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Introduction: The need and use of long-term care services for older people has increased with their rising population and there is little information about the state of serving in nursing homes. This study aimed to identify the caring process in Iranian nursing homes. Methods: This qualitative study was conducted in three Iranian nursing homes using grounded theory approach. The participants included 28 individuals (14 older people and 14 caregivers). The data were collected using unstructured interviews up to data saturation, and analyzed by constant comparative method. Results: Fragmented care emerged as the core variable. The main factor for developing the core variable was ‘experience-based caring’. Other factors included ‘inappropriate structure for care’ as contextual factors in the nursing homes environment and ‘keeping instead of caring’, ‘dismal life’, and ‘up and down of the path’ as strategies and consequences. Conclusions: The most common type of care was the routine and unplanned one with focusing on physical aspects. To improve a delivery care system for older people in nursing homes, proposing a care plan with focus on an integrated model of care in nursing homes, provision of instructions for treatment, as well as supervision and training caregivers to provide better care are necessary

Background: Providing care for patients in Persistent Vegetative State (PVS) by family caregivers without enough training and knowledge may be problematic both for the patients and for the caregivers. Therefore, the present study tries to explain the experiences of family caregivers of patients with PVS of seeking information needed to provide adequate care. Materials and Methods: Twenty two participants, including 17 family caregivers and 5 professional caregivers were enrolled by purposive sampling into this qualitative content analysis study, carried out between 2013 and 2015. Unstructured interviews and field notes were used to gather the data. Data collection was stopped when data saturation was achieved. Data analysis was performed by content analysis based on Graneheim and Lundman's approach. Results: As a result of the analysis of the collected data a main theme emerged labeled as “Seeking constructive education” with three categories including “Neglected requisite education,” “Greedy search for useful education” and “Dynamic independence in care.” Conclusions: In this study, information seeking by family caregivers of patients with PVS was constructive. Family caregivers insistently sought needed information from various sources. Ultimately, they found these insistent efforts beneficial and fruitful, because their efforts made them independent in providing care for their patients.

Introduction: The care of patients in vegetative state at home is difficult because they need continuous medical interventions and extensive care. The present study aims to explain the process of home care of patients in vegetative state at home. Methods: This study was a qualitative research with a grounded theory approach. The participants were 22 people (included 17 family caregivers and 5 professional caregivers) who were enrolled in a purposive sampling. Data was gathered through unstructured interviews, observations and field notes. Data collection was continued to saturation. Data analysis was performed through the Strauss and Corbin 1998 approach. The MAXQDA10 software was used to facilitate data analysis. Results: The data analysis led to emerge four main concepts included "erosive care", "erosive expenditures", "seeking solver education" and "lasting hope" as the axes of the study. Participants' experiences showed that the main concern of family caregivers of vegetative patients was "playing an inevitable role in care", in which they did not hesitate to make any effort, and they tolerated all the problems and issues. Therefore, "resilient care" was extracted as the underlying idea of this study. Conclusion: The process of resilient care of vegetative patients at home showed planning by policy makers in health system is very important and underscored the necessity for supporting families and family caregivers of these patients. So some changes in the health system for this goal might include considering home care and supporting them in various aspects, especially information, financial and emotional dimensions.

Background: To respond to the growing and emerging needs of the people in the health sector, the nurses need to develop their working domain from the hospitals to the community and be prepared to provide entrepreneurial roles at different care levels. Thus, to discover how to identify entrepreneurial opportunities in the field of nursing entrepreneurship, a study was conducted with the aim of describing the experiences of Iranian entrepreneurs on the identification of proper opportunities in entrepreneurship. Materials and Methods: This study was a qualitative research in which the Graneheim and Lundman's content analysis was used to collect and analyze the data. Thirteen entrepreneurial nurses were purposefully selected, and the data were collected by unstructured interviews. Results: As a result of data analysis, three main themes were obtained including the resources for opportunity identification and opportunity assessment and identification of proper opportunities. Conclusion: The findings indicate how to identify entrepreneurial opportunities in the field of health by entrepreneurial nurses which is the first step in the entrepreneurial process. Therefore, the findings of this study can be used to educate nurses who are interested in entering the field of nursing entrepreneurship.

