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Abstract Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p

Summary: Purpose: Adequate medical knowledge and skills are fundamentals for nurse prescribing authority development. This study will explore the potential for developing nurse prescribing training in Iran, where nurses currently lack prescribing authority despite their strong academic nursing education. Methods: This is a study with two phases. At first, in a conventional qualitative content analysis method, with purposive and snowball sampling, from June 2021 to March 2023, 20 participants, including 16 nurses in different clinical, managerial, educational, and policy-making settings, three physicians, and one clinical pharmacist were interviewed. Unstructured interviews were conducted face-to-face or virtually as the situation required during the pandemic period due to Coronavirus disease, 2019 (COVID-19). Qualitative content analysis as developed by Elo and Kyngäs in 2008 was used for data analysis. In the second comparative analysis phase, four masters of science and one doctor of nursing curricula analyzed in the existence of the nurse prescribing prerequisite courses and these five curricula and two potential masters of science in community health and critical care nursing curricula were compared with John Hopkins University curricula. Results: In the qualitative phase, two themes emerged: nursing education challenges and the potential for nurse prescribing training development. These were further broken down into four subthemes: inadequate nurses' knowledge in prerequisite nurse prescribing courses, unprepared educational infrastructure, treatment sector potentials, and educational potentials, with a total of 12 concepts identified. During the comparative phase, it was found that none of the nursing curricula had adequate prerequisite courses for nurse prescribing. However, the Community Health and Critical Care nursing curricula showed potential for developing nurse prescribing training. Conclusions: In the nursing education system, there are some challenges and potentials for prescribing training, and the community health and critical care nursing curricula have the potential capacity to prepare the graduated nurses to prescribe. It needs educational and managerial policies. More developmental research and pilot studies are recommended.

Introduction Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran.Methods and analysis A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study.Ethics and dissemination This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.

Abstract Background To determine the health needs and promote women's health, their quality of life should be investigated. For this purpose, a valid tool is needed, that has credible validity and reliability, and its concepts are clearly defined and culturally appropriate. This study aimed to develop and assess the psychometric properties of “Iranian Women’s Quality of Life Instrument (IWQOLI)”. Methods The items of “IWQOLI” were generated from themes extracted (150 items) from a content analysis approach with the participation of 40 women. Face validity of the questionnaire with the participation of 10 women and content validity by 10 experts was approved. To determine the domains of the questionnaire, exploratory factor analysis (principal component extraction method) was performed. Internal consistency and test—retest reliability methods with 14-day intervals (30 women) were used to assess the reliability of WQOLI. Results After performing the face and content validity, 32 items were deleted. S-CVI/Ave was obtained for the instrument (0.93). The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 590 women. Five factors were extracted with a total variance account of 56.24% and 28 items dropped at this point. The IWQOLI score was significantly correlated with the SF-36 (r = 0.717, p

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

BACKGROUND: Nursing education faces many challenges that must be identified and removed to improve nursing education and promote the quality of nursing care. Identifying the challenges of nursing education helps to solve or correct the weaknesses and achieve educational goals, which ultimately help to train skilled professionals capable of providing higher quality care to patients. The present study was conducted with the aim of explaining the experiences of nursing tutors in regard to the process of challenge formation in nursing education in Iran. MATERIALS AND METHODS: This is a qualitative study with a grounded theory approach that was conducted in two stages. In the first stage, which took about 9 months, 18 experienced nursing tutors with managerial positions were selected by purposeful sampling from universities across the country. Data were collected through semi-structured interviews, field notes, observation, and memos. Data analysis was done by Corbin and Strauss method through MAXQDA software version 10. In the next step, using the method of Walker and Avant (2011), concepts and statements were gathered within a whole and a model was presented. RESULTS: Twelve male university tutors and six female tutors participated in this study. The mean age of the participants was 45.38 ± 2.1 years, and their mean work experience was 18.66 ± 3.8 years. The findings showed that the challenges of nursing education could be categorized into three categories (defective educational cycle, efforts to restore the educational structure, and learning is a member of educational family), and 12 subcategories. After analyzing the data, trying to provide a need-based education was determined to be the central theme of this study. The components of model developed in this study were presented in the three axes of improving the tutor’s teaching skills, managing the situation and educational facilities, and facilitating student’s participation in the education process and decision-making. CONCLUSION: Identifying barriers and facilitators of need-based education in health policy making can enable nurses to build a better future for their nursing position. To provide need-based education, it is necessary to create a suitable ground and platform for proper education. Such platform and ground are a necessity of educational, therapeutic, and community environments. To achieve this goal, it is recommended to improve the professional capabilities of tutors and support educational organizations.

Introduction: Infertility is one of the main problems of the family and is one of the factors that determine the identity and personality of Iranian infertile women. Family-centered empowerment model is a step toward increasing the self-efficacy of patients and enabling them to take responsibility of their illness. This study aimed to determine the effectiveness of applying family-centered empowerment model on irrational thoughts of Iranian infertile women. Methods: This study was a randomized clinical trial conducted on 80 infertile women and their husbands that were randomly divided into two intervention and control groups. Irrational Parenthood Cognitions questionnaire was given to the intervention and control groups to complete before and 3 months after the intervention. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA). Results: The mean (SD) of irrational thoughts’ scores in the control group before and after the study were 33.92 (5.98) and 33.20 (6.83) respectively, and in the intervention group were 34.55 (5.61) and 19.97 (3.52), respectively. The result of independent t-test showed a significant reduction in irrational thoughts of women in the intervention group after the family-centered empowerment model intervention. Conclusion: The family-centered empowerment model after three months of continuous implementation was able to effectively reduce the irrational thoughts about having children in infertile women.

