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Abstract Background The treatment of multiple sclerosis, an autoimmune disease that predominantly affects women of reproductive age, has undergone considerable advancements. Nevertheless, their unique needs, particularly those related to motherhood, continue to be disregarded. This study aims to ascertain the needs of women diagnosed with MS about motherhood. Methods Using the Noblit and Hare methods, meta-synthesis research was conducted on 10 qualitative studies. The relevant studies were obtained by conducting a comprehensive search using keywords in the PubMed, Scopus, Web of Science (ISI), and ProQuest databases without any time limitations until June 2023. The CASP checklist was used to assess the quality of the articles, while the technique of Brown and Clark (2006) was utilized for data synthesis. Results Four key themes emerged from this meta-synthesis, highlighting the significance of a support system, psychoeducational counseling, knowledge promotion, and continuous, comprehensive, and unique care. Conclusion Identifying the needs of women diagnosed with MS and addressing these needs concerning motherhood can enhance the quality of services rendered and enhance women’s contentment with their choice to embark on motherhood. Furthermore, recognizing these needs during subsequent stages can be utilized in formulating tailored programs catering to this specific cohort of women.

Abstract Background Understanding and finding the correlation between morphometric measurements and horse blood parameters is crucial for predicting equine metabolic issues. Objective This study aims to analyse morphometric measurements and blood samples in horses with varying adiposity levels. Study design Cross‐sectional observational. Methods A total of 50 horses were included in the study and categorized into groups based on their body condition score (BCS) and cresty neck score (CNS). Results The insulin concentration was significantly higher in overweight horses (p = 0.022). Female horses exhibited higher cortisol concentrations (p = 0.025) and girth circumference at the withers (p = 0.004) compared to males. Lactating mares exhibited higher concentrations of serum total protein (p = 0.012) and globulin (p = 0.003). A positive correlation was observed between BCS and insulin concentrations (r = 0.290, p = 0.041). Negative correlations were found between neck circumference to height at withers and glucose (r = −0.309, p = 0.029), CNS and glucose (r = −0.315, p = 0.026) as well as between crest diameter and cortisol (r = −0.360, p = 0.01). Main limitations Increasing the sample size and conducting longitudinal studies would enhance the study's validity and reliability. Conclusion Although insulin, glucose and cortisol concentrations have predictive capabilities based on signs and certain morphometric measurements, their correlations are not always strong. Therefore, this study challenges the notion that all overweight horses are unhealthy, as overweight horses can still have good metabolic health. Conversely, lean horses may also experience metabolic issues. Hence, relying solely on visual cues is insufficient to diagnose the metabolic status of horses. Other factors must also be considered to assess their health status accurately.

Abstract Background The maternal role is one of the most challenging yet rewarding roles that women experience in their lives. It begins when a woman becomes pregnant, and as the pregnancy progresses, she prepares to fulfill her role as a mother. A woman's health plays a crucial role in her ability to fulfill the maternal role. Multiple sclerosis (MS), as an autoimmune disease, presents unique challenges in achieving this role. Failing to fulfill the maternal role can have lasting consequences for both the mother and the baby. Given the increasing number of women with MS of reproductive age in Iran and the absence of specific programs for this group during pregnancy and postpartum, researchers have decided to develop a supportive program by exploring the meaning of the maternal role and identifying the needs of these women during this period. Methods/materials This study will be conducted in 3 stages. The first stage involves a qualitative study to explore the meaning of the "maternal role" in women with MS through a descriptive and interpretive phenomenological approach based on Van Manen's method. Data will be collected through semi-structured interviews with pregnant women with MS and mothers with MS who have children under one-year-old, recruited from the Multiple Sclerosis Society of Mashhad, Iran. The second stage will involve designing a support program based on the findings of the phenomenological study, literature review, and exploratory interviews. A logical model will guide the development of the program, and validation will be conducted using the nominal group technique. Discussion This study is the first of its kind in Iran to explore the meaning of the maternal role and develop a support program for women with MS. It is hoped that the results of this study will help address the challenges of motherhood faced by these women.

Background: The prevalence of breastfeeding is less common among adolescent mothers than adultmothers. These mothers experience various issues during breastfeeding. The present study aimed toexplore the normative needs of adolescent mothers during breastfeeding from health care providers’perspective.Methods: This qualitative content analysis study was conducted from October 2022 until June 2023.14 health care providers who had worked in the field of breast milk were purposefully selected withmaximum variation. Face-to-face semi-structured interviews were conducted and sampling continueduntil data saturation. Data analysis was performed using Graneheim and Lundman’s method withMAXQDA software version 10.Results: The main concepts obtained from the data were classified into one theme entitled,“comprehensive support”, and seven categories including “need to correct wrong traditional beliefs”,“educational and counseling needs”, “providing quality services”, “need for psychological support”,“need for protective laws”, “financial needs”, and “the need for social network support”.Conclusion: Adolescent mothers in Iran have various needs during breastfeeding, and they requirethe assistance of their families, healthcare providers, and the government to fulfill them. Therefore, itis also recommended that policymakers in the health system should design policies to accommodatethe requirements of this group of mothers. In addition to policy development in the health system, theinfrastructure required for policy and law to be executed should be considered.

Introduction: A maternal near-miss (MNM) case is defined as "a woman who nearly died but survived from life-threatening pregnancy or childbirth complication". This study was conducted on health care providers and near-miss mothers (NMMs) with the aim of discovering the unmet needs of Iranian NMM. Methods: In this qualitative study 37 participants of key informants, health providers, NMMs and their husbands were selected using purposive sampling. Semi-structured in-depth interviews were conducted for data collection until data saturation was achieved. Data were analyzed using Graneheim and Lundman conventional content analysis. Results: The analysis revealed the core category of "the need for comprehensive support". Eight categories included "psychological", "fertility", "information", "improvement the quality of care", "sociocultural", "financial", "breastfeeding" and "nutritional" needs emerging from 18 sub-categories, were formed from 2112 codes. Conclusion: Many of the real needs of NMM have been ignored. Maternal health policymakers should provide standard guidelines based on the needs discovered in this study to support the NMMs’ unmet needs.

Purpose: The development of e-commerce and online shopping has given rise to emerging concepts of consumer behavior, including webrooming. Due to the novelty of the concept of webrooming in this study, an attempt has been made to provide a conceptual framework to explain this behavior and the factors affecting its formation.Method: In this regard, a field survey study was conducted by distributing questionnairy among a sample consisting of 384 gold and jewelry customers in Tehran. The questionnaires consisting of 9 dimensions and 38 items were distributed among the members of the statistical sample after ensuring reliability and validity. Data analysis along with partial least squares technique and Smart PLS software were used.Findings: According to the results, the benefits of online and offline channels have a significant impact on webrooming attitude; It was also discovered that attitude, perceived risk, anticipated regret, subjective norms and behavioral control have a significant impact on behavioral inclination and webrooming.Conclusion: The results of goodness of fit showed that the proposed model in this research has a good validity and fit. Given that webrooming has a negative impact on online sales; the results help online retailers mitigate this phenomenon by targeting webrooming antecedents.

Purpose: The key to startup success is a brand-centric approach that combines brand leadership strategy with creative, targeted, and cost-effective business methods. In the brand-centered approach, all company processes revolve around the development of brand identity in continuous interaction with customers, to create long-term competitive advantages for the brand. The purpose of this research is to investigate the impact of entrepreneurship-based branding in cyberspace on the performance of startups.Method: The current research is of an applied type and with a mixed method and a sequential qualitative-quantitative approach, first qualitative and then quantitative data was collected and analyzed. Due to the small size of the population, sampling was not done and all 52 people were examined. Smart PLS software was used to analyze quantitative data and test research hypotheses and implement structural equation modeling. Confirmatory factor analysis was also used to test the significance of the relationships and the fit of the obtained measurement models. To analyze the data and test the research hypotheses, the structural equation modeling method was applied.Findings: Qualitative findings showed that the branding model based on entrepreneurship in cyberspace includes six main themes and 18 sub-themes. Causal factors include risk-taking categories, business situation analysis, and brand content capabilities; Background factors include the categories of brand organizational structure, market orientation, and brand orientation; intervening conditions include the categories of legal infrastructure, customer characteristics, and economic uncertainty; the central category includes the three categories of brand vision depiction, brand integrity and entrepreneurial capabilities; strategies including three categories of brand positioning, strategic planning for branding and value creation; And the consequences include three categories of competitive advantage, strategic brand development and brand identity development. Quantitative findings showed that the causal conditions of branding with a score of 26.719 has a positive and significant effect on entrepreneurial branding; Entrepreneurial branding with a score of 4.873 on value-based brand positioning; And value-based positioning with a score of 29.960 has a positive and significant effect on the performance of startups.Conclusion: The results indicate that the branding model based on entrepreneurship in cyberspace and its impact on the performance of startups includes six main themes and 18 sub-themes, and branding based on entrepreneurship in cyberspace has a positive and significant effect on the performance of startups.