Background and objective: The overall objective of this study is "to determine Maturity level of health literacy on Care skin and hair in girls 16-14 years old, first high school Eghlid city. Health literacy can be defined as the ability to read, understand and act upon the recommendations of health. Methods: This study is quantitative - descriptive that occurs on 186 girls and Stratified random sampling was performed. In order to access information from a two-part questionnaire (A - health literacy, reading comprehension, b – performance and computing) related to health of skin and hair, the validity, and reliability of the questionnaire using Cronbach alpha and ending coefficient (r=0.81) and analysis the data by SPSS software (V.18). Results: Mean age, weight, height, body mass index standard deviation of students participating in the study, was respectively (15.31±0.63, 51.60± 9.15), (162.21± 7.48), (19.59± 3.11). Also the age of onset of sexual hair growth 12.09 years indicated. Level of health literacy and reading understanding of dermatological was adequate and health literacy in the calculation of the skin and the hair was border line. Between reading comprehension and performance measures correlated significantly with skin and hair (P=0.05). Conclusion: The research, health literacy level maturation, hair and skin health in adolescent girls Eghlid city have been evaluated borders. So by increase students' reading comprehension and calculation of their performance in the field of dermatology also increased. Paper Type: Research Article.

Background and objective: Health literacy is a global issue, according world health organization’s statement health literacy is central role in determining the health inequality. The overall aim of this study was to" Maturity level of health literacy in 14-16 year girls in first grade of high school. Methods: This descriptive is a quantitative study on 186 girls (14-16 years old) who attend high school in first grade. Sampling method based and designed on a stratified random sample of Morgan. In the course of the study, in order to achieve the desired data, was used from the 5 questionnaire that verification and face and content validity and for reliability of data analysis used from SPSS software (V.18). Results: Overall, this study related to the general level of health literacy and reading understanding puberty (the borderline), skin and hair, genital health (adequate), health, menstruation (far enough) and functional health literacy calculation of the overview of puberty, the skin and hair, genital health (the borderline) healthy menstruation (far enough) and suggests that health literacy on health promotion programs. Calculation of the overall performance of the students in adulthood, independent of reading comprehension and reading comprehension performance and computation between menstrual health, skin and hair, genital health, a significant correlation (P=

Purpose: This study identifies challenges to the first nurse training program for undergraduate nursing students at a nursing and midwifery school in Iran using a collaborative approach in order to improve the program. Methods: Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. The participants were 148 individuals from nursing academic and clinical settings, including administrators, faculty members, students, and staff nurses. We obtained approval from the research deputy and ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran for this study. Results: Lack of coherence in the educational program and implementation of the program, inadequate communication between management inside and outside the organization, insufficient understanding of situations by students, and improper control of inhibitors and use of facilitators in teaching and in practice were among the major challenges in the first training process in the context of this study. After classification of problems, the educational decision-making authorities of the school developed an operational program with stakeholder cooperation to plan initial reforms, implementation of reforms, reflection about the actions, and evaluation. Comparison of student satisfaction with the collaborative learning process versus the traditional method showed that except for the atmosphere in the clinical learning environment (p>.05), the mean differences for all dimensions were statistically significant. Conclusions: The results confirm the overall success of the revised partnership program, but stressed the need for further modification of some details for its implementation in future rounds.

Introduction: Drug overuse is a serious problem for health care, and one of the biggest problems for the socio- economic well-being of different communities. The elderly tend to use more drugs due to changes in their cognitive and physiological factors. One of the best ways to evaluate the health level of elderly people is to evaluate their self-medication. This study was conducted to investigate self-medication among the elderly in Shahr-e-Kord. Methods: This cross-sectional study was conducted on 350 people older than 65 in Shahr-e-Kord in 2015. Sampling was done in two stages. In the first stage, the city of Shahr-e-Kord was divided into four areas using geographical maps. Eighty-eight people were selected from each area. The research instrument was a questionnaire called the Health Belief Model (HBM). The data were analyzed using SPSS version 20, the chi- squared test, the independent-samples t-test, and the Pearson correlation coefficient. Results: No significant relationship was observed between the prevalence of self-medication with demographic variables and level of awareness. But there was a significant difference between sensitivity, perceived severity, and perceived barriers and educational level. There also was a significant difference between the perceived benefits and their income level. There also was a significant difference between the level of awareness, sensitivity, severity, benefits, and barriers of people with and without a history of self-medication (p < 0.05). Conclusion: Due to the adverse effects of self-medication and the high prevalence of this activity among the elderly, it is recommended that a training program be developed and implemented to change the knowledge and beliefs of the elderly about self-medication