Background: Lifestyle changes due to the COVID-19 pandemic may affect individuals' sexual lives and probably their sexual function. The present study aimed to explain the sexual lived experiences of health workers on the Iranian frontlines of the fight against the COVID-19 pandemic. Materials and methods: The present study was qualitative research using the conventional qualitative content analysis method. It was conducted in the city of Ramsar, Iran, in 2022. The data were collected using 12 in-depth personal interviews and a purposive sampling method. Lundman and Granheim's method was used to analyse the data. Results: The analysis of the data in the first phase of the research led to 60 initial codes, 7 subcategories, 3 main categories (concerns about health risks, sexual dissatisfaction, and sexual facilitators and barriers), and one theme (unhealthy lifestyle due to sexual dissatisfaction). Conclusion: The present study revealed new and different dimensions of the sexual experiences of health workers on the frontlines of the fight against the COVID-19 pandemic [concerns about health risks, sexual dissatisfaction, sexual facilitators, and sexual inhibitors]; these dimensions are based on the Iranian context and culture that can be considered to enhance sexual pleasure and the physical and mental health of health professionals that have an impact on improving patients' and people's health status in society.

Abstract Background Applications of mobile technologies (mHealth) have the potential to reduce health inequalities, give patients more control over their health, and improve health care’s cost-effectiveness. The widespread use of mobile phones offers us a new way to prevent cervical cancer. The objective of the study was to design and develop a mobile phone application (app) that aims to conduct a behavioral intervention for women and to evaluate the efficacy of the app-based intervention. Methods This study involves 5 phases. In the first phase, understanding women’s perspectives will be identified using a qualitative approach based on the I-Change model. In phase 2, the results from the qualitative approach and requirement prioritization through providing experts’ perspectives will be done. The main outputs of this phase will be resulted in prioritizing the main measurable effective variables of the I-Change model. Phase 3 will be processed for the development and psychometric of an assessment tool regarding selected constructs. In phase 4, the App framework and content development will be performed. In phase 5, a three-armed, parallel-design randomized controlled trial will be conducted on women. Two hundred ten women will be randomly assigned to three groups including two intervention groups and one control group. The intervention groups included the following: (1) a mobile application and (2) a digital book. The data will be evaluated using tools designed and constructed in phase 3 of the study at baseline in 3-month follow-up assessments. The impact of the two interventions on cervical cancer prevention behaviors through mobile-based educational intervention will then be evaluated. Discussion A theory-based health education program using a mobile app to improve cervical cancer-preventive behaviors will be implemented for the first time in Iran. With an effective health mobile-based educational design, it is very important to determine whether Iranian women will be motivated to adhere to preventive behavior related to CC. Trial registration Iranian Clinical Trial Register IRCT20181205041861N3. Registered V2.0 on 26 October 2021.

Background & Aims: Infant hospitalization in the intensive care unit is a psychological crisis for the family that causes stress and disability for the family. In critical situations, the knowledge of the healthcare team is devoted to patient care, while it is necessary to emphasize the needs of the family. This study aims to determine the impact of family-centered empowerment model on quality of life of premature infants parents’ were admitted to the neonatal intensive care unit. Materials & Methods: This quasi-experimental controlled study was performed on 84 parents with preterm infants admitted to the intensive care unit. Samples were continuously targeted in both intervention and control groups. They received training sessions in four steps and 8 sessions. The ability of the subjects was also assessed by the competency questionnaire (including three dimensions; threat perception, self-efficacy and self-esteem). Demographic questionnaire, and WHOQOL-BREF quality of life questionnaire once at the beginning of the study and again one month after completion. Intervention sessions were completed and the data were analyzed using Chi-square, independent t-test, analysis of variance and Spearman and Shapiro-Wilk correlation coefficient using SPSS software. Results: There was no significant difference between the two groups in terms of demographic characteristics and baseline competency scores (self-efficacy, self-esteem, severity and sensitivity) and quality of life. Comparison of total quality of life score (P=0.041) in the intervention group was significantly higher than the control group. In-group comparison, empowerment scores [self-esteem, self-efficacy (P

Background: According to the widespread prevalence of different chronic diseases, nurses need to know the choices, necessities, and abilities of patients. The study purpose was to investigate the methodological quality of published papers based on Family-Centered Empowerment Model (FCEM). Methods: This study was a systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to retrieve all national and international studies in the field of FCEM. The final papers were reviewed for different methodological dimensions using three quantitative scales: Jadad, Consolidated Standards of Reporting Trials (CONSORT) 2010, and Newcastle-Ottawa, and qualitative scale of Cochrane risk of bias. Findings: In the initial search, 644 papers were retrieved; following PRISMA screening guideline, 47 relevant papers were recognized. Jadad scale scores showed that one study received a score of 5 and 33 received a score of less than 3. Consort scale scores indicated that four studies were scored 7 and the same number were scored less than 5. The Newcastle-Ottawa scale scores showed that 13 studies were scored 8, and 4 were scored less than 4. The five dimensions of Cochrane's risk of bias scale are detailed in the paper. Conclusion: The methodological quality of applied studies based on the FCEM was relatively good, but their reporting style and quality were inadequate.

Objectives: High tension is the leading cause of the increased risk of mortality among family caregivers (FCGs), resulting in inadequate care and abandonment of the patient. Spirituality promotion is a sense of mastery and control and strength to endure the stressors of illness. To the best of our knowledge, no tool is available for investigating the current spiritual state of the FCG and identifying the need for spiritual intervention in Iran. Therefore, the present study aimed to identify the level of independence of patients with chronic disease and to explore the concept of spirituality and psychometric of related scale, namely, caregiver’s spiritual empowering scale (CSES). Materials and Methods: This study used a multiphase mixed-method approach and was conducted from June 2016 to August 2018 in the southwestern region of Iran. The cross-sectional surveys of activities of daily living (ADL) and instrumental activities of daily living (IADL) were conducted on people with chronic diseases (n = 389) in the first phase. In the second phase, the exploratory sequential mixed method was applied for content analysis study (n = 26) and psychometric of CSES in FCG (n = 395). Results: The caregivers’ age was within the range of 17-74 years (42 Mean ± 12SD). Based on the results of ADL IADL, 87% and 99.5% of patients were dependent or in need of help. In the qualitative study phase, four main categories emerged in the context of "Empowering spirituality". The reliability and validity of CSES including 12 items loaded one a single factor were confirmed based on the content validity ratio >0.45, content validity index >0.78, kappa coefficient >0.75, impact score > 1.5, α = 0.92, interclass correlation coefficient = 0.91, 95% CI = 0.90-0.92, r = 0.57, P = 0.000, standard error of the mean = 1.64, and Kaiser-Meyer-Olkin index = 94, P < 0.001. Conclusions: In general, spiritual empowerment is essential as a low-cost and effective method in increasing the dependence of people with chronic diseases and the risk of burnout in FCG. Accordingly, the CSES is considered a valid and reliable instrument for measuring the status of empowerment spirituality in informal caregivers and the effectiveness of interventions.