مقدمه: افراد مبتلا به اختلالات روانپزشکی به عنوان یک گروه اقلیت مورد تبعیض اجتماعی، انگ و طرد شناخته می شوند. منابع متعدد انگ برای بیماران مبتلا به اختلالات روانپزشکی، از جمله روزنامه ها، فیلم ها، تلویزیون، وب سایت ها و کتاب ها، کلیشه های منفی را ترویج می کنند. از آنجایی که تأثیر رسانه ها بر دیدگاه و تفکر مردم نسبت به این بیماران بسیار مهم است، هدف این مطالعه درک تجربیات زیسته بیماران مبتلا به اختلالات روانپزشکی از انگ رسانه ای است. روش‌ کار: این مطالعه پدیدارشناختی هرمنوتیکی بخشی از دوره دکتری است. پایان نامه در رشته پرستاری مطالعه اصلی بر روی 12 بیمار روانپزشکی بستری در بیمارستان ابن سینا مشهد در سال 1396 انجام شد که به روش نمونه گیری هدفمند انتخاب شدند. برای جمع آوری داده ها از مصاحبه های عمیق بدون ساختار استفاده شد. تجزیه و تحلیل داده ها با روش تحلیل پدیدارشناسی تفسیری انجام شد. یافته‌ها: ارائه نادرست رسانه‌ای یکی از موضوعات اصلی مورد بررسی پدیده در پروژه اصلی است که از دو موضوع فرعی اغراق رسانه ای و تشویش اذهان عمومی، تشکیل شده است. چندین معنی مشترک از هر یک از اینها پشتیبانی می کنند. نتیجه گیری: نتایج این مطالعه برای مبارزه با انگ در بیماران مبتلا به اختلالات روانپزشکی در ایران، مناسب است. همچنین، یافته‌های این پژوهش می‌تواند مداخلات و سیاست‌هایی را برای جلوگیری از گسترش انگ از طریق رسانه‌ها در مورد افراد مبتلا به اختلالات روان‌پزشکی شکل دهد.

مقدمه: شیوع جهانی انگ مرتبط با اختلالات روان پزشکی غیرقابل انکار است. افراد مبتلا به اختلالات روان پزشکی همچنان از تعصب، تبعیض و انگ زیادی از سوی جریان اصلی جامعه رنج می برند. از این رو، این ناتوانی انسانی یک اورژانس جهانی است و نیاز به اقدامات فوری و طولانی مدت دارد. بنابراین، این مطالعه با هدف بررسی پدیده انگ بر اساس تجربیات بیماران مبتلا به اختلالات روان پزشکی انجام شد.روش‌ کار: این پژوهش یک مطالعه کیفی پدیدارشناسی هرمنوتیک در بیمارستان روان‌پزشکی ابن سینا مشهد است. در مرحله کیفی، 12 نفر از مراجعان مبتلا به اختلالات روان پزشکی به روش نمونه‌گیری هدفمند انتخاب شدند. داده ها با روش های تفسیری دیکلمن، آلن و تانر (1989) تجزیه و تحلیل شدند.یافته ها: در این پژوهش یک الگوی سازنده با عنوان «از آسمان تا زمین» و 6 مضمون و 23 زیرمضمون از پدیده مورد بررسی کشف شد. موضوعات شامل خانواده؛ لانه رنج، جامعه، پایان تاریکی، بیمارستان روانی؛ مکان ناامن، رسانه بی بیان، شخصیت شکسته و گرداب ننگ بودند.نتیجه گیری: یافته‌ها نشان داد که مراجعین مبتلا به اختلالات روان پزشکی از منابع متعددی که بر حوزه‌های مختلف زندگی آنها سایه انداخته و منجر به پیامدهای نامطلوب شده است، انگ دریافت می‌کنند.

Abstract Background Detecting a health-promoting lifestyle in colorectal cancer (CRC) survivors is of paramount importance to manage disease complications, prevent their recurrence, and enhance survival; however, no specialized tool has yet been provided to measure the lifestyle of these patients. Accordingly, this study aimed to develop and determine the psychometric properties of the Health-Promoting Lifestyle Scale in CRC Survivors (HPLS-CRCS). Methods This study was a mixed study with an exploratory sequential design in two phases. Concept analysis was performed in the first phase according to Schwartz-Barcott and Kim’s (2000) hybrid model to explain the concept, identify dimensions, and generate items. In the second phase, psychometrics including validity (face, content, and construct) and reliability (internal consistency and stability) were determined. Responsiveness, interpretability, ease of use, item weighting, and scale scoring were also determined. Results After explaining the concept, an initial scale encompassing 211 items was developed, content and item analyses were conducted, and the items decreased to 89 items after the face validity assessment. For construct validity, confirmatory factor analysis (CFA) was conducted with a sample size of 500 survivors, and convergent validity was performed for the Persian version of the Health-Promoting Lifestyle Profile II (HPLP-II). Accordingly, 80 items were classified into six factors: activity and rest, spiritual growth, health responsibility, nutrition, interpersonal relationships, and psychological management, with RMSEA = 0.055, χ2/df = 2.484, and χ2 = 6816.516. The reliability of the scale was confirmed, Cronbach’s alpha was between 0.865 and 0.928, and the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal important change (MIC), and the smallest detectable change (SDC) were 0.896, 3.36, 13.86, and 19.87, respectively. Conclusion The HPLS-CRCS consists of 80 items in six dimensions and is a valid and reliable scale for evaluating the health-promoting lifestyle in CRC survivors. Using this scale to evaluate the healthy lifestyle in these survivors can lead healthcare providers to detect deficiencies and plan the lifestyle of CRC survivors during the post-treatment period.

Introduction: Health-promoting lifestyle (HPL) among the survivors of colorectal cancer (CRC) is essential to reduce CRC complications, prevent its recurrence, and improve survival. Nonetheless, there is no comprehensive definition for the concept of HPL in CRC survivors. This study aimed to define the concept of HPL among CRC survivors based on the existing literature. Methods: This integrative review was conducted in 2021 using Whittemore and Knafl’s method. The national and international databases of SID, Magiran, ProQuest, Medline, ScienceDirect, Web of Science, and Scopus were searched. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT) and the data were analyzed using the four-step approach proposed by Whittemore and Knafl. Results: After data evaluation, 167 documents were included in final analysis. In total, 1863 codes were generated and categorized into eighteen main categories and the three main themes of antecedents, attributes, and consequences. Accordingly, HPL among CRC survivors was defined as "a set of behaviors in the areas of health responsibility, physical activity, nutrition, spiritual growth, psychological management, and interpersonal relations which are affected by socio-demographic characteristics, clinical characteristics, psychological status, physical conditions, time and place limitations, and patient education, and lead to better disease prognosis, better general health status, better bio-psycho-social status, and better quality of life". Conclusion: The definition of HPL among CRC survivors provided in the present study can be used in counseling, educational, supportive, and care programs for CRC survivors in order to improve their quality of life and survival.

Objective: Myocardial infarction (MI) is one of the main causes of disability and death worldwide. Peer-support can ameliorate the psychological and physical morbidities associated with heart diseases. The aim of this study was to determine whether peer-support interventions could improve the psychological and behavioral health outcomes commonly experienced by MI patients. Methods: In this systematic review, international databases (PubMed, Web of Science, and Scopus) were searched to gather related publications up to March 2023. Eligible papers were those addressing the outcomes of peer-support interventions in individuals with a history of MI. Result: Twelve clinical trials published in English with a Jadad score of 3 or 4 (out of 5) were included in the final review. These studies used four approaches to deliver peer-support interventions: face-to-face, telephone-based, educational videos, and group discussion. The results showed that peer-support could have a positive effect on depression, anxiety, quality of life, sexual performance, self-care, and medication adherence. Conclusion: Considering the serious impacts of MI on life, these patients need empowerment training. Peer-support can be used as a complementary supportive method to reduce MI patients’ psychological complications and improve their behavioral outcomes.

Introduction: Providing psychological support is one of the traditional roles of nurses for patients with HIV/AIDS. Searching the literature showed that various psychological interventions have been performed by nurses to support HIV/AIDS patients; however, no summary of these interventions is available. We aimed to systematically review the interventional studies which investigated the effectiveness of psychosocial interventions delivered by nurses to HIV/AIDS patients. Methods: This systematic review was performed based on Cochrane’s handbook of systematic reviews of interventional studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were used in this study. The databases of PubMed, Web of Science, Cochrane, Scopus and World Health Organization were searched from January 2009 to December 2022. Based on inclusion criteria, nine studies included in this systematic review. Cochrane data extraction form was used for the systematic review and the article’s information was summarized using the modified Jadad scale. Results: The interventions provided by the nurses included: virtual and face-to-face educational programs, written information resources, palliative care, motivational interview, case management, home visit, and care services, along with face-to-face and telephone follow-up. These interventions have a significant positive effect on the quality of life and management of high-risk behaviors, disease management, symptoms and complications, adherence to treatment, immune function, and mental health in patients with HIV/AIDS. Conclusion: The results of the present study show that despite the fact that the interventions have a purely psychological content and can be done with various methods, they are able to have positive consequences in physical, psychological, behavioral, and laboratory health in HIV/AIDS patients.

