care evaluation scale2.0 (r = 0.459, P

Abstract Aim To conduct, translate, and psychometric evaluation of the MISSCARE‐Persian Survey. Design A cross‐sectional study was conducted in Iran in February–June 2021. Methods The translation of the MISSCARE Survey was accomplished according to World Health Organization (WHO) guidelines. Construct validity was performed by (N = 300) exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). The study adhered to COSMIN guidelines. Results The exploratory factor analysis, which resulted in the identification of three factors in the second part of the tool, explained 79.6% of the total variance. Confirmatory factor analysis indicated the model's good fit of information. The reliability of the first and second parts of the tool was 0.912 and 0.901, respectively. Additionally, the ICC was found to be 0.687 for the first and 0.706 for the second part of the tool.

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.

Abstract Background Self-care is a necessary measure against occupational injuries of nurses and improves nursing performance at the bedside. Nurses have different scales to measure self-care, and researchers are confused about choosing valid and reliable scales. This systematic review aimed to evaluate the measurement properties of self-care scales in nurses to identify the best available scales. Methods Four databases (PubMed, Web of Science, SCOPUS, and ProQuest) were systematically searched, with no date limiters, until 9 Jun 2023. A manual search was performed with Google Scholar and the reference list of articles to complete the search. Studies aiming to develop or determine the measurement properties of self-care in nurses were included. Based on Consensus-Based Standards for the Selection of Health Measurement Instruments, the methodological quality of the studies was determined, and the result of each study on a measurement property was rated (sufficient, insufficient, or indeterminate). The quality of the evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach (high, moderate, low, or very low). These processes were used to make recommendations and identify the best scale to assess self-care in nurses. Results Out of 8601 articles, six articles with five different scales were included. Only internal consistency was reported across all scales. Criterion validity, measurement error, responsiveness, feasibility, and interpretability, were not reported in any of them. Content validity was reported only in two studies with inconsistent results and low-quality evidence. None of the scales had methodological quality with a rating of very good and sufficient high-quality evidence for all measurement properties. Conclusions None of the scales is strongly recommended to measure self-care in nurses. Only the Professional self-care scale is temporarily recommended until their quality is assessed in future studies. Considering that the content of the examined scales does not meet all the professional self-care needs of nurses, designing a valid, reliable, and specialized scale for nurses is needed.

Abstract Background Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses’ moral reasoning, moral distress and moral sensitivity. Methods In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. Results Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238–15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171–2.005, P

Abstract Patient Contribution Older people with T2D participated in this study to achieve the objective of the study. Aim Treatment adherence is an important indicator for evaluating successful diabetes control and overall disease management. It is necessary to identify the hidden themes of the concept of treatment adherence and related factors based on the experiences of older people with T2D. Therefore, the present study was conducted to identify the concept of treatment adherence and its associated factors in older people with type 2 diabetes (T2D). Design The study was conducted as a qualitative study using a content analysis approach. Methods Semi‐structured interviews were conducted with 20 older people with T2D, between May and September 2021. Data were organized using MAXQDA‐10 software and analysed using the Elo and Kyngas qualitative content analysis method. We followed the COREQ Checklist to ensure rigour in our study. Results Three themes emerged from the analysis of the data, including: ‘Health literacy’, ‘Support umbrella’ and ‘responsibility’.

Background: Emergency medical services (EMS) personnel are subject to moral hazards during work, leading them to find moral distress (MD). Our literature review showed a gap in knowledge related to MD in EMS personnel. Therefore, this study investigated MD and its influential factors in pre-hospital emergency technicians. Materials and Methods: This descriptive-analytic study was conducted in Iran in 2017. A convenience sampling method was used to select 265 technicians working in EMS from several cities in Iran. The MD thermometer was used to measure the MD in the technicians. The collected data were analyzed using SPSS software, version 20. Results: All the participants were male with mean age and work experience of 31.64±6.5 and 7.76±5.1 years, respectively. The mean score of MD was 4.6±1.8 (out of 10). Nearly 76% of the participants were with moderate levels of MD. A significant relationship was observed between the willingness of technicians to change or leave their job and the mean scores of MD in the participants. Conclusion: EMS technicians experienced moderate levels of MD. Therefore, healthcare planners and policymakers need to pay more attention to this issue due to the complications of MD in healthcare personnel.