Background & Aim: Self-control is the capacity to organize cognitive and emotional responses in order to provide continuous and adaptive behavior with ideal standards for long-term goals. Due to the high levels of care burden of patients with chronic disease, this study aims to explain the concept of self-control in the family caregivers of patients with chronic disease based on the family-centered empowerment model. Methods & Materials: Data were collected through in-depth, semi-structured interviews with 26 participants (19 caregivers, four nurses and three patients with chronic disease) from June 2016 to August 2017 in southwestern of Iran. Data were analyzed using the directed content analysis approach. The documents recording, accurate description of details, member checking, peer checking, and maximum variation of participants, were considered for ensuring the trustworthiness of the data. Results: “Transcendental self-control” of family caregiver was explained by four conceptual categories: “caregiver insight", "value prioritization in care", "acceptance of care responsibilities" and "committed care". By predicting the potential risks of playing the care role and deeply understanding the conditions of care while paying attention to the value prioritization outcome-centered and virtue-based care, the family caregiver accepts the care burden through positive thinking and expediency and modestly offers "committed care" while having competent care experiences. Conclusion: The explanation of self-control concept based on family-centered empowerment model in the real field creates a clear understanding of this concept and leads to "commitment care" by family caregivers of patients with chronic diseases and in turn provides a basis for reducing workload in the clinical setting.

Objectives: The communication is not just being able to verbally pronounce words and sentences, but it includes understanding information through inspiration, inner instinct, or external guidance. To achieve a better quality of life (QoL), there is a need for determining pleasant communication. The current study aimed to explore the women’s perception about different aspects of communication in their life. Materials and Methods: This qualitative content analysis aimed to understand the meaning of communication as a key factor in Iranian women’s QoL, which was conducted on 40 women. The data were gathered through depth interviews from May to November 2016 in Tehran, Iran. The interviews were transcribed verbatim and analyzed using conventional qualitative content analysis in 8 stages recommended by Zhang. Results: Two categories were identified based on the interviews, including constructive spiritual and pleasant peripheral communication and each theme consisted of some categories. Conclusions: Overall, awareness about different aspects of communication in women’s life must be considered by politicians and health care providers in Iran. In addition, efforts would be made to improve nurses’ understanding of different aspects of the QoL, especially pleasant communication in women’s life which could help their health promotion.

Background: Quality of life drives from the individuals' perceptions of their position in life long and allows holistic assessment of the effects of health conditions beyond the symptoms, signs, and complications. This study aimed to assess the quality of life and recognize females' point of view about the quality of life aspects. Hence, perhaps it could be a step toward improving women's health status. Materials and Methods: This study was an explanatory mixed method research one which was conducted in the two following steps. In the quantitative step, five hundred women aged 15–49 years were selected from varied zone of Tehran Province, using cluster random sampling method. In order to assess the quality of life, Short Form SF-36 instrument was used. In the qualitative step, forty women were selected by purposive sampling in a different range of quality of life based on the result of the first step. Data were collected through semistructured, in-depth individual interviews, which continued up to data saturation point. Data analysis was performed through conventional content analysis. Results: Among different aspects of quality of life, the highest and the lowest means (SD) were related to physical functioning mean (SD) 70.58 (24.52) and general health 67.72 (27.66), and mental health 55.27 (30.22) and social functioning 57.02 (30.62), respectively. From the interviews, three main themes were extracted as the following: (i) financial support, (ii) informational support, and (iii) service-based social support. Conclusions: The present study revealed that Tehranian women do not have high experience related to the quality of life; however, a sense of receiving support from different sources could help them to wrestle with a complicated condition in everyday life.

Background: Patients with heart valve disease need to receive long-term care from their family members after surgical valve replacement. Thus, family caregivers should have adequate self-efficacy for patient care. Objectives: This study examined the effects of the family-centered empowerment model (FCEM) on self-efficacy and self-esteem among the family caregivers of patients with prosthetic heart valve. Methods: In this quasi-experimental study, forty patients together with one of their family caregivers were consecutively recruited and allocated to an intervention or a control group. The FCEM was used in three to five sessions for patients in the intervention group. Besides, we sent their family caregivers educational cards containing the same educations provided to their patients. Finally, an educational session was held for family caregivers in which their questions were answered and each of them was provided with an educational booklet containing the same materials as the educational cards. Patients and their family members in the control group received routine care. Self-efficacy and self-esteem of family caregivers were assessed before, 1 week, and 1.5 months after the intervention. Data analysis was performed through the independent-samples t- test and the repeated measures analysis of variance. Results: Before the intervention, the mean scores of self-efficacy in the control and the intervention groups were 26.68 ± 4.79 and 26.79 ± 5.49, whereas the mean scores of self-esteem in these groups were 33.74 ± 4.55 and 33.84 ± 4.72, respectively. None of the between-group differences were significant. After the intervention, the mean scores of self-efficacy and self-esteem in the intervention group were significantly greater than the control group (37.32 ± 2.68 versus. 29.89 ± 2.20 and 36.26 ± 3.66 versus. 29.26 ± 5.84; P < 0.05). Conclusion: The use of the FCEM promotes self-efficacy and self-esteem among the family caregivers of patients with prosthetic heart valve.