Abstract Background Inborn errors of amino acid metabolism are chronic conditions that have many sequels. Mothers of these children are facing different challenges which are underdetermined. This study was done to explore lived experience of mothers caring for these children. Methods This is an interpretive phenomenology with van Manen’s approach which has 6 steps. Data were gathered by convenience and purposeful sampling. Nine mothers with different experiences were interviewed and the interviews were audiotaped. Results Six final themes were revealed from the exploring mothers’ experiences including the future tied to the past, psychosis in the shadow of a lost ideal child, rebellion and blaming, the ways of escaping difficulties, self-forgetting in the shadow of full-time care, passing difficulties in the duality of hope-hopelessness, caring in a continuum of isolation-socialization. Conclusion Mothers have multiple challenges in taking care of their children, especially psychologically and financially. So, nurses must plan programs for helping mothers of children with inborn errors of amino acid metabolism to reduce the effects of disease on mothers and consequently the children and the whole family.

Background & Aim: Today, ageing is a challenge for health and care systems, and one of its main consequences is an increase in the readmission rates. Therefore, in all countries, efforts are being made to reduce the readmission rate. The Readiness for Hospital Discharge Scale was designed to understand patients' readiness levels for discharge. This study was conducted to translate and evaluate the psychometric properties of the Readiness for Hospital Discharge Scale. Methods & Materials: In this methodological study, a convenience sample of 500 elderly patients admitted to hospitals affiliated with Mashhad University of Medical Sciences was selected in 2020-2021. The instrument was translated using the forward-backwards method. The psychometric properties of the final version of the instrument were assessed by employing exploratory and confirmatory factor analysis (validity) and Cronbach's alpha and the Guttman's split-half coefficient (reliability). Results: In the factor analysis, all items had a factor loading above 0.3 and, all of them were retained. The goodness of fit indices confirmed the model and a good fit of the model. The Cronbach's alpha coefficient for the whole scale and the Guttman's split-half coefficient were 0.92 and 0.86, respectively. Conclusion: The results of our study supported the four-dimensional structure of this instrument and indicated that this instrument has adequate validity and reliability. Therefore, nurses and doctors can use this tool as a suitable method to measure the elderly patients' readiness for discharge and to achieve a safe transfer from the hospital to home.

Introduction: Care is the fundamental fact of nursing. In recent years, poor care is discussed frequently in articles and newspapers, however health care providers do not have a common understanding of this concept. Therefore the purpose of this paper was to clarify the concept of poor care in nursing and highlight the importance of tackling this issue. Methods: The concept was analyzed using the 8-step Walker and Avant’s method. The SCOPUS, PubMed, ISI, and Embase databases were searched with the keywords "poor care" and "poor nursing care" in the titles and abstracts of articles. Of 550 sources found in the initial survey, 32 articles were finally included in the study. Results: Poor care attributes include poor evaluation, inadequate or inappropriate patient management, and delay, treating, and referring patients to other departments. These attributes are caused by antecedents of nursing workload, the complexity of patient conditions, inappropriate interactions, insufficient workforce, and educational and organizational factors. Conclusion: Poor care is a general concept that includes undesirable and unacceptable standards for receiving or providing clinical and interpersonal health services. Poor care includes eliminating planned activities or performing unplanned activities that are experienced by the patient, health care workers, or caregivers.

Background: Ostomy-related challenges in everyday life may negatively affect patients' Quality of Life (QL), even long after ostomy surgery. Nurses provide care interventions that may have a significant effect on the patients' QL. Therefore, the purpose of the present study was to determine evidence of effective nursing interventions on the QL of patients with an ostomy. Materials and Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. English articles published from 2000 to 2021 were identified and retrieved from PubMed, Medscape, MedlinePlus, ScienceDirect, Web of Science, Scopus, Wiley Online Library, ProQuest, ClinicalKey, SAGE, IRCT, and Cochrane. We assessed all included studies (18 articles) using the JBI Critical Appraisal Checklist. Results: Interventions reviewed in the study were categorized based on intervention, content of nursing intervention, training method, and target group of the nursing intervention. The nursing interventions involved natural treatments, self-care, and psychological support for patients. The training methods used in the studies included demonstration and lecture, mixed media presentation including PowerPoints, and Internet tools such as WeChat Applications. Some interventions were only presented to patients, caregivers, caregivers and patients together, or peer patients. Conclusions: According to the results of the present study, it is suggested that a regular care plan be used with the participation of families and patients from pre-operational to discharge along with nurses' follow-ups and home care to promote the QL. A combination of self-care and psychological education can promote these patients' QL.

Background: A combined morphological and molecular survey was performed to determine the agent of human linear dermatitis Paederus Fabricius, 1775 (Coleoptera: Staphylinidae, Paederinae) species composition in Mazandaran Prov­ince in the Caspian Sea coast in northern Iran, where most of linear dermatitis cases of the country occurred. Methods: Altogether, 397 Paederus specimens were collected from May to August 2021 and classified using morphological characters and ITS2-rDNA sequence analysis. Results: Morphological investigation revealed that all the specimens were Paederus fuscipes. ITS2 polymerase chain reaction (PCR) direct-sequences and the profiles of restriction fragment length polymorphism (RFLP) derived from digestion of PCR products by HinfI, HpaII, and SalI enzymes were identical confirming the morphological results, implying that all specimens belonged to a single taxon. Conclusion: Paederus fuscipes (Fabricius, 1775) is considered the dominant taxon and responsible for linear dermatitis in Ma­zandaran Province. To our knowledge, we have provided the first molecular typing of Paederus beetles at the species level, suggesting that ITS2-rDNA characterization is an alternative tool for species discrimination of Paederus spp.

In this research, the geometric optimization of a tangential swirl burner for the rotary furnace of Luleh Gostar of Esfarayen (LGE) as a steel pipe industry has been studied, experimentally and numerically. To improve the combustion process in the burner, three different parameters namely Diffuser Diameter (DD), Clearance Space (CS) and Fuel Inlet Tube Length (L) are considered and optimized by Response Surface Methodology (RSM). ANSYS-Fluent software with SST k-ω turbulence model has been used for the simulation where the modeling results confirmed that the applied method had good accuracy with a maximum error of 2.42% for temperature greater than the experimental values. A multi-objective optimization for the temperature, NOx and CO emissions as responses is applied and results show that when the parameters are DD = 13.73 cm, CS = 5 cm and L = 30 cm, the burner will be optimized where the temperature increased 9.15%, NOx and CO emissions were reduced 4.42% and 39.08%, respectively.

Introduction: The inevitability of human mortality encourages the care system to enhance the quality of life (QOL) at the end of life. However, the main problem is that the boundaries of care as end-of-life care (EOLC) have not been defined precisely. Hence, this study aimed to clarify the concept of EOLC. Methods: This study was conducted based on Walker and Avant’s eight-step approach (2019). A detailed review of the literature was accomplished in the databases including PubMed/Medline, Web of Sciences, Scopus, EMBASE, and Google Scholar from January 2010 to September 2020 using the keywords ‘Terminal Care’, ‘Hospice Care’, ‘Nursing Palliative Care’, and ‘End of Life’. Out of a total of 302 articles obtained, 14 articles were included in the study. Results: The properties of EOLC included the following items: palliative care; improving QOL; reducing pain and suffering from physical, psychological, and psychological symptoms; and filling the gap between treatment teams and family caregivers through considering ethical issues and respecting patients’ independence. Furthermore, through taking a team approach, EOLC helps the family with physical, emotional, social, and spiritual supports. EOLC is a comprehensive and compassionate process that does not hasten or delay death, but respects and comforts the patient. Conclusion: The EOLC can be defined as a palliative and humanistic care with a holistic and team-based approach focusing on all dimensions of the patients and their families. It also improves well-being at the end of life or even at the time of death, and helps the families with their grieves.

Objective: To identify the elements of teamwork in resuscitation, an integrative review and synthesize current primary studies conducted.Methods: PubMed, Scopus, Web of Science, and Embase, as well as Google Scholar search engine were searched from November 2015 to March 2020 to review previously published peer‐reviewed studies. Out of the 5495 articles, 16 were finally included in the study. Search strategy implemented with these keywords (in the title/abstract) were (team* AND CPR) or (team* AND resuscitation). Six descriptive criteria was performed by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to analyze the articles and a modified version of Cooper’s five‐stage method.Results: Sixteen studies were included in this research. Twenty elements related to teamwork in resuscitation were identified by using data synthesis, then classified into four categories includes team interaction elements, leadership skills, individual elements and environmental elements. Communication, leadership, situation awareness and scene organization had the highest frequency of reviewed articles 10, 5, 4, 4, respectively.Conclusion: The interactions between resuscitation team members and the skills of the leader and team members along with environmental elements had attracted the most attention of researchers by focusing on teamwork in resuscitation. Due to the limited number of articles related to this subject, more research is needed to reveal all the key elements of teamwork in resuscitation.