Objective With the advancement of information and communication technology, the use of telepractice has expanded to provide speech, language, and swallowing services. In different countries, studies have been conducted in the field of telepractice of speech, language, and swallowing disorders, including stuttering, and these studies have confirmed the effectiveness of this method of providing treatment and have mentioned some problems. To present this method of treatment more effectively, the challenges of this treatment should be examined. The present study has been conducted to investigate the facilitators and barriers to the telepractice of stuttering in preschool children. Materials & Methods In this qualitative study, individual unstructured interviews have conducted using qualitative content analysis with 11 participants, including therapists with experience in stuttering telepractice in preschool children, therapists who were opposed to this treatment (n=7 people) as well as parents who have had successful telepractice and parents who have had unsuccessful telepractice (n=4). Results Telepractice facilitators included cost reduction, therapist-client communication between sessions, greater parental cooperation and responsibility in telepractice, reduced stress and increased child-therapist collaboration in the natural environment, more time freedom, and time flexibility for the family and therapist. Barriers to telepractice in this group included lower trust in the therapist in telepractice, limited communication cues, spending more energy by the therapist, difficulty in educating parents, and lack of comprehensive protocols in telepractice. Conclusion When these cases are recognized, it is possible to provide higher-quality treatment to people who need these services by reducing barriers and strengthening facilitators. To achieve this goal, it is necessary to conduct studies to develop comprehensive and detailed protocols for providing this method of treatment, taking into account the existing facilitators and obstacles.

Background & Aims One of the challenges in accurate and macro planning for the future is the uncertainty involved in estimating the future and rapid changes in various health-related fields. A powerful tool that can predict future competitive environments is the scenario planning tool. The current research aims to provide scenarios for the future of nursing education in Iran. Materials & Methods This exploratory research was conducted in 2022. In the first stage, the drivers and trends of nursing education were identified using meta-synthesis, interviews, and the Delphi method. Then, the influence and uncertainty of the identified trends were rated using the opinions of a panel of experts. In the next step, using influence/uncertainty diagrams, the key factors for writing the scenario were identified. Scenarios were then designed by Scenario Wizard software, version 4.11, and strategies were presented. Results The experts agreed on 6 drivers and 31 trends. With five key uncertainties, the scenarios were designed with three optimistic, realistic, and pessimistic assumptions. According to the size of the matrix and its dimensions (15×15), four problem-oriented, ethics-oriented, maintaining the status quo, and limited educational system scenarios were designed. The validity of the scenarios was examined according to feasibility, internal consistency, usefulness, and differentiability. Conclusion Each of the four designed scenarios has the potential to be realized, but their occurrence depends on the current plans. The use of future planning methods, such as the scenario planning tool, can be used as a warning system for awareness of opportunities and threats in Iran's health system before a crisis.

