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Abstract Background Mental health among older women is substantial due to their longer life expectancy. They are more susceptible to mental disorders like depression and anxiety compared to older men. Additionally, older women fulfill essential family roles and depend on social support for age-related health issues. Family-centered education provides a platform to assist families and foster a collaborative relationship between the patient, family members, and health care providers in end-of-life care. The study aimed to explore how education based on family‑centered empowerment model affects mental health in aged women. Methods This randomized controlled trial involved a group of 60 elderly women aged 60 years and older, specifically selected