Introduction: Many factors affect desirable quality of life. Regarding the subjective and multivariate nature of the quality of life concept and the need for attention in different cultures and groups of the society, the present study was performed to analyze the concept of quality of life from women's perspectives. Method: To analyze the quality of women's life, Schwartz-Barcott and Kim's hybrid model was used. At theoretical stage, in order to deeply analyze and redefine the concept of women's quality of life, 571 articles from available and reputable databases without a year limit and with keywords of life quality and women were searched in Persian and English. At practical stage, 40 Iranian women living in Tehran were interviewed. Then, the text of interviews was handwritten and analyzed using Zhang's content analysis method. Finally, the similarities and differences of definitions obtained from the previous two stages were evaluated and a general analysis was performed. Results: In the final analysis, women's quality of life was defined as follows: “The quality of life from women's perspectives is a subjective concept and expressed as the sense of happiness that they experience it in their lives by having peace of mind in life, satisfaction with health due to responsibility for health and communicating with themselves, God, environment, and others, sense of security, and understanding of the comprehensive support received to have an ideal life. Conclusion: Based on the findings, paying attention to the status of women in the field of comprehensive support, sense of security, health responsibility, and communication can bring useful and significant results to improve the quality of women's life.

Background & Aim: Empowerment is a dynamic, positive, interactive and social process, leading to the improvement of quality of life (QOL) in patients with chronic disease. The purpose of this systematic review and meta-analysis was to determine the effect of family-centered empowerment model (FCEM) on QOL in adults with chronic diseases. Methods & Materials: By searching FCEM in Persian databases including SID, MagIran, IranMedex, IranDoc, and googlescholar, Scopus, Pubmed, Web-of-science, Proquest, and Sciencedirect, all relevant studies were extracted. The methodological quality of the papers was examined using Cochrane-risk-of-bias. Data analysis was carried out through the random effects model and heterogeneity by I2 index. The data were analyzed using the STATA software version 11.0. Results: Of the 647 initial studies, only 8 studies examined the effect of FCEM on the QOL in adult patients using SF-36. The pooled standardized mean difference of the 8-dimensions of QOL included: social-functioning (1.781), Physical role limitation (1.416), bodily pain (0.987), general health (1.352), social functioning (1.010), general health (1.122), emotional role limitation (0.656), and vitality (1.361). Conclusion: The implementation of FCEM had a significant effect on the 8-dimensions of QOL based on the SF-36 questionnaire. The implementation of FCEM is recommended in order to improve the QOL of adult patients with chronic disease.

Abstract Background Community-oriented nursing care is an important model of nursing care. Counseling and Nursing Care Service Centers (CNCSCs) have been providing these private services to the Iranian community for nearly two decades. Resource management, cost-benefit analysis and affordability are important steps in providing these services. The present study was conducted to explore the challenges of financial transactions between CNCSCs and their clients. Methods This study has a qualitative design and was conducted on a total of 30 participants, consisting of CNCSC managers, staff, physicians and clients who were selected through purposive theoretical sampling. Data were collected through in-depth interviews and direct observations and were analyzed using conventional qualitative content analysis. Results The analysis of the data led to the extraction of three main categories, including the flaunted atmosphere due to direct financial transaction, instability in determining tariffs for nursing services and the use of strategies for cost-effective services and client satisfaction. Conclusion To increase affordability and satisfaction and expand private community-based nursing. Services, appropriate financial policies should be designed and applied that can lead to transparent and simple financial transactions with the clients by way of indirect monetary exchanges. These policies should be designed in a systematic manner with integrity, facilitate inter-sectorial cooperation in the health sector and be cost-effective for the clients, insurance companies and the health system.

Background: Clinical judgment of nurses to conduct medication orders is based on patient assessment, medication knowledge, observation, and interpretation of the data collected. This process is influenced by many factors. Objective: This study aims to explore nurses’ experience about facilitating factors in medication administration based on clinical judgment of nurses. Methods: This qualitative study was part of an approved project research of the Iranian National Institute of Health Research, which was conducted in Kurdistan University of Medical Sciences in 2015. Based on purposive sampling of 18 participants, 26 open and semistructured interviews were conducted. Based on conventional content analysis method and using MAXQDA2010, coding and categorizing the data were applied. During the analysis, data collection continued until saturation. Results: Analysis of the data led to the emergence of five themes, including the implementation of evidence- based medication orders, situational-based medication orders, medication orders in critical condition, educational interventions in medication orders, and supporting the nurses as facilitator of the implementation of medicinal orders based on clinical judgment of nurses. Conclusion: In response to constraints such as the routines, clinical crisis and lack of evidence in medicinal orders, nurses used following ways to fix these barriers and facilitators. Combining evidence such as clinical guidelines, physician’s views based on patients, and clinical conditions proved the best facilitator. It is recommended that, using these results, a perfect background for the proper administration of medication orders by nurses should be provided.

Objective (s): Cardiovascular diseases are the main cause of death in developed and developing countries. The aim of this study was to investigate the effect of a family-centered empowerment model (FCEM) on quality of life in elderly patients with angina. Methods: This was a randomized trial on a convenient sample of patients 60 years and older with angina hospitalized in cardiology clinics of a teaching hospital in Qazvin, Iran. Patients were randomized to receive intervention or the usual care. The intervention group received a four dimensions program (perceived threat with group discussion method, self-efficacy with problem solving methods, self-esteem with educational partnership and outcome and process evaluations). To collect data we used an specific FCEM instrument, and the Seattle Angina Questionnaire. Results: Following the implementation of the program the intervention in group showed better quality of life in all dimensions compared to their own baseline score and the control group (p