Objectives: This study aims to evaluate the prevalence, severity, and nature of adverse events (AEs) and provide suggestions on how to prevent AEs recurrence in an inpatient rehabilitation hospital in Iran. Methods: This retrospective descriptive-analytical study was conducted in 2021 at Rofaydeh Rehabilitation Hospital in Tehran City, Iran. AEs associated with rehabilitation services and nursing care, which were reported in the hospital’s voluntary reporting system from 2018 to 2021 were evaluated. A standard checklist codified by the Ministry of Health of Iran was used to collect the data from the medical error documentation. The data were analyzed by the SPSS software, version 21, using descriptive statistics, the chi-square, and the Fisher exact tests. Results: A total of 5642 patients had been hospitalized in the study setting and 517 AEs had been documented during the 4 years of the study. The most common AEs in descending order were as follows: falls 288(55.7%), pressure ulcers 57(11.02%), medication errors 50(9.67%), clinical process 49(9.47%), clinical administration (issues with admission process 10(1.93%) and wrong patient identification 5(0.96%). Among 58(11.21%) cases of hospital-acquired infections, 45(77.58%) cases were urinary tract infections. There was a significant relationship between age and fall (P=0.026), pressure ulcer (P=0.006), and hospital-acquired infection (P=0.001), and between gender and fall (P=0.01), pressure ulcer (P=003), and hospital-acquired infection (P=0.01). The severity of identified AEs was categorized into mild 431(83.36%), moderate 61(11.79%), and severe 25(4.83%). The most common causes of AEs were limited supervision of patients by healthcare providers. Discussion: This study showed that patient fall, pressure ulcer, and hospital-acquired infection were the most prevalent AEs in the rehabilitation hospital. Future efforts to improve patient safety in these settings should focus on reducing such AEs along with removing barriers to voluntary incident reporting.

Abstract Background Marine medicine is one of the medical fields that deals with the health and safety of people related to the sea but the marine medicine syllabus for education to the students is not specified yet. The present study aimed to develop the marine medicine syllabus to medical sciences students education. Methods This study was conducted in three phases. First, a literature review was conducted to find the concepts and topics related to marine medicine. Second, a content analysis research method was conducted. Data collection was done first by using semi-structured interviews with the 12 experts in marine medicine. Sampling was purposeful and continued until data saturation was reached. The information obtained from the interviews was analyzed by conventional content analysis with Geranheim's method. The found topics in the literature review and content analysis of interviews were combined and formed the initial draft of the marine medicine syllabus, which was validated with the Delphi method in the third phase. The Delphi was conducted in two rounds and the panel consisted of 18 experts in the field of marine medicine. After the completion of each round, the items that had less than 80% consensus among the participants were removed and the remaining topics after round two formed the final syllabus of the marine medicine. Results The findings showed that the marine medicine syllabus should include an overview of marine medicine, health at sea, common physical diseases and injuries at sea, subsurface medicine and hyperbaric, safety action in marine incidents, medical care at sea, psychology at sea and medical examinations of people working at sea main topics and their sub topics. Conclusions Marine medicine is an extent and specialized medical field which has been neglected and it is necessary to teach this lesson to medical sciences students with the syllabus found in the present study.

A prerequisite for interventions for sexual satisfaction in postmenopausal women is a clear, objective measurement of the concept. Despite the large number of studies on the sexual satisfaction of postmenopausal women, there is no clear definition of sexual satisfaction in menopause. This study was conducted to investigate the concept of sexual satisfaction in postmenopausal women. The present study was carried out using an integrated review of data obtained from secondary sources, utilizing Whittemore and Knafl's method of bibliographic search. A literature search was performed without any data limitations in journals and international databases. The primary inclusion criterion was relevance to sexual satisfaction in postmenopausal women. The full texts of all these articles were evaluated using the checklists of the MMAT and PRISMA. Data were analyzed using MAXQDA 10 software using a constant comparison method. Meaning units were identified and coded. The codes were classified into subgroups and categories according to the characteristics, antecedents, and consequences of sexual satisfaction in postmenopausal women. During the integrative review of the 62 articles and three books, 580 codes about sexual satisfaction in menopause were extracted. The codes were grouped into three main attributes, five main antecedents, and three main consequences of sexual satisfaction in postmenopausal women. Four attributes, symptoms, or components were identified for the concept. These attributes were as follows: Change in sexual objective and subjective dimensions of sexual satisfaction after menopause, conditional sexual consent, change in behavior, and sexual function. These dimensions distinguish sexual satisfaction in menopause from other conditions. The concept of sexual satisfaction in menopause is a subjective (emotional interaction) and objective (physical interaction) experience that is conditioned by the fulfillment of expectations and the reconstruction of sexual relations while also being influenced by the change in sexual capacity during menopause.