Abstract The purpose of this research is to design and explain the behavior model of buyers of luxury goods centered on the gold market. In this regard, while reviewing concepts such as buyers' behavior, luxury goods and the gold market, with interviews from experts and professors in the field of luxury and gold industry as well as marketing, qualitative analysis method was used to present the pattern of behavior of buyers of luxury goods centered on the gold market. The studied community includes all experts and professors in the field of luxury and gold industry as well as marketing. The sample size of the study includes 10 experts in the field of luxury and gold industry as well as marketing, which was selected by the theoretical saturation method. Semi-structured interview and Delphi method were used to collect data in this research. The results of qualitative analysis by Max Kyoda software showed that the components of designing and explaining the behavior model of luxury goods buyers centered on the gold market by thematic analysis method include: 1- social factors, 2- cultural factors, 3- individual factors, 4- economic factors, 5- consumer attitude, 6- consumption motivation, 7- value, 8- experience, 9- awareness and 10- consumer behavior. Also, for these components, 65 indicators were finally approved by the experts. Extended Abstract Introduction Luxury consumption is a relatively global phenomenon that is more widespread in developed countries. It can be said that luxury consumption is more common in cultures that are luxurious and tend to materialism (Heidarzadeh & Reise Rohani, 2014). Social attitude is defined as giving importance to friends knowing that they have a luxury brand and introducing the luxury brand as a symbol, character and high social status. Value attitude means that people value the brand for the reasons: reflection of the personality by the luxury brand, creating identity with the brand, creating a favorable feeling in people, and increasing self-confidence. Hedonic attitude is the attitude towards the luxury brand from the aspects of: luxury brand being fun, not boring, and creating excitement and euphoria by the luxury brand (Schade, Hegner, Horstmann & Brinkmann, 2016). Today, business success cannot be taken lightly; therefore, understanding and predicting consumer behavior is the key to the success of organizations in planning and managing this changing environment (Dehdashti Shahrokh & Ahmadi, 2016). Identifying the factors affecting consumer behavior is very important in all industries, but in some areas, such as luxury brands, it becomes more apparent because the factors influencing the purchase of luxury consumers from ordinary and daily goods are more complex and are rooted in the psychological and social factors of individuals and consumers. They seek to achieve higher values ​​than usual brands (Kapferer & Valette-Florence, 2018). In fact, this research is an attempt to find an answer to the question that what are the most important components of buying behavior of luxury products (gold and jewelry) among Iranian customers? Theoretical framework Along with the significant growth trend of luxury goods consumption, research on luxury goods has also boomed in recent years (Zhang, Cude & Zhao, 2020). Usually, there is no single and coherent definition of the concept of luxury among academics. However, this term is mostly used for products, services or brands that have a higher price, exclusive position in the market, excellent quality, unique beauty and creating a sense of pleasure (Cho, Rha & Burt, 2015). Luxury goods are different from goods that are bought on a daily basis because these products, in addition to being daily needs, also meet social needs such as social prestige, and buyers show their personality by purchasing luxury products (Haghighi Nasab, Islami & Davarpanah Kiasraei, 2016). The gold reserves in the balance sheets of the central banks of the world, on the one hand, and its attractiveness for investment purposes and dealing with the unstable macroeconomic environment, on the other hand, caused this valuable metal to attract the attention of policymakers, researchers, and macroeconomic market players even after the collapse of the Bretton Woods system (Jalili, 2013). Gold is always in high demand by individuals, governments and central banks. The flow of a large amount of financial capital towards gold causes the stagnant capital that could be used in the production capacity of the country (Jalili, 2013). Koles (2022) in a study entitled "Factors affecting the buying behavior of luxury products" investigated the impact of customer experiences on the purchase of luxury products. In this study, which was conducted with a survey approach among 413 customers of luxury products in India, the researchers showed that brand experience, brand resonance and brand trust have a significant effect on the intention to purchase luxury products. Jiachen (2022) in a study entitled "Luxury consumption behavior after the financial crisis" investigated the trend of buying luxury products after the financial crisis in the last decade. In this research, it was found that although the financial crisis affected the market of luxury products as a shock; this influence was temporary and did not have a great impact on the buying behavior of luxury products. Research methodology In terms of research philosophy, this research falls under positivist studies. In terms of strategy, this research is of an applicable type, which is carried out with a descriptive-non-experimental approach. In terms of the type of data, this research is qualitative. In terms of time, this study is done in a single section. In terms of data collection method, interviews are used in this research. The statistical population of the research consists of experts in the field of luxury and gold industry as well as marketing. In this research, non-probability targeted sampling methods were used to select the sample from purposive sampling. A total of 10 people were interviewed. Data collection continued to the theoretical saturation of the categories until it was not possible to obtain new data. Accordingly, data has been collected through in-depth semi-structured interviews with experts. The Holstein coefficient was used to evaluate the reliability of the interviews. In the present research, in the first step, using the library method and interviewing experts and implementing it in the MAXQDA18 software and performing open and axial coding, the indicators and components were identified and summarized, and then the indicators and components were confirmed by the experts, using the Delphi method, and in the next step, the final framework of the final model was formed using selective coding. Research findings In the current research, MAXQDA20 software was used and open and axial coding of indicators and components was identified and summarized, and then using the Delphi method, the indicators and components were finally approved by experts. In order to design and explain the behavior model of buyers of luxury goods centered on the gold market, 10 components and 65 indicators were identified and approved by experts. In this research, according to the model, it seems that the behavior of buyers of luxury goods will be influenced by the gold market. In the current research, according to the model, it seems that the components of social, cultural, individual and economic factors will affect the consumer's attitude, consumption motivation and value, and in this way, they affect the experience and awareness. The results of the model continue to show that the components of experience and awareness have an impact on consumer behavior. Regarding the indicators obtained in this research, according to the weight obtained in the coding stages, the indicators of feigned behavior and pretending, information search and exploration, aesthetic experience, occurrence of economic crises, ethnic and tribal culture, the most weight was allocated to Iranians. Conclusion The current research was conducted with the aim of designing and explaining the behavior model of buyers of luxury goods centered on the gold market as a qualitative study. The results of this research are in line with the results of Eastman et al., (2020). In an article, they showed the critical roles of social media, peers, and family in influencing students' luxury consumption and providing insight into how they form an emotional bond with them. Luxury marketers can build business relationships with college student consumers by presenting products as current luxury consumer goods and see their consumption expand into the future. It is also consistent with the result of Dhaliwal et al., (2020). They show that the consumer behavior towards luxury goods has been studied in the past. This article combines the determinants of luxury shopping behavior and previous traditions into four main factors: individual factors, psychological factors, cultural and social factors, and factors related to luxury goods. This research is consistent with the current research in terms of individual factors, psychological factors, cultural and social factors. According to the results of the research, it is suggested to investigate consumer behavior by perceived behavioral control and mental norms, adaptive behaviors and attracting the attention of others, as well as pretentious behaviors and pretending in social behaviors and imitative behaviors, following the behavior of widespread urbanization and understanding and predicting the behavior of consumers. It is suggested that by recommending and ordering to people around you about this brand, awareness of product quality and diversity in selection, as well as awareness gained through online advertising, by searching and exploring information, by awareness from family and friends, and awareness through foreign trips and awareness of the internet and satellite networks to improve the level of brand awareness.