Introduction: Despite the importance of perceived barriers against self-care in diabetic patients, the role of this factor is rarely addressed in the improvement of self-care behaviors of Iranian patients. The lack of appropriate instruments that fit demographic properties of Iranian society is one reason. The aim of this study was to develop and validate the scale of perceived barriers to self-care in patients with type 2 diabetes mellitus. Methods: This cross-sectional study conducted on 400 patients with type 2 diabetes who were covered by the health centers in Isfahan (Iran) in 2015. A 22-item, researcher-made instrument was designed; the face and content validities of the instrument were examined through obtaining the opinions of an expert panel before administering the instrument in the study. Also, the exploratory factor analysis was used to investigate the instrument's validity. Cronbach's alpha was employed to measure its internal consistency (reliability). To examine the validity of the final scale, the mean scores of perceived barriers in patients with appropriate and inappropriate self-care behaviors were compared. Results: The research sample was comprised of 240 women (60%) and 160 men (40%). The mean value of the content validity index was 0.84. The results of factor analysis confirmed the validity of the 11 items and 3 factors of the developed scale. The factor loading ranged from 0.46 to 0.78. These three factors together explained 40.28% of the total variance. The overall reliability coefficient of the instrument was 0.79, ranging from 0.82 to 0.93 for three factors. Conclusion: According to the results, the developed scale was a valid and reliable instrument for examining the barriers perceived by the patients. The findings of this research can help health policy makers in planning to facilitate the self-care behaviors as the most vital factor in diabetes control.

Background and aim: Breast cancer and chemotherapy are with complications that they can lead to reduce quality of life. One of the important tasks of oncology nurses is prevention, control of complications of cancer and its treatment. The aim of this study was to investigate challenges nursing role on improving quality of life in women with breast cancer undergoing chemotherapy. Methods: This study was a cross sectional descriptive-analytic research that was done in 2013 in two educational hospitals in Shahrekord and Isfahan. Samplings were collected from 45 nurses by purposive sampling. Data were collected by demographic questionnaires and nursing role questionnaires on improving the quality of life in women with breast cancer undergoing chemotherapy. Results:High and hard procedures such as venipuncture, nursing staff shortage, low importance by managers to assess and improve the quality of life, and lack of quality of life assessment form in ward, respectively are the main obstacles. In other words, the most problems are in the field of execution- management (%42), individual-nurse (%21), individual-patient (%14), education (%13), and equipment-environment (%10), respectively. Then, strategies for holding training courses for managers, and providing quality of life assessment form to consider the evaluation of nursing education with higher points were obtained. Finally, strategy of “Empowerment of nurse managers " was suggested as the best way to cover all strategies. Conclusion: Most problems were reported in the executive management field. Therefore, it is suggested that managers try to facilitate field of research and plan for the implementation of the "Empowerment of nurse managers" for improving quality of life in women with breast cancer undergoing chemotherapy.

Introduction: Iron deficiency is one of the most common nutritional disorders worldwide. Regarding that fact, the aim of this study was to study the effectiveness of education-based intervention using small group discussions in empowering adolescent girls to prevent Iron deficiency anemia. Materials and Methods:The present semi-experimental practical research was performed by choosing 60 female high-schoolers through random cluster sampling (n=30 test group and n=30 control group). The research tools included one questionnaire of demographic information & an assessment questionnaire for subjects’ empowerment in preventing iron deficiency anemia. After collecting pre-test data, the educational intervention was implemented for adolescent girls in the test group & the post-test was carried out one week after the intervention ended. The data were analyzed using SPSS software and applying appropriate statistical tests. Results: At baseline, independent T-test showed no significant difference between the two groups in the perceived susceptibility, perceived severity, and self efficacy, all of which could be regarded as empowerment process components (P>0.05). However, significant differences were observed after intervention. Also, the paired T-test showed a significant difference before and after the intervention in the test group in means of the perceived susceptibility, perceived severity, self efficacy and, in the grand scheme, adolescent girls' empowerment (P

Background & Aim: Nurses’ clinical judgment is an evolving complex concept. In order to understand the concept, clarification is needed. This study aimed to conduct the concept analysis of clinical judgment in nursing . Methods & Materials: Based on the Rodgers’s evolutionary method, evolving concept of clinical judgment in nursing was analyzed. Literature was retrieved from scientific databases during 1980 to 2013. Based on the inclusion criteria, 42 articles, three books and one dissertation were analyzed using thematic analysis method . Results: The results showed that clinical judgment in nursing was a complicated process with attributes including intention, observation, data collection and information process, interpretation, prioritization and inference. Antecedents included knowledge, experience, evidences, clinical reasoning, intuition, critical thinking and consequences included nursing diagnosis and clinical decision making . Conclusion: Clinical judgment in nursing is a critical thinking process, situational based and beyond observation and assessment. This concept analysis could distinct the transposition concept of clinical judgment and other related concepts. The results of this study would help to develop theories and clinical judgment measurement instruments in practice, research and educational settings .

BACKGROUND: A varying background in situations of chronic diseases affects the selection of strategies in clinical judgments. This study explained the strategies used to enhance the clinical judgment in chronic diseases situations. METHODS: This article was the part of a grounded theory study. Obtained data from open and semi-structured interviews were analyzed simultaneously with data collection and according to the Corbin and Strauss approach. The first experienced nurse was selected with purposive sampling and 25 other participants were selected on the basis of the theoretical sampling from different wards of the clinical and educational care centers of Sanandaj, Iran from 2011 to 2013. RESULTS: As shown in results, the core variable “situation-based efforts for enhancing clinical judgment” represented the main process used by participants in the promotion of clinical judgment in situations of chronic disease. The main categories included a "comprehensive collaboration", "inclusive education", "matching of clinical judgment skills", "maintaining patient's and nurses' autonomy" in a clinical judgment. CONCLUSION: Participants were trying to use strategies appropriate to different situations for clinical judgment in terms of chronic diseases conditions. Applying these processes with regard to the present context, can enhance the clinical judgment in chronic diseases situations.