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

Background: Traffic accidents are the main cause of death and disability in the world and Iran. The Injuries caused by traffic accidents may result in severe limitations and worst outcomes in various aspects of lives of traffic accident injured people and their families. Therefore, understanding their experiences is very important to design better programs with regard to their treatment and returning to the society. In this regard, we conducted this study with the aim of understanding and describing the experiences of encountering with physical trauma resulting from traffic accidents. Materials and Methods: This study was conducted with qualitative research approach, using qualitative content analysis method. The study participants had a record of upper and or lower extremity injuries caused by traffic accidents of at least 3 months and at most 2 years after the accident. They were chosen by purposeful sampling method. Data were collected through semi-structured interviews and continued until data saturation. Data analysis was carried out using content analysis method. Results: The study findings based on the experiences of participants were conceptualized in three main categories; experiencing some limitations, disturbances in performing professional duties, and family problems caused by trauma. Conclusion: The study findings showed that injured people due to traffic accidents experience numerous constraints in different areas of their lives. Accordingly, proper interventions can be designed based on understanding these needs and experiences from participants’ own words to alleviate these problems. Finally, the study results provide a new insight to the medical team to understand these patients and their real health problems in a more realistic way.

Introduction: Professional values comprise a significant part of the nursing profession. Learning the concept of these values and creating conditions for developing and completing them are necessary. The aim of this study was to examine the professional and ethical values in providing nursing care from the nurses’ perspective. Methods: This descriptive, cross-sectional study was performed on 150 nurses in Shiraz’s Shahid Chamran Hospital who were selected by convenience sampling in 2015. The data was collected through a two-part questionnaire comprised of the nurses’ demographic information and Shank and Weise’s Nursing Professional Values Scale-Revised (NPVS-R) which measured five aspects (caring, activism, professionalism, trust and justice) in a five-point Likert scale (from unimportant to highly important). The collected data were analyzed using descriptive statistics (mean and standard deviation). Results: Among the components of nursing professional values, the highest mean score was related to “justice” at 3. 91±0. 79 and the lowest mean score was related to “activism” at 3. 31±0. 74. The total mean score of the questionnaire was 3. 72±0. 53. The aspects of the professional values were prioritized from the nurses’ perspective as justice, caring, trust, professionalism and activism respectively. Conclusion: The results show that nurses consider those nursing values important which directly relate to their job. Therefore, understanding the importance of certain aspects of the professional values which are related to the nurses’ indirect tasks requires further support, and it is necessary that all of the aspects of professional and ethical values should be taught during the nursing education.

Background: The epidemic of smoking is a great concern of health systems. Moreover, the number of smokers is increasing worldwide and this has led to an escalating trend of morbidity, mortality, and burden of smoking-related diseases. Therefore, monitoring the implementation of tobacco control laws in different countries is of extreme importance. This study aimed to describe policy makers’ experiences and perceptions of the facilitating factors of the implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) in Iran. Methods: This was a qualitative research in which data were collected through individual interviews. The participants included policy makers who were members of the national assembly for tobacco control. In this study, 13 unstructured interviews of about 45 to 60 minutes duration were conducted in an extrapolative manner. The qualitative content analysis method was applied until extrapolation of basic themes was complete. Results: As a result of the analysis, the themes of performance through training, through research, through intersectoral collaboration, and through setting priorities emerged. The emerged themes connote some critical points that have key roles in promoting the effective implementation of the WHO FCTC. Furthermore, the main role of the health sector becomes predominant. Conclusion: The study findings suggested the managed and coordinated work as one of the main facilitating factors of the implementation of the WHO FCTC at a national level.