Issue: Customer participation in a wide range of voluntary, active and interactive business behaviors increases the perceived value of the brand. In fact, there is a great deal of empirical evidence to support a general link between customer engagement and customer perceived brand value. However, the concepts of customer engagement and brand value co-creation are significantly multifaceted issues. Therefore, there is an important research opportunity to examine the relationship between different factors affecting the creation of brand value through customer participation. Recognizing this research hypothesis, the present study seeks to identify a set of factors that affect the creation of brand value in various ways through customer participation with a precise and meticulously meticulous approach, and thus, a model for explaining co-creation. Provide brand value in the tourism industry. The lack of comprehensive and multifaceted models on the issue of brand value co-creation in the tourism industry further clarifies the theoretical importance of this paper. At the same time, since the main evidence and information of this research is provided through interviews with tourism industry stakeholders who are fully acquainted with the subject; Therefore, it can be inferred that the proposed model of this research has a good validity.Method: The present study is a fundamental study that has been conducted with the aim of developing and validating the pattern of brand value creation in the tourism industry. From the perspective of data type, the present study has been conducted by mixed method (quantitative-qualitative) and from the perspective of data collection period is in the category of cross-sectional research. The study population in the qualitative section, including marketing and branding specialists in the tourism industry, reached a theoretical saturation with 15 experts. And in a small part, a sample consisting of 311 employees of Tehran hotels has been selected. The main method used in the qualitative part is the data approach of the foundation (grounded theory) and using this method, the main and sub-categories of designing the pattern of creating brand value in the tourism industry have been identified. In the quantitative part, the partial least squares method is used to validate the model. MaxQDA 11 software was used for content analysis and partial minimum squares calculations were performed with Smart PLS 2 software.Discussion and Conclusion: Managers should try to adapt services in the digital context to the needs of the day and with changes, and also by increasing customers' trust in the brand, their service to the services they provide and the conditions they create in the minds of consumers. Raise the brand in the context of e-commerce. The importance of trust in the development of e-business in the service sector has already been mentioned (Das et al., 2019). In this regard, it is necessary for managers of tourism and hotel industry with appropriate activities and investments in marketing in the digital context, setting fair prices and appropriate to the level of service quality, customer participation in programs and social activities with the aim of promoting the brand name in different market segments. Promotional activities such as offering cash discounts, prizes, etc. provide the necessary platform for promoting customer engagement with the brand and managing the brand value of the hotel in the field of e-commerce.

Purpose Maternal near miss (MNM) refers to women who survive death as a result of life-threatening obstetric complications or organ system dysfunction during pregnancy, childbirth or postpartum. The aim of the present study was to gain an understanding of mothering experiences in survivors ‘mothers due maternal near miss event. Materials and methods Heideggerian hermeneutic phenomenology guided this qualitative study. The study was conducted 1 June and 30 December 2019. The sampling was purposeful with maximum variation of 11 near miss mother that used unstructured face-to-face interview for data collection. Data analyzed using Diekelmann, Allen, and Tanner seven stage thematic analysis approach. Findings Emergent theme was “mothering sweetness mixed with the bitterness of death.” The two themes constituting the essence was: “An Angel with Broken Wings” and “Mothering in the Shadow of Death.” The subthemes comprised five sub-sub themes which emerged from over 850 meaning units. Data were analyzed using MAXQDA10 software. Conclusion Maternal health providers need to know that it is not enough only to focus on saving the mother’s physical life. While strengthening the role of mothering is essential element to support near-miss mothers who have experienced difficult physical and psychological conditions. The “beyond numbers” concept, implies that it is not enough only to focus on saving the mother’s physical life. Removing barriers in order to achieve to early mothering, can have a significant impact on reducing the psychological burden of MNM events.

IntroductionGeo-marketing is a tool that uses geographic, or location-based, information to help companies put together marketing strategies and campaigns. Using digital mapping to organize and display data enables marketers to analyze data by region or a particular physical location. Geo-marketing can be used to choose a website for a new business or branch, determining key locations for advertising, displaying website content that is distinct to a user’s origin, and offering online advertising based on a user’s location. Other applications include showing how a customer segment might be distributed in particular. Geo-marketing is a new way of knowledge-based marketing, which is supported by digital maps and specialized GIS software. Knowledge-based marketing use packaged information such as marketing information systems, such as model building, data mining, etc., to determine customer profiles, deviation analysis, and trend analysis. Location Intelligence is a technical way to organize spatial data with business and human data in a geographically correct way in order to reveal hidden relationships that may lead to benefitting a business and/or avoiding spatially wrong located investments. Digital urban environments and e-cities in the rapidly evolving world have created many opportunities for people's living, working and entertaining environments. Therefore, the purpose of this study was to provide a model based on e-city management for the development of e-cities with the data theory approach which was particularly applied for Tabriz city as a case study. This research was in the framework of a qualitative approach and by applying the data research method of the foundation. The data collection approach was semi-structured interviews and 28 experts were selected using purposive sampling method to collect information. Data analysis was performed in three stages: open coding, axial coding, and selective coding in GIS environment. Based on that, a qualitative research model was applied. MethodsThe research methodology was developed based on the GIScience approaches. This technology is the spearhead of geospatial research in a) the connection between technology and thinking, b) training and, c) professional upgrade. All of the above tools are essential for the improvement of a business because they are real time data, they can collect, visualize and analyze their client’s assets in real-time in combination with the real world of a satellite image or any other aerial imagery (i.e. image from a drone) and the process of the data in real-time. This allows an almost instant updating of the maps used by the business. This can be done when the business uses web mapping software in order to update its database. All web mapping software is on the cloud and gives the opportunity to be used from any place any time by any employee of the company who has the right to do so. Also, the database is on the cloud and can be retrieved accordingly. Results and conclusionThe results of the present study show the identification of 367 open sources, 22 subcategories or concepts, and 6 categories of extraction and their characteristics. In this regard, the extractive categories were categorized as follows: Causal conditions: lifestyle change, smart governance (participation), reduction of environmental damage and the development of new technology and social networks, pivotal conditions: individual and social requirements, achieving sustainable economic development and information technology, ruling context: Infrastructure platforms, electronic infrastructure, financial and legal indicators of the country and the status of communication networks, intervention conditions: managerial, educational and cultural anomalies, strategies: upgrading infrastructure, using the experiences of other countries and localizing them, establishment Electronic unit window, using IT managers, culture and education, consequences: improving the quality of services and welfare and satisfaction of citizens, comprehensive development of the country and reducing pollution, traffic and environmental damage. The results of the present study are of great importance in the development of concrete electronic city management on data processing techniques and can pave the way for future research for the implementation of electronic cities. Results also indicated that the Janbo store is well located spatially and has a chance to build up a successful business. Results of this research are of great importance for developing a GIS by bridging GIS and marketing and presenting a new approach for GIScience.

Background: Despite the obvious importance of teamwork in emergency care, the dimensions of teamwork in resuscitation remain a subject of debate among specialists and researchers. The aim of this study was to identify the dimensions of teamwork based on the experiences of members of the resuscitation team. Materials and Methods: This study was conducted between March 2020 and April 2021. By purposive sampling, participants were selected. Sixteen semi-structured interviews were conducted with experienced emergency nurses and emergency medicine residents individually and analysed through deductive content analysis by using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) model. Interviews were encoded for analysis using MAXQDA software (version 2020). Results: Three main categories were identified around teamwork in resuscitation. These categories were as follows (1) leadership, (2) teamwork, and (3) essential prerequisites for resuscitation. The main leadership category consisted of three sub-categories of time management, resource allocation, and task management. From sub-categories, situation monitoring, communication, and mutual support, the main category of teamwork emerged. Also, the emerging category of essential prerequisites for regeneration included two generic categories: professional requirements and workplace requirements and the teamwork category included situation monitoring, communication, and mutual support. Conclusions: Based on the experiences of the resuscitation team members, leadership, teamwork, and essential prerequisites for resuscitation are the most important dimensions of teamwork in resuscitation. Recognizing the dimensions of teamwork in resuscitation is an initial step and then should be reflected in educational programs and future guidelines.

Plain language summary A maternal near miss (MNM) is a life-threatening condition experienced by a mother with organ failure due to severe maternal morbidity. Near miss mother (NMM) experiences adverse outcome such as physical, emotional, and psychological consequences after near miss event. Understanding the meaning of these mothers' lived experience and listening to their voices will help in reducing the burden of complications and will be effective in rehabilitating the disability created in their life. "Death-stricken survivor mother" was the central emerged theme resulting from the study of phenomenology. The main body of this theme reflects the severe physical, psychological burden and vicissitudes life. Server maternal morbidity due pregnancy and childbirth, have made NMM mother's life very different from those of normal mothers. The living conditions of these mothers are mixed in all aspects of the MNM event. Long-term physical and psychological damages they have endured, should be on the agenda of women's health policy makers to support them for years after discharge with integrated care.

Background: Mothers with children undergoing hemodialysis play the role of primary caregivers for their child and fully sacrifice themselves for care, leading to social isolation, suffering, stress, and negative effects on their health. Therefore, this study was conducted to design a supportive program based on the real needs of mothers with children undergoing hemodialysis. Materials and Methods: This qualitative study was conducted in the Hemodialysis Division of Doctor Sheikh Pediatric Hospital in Mashhad City, Iran, from September 2016 to February 2019. The research included phenomenological study, meta-synthesis of qualitative studies, focused group, and nominal group. Participants were selected based on purposive sampling. Eleven mothers with children undergoing hemodialysis and seven key people related to these mothers participated in the study. MaxQDA software was used to facilitate data management. Results: The six main areas including information needs, how to deal with the child, maintaining the mother's physical and functional health, maintaining family relationships, income earning and maintaining financial resources, and emotional-psychological support were extracted. Based on the needs of mothers, 28 support strategies were presented; then, 19 ideas were presented to screen the needs, and finally, the best idea was selected for each need. Conclusions: According to the findings of this study, mothers with children undergoing hemodialysis need support in various physical, psychosocial, informational, economic, and functional dimensions. The supportive program designed provides a systematic framework for screening the needs of these mothers and providing multifaceted support measures with the participation of a multidisciplinary care team.