Background and objective: Coronary Bypass Graft Surgery (CBG) is one of the therapeutic approaches having the leading effects on the function of the patients. Because of paramount importance of self-efficacy and self-esteem, we aimed to evaluate the effectiveness of family-centered empowerment on the self- efficacy and self-esteem of the patients undergoing coronary bypass surgery. Material and Methods: This case control clinical trial was conducted on 102 patients with elective heart surgery and 102 of their active family members in 2011.‌ The patients were selected via convenience sampling and randomly assign ed to experimental and control group. After measuring the self-efficacy and self-esteem, family-centered empowerment care, including individual training, group discussion, film and active participation,‌ was performed in experimental and just routine care in control group. Using PASW statistics-18, we analyzed the data. Results: The results showed that the two groups were the same considering population variables and the mean scores of self-efficacy and self-esteem. The level of self-efficacy and self-esteem in case group were significantly higher than those of controls (P

Background and Objectives: Thalassemia is a chronic disease that affects the quality of life. Health care providers, especially nurses, have an effective role in enhancing the quality of life. This study aimed to investigate challenges nurses encounter in promoting the quality of life in children suffering from Thalassemia. Material and Methods: The descriptive study recruited nurses from four Thalassemia wards in Guilan using purposeful sampling method in 2007. Data were gathered using a questionnaire. The validity of the questionnaire was approved through content validity. The reliability of the questionnaire was measured using the Cronbach alpha ( =80%). Results: According to the results of the study, 11 major barriers were identified to promoting the quality of life in children suffering from Thalassemia. Nurses attributed the most important barriers to the individual–motivational problems. Conclusion: This study identified 11 major barriers. Prioritizing the barriers and meeting them should help the planners to provide solutions to the nurseschr('39') problems in promoting the quality of life of the children. The "empowering managerschr('39') program" is recommended as an effective program for promoting quality of life in children suffering from Thalassemia.

Introduction: Information about the nature of disease decreases the anxiety and unusual ‎behaviors of parents specially mothers, and reduces their problems in recurrence of disease, ‎which occurs in at least ‎‏30%‏‎ of cases. Parents want correct information about the status of ‎their hospitalized child and also want to be involved in their child s care and expect health ‎care providers to let them know about the expected changes that may occur in children s ‎physical condition. ‎ Objective: The present study aims to determine the effect of family centered care on meeting ‎parental information needs of hospitalized children. ‎ Methods: In this quasi experimental study, ‎‏76‏‎ mothers of hospitalized children admitted to ‎emergency ward of ‎‏17‏Shahrivar educational hospitals in Rasht were chosen by sequential ‎sampling and divided into two groups of experimental and control group. Informed consent ‎forms were given to selected mothers and after their agreement, family centered care was ‎performed for experimental group based on developed protocol with participation of mothers. ‎The control group received routine cares. ‎ Results: Research findings showed that the level of meeting parental needs for information ‎was ‎‏%21.1‏‎ in control group and % ‎‏81.6‏‎ in experimental group. The t-test (p< ‎‏0‏‎.‎‏0001‏‎ t=‎‏6.922‏‎ ‎df=‎‏74‏‎) showed significant difference between the two groups. ‎ Conclusion: According to the study results family centered care was effective on the level of ‎meeting parents need for information and also lead to its increase.‎

Introduction: Community health nursing education in filed is one of the main courses of Iranian nursing education curriculum however, little scientific attention has been paid to the evaluation of community health nursing process so far. Therefore, the present study was conducted to explore nursing students' comprehension of community health nursing in field education. Methods: A qualitative study was employed using content analysis approach with 19 bachelor degree nursing students. Data were gathered through unstructured interview technique. Results: The data analysis resulted in emerging 2 main categories as ‘suitable learning aspects for students’and ‘learning inhibitor aspects’. The participants mentioned the education in filed with its specific conditions as a way to personality development, employing theory in practice, in-depth learning, learning from various human resources, and achieving skill to teach patients. Inhibitor aspects were related to ineffective clinical instructors, inefficiency of management of training, and theory-practice gap. Conclusion: Clinical education of nursing students should cover active learning and personal/professional growth.It also should be compatible with community requirements. The study participants pointed out to factors which nursing education policy makers and nursing faculties should pay attention to in order to improve the quality of training community health nursing in filed.

Introduction: There is a need for revising our nursing educational curriculum regarding emergencies and crisis management. This study aimed to explore students and instructors' experiences and perspectives about emergency and crisis management in nursing. Methods: In this qualitative study by using a content analysis approach four faculty members,and seven senior and junior undergraduate nursing students were selected through purposeful sampling method. Semi-structured interviews were held to gather data. All interviews were transcribed andanalysed manually. Results: The analysis of the transcripts showed four main themes including management and coordination, management and planning of theoretical instruction, management and planning of clinical instruction, students' knowlegeability. One final theme as management Was recognised. Conclusion: The compromising factors in the process of emergency nursing education are related to ineffective management and lack of continuous evaluation of the final product of the process. Evaluating the educational process and conducting studies in order to employ their results in practice will be precious in empowering students and promoting their capabilities.

Background and Aim: Education as a continuous and dynamic process can be analyzed through educational pathology to identify problems and barriers and to plan applicable strategies. The aim of this study was to determine factors influencing Health Assessment Course in Bachelor of Science nursing program. Material and Method: This is a qualitative study with thematic analysis method in which face-to-face semi-structured interviews and focus group was used to collect data from a purposeful sample of 17 participants, 14 nursing students and 3 nursing instructors in Baghiatallah nursing faculty. Content analysis was used to analyze data. Results: Data showed that barriers in Health Assessment Course presentation were in educational planning, environmental equipments of nursing school and hospital, nursing instructor and evaluation methods. Conclusion: Regarding the barriers, we should focus on nurses' roles in real situations to make this course applicable. Also, reinforcing present educational system and continuing education of instructors and clinical nurses would minimize problems.