Objective Grammar is a key element of language knowledge and a factor in predicting language learning and success. Early diagnosis of grammatical errors in children before entering school is very important. So far, no tool has been designed to evaluate the Azerbaijani language grammar comprehension in Iran. The present study aims to design the Azerbaijani language grammar comprehension test for Iranian children aged 4-6 along and assess its validity. Materials & Methods This is a mixed-method (qualitative-quantitative) study. After searching in various databases and reviewing available articles, 42 grammatical structures of the Azerbaijani language were extracted, of which 8 were removed after preliminary examination by experts. Then, 204 items were formulated for the remaining 34 grammatical structures. To determine the content validity, the test was sent to 11 experts in the field of Azerbaijani language grammar to evaluate the items. According to their opinions, two more suitable items were selected from among four items for each grammatical structure and included in the initial version for the pilot study. The initial test version was conducted on 30 children aged 4-6 years with normal language development. Results After calculating the content validity ratio (CVR), two grammatical structures were removed, and 32 structures with 128 items having CVR≥0.59 remained. After calculating the content validity index (CVI), the items with CVI≥0.79 were selected. The initial version had 32 grammatical structures and 64 items. None of the items were removed in the pilot phase, and only 10 items were modified. The CVR and CVI of the test were 0.91 and 0.87, respectively, indicating good content validity. Conclusion The Azerbaijani language grammar comprehension test has good content and face validity and can be used to evaluate the grammar comprehension of children with Azerbaijani language aged 4-6 years.

BackgroundPre-hospital medical staff faced numerous challenges during the COVID-19 pandemic. However, these challenges specific to pre-hospital services have not been thoroughly explored in Iran. This qualitative study aimed to examine the essence of pre-hospital care during the COVID-19 pandemic.MethodsThis phenomenological study was conducted from June to August 2021 in Tehran, Iran. Semi-structured interviews were conducted with pre-hospital medical staff. Data analysis was performed using Colaizzi’s approach, and rigor was ensured by adhering to the consolidated criteria for qualitative reporting research.ResultsA total of 17 pre-hospital medical staff were interviewed, and five themes were extracted from the data: workload and resilience, damage, lack of control, under preparedness, and post-traumatic growth. These themes highlight the resilience demonstrated by pre-hospital medical staff, who faced an unprecedented crisis with limited preparedness and significant damage.ConclusionThe findings of this study indicate that pre-hospital medical staff in Iran encountered challenges during the COVID-19 pandemic due to a lack of preparedness and substantial damage. Despite these adversities, the participants exhibited resilience and experienced post-traumatic growth. The study emphasizes the importance of proper planning and preparedness to enhance the resilience of emergency medical services during pandemics. Furthermore, the results underscore the need to address the challenges faced by pre-hospital medical staff and improve the quality of care provided to patients during crises such as the COVID-19 pandemic.

Abstract Background The evidence on the psychological consequences of coronavirus 2019 mainly relates to general psychiatric problems, and a few studies have reported the incidence and predictors of obsessive-compulsive disorder. Objective To determine the prevalence of obsessive-compulsive disorder (OCD) and its predictors in Iranian COVID − 19 recovered individuals at 3–6 months, 6–12 months, and 12–18 months after recovery. Method In this cross-sectional analytical study, 300 participants were randomly selected based on the inclusion criteria from three hospitals in three different regions of Tehran, Iran, and were assessed by the Clinical Demographic Information Questionnaire, the Obsessive Compulsive Inventory-Revised (OCI-R), the Depression, Anxiety and Stress Scale 21 (DASS21), The Pittsburgh Sleep Quality Index (PSQI) and Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). The obtained data were analyzed with SPSS version 26. Results The results showed that the mean score of OCD is 30.58 ± 15.22, with a prevalence of 71% (n = 213). Female gender (BF = 0.50, p = 0.01), sleep disturbance (BF = 0.02, p = 0.001), PTSD (BF = 0.009, p = 0.0001), depression (BF = 0.0001, p = 0.0001), and stress (BF = 0.0001, p = 0.001) are the strongest predictors of the presence of OCD in recovered COVID − 19 individuals. Conclusion OCD-like symptoms was observed in the majority of COVID − 19 recovered individuals with mild to moderate severity. In addition, the stated prevalence, severity, and significance varied according to sociodemographic and health inequalities.