Abstract Introduction:Maternal near-miss (MNM) is defined as "a woman who almost died but survived a serious maternal complication during pregnancy, childbirth, or within 42 days of completion of pregnancy". Despite the long-term physical and psychological burden of this event on the mother’s life, the meaning of MNM is not clear. In addition, the mother’s role complicates the understanding of this phenomenon. Therefore, this study aimed to understand lived experience of Iranian "near-miss" mothers in the postpartum period. Methods:In this Heideggerian phenomenological study, we used Souza and colleagues’ theoretical framework to understand the meaning of the lived experience of near-miss mothers in-depth. The participants had experienced MNM at least one year ago by World Health Organization (WHO)approach in multicenter, academic, tertiary care hospitals in Mashhad, Iran. Taking into account reflexivity and after obtaining ethical approval, participants were purposively sampled using semi-structured interviews, and data analysis was conducted by Diekelmann and colleagues up to data saturation. Data collection and analysis has been argued by Lincoln and Guba. Discussion:Our findings resulted in updating the existing knowledge about the meaning of MNM and its implication. Given the different needs and challenges of near-miss mothers, it is necessary to design a supportive program of primary care for them. Policymakers and managers should consider the lived experience of these mothers when planning and taking decisions.

Background: Social stigma is the most common and challenging burden of care on the family of people with Borderline Personality Disorder (BPD) In Iran, despite the cultural and social influences, this issue has been less studied. Therefore, present study was conducted to determine the lived experiences of caregivers of patients with BPD of social stigma. Materials and Methods: This qualitative study was performed at Ibn Sina hospital in Mashhad, Iran from 2017 to 2019. Participants were selected by purposive and snowball sampling method. Data were collected through semi-structured interviews. Data saturation was achieved after 16 interviews. Finally, the data were analyzed by the method proposed by Diekelmann (1989). Results: In data analysis, one main theme and two sub-themes emerged. The main themes include Black shadow. Two sub-themes consisted of society dagger and secrecy. The sub-theme of society dagger included the two common meanings (inner turmoil in response to the stigma of others and weakening of family status among relatives and acquaintances). The sub-theme of secrecy comprised of the three common meanings (concealment of disease, hide hospitalization, and seclusion). Conclusions: An understanding of the experience of family stigma can lead to the development of supportive strategies to manage this problem among caregivers of patients with BPD. Nurses can support caregivers by offering them opportunities to discuss how stigma is disrupting their caregiving roles. They can also support the caregivers in negotiating the experienced social and emotional distress and when necessary, refer them to the other members of healthcare teams.

Background: The families of children with Congenital Heart Disease (CHD) experience challenges in taking care of their child, which may affect the whole family. Therefore, the families need to manage and organize the caregiving process for the child. In order to help families provide optimized and quality care for their child, it is important to understand how they manage caregiving challenges. This study was conducted with the aim to explore the strategies used by families for managing family caregiving for their child. Materials and Methods: This qualitative study was conducted on families of children with CHD referred to hospitals in Mashhad, Iran. The participants were selected using a purposive sampling method. The data were collected from among 40 eligible participants using in-depth and semi-structured interviews from November 2017 to December 2018. Conventional content analysis was used for data analysis and MAXQDA software for managing the coding process. Results: According to the results, effort to manage caregiving emerged as the main theme, which included the 4 categories of “monitoring the child's health conditions,” “organizing family life,” “optimizing family life,” and “establishing interaction.” Conclusions: The families used various strategies to manage caregiving including monitoring of the child's health conditions, organization, and optimization of family life, and effective interaction based on their knowledge, experiences, beliefs, and available sources. The results of the present study can help healthcare professionals and nurses to develop family-centered empowerment programs in order to promote families' abilities to manage family caregiving for a child with CHD.

Objective: Understanding the experiences of survivors and healthcare providers about health-promoting lifestyle (HPL) in colorectal cancer (CRC) survivors is important in planning for coping with the disease, managing treatment side effects, increasing survival, and improving quality of life (QOL). This study was conducted to explore the experiences and perspectives of CRC survivors and healthcare providers about HPL in CRC survivors. Methods: This descriptive qualitative study was performed in 2020 at Omid and Imam Reza Hospitals in Mashhad, Iran. Participants were CRC survivors (n = 12) and healthcare providers (n = 33) who were selected by purposive sampling. Data were collected using in-depth semi-structured interview by face to face and then analyzed by Zhang and Wildemuth content analysis method. MaxQDA software was used to organize the data. Results: Following the treatment of cancer, CRC survivors seek to make changes in lifestyle and they choose a HPL that maintains or improves their health. HPL in CRC survivors includes nutrition, activity and rest, health responsibility, interpersonal relations, spiritual growth, and psychological management. The results showed that HPL can lead to motivation, the ability to self-care and improve daily performance, reduce treatment complications, and increase the QOL. Conclusions: CRC survivors can help change their lifestyle patterns with healthy eating, treatment adherence, regular physical activity, and good sleep habits. Furthermore, effective personal and social relationships, spiritual growth, and management of psychological disorders develop health-promoting behaviors in them. CRC survivors also face challenges and limitations in their life after treatment; identifying the components of a HPL in CRC survivors can lead to desirable care, treatment, education, and counseling services.

Background: Intravenous (IV) cannulation is difficult, especially in patients undergoing chemotherapy due to frequent exposure to venous catheterization as well as the destructive effects of chemotherapy drugs on the vessel wall. Therefore, an easy, accessible, and fast method is needed to facilitate venous cannula insertion. Objectives: This study aimed to systematically review studies on the effects of local warming before insertion of peripheral venous cannulas on vascular access in adult patients receiving chemotherapy. Methods: This systematic review was conducted by searching databases including PubMed, Scopus, Cochrane, Embase, CINAHL, and ProQuest. The full search of information sources was conducted from the inception of the databases up to December 7, 2020, using the keywords namely “warming”, “heat”, “chemotherapy”, “cancer”, “vein score”, “catheterization”, “visibility,” and “palpability.” All randomized and nonrandomized trials that were in English language and full text were included. The search was based on the PRISMA guidelines, and finally, six articles were selected for the review. The 8-item JADAD scale was used to evaluate the quality of the included articles. Results: After a complete search, 244 articles were recovered and reviewed. Finally, six articles, including 516 samples, met the criteria for entering the study. Findings indicated that local warming at the IV insertion site increased insertion success rate at the first attempt, increased vein score, increased patient satisfaction and relaxation and reduced the catheterization time, reduced pain intensity, reduced pain perceived by the nurse, and reduced the number of pricks. Conclusion: Findings suggest that using local warming at the IV insertion sites in patients receiving chemotherapy is an effective, easy, and cost-effective method that can be performed using very simple tools and is recommended for all health care providers.

Abstract The need for the constant presence of nurses in patient care and the non-cooperation of other care providers has made the conflict in the defined roles an inevitable issue in the nurseschr('39') daily care activities. This study aimed to analyze and define the concept of nursing care role conflict and determine its causes and consequences. Methods: This concept analysis study was conducted with detailed research on databases, including SID, Iranmedex, MEDLIB-ED, PubMed, Scopus, Medline, Embase, Web of Science, and Google Scholar. The English and Persian articles published within 2010-2020 were included and the search process was performed with the following keywords: "Care role conflict", "Role conflict", "Nurses", and "Nurse". The review of the titles and content of articles was based on inclusion criteria. Data analysis was performed using the Walker and Avantchr('39')s 8-Step Method. Results: Numerous factors, such as inequality in the distribution of financial rewards, high workload, inappropriate management systems, and lack of specified job description, are among the effective factors leading to the creation of nursing care role conflict. Various concepts were used rather than nursing care role conflict, among which included role ambiguity, unclear goals, role insecurity, uncertain expectations, misinterpretation confusion, exhaustion, and job stress, as well as lack of clarity and planning. Conclusion: It was revealed that the lack of clarity in job descriptions was the main cause of the nursing care role conflict. Moreover, the supportive and protective nursing roles were effective in the creation of nursing care role conflict.

Background & aim: Women experience many physical and emotional changes during pregnancy. Simultaneously, they experience dramatic alterations in their family structure and function including changes in the spousal role of couple. Due to the scarcity of studies in this regard, the present study aimed to provide an account of women's experiences of spousal role during pregnancy. Methods: In this ethnophenomenological exploration, 25 pregnant women referred to health centers, prenatal clinics of hospitals, and private offices of obstetricians, were included in the study. Participants were selected using purposive sampling with a maximum variation strategy between October 2016 and March 2017. Data were collected using semi-structured in-depth individual interviews, vignette interviews, and participant observations. The data were analyzed adopting Van Manen's descriptive-interpretive phenomenological approach (1997) using MAXQDA software (version 10). Results: The main theme of "attempt to preserve spousal role" was emerged. This theme was derived from four themes of "mother's effort to manage marital issues", "couples' interactions", "husband physical and mental care of wife" and "mother's conflicts with the rights and duties attached to the spousal role". Conclusion: Pregnant women consider the spousal role to be one of their main duties and regarded it as their central responsibility. Therefore, they meticulously play their spousal role to provide constructive interactions with their spouses. The inclusion of gender-sensitive programs and services, including providing prenatal care, is of utmost importance to pregnant women in order to meet their needs to play their spousal role, appropriately.