Background: To respond efficiently to the increasing and new needs of people in health issues, it is necessary for nurses to develop their knowledge from hospital to society and to be equipped to play entrepreneur role in different levels of care. The present study was conducted to describe Iranian entrepreneur nurses' perceived barriers to entrepreneurship, in order to identify the existing barriers. Materials and Methods: This is a qualitative study in which Graneheim and Lundman's content analysis method was employed. Thirteen entrepreneur nurses were chosen purposively, and data were gathered by unstructured interviews. Results: As a result of the data analysis, five major themes were extracted: Traditional nursing structure, legal limitations, traditional attitudes of governmental managers, unprofessional behaviors of colleagues, and immoral business. Conclusions: The findings of the present study show that Iranian nurses are confronted with various problems and barriers to enter entrepreneur nursing and keep going in this area. By focusing on such barriers and applying appropriate changes, policymakers and planners in health can facilitate nurses entering into this activity.

Background: Reaching geriatric period is one of the greatest successes in human Beings.The older adults are predisposed to risk of many diseases and disabilities, and physical activity is one of the most efficient methods to prevent geriatric period disorders.Therefore, the present study aimed define the effect of an empowerment program on physical activity of the elderly residing in Shahid Rezaian health care center in 2014. Materials and Methods: This quasi-experimental study was conducted on 70 older adults, age 65 years and over, selected through convenient sampling and assigned to groups of study and control. Study group was divided into 5 seven-member subgroups and a one-hour session of physical exercises was administrated for them once a week for eight sequential weeks. All subjects evaluated before and after intervention by International Physical Activity Questionnaire. Subjects′ physical activity was scored, based on the personal activity protocol,and the results were compared. Significance level was considered as P

Background and aims: Having a vegetative patient in the family is a complicated and stressful experience. Caring such patients with complete disability at home is very challenging. The present study aimed at exploring the caring experiences and challenges of the families with patients in the vegetative state. Methods: In this qualitative study that was done from August, 2013 to Sep, 2014 in some provinces of Iran (Khuzestan, Tehran and Lorestan), 17 vegetative patients’ caregivers including 14 family caregivers and 3 professional caregivers were entered to the study. Unstructured interviews and observations were used for gathering data. Data collecting was continued until saturating data and emerging main themes. Data analysis was performed by content analysis method. Results: Caring challenges that families with vegetative patient were faced included in 5 main themes: education greed, undertaking hard caring, corrosive costs, limbo of words and emotional erosion. Conclusions: The finding of present study showed that all the families with vegetative patients during caring period were faced with various challenges. The main part of these challenges is related to policies of health system and some of them were related to knowledge level of the public. So, more attention to these challenges by authorities is recommended.

Introduction: Nursing curriculum is not always overt; it can also exist covertly in the form of a hidden curriculum. This study aims to explain the factors influencing learning through the hidden curriculum in the perspective of undergraduate baccalaureate nursing students. Method: This qualitative study was conducted through purposeful sampling strategy on 24 undergraduate baccalaureate nursing students studying in the first to the fourth years of their education. The data were collected using semistructured interviews and this process continued until data saturation and categories’ emergence. Inductive content analysis was used for data analysis. Results: Professional promotion as a learning factor, impact of personal characteristics on learning, educator’s behavior as a learning stimulus, and feedback as a learning stimulus are the main categories emerged in this study; some of them included sub-categories as well. Conclusion: Professional promotion, personal characteristics, educator’s behavior and feedback were the main influencing factors on learning through the hidden curriculum in undergraduate baccalaureate nursing students. The findings of this study can be used for developing strategies to promote nursing education and as a result patient care. Further studies are recommended to identify other factors.

This study aimed to develop indicators for evaluating the implementation of The Framework Convention on Tobacco Control (FCTC) in Iran. We used the “grounded theory” framework. Totally, 265 policy-makers, stakeholders, and community members were recruited by purposeful sampling in 2008. After analyzing the gathered data, 251 indicators, including 82 indicators as “applied indicators”, were derived from second-level codes for three groups. A suitable evaluation questionnaire can be designed based on the extracted indicators for policy makers, stakeholders, and the community to follow the implementation of the FCTC in Iran.