Abstract Aim Identifying threats to the nurses' professional dignity has an important role in maintaining and promoting their dignity. This study aimed to evaluate the perception of Iranian nurses' experiences of threats to their professional dignity in clinical settings. Design A qualitative directed content analysis approach was used. Methods The present qualitative study was conducted in Iran.Clinical nurses were selected using the purposive sampling method. Data were collected through in‐depth semi‐structured interviews with 15 clinical nurses from October 2020 to March 2021. The qualitative content analysis method was used to analyze the data. Results Two main categories and 16 subcategories were extracted as follows: (1) professional factors (containing seven subcategories) and (2) organizational factors (containing nine subcategories). Conclusions To promote the professional dignity of nurses, it is recommended to identify the factors threatening their professional dignity and create healthy work environments for them.

Abstract Background Situation awareness (SA) is a key factor in accountability and ensuring patient safety in health care. SA is an essential element to research on human factors in healthcare. It is essential to identify valid instruments for measuring this concept and assessing how it is affected by interventions and educational methods. Methods This systematic review aimed to assess the measurement properties of situation awareness instruments in health care providers’ (HCPS) using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Four databases (Medline (through PubMed), Embase, Scopus, and Web of Science) were systematically searched. A manual search was also conducted on Google Scholar and the reference list of the included primary studies to supplement the electronic search. Studies aiming to determine the measurement properties of SA instruments or non-technical skills in HCPS were included. The overall results for each measurement property were reported as sufficient, insufficient, inconsistent, or indeterminate, and the quality of evidence was reported as high, moderate, low, or very low. Results A total of 25 studies and 15 instruments were included in the study. More than one measurement property was reported in some of the studies, and none of the studies presented all measurement properties. The most common measurement properties were content validity (12/25) and internal consistency (12/25). Cross‐cultural validity and responsiveness were not investigated in any study. Evidence quality for the measurement properties was not high in any of the 15 instruments. Conclusions None of the instruments can be recommended as the most suitable instrument, and all instruments were classified as promising instruments in need of further psychometric assessment. This systematic review proves the dire need for the development and psychometric evaluation of instruments to measure SA in HCPs in clinical settings. Systematic review registration PROSPERO CRD42020147349.

Background: The process of diagnosis and treatment in Persian medicine (PM) are based on the concept of Mizaj (temperament). Among the indices of Mizaj determination, anthropometric indices are less influenceable regarding age change and other environmental factors. The purpose of this study was to investigate the relationship between anthropometric indices and Mizaj. Methods: Four PM experts determined the Mizaj of 121 participants. Those who had ≥70% agreement in their Mizaj determination by the experts were selected and their anthropometric indices were measured. The best cutoff point of each index and its relationship with the defined Mizaj were extracted using Receiver Operative Characteristic Curve and Binary Logistic Regression. Results: 52 out of 121 participants entered the main study. The warm-Mizaj people had larger dimensions in height, shoulder, chest, palm and sole width, and head height. Cold-Mizaj people had smaller dimensions in weight, height, shoulder, chest and head. High levels of BMI, chest depth and head dimensions had the highest correlation with the wet Mizaj and lower dimensions of these indices had the highest correlation with the dry Mizaj. Conclusion: Among the anthropometric indices, chest, palm, sole dimensions, head height and weight had the highest correlation with warmness/coldness and BMI, head width and chest dimensions had the highest correlation with wetness/dryness. The BMI which is more closely related to the soft tissue, only correlates with the wetness/dryness, while, bone dimensions are associated with warmness/coldness. Further studies are needed to metricize the anthropometric indices for Mizaj determination.