Background: Household labor has been indicated as a feminine role even in the present millennium,in which gender role orientations have been changed. As pregnancy is an important time for studyingthe division of household labor, this study aimed to discover the meaning of the pregnant women’sexperiences of household roles.Methods: An ethno-phenomenological study, in which van Manen approach to phenomenology wasits core and focused ethnographic approach was its supplementary component, was used to conductthis study. 25 pregnant women with maximum variation were recruited via the purposeful samplingduring 2016-2017 in Mashhad, Iran. In-depth semi-structured interviews, vignette interviews aswell as observations were used for data collection. Six-step van Manen’s descriptive-interpretivephenomenological approach was used for concurrent data collection and analysis. MAXQDA, version10, was used for data organization.Results: Data analysis led to the emergence of an overarching theme entitled: “couples’ preservation,keeping up and protection of the household roles”. This was derived from two subthemes includingthe mother’s efforts to play the household roles and spouse confrontation with the household chores.Conclusion: The consequence of all endeavors of pregnant women along with their husbands developsthe experience of preserving and maintaining the importance of household roles. As pregnancy is animportant period for considering division of household responsibilities, it is necessary to design andimplement gender sensitive programs to empower pregnant women and their families as well.

Functionally Graded Materials (FGMs) can be described by continuous variation in structure and composition over volume, resulting in corresponding changes in the properties of the material. These kinds of materials are designed to achieve specific properties for specific applications. For the first time, the effects of stepwise fractional axial material gradation pattern and axial compressive load with piecewise function on buckling behaviour of Euler-Bernoulli beam rested on semi-rigid restraints are studied. It is worth mentioning that the more computational efforts are required to solve current problem with respect to the buckling problem of transversely graded beam due to discontinues material gradation especially in the axial direction, axial span-load with piecewise function and natural conditions of rotational spring hinges. The deflection continuity, natural equations as well as boundary conditions are written in the matrix form. The beam discretizing and nontrivial solution are employed to obtain buckling characteristic equation and matrix operations are used to calculate corresponding first mode shapes. Compatibility with various conditions and eliminating convergence drawbacks of conventional numerical tools are advantages of the proposed method. It is observed that the buckling load is decreased by increasing lengths of beam parts and increased by increasing rotational stiffness at semi-rigid supports. In the case of homogeneous beam, the result validity is proved by observing an excellent agreement between results of current work and well-known data in literature.

Students’ engagement in academic-related learning activities is one of the important determinants of students’ success. Identifying the best teaching strategies to sustain and promote nursing students’ engagement in academic and clinical settings has always been a challenge for nurse educators. Hence, it is essential to provide a set of strategies for maintaining and enhancing the academic engagement of nursing students. The purpose of this review was to explore and summarize the strategies that nurse educators use to sustain and promote nursing students’ engagement in academic and clinical settings. A narrative literature review was conducted. CINAHL (nursing content), ProQuest, Medline, the Cochrane, Google Scholar, and Scopus were searched. Of 1,185 retrieved articles, 32 teaching strategies were identified and extracted from the nursing literature. We used thematic analysis approach to organize these strategies into five main categories as follows: technology-based strategies (15 articles), collaborative strategies (10 articles), simulation-based strategies (two articles), research-based strategies (two articles), and miscellanea learning strategies (three articles). As a general comment, these strategies have the potential to promote nursing students’ engagement. Among the strategies discussed in this review, the use of technology, particularly the response system and online learning, was more common among nursing educators, which is in line with today’s advances in smart technologies. The collection presented in this review can be used as a starting point for future research to evaluate the effectiveness of an educational intervention on the academic engagement of nursing students. Nevertheless, due to the lack of experimental studies, the optimal strategies remain to be elucidated through future high-quality experimental study.

Background: The families of children with congenital heart disease experience significant stress as to the care of the child and need to cope with stress. Accordingly, understanding of how families cope and use coping strategies is more important to help them better cope with stressful situations caused by caregiving. This study aimed to explore coping strategies used by families in the face of caregiving stress. Methods: This qualitative study was conducted on 40 eligible participants from the families of children with congenital heart disease. They were recruited through a purposive sampling method from those referred to hospitals in Mashhad, Iran. In-depth and semi-structured interviews were used for data collection from November 2017 to December 2018. The data were analyzed using conventional content analysis, and MAXQDA software (Ver.2010) was used to manage the data encoding process. Results: According to the results, effort to maintain well-being emerged as the main theme which included five categories: “spirituality in caregiving”, “acceptance and adjustment”, “optimism and hopefulness”, “self-control and patience”, and “ management of psychological needs”. Conclusion: Families used various coping strategies including spirituality, acceptance, optimism, patience, and management of psychological needs based on their beliefs, attitudes, abilities, and available resources for coping with caregiving stress. The results can help the nurses and health care professionals to develop appropriate educational, supportive, and psychological interventions based on the family’s needs to cope effectively with caregiving stress.

Background: patients with borderline personality disorder(BPD) in the family are a complicated and stressful experience. The caregivers’experiences of problems they have in care of patient with BPD have remained unknown. The aim of this research was to explore experiences of caregivers while living with BPD patients in iran. Methods: This interpretive phenomenological research was performed on 10 caregivers of patients with BPD at Ibn-sina Hospital in Mashhad, Iran in 2019. Purposeful sampling were used for sampling. Data were collected through semi-structured interviews and saturated after 16 interviews. The analysis of data was concurrently carried out using method proposed by Diekelman (1989). The MAXQDA software (Ver.10) was used for data organization. Results: The participants in this study were aged 25 to 55 years. after data analysis, three themes (“life in hell”, “chain to the feet”, and “black shadow of stigma”) and six sub-themes (“disrupted from the life”, “self-discrepancy”, “care bottlenecks”, “in the fence of restriction”, “society dagger” and “resort to secrecy”) emerged. Conclusion: The results of this study showed that the caregivers of patients with BPD during period of care were faced with variety of problems. It is suggested that health policy makers pay more attention to these problems related to the mental health of caregivers.

Background & aim: In some situations in quantitative or qualitative research, complementary tools would be of great help in data collection. Vignette technique is a data collection tool, which has been used for over 50 years in different disciplines including health sciences. Nonetheless, there is a paucity of information regarding this method. With this background in mind, the present review aimed to provide thorough information about the vignette technique. Methods: This was a narrative review conducted through searching of databases of ISI Web of Science (65), PubMed (27), Scopus (24), CINAHL (110), ProQuest (23), ERIC (44) as well as Science Direct (123) using keywords including “vignette”, “qualitative research”, “quantitative research”, and "research” from their inception to September, 2018 to assess those studies regarding different aspects of vignettes. Out of 416 documents, a number of 105 books and articles were reviewed regarding the different aspects of the vignettes. No language restrictions were imposed. Results: Vignettes are used in different forms including text, illustrations, images, videotape and cartoons, computer-based data, and music as an elicitation tool to provide supplementary and complementary data during a research process. Using this technique, the researcher can collect some data which is not accessible through other sources. At the same time, the researchers should be cautious about its accurate design and validity to get more realistic data. Conclusion: Vignettes as an effective tool can be employed in both quantitative and qualitative research to collect more diverse and thorough data, particularly, in cross-cultural research.

Background: The role of women and men is changing across the world, and women, including pregnant women, are adopting newer roles in traditional societies like Iran. This study aimed to explore the meaning of pregnant women's experiences regarding their social roles in the sociocultural context of Iran. Materials and Methods: This study was carried out using an ethnophenomenological approach. Participants included 16 pregnant women who attended health centers, hospitals, and private obstetric clinics in Mashhad, Iran, between 2016 and 2017 and were selected based on purposive sampling. In-depth semistructured interviews, vignette interviews, participant observations, and field notes were used to collect data. To analyze data, six-step van Manen's (1997) descriptive-interpretive phenomenological approach was used. Results: Through data analysis, the overarching theme of “selection, management, and adjustment of various roles to play social roles” was emerged. This was consisted of four themes: “Mother's perspective regarding out-of-home employment, incompatibility between pregnancy and social roles, mother's management strategies to play different roles, and husband's authority regarding mother's employment.” Conclusions: The consequence of reciprocal endeavors of pregnant women along with their husbands as well as their work environment expectations tends to selection, management, and adjustment of feminine roles. Since the employment of pregnant women leads to their more physical and psychological involvement, not only the problems of working women but also the expectations and rules of the workplaces as well as the requests of their husbands should be taken into account.