Introduction: Regarding the social and economic changes and developments, the increasing presence of working women in the present society and their important role in the family, paying more attentions to the importance of maternal role among working women who face multiple roles seems to be necessary. Hence, the process of maternal role among working women has been investigated in this study. Methods: The grounded theory approach is used in this qualitative research. In-depth and unstructured interviews were the main way in collecting the data. Initially, the targeted sampling was started and continued gradually to the data saturation, in the form of theoretical sampling based on the obtained classes. The data was analyzed using Strauss and Corbin analysis. Accuracy and validity by four criteria in this study included: Credibility, dependability, Confirmable potential, Transferability or Fittingness. Results: Data analysis led to the identification of the core variable of role conflict. The main classes of occupied mothers′ experiences included: different pregnancy experience, returning concerns, supportive umbrella, role assignation, role overlap, role strain, gradual acceptance, satisfaction and erosion. Conclusions: The acceptance of numerous roles such as maternal and marital roles by working women creates various role expectations of them from their children, spouses, family and the society which in turn forces them to meet both family and job requirements and expectations; This causes role conflict in working mothers and endure a lot of pressure and stress, that can influences of mental and physical health of the mothers.

Introduction: Several studies have recommended revisions in educational programs based on learners' feedbacks and needs. This study was performed with the aim of exploring and describing the meaning of challenges and feelings experienced by nursing students during their study. Methods: This qualitative study was performed as phenomenology on 20 senior nursing students selected by purposeful sampling method. In-depth and semi-structured interviews were used for data gathering. Data was analyzed by the team of researchers using hermeneutic analysis method. Results: Findings were categorized into three major themes including challenge of "integrating knowledge and practice" with minor themes of employing theory in practice, using nursing procedure, and following scientific principles in clinic, the challenge of "management of learning environment" with the minor themes of environmental factors' effect on students' learning, causes of hopelessness and disappointment with nurses, preference in evaluation, deficiencies of educational programming, and lack of respecting patients' rights and privileges, and the challenge of "lack of community's respect to the value of nursing" with the minor themes including recognizing stَAuts of nursing discipline, and the necessity for its revision, attitude of individuals and society toward nursing and limited independence of nursing. Conclusion: Interviewing students provided an insight into the challenges of educational environment which students had faced, during their study. Using the results of this study, nursing educators could build a positive and stimulating environment for students' learning and motivate them to maintain their interest in education and learning.

Background: Studies have shown that methadone maintenance treatment (MMT) is effective in improving the client’s quality of life and physical health. This study aimed to describe the nature and structure of drug dependents' experiences and the physical effects of MMT Methods: The present study is a qualitative and a phenomenology study on 32 clients referred to methadone clinics in the city of Kerman in 2008. Colaizzi’s method was used for data analysis and to evaluate the data, validity and reliability criteria were used. Findings: Encoded concepts were categorized in general groups of effectiveness on general health, sleep, appetite and weight, sexual desire, appearance and other effects. These six categories showed the main structure of experience and physical effects of MMT. Conclusion: The clients' viewpoints towards this treatment had a role in their experience expression and feelings, but MMT had an overall positive physical effect on the clients Keywords: Methadone maintenance treatment, Physical effects.

Introduction: The Framework Convention Tobacco control (FCTC) is designed by World Health Organization (WHO), in response to the globalization of the tobacco epidemic, in 2003. All treaty signatories including Iran adopted to perform it during 3 years. This study was performed to design a model for evaluation of the implementation of this treaty in Iran. Methods: This study was a qualitative study which was held in 2008. We have interviewed with 265 policy makers, stakeholders and community members. After extracting first and second level codes and changing them to the third level codes, main concepts obtained. Results: Totally 72 third level codes collected. The main concepts classified in 12 total groups as well. Then by considering these groups the evaluation model was designed. Conclusion: Regarding the obtained concepts and model, in Iran, treaty evaluation should perform in various levels and considering all the objectives. Keywords: Evaluation; Models; Theoretical; Smoking.