Teaching ethics to nurses leads to their involvement in providing high quality care, enable them to duly encounter ethical issues. One of the key elements of educational systems is nursing instructors. Even though lots of studies show the role of instructors in students' learning, their role in promotion of professional ethics has been attended to less.The objective of this study is surveying the experience of nursing students with respect to the role of instructors in promotion of professional ethics.This qualitative study enrolled 15 undergraduate nursing students from three nursing schools in Teheran whom depth interview was performed. The interview was semi-structured with open ended questions. The analysis was accomplished by use of qualitative content-analysis method.Data analysis demonstrated 2 main themes and 7 subcategories in regard to the role of instructors in promotion of professional ethics in nursing students including: 1) the effective professional role model 2) facilitating creative learning. The effective professional role model encompasses individual characteristics and beliefs, clinical skills and professional commitment of role model. Creative learning facilitates by encouraging critical thinking and decision-making, Providing supportive learning conditions, providing proper space for sharing knowledge followed by evaluation and creative feedback.The findings of this study provides a background for strengthening the role of instructors in promotion of professional ethics with more emphasis on research which increase capability of instructors at nursing education centers.

Background and Aim: Coronary artery diseases are the most common cardiovascular diseases and considered as the main cause of mortality in the world and in Iran. A set of risk factors interfere to make these diseases. The aim of this study was to evaluate risk factors of coronary artery diseases in patients with myocardial infraction. Material and Method: This case-control study was conducted on 60 patients with myocardial infarction admitted in cardiac care unit of Fatemieh hospital (as case group) and other 60 patients admitted in ENT and eye ward of Amiralmomenin hospital (as control group) in Semnan, Iran. The data collection tool was checklist, and the patients were evaluated regarding four main modifiable risk factors of coronary artery diseases as smoking, hypertension, diabetes, and hypercholesterolemia. Results: The findings showed that 71.7% of the patients with myocardial infarction were male, the mean age of patients with myocardial infarction was 62.9 years, and the most common risk factors were smoking and hypertension, diabetes, and hypercholesterolemia, respectively. There was a statistically significant difference between two groups relative to the prevalence of the risk factors as smoking, hypertension, and hypercholesterolemia, but the difference was not statistically significant for diabetes. Odd's ratio relative to smoking, hypertension, hypercholesterolemia and diabetes were 2.95, 2.25, 2.78, and 2, respectively. Odd's ratio relative to smoking, hypertension, and hypercholesterolemia were significant, but it was not significant relative to diabetes. Conclusion: The results indicated that smoking, hypertension, and hypercholesterolemia are the most common risk factors in patient with myocardial infarction. Smoking with the highest Odd's ratio is the most important risk factor. Because these risk factors are modifiable, therefore, knowing them and taking actions to modify them are very important in reducing the risk of myocardial infarction and related mortality.

Background and Aim: Sleep and rest are major needs of human which are included in physiologic needs category of Maslow's hierarchy of needs. Since nurses work on morning, evening and night shifts irregularly, they are exposed to sleep problems. The purpose of this study was to investigate the quality of sleep and related factors among staff nurses working in Imam Khomeni hospital affiliated to Tehran University of Medical Sciences and Health Services. Material and Method: This study had a descriptive – analytical design in which staff nurses working at Imam Khomeini Hospital lacated in Tehran were studied. The samples consisted of 120 nurses selected by simple random sampling. The instrument for data collection was the Demographic Information Questionnaire and Pittsburgh Sleep Quality Index. Results: The results showed that %62.5 of nurses had low sleep quality %33.5, low sleep quality and only %4.2 had good sleep quality. When examining relationship between sleep quality and the pattern of working shifts, statistical Chi-square test showed a statistically significant relationship (P

Introduction: Most studies concerning clinical education of nursing students have been performed qualita-tively. This study was performed to more deeply investigate the students’ education at nursing clerkship and explore the experiences of nursing students, instructors, and hospital administrators from the clinical educa-tion of nursing students. Methods: In a qualitative study a semi-structured interview was done with 8 nursing students at the end of clerkship, four nurses working as ward administrators, an education supervisor, and two supervising instructors. Qualitative content analysis was employed for analyzing the data. Results: Six central variables were realized (emerged) including lack of readiness for entering into clinical learning environment, undesirability of student assessment process, lack of advantageous relationship between the nursing school and the hospital, ideal planning for clerkship shifts, deficiency in clinical educa-tion, and the effects of clerkship on hospital and patients' affairs. Conclusion: According to the findings of the study, it is necessary for the nursing administrators to place more effort to resolve the present problems specially the relationship between the nursing school and the hospital, and to renovate hospital into a favorable learning space to meet educational goals of nursing clerkship

Payesh2009; 8: 407-413Accepted for publication: 14 April 2009[EPub a head of print-28 September 2009] Objective(s): This study was designed to investigate the relationship between planned physical activities and quality of life in women reside in the west of Tehran, Iran.Methods: The Short Form Health Survey (SF-36) was applied to measure quality of life and demographic and other related information were additionally collected. Three parks from western areas in Tehran were randomly selected. A group of volunteer women aged 35-55 years were randomly selected by the researcher in parks and divided into active and non-active groups (walking & not walking). Using SPSS 15, Mann-Whitney and Kruskal-Wallis statistical tests were performed to analyze data.Results: In all 148 women were studied and the mean age of women in active and non-active groups were 42.1 (SD=5.7) and 41.7 (SD=5.6) respectively. The results of Mann-Whitney test showed that women in the active group had higher mean scores in all quality of life scales and except two (physical functioning and role-emotional), there were statistical significant differences (P

Introduction: The situations affecting teaching and learning nursing fundamental course may influence acquiring competencies in primary clinical skills. Several reasons have been mentioned for this problem. The aim of this study was to describe the experiences and viewpoints of nursing students and instructors on nursing fundamental course. Methods: This was a qualitative study using thematic analysis method. Fifteen nursing students, 4 nursing instructors, the head nurse of operating ward, and two nurses graduated from the university in which the study was performed, were selected through purposive sampling and interviewed. All interviews were transcribed, analyzed. Results: Using thematic analysis, a significant number of preliminary themes and 7 main themes each having few other sub-themes, were extracted. The main themes included educational factors, not respecting the standards in performing the techniques, the gap between theory and practice, motivation, human resources, communications, management staff, equipments, and physical environment. These main themes and other sub themes have been explained in the main article using direct statements of study samples. Conclusion: The results of this study revealed problems in communication in educational environment and interaction between instructor and students as well as lack of motivation among nursing instructors and students. These are the main principles of the appropriate teaching and learning. It is recommended that nursing education administrators pay more attention to these aspects of educational process and remove the causing factors.

Background: Obesity in children and adolescents is a significant health problem that requires comprehensive prevention and intervention efforts. The present study was carried out to assess the effect of implementation of health promotion program in school on control of risk factor for obesity in obese adolescents and those at risk of obesity. Methods: This quasi-experimental study was carried out involving two groups (case and control) in 1385 in Tehran. Two boys’ secondary schools were selected randomly from secondary schools of 6th region of Education Ministry in Tehran. Body weight and height of the students were measured and body mass indexes (BMI) were calculated. They were divided into two case and control groups, each containing 35 students. The case group consisted overweight and at risk for overweight students (Overweight and at risk for overweight were defined as ≥ 85th and ≥ 95th percentile of age-sex-specific CDC 2000 BMI values, respectively). The tools for data collection included electronic scale, stadiometer, demographic questionnaires of adolescents and parents, Food Frequency Questionnaire (FFQ), nutritional knowledge and a questionnaire for recording physical activity and watching TV in one week. They were distributed to be filled out by students before and one month after the intervention. The interventional program was done in four months included separate educational sessions for teachers, parents and adolescents and changes in school environment. Results: There was no significant differences between the adolescents’ mean Body Mass Index (BMI) in two group after intervention (P>0.05). There was a significant difference between mean nutritional knowledge score in the case group before and after the intervention (P=0.0015). We found significant differences between the mean of intake of dairy products, salty snack, sweets, carbonated beverages and fast food in the case group after and before the intervention (P=0.001, P=0.006, P=0.034, P=0.001 respectively), but there was no significant difference between the intake mean of these food products in the control group after and before the intervention (P>0.05). There were significant differences between the mean time of vigorous physical activity in one week and TV watching in the case group after and before the intervention (P=0.04, P=0.001 respectively) whereas there is no significant differences between mean time of these activities in control group (P>0.05). Conclusion: This research showed that although there were no significant differences between the students’ mean BMI between the two groups after intervention but implementation of this program to control risk factors for obesity regarding dietary pattern and physical activity was successful. Therefore, it is recommended to investigate the effectiveness of such interventions over time in further studies.

(Received 15 August, 2009 ; Accepted 7 October, 2009)AbstractBackground and purpose: Leptospirosis is an infrequent zoometric bacterial disease which is caused by pathogenic bacteria called Leptospira. The risk factors of the disease include living in tropical and rural areas, contact with contaminated water, living near sewers and sanitation work. The disease may cause symptoms such as chills and fever, severe headache and myalgia. Costal region of Caspian Lake has desirable conditions for occurrence of this disease. The aim of this research is to study this disease in the North of Iran, by using and analyzing a 6-year set of recorded cases in Mazandaran province between 2003 and 2008, that provides more completed information.Materials and methods: This study is a descriptive, retrospective (case series) study. All of the recorded information concerning to patients with leptospirosis in Mazandaran Health centre from 2003 to 2008 were collected and checklist forms were completed, followed by data related to three characteristics including patients, living conditions and then the disease was analyzed.Results: Of the 102 patients, 76.5% were males, 46.6% were farmers and the mean age was 48.8 + 15.5. The prevalence of the disease was at the highest in 2007 and in summer seasons. The most common symptoms were fever (74.5%), myalgia (68.6%) and icter (47.1%). The greatest number of the cases was from Ghaemshahr city (37.3%), the majority of the cases (88.2%) had history of working farm. Over-all, 97.1% of the patients were cured.Conclusion: According to the findings, leptospirsis affects farmers in their working season in Mazandaran province. It is necessary to provide information to the medical practitioners, especially general practitioners and also, to develop diagnostic and therapeutic facilities in the province.Key words: J Mazand Univ Med Sci 2009; 19(72): 72-75 (Persian).

Background: One potential coping strategy frequently offered by university counseling services is time management for studying. Besides stress relief, time management skills will positively influence key outcomes such as academic performance, problem-solving ability, and health. Thus, it is necessary to investigate how college students manage their timing for studying. The aim of the present study was to assess the pattern of college students' time management in Kerman University of Medical Sciences. Methods: This cross-sectional study was conducted on 300 students who were selected by stratified random sampling method among students of Kerman University of Medical Sciences. Information about how students managed their study time during their educational course was collected using a questionnaire which consisted time management stages such as planning, prioritizing, time allocation, listing all study-related tasks and goal setting. Study time management was measured according to Likert scale in range of “never” to “always”. Results: There was a significant difference between the course of study and the mean of study duration (p

The purpose of the present study was to explore nurses' perception about spirituality and spiritual care. A qualitative content analysis approach was conducted on 20 registered nurses interviewed using unstructured strategy in 2009. Three themes emerged from the data analysis: 1) "meaning and purpose of work and life" including ‘spiritualistic view to profession', ‘commitment and professional responsibility', and ‘positive attitude'; 2) "religious attitude" including ‘God approval', ‘spiritual reward', ‘taking advice', ‘inner belief in the Supreme Being', ‘faith-based interactions and altruism'; 3) "transcendence-seeking" including ‘need for respect' and ‘personal-professional transcendence'. Therefore, the spirituality produces maintenance, harmony and balance in nurses in relation to God. Spiritual care focuses on respecting patients, friendly and sympathetic interactions, sharing in rituals and strengthening patients and nurses' inner energy. This type of spirituality gives a positive perspective to life and profession, peaceful interactions, a harmonious state of mind, and acts as a motivator among nurses to promote nursing care and spirituality.