BACKGROUND: Non-technical skills as a complement to technical skills have become increasingly important in cardio-pulmonary resuscitation, and teamwork is one of the most prominent of these skills. Because of the limited number of tools introduced and validated for measuring teamwork in resuscitation, this study was conducted to develop and evaluate the psychometric properties of the Teamwork Scale in Resuscitation (TSR). MATERIALS AND METHODS: This study was a sequential exploratory mixed-method study and was conducted between March 2020 and April 2021 and in two phases. In the first phase (qualitative), semi-structured interviews were performed with resuscitation team members who were selected using a purposeful sampling method with maximum variation in terms of experience, level of education, age, and gender. Using directed qualitative content analysis, the data were analyzed and the primary item pool was developed. In the second phase (quantitative), assessing face, content, and construct validity as well as reliability via the internal consistency and stability, the psychometric properties of the instrument are evaluated. RESULTS: The initial tool consisted of 54 items; after assessing the face validity, ten items were removed during content validity, and the final tool consisted of 44 items and three main categories including the essential prerequisites for resuscitation, leadership, and teamwork, which was scored based on a 5-point Likert scale from strongly disagree to strongly agree. The convergent validity and concurrent validity of the tool were confirmed. The reliability of the instrument was also confirmed using Cronbach's alpha test and re-test and the intra-class correlation coefficient (ICC) between raters. CONCLUSION: The validity and reliability of TSR for measuring teamwork in resuscitation in a simulated environment are approved. Further studies are suggested for different contexts of resuscitation and with trained raters to evaluate its use in real resuscitation situations.

Introduction: In providing pregnancy services, particular attention is given to the mother and her infant and comparatively less consideration is paid to men’s role. This study aimed to explore how Iranian men are confronted with pregnancy from pregnant women’s point of view. Methods: This study was conducted, using an ethno-phenomenological approach. 25 Pregnant women were recruited via purposeful sampling from health centers, hospitals, and private obstetric clinics in Mashhad, Iran. In-depth semi-structured interviews (n=25), vignettes, (n=13) as well as observation were used for data collection. The data were organized with MAXQDA software version 10 and analyzed, using van Manen descriptive- interpretive phenomenological approach. Results: The main theme which emerged was: "adaptation, skillfulness and self-actualization of man in confrontation with pregnancy". This was derived from two themes: 1) "spouse's emotional engagement" subthemes spouse’s emotional confrontation with pregnancy occurrence, man's sentimentality following being an expectant father, husband`s confrontation with wife's motherhood, man's emotional excitement, seeing the symptoms of fetal survival, husband's gender orientation and 2)"Concentration, vigilance and active efforts of spouse during pregnancy" subthemes managing wife towards successful pregnancy, efforts to acquire paternal skills and pregnancy as an issue to expand spouse's mental horizons. Conclusion: Besides an overwhelming sense of emotion, men tend to be supportive in managing successful pregnancy. As an opportunity window pregnancy seems to develop thinking, vision and horizons of life among men and increases their responsibility. By promoting male participation in pregnancy, important steps could be taken to improve maternal and infant health using spouses` support approach

Background & Aim: Postoperative pain is one of the clinical challenges for nurses who care for patients. The objective of this review was to evaluate the effect of preoperative education on postoperative pain after elective surgery. Methods & Materials: A literature search was done on PubMed, CINAHL, Cochrane Library, Web of Science, Scopus and EMBASE to find the articles published in English on clinical trials from January 2012 to June 2018. Results: Out of 153 studies retrieved, 13 studies (2482 people) were reviewed. Generally, most studies indicated the effectiveness of preoperative education on postoperative pain relief (7 studies, n=1678). In other studies, there was no significant difference between education and the degree of pain reduction in the patient. Also, the results of some studies (n=204) showed that education with empathy could reduce anxiety in half of the cases. Conclusion: Preoperative education as a complex intervention can reduce postoperative pain. Interactive education with empathy reduces patient’s anxiety and the need for postoperative analgesics. Therefore, training skilled nurses and the providers of such education is suggested for managing pain in patients.

Introduction: Triage in the interactive atmosphere of the emergency department (ED) has been described as complex and challenging. The influence of nurses’ belief systems on triage decision making has not to the authors’ knowledge been addressed. This study attempted to gain an understanding of the ED nurses’ culture of practice with respect to contextual factors that affect triage decision making. Methods: A focused micro-ethnographic study based on Spradley’s developmental research sequence (DRS) has been conducted in the emergency department of the Mashhad University hospital, Iran, from February 2014 to February 2015. Data were collected during 300 hours of participant observations that were accompanied by formal and informal interviews, then analyzed based on Spradley’s DRS. Results: Nine study participants were formally interviewed. From these interviews, eight core beliefs emerged related to nurses’ culture of practice: namely, triage decision making is arbitrary; the facility/locale of the emergency medicine department is the pivotal contextual factor affecting decision making; not every nurse can be assigned to triage; each patient assumes the existence of an emergency condition; the on-duty physician must be known; triage decision making must be considered plausible by colleagues; “they” tell us something, we should do something else; and triage guidelines are not practical. Conclusion: Contextual factors have a strong tendency to guide triage decision making and violate the principle of patient acuity (that is, that patients with the most acute medical conditions should be prioritized). In response, triage guidelines need to integrate the priorities of patients, nurses, physicians, and administrators.

Background: Home care has gradually become a nursing model for nursing care. The nurses’ experiences of challenges they have in home care have remained unknown. The aim of this study was to explore the hidden aspects of challenges related to home care in Iran. Methods: This study was conducted to explore the challenges of home nursing care using a qualitative content analysis method. Purposeful and snowball sampling methods were used for sampling. The study was conducted from September 2016 to September 2017 in the provinces of Khorasan and Tehran in Iran. Semi-structured interviews were conducted on 33 nurses who were providing home care. After data saturation, the data were analyzed. Results: The data analysis led to the development of five main categories of “difficult instances “, “economic problems”, “professional barriers”, “social difficulties”, and “bureaucratic tension”. Conclusion: The results of this study showed how nurses faced with a variety of challenges in home care and how they were different from hospitals. Facilitating the nursing processes, supporting home care, and recruiting nurses that had the potential to cope with the existing stressful factors and economic incentives can increase the quality of home care.

Background: According to the World Health Organization, one in four people experience a psychiatric disorder throughout his/her life. For centuries, psychiatric patients have been sent to psychiatric hospitals that often stigmatized and located out of the community. Moreover, these patients are stigmatized by the hospital staff because they are not aware of patients’ experiences in this domain. This humiliating attitude leads to low self-esteem, isolation, and frustration, and prevents patients from seeking treatment. Aim: This study aimed to explain the lived experiences of patients with psychiatric disorders on the consequences of stigma in mental health centers. Methods: This hermeneutic phenomenological study is a part of a larger study undertaken for partial fulfillment of the requirement for PhD dissertation in nursing. The main study was conducted on 12 psychiatric patients during 2014-2015. They were selected based on purposeful sampling method. Data were collected using unstructured interviews and analyzed by an interpretative method. Results: Psychiatric hospital as an unsafe place is one of the main themes of the phenomenon under study in the original project. It consists of two sub-themes (i.e., an egregious hospital and cold-hearted white collars) each of which is supported by a number of common meanings. Implications for Practice: The results of this study can shape the interventions and policies to combat and prevent the spread of stigma through health centers about people with psychiatric disorders.

Background: Wastewater contaminated with dyes such as Reactive Blue 203 can produce a lot of health problems if it is released into the environment without a suitable treatment. Although there are several studies on dye removal from wastewater, removal of Reactive Blue 203 has not been investigated by hybrid methods. Therefore, the aim of this study was to investigate the removal of Reactive Blue 203 from aqueous solution, using combined processes of zinc oxide (ZnO) nanoparticles, Fe(VI) oxidation process, and UV radiation. Methods: The removal of dye from aqueous solution using ZnO nanoparticles, Fe(VI) oxidation process, and UV radiation was individually evaluated. Then, the results of combined methods were compared. Hydraulic retention time (HRT), pH, and temperature were the most important factors which were investigated in this study. Results: ZnO nanoparticles, Fe(VI) oxidation process, and UV radiation were able to remove 97%, 71%, and 47% of the dye in the optimal conditions, respectively. Also, the removal of dye using combination of Fe(VI) oxidation process/UV radiation, ZnO nanoparticles/Fe(VI) oxidation process, and ZnO nanoparticles/UV radiation under optimum conditions was 100%. It seems that the combined methods were significantly more effective than the methods alone for removal of dye from water. Conclusion: UV radiation alone is a simple and efficient method for removal of Reactive Blue 203 from water. Removal of Reactive Blue 203 using Fe(VI) oxidation process can be completed in a fraction of second, therefore, it can be categorized as a rapid reaction.