Abstract Backgrounds: To assess patients' satisfaction and to evaluate methadone therapy program, it is important to understand the experiences of opium dependents during the treatment period in methadone centers and determine the quality of this program and revise standards based on that. This study aimed to describe the nature and structure of patients' experiences during treatment in methadone centers. Methods: This was a qualitative method using phenomenology. Sampling was purposive and the participants were selected from opium dependents referred to Kerman methadone centers during 2007. Sampling continued until data saturation and the sample size was 32. Colaizzi's method was applied for data analysis. Findings: The findings of this study included 27 codes categorized in four main groups: experiences of structure, personnel, patients, and regulations. These four categories showed the main structure of experiences in methadone centers. Conclusion: Lack of treatment centers in near-by cities or the problems of those centers suggest that it is necessary to establish new centers or solve the problems of centers in near-by cities. The type of patients referring to the centers plays a role in treatment process. The regular presence of physicians and other personnel and their concerns and care for patients as well as longer working hours of the centers have roles in patients' satisfaction and increase of consistency with treatment. Discussing the rules and regulations of the center with patients including the obligatory of daily reference to the center to obtain medicine and injections sound necessary. Also, it is necessary to find ways for solving problems of urine tests. Keywords:Experiences, Methadone, Performance, Qualitative study.

Abstract Background: Methadone maintenance therapy is a treatment of choice for opiate addiction. Understanding opiate dependents’ experiences of patients' treatment is a key to continue the treatment and can provide help to revise the standards of methadone centers and improve the quality of treatment. This study aimed to describe the essence and structure of opiate dependents’ experiences with methadone maintenance therapy. Methods: It was a qualitative phenomenological study, in which participants were selected from opiate dependents referred to methadone centers in Kerman city in 2007. Sampling was purposive and continued until data saturation, which was achieved at 32 participants. Data were collected by in-depth interviews. Colaizzi's method was applied for data analysis. The rigor of the present study was assessed based on the criteria of confirmability and credibility. Findings: A total of 26 themes were extracted and categorized into three main themes including positive therapeutic alliance, negative therapeutic alliance and therapeutic alliance requests. Conclusion: Client–centered therapy in methadone clinics creates a positive therapeutic alliance, and persuades patients to continue their treatment. Establishing a good relationship with patients during their treatment procedure is an effective way to meet the goals. Individual and group counseling sessions and advices on family and career related issues during the treatment should be considered as well. Keywords: Methadone, Experiences, Professional Patient Relationships, Qualitative research, Opiate dependence

Introduction: Evaluation of interventional community-based initiatives is a basic issue for improvement and management of programs toward the goals of the health system. This paper presents the qualitative part of the process evaluation (PE) of a community-based educational program entitled Isfahan Healthy Heart Program (IHHP) conducted for prevention and control of non-communicable diseases. PE of IHHP aimed to shed insight about implementing interventions; guiding program management and corrective decision makings have been done respectively. Methods: In this qualitative survey, the study population consisted of policy-makers, managers, principal practitioners and their coworkers as well as stakeholders of IHHP. The study was directed in the same place as practicing interventional projects located in Isfahan province. It was begun in 2005 and data analysis phase was completed in 2008. The data were collected through conducting interview with a purposive sample of 60 participants and were analyzed using qualitative content analysis method. Results: Qualitative data were categorized in several headings. Four of the most important headings were as experiences of resources, attitude towards interventions, motivating factors and consistent partnership. Conclusion: Emphasizing on usefulness of qualitative data in process evaluation of IHHP, findings of the present study disclosed some of the effective underpinning factors that the most important of them was described as “executive level human factors”. The study findings emphasized on the vital role of the resources, nevertheless “accepting” the used resources as well interventions specifically on behalf of managers and executive agents were primarily affected by their humanistic qualities such as attitude and willingness to moving towards aimed change. Accepting the program in behalf of users, specifically executive agents, must be considered in such a vast community-based educational program. Keywords: Outcome and Process Assessment (Health Care); Health Education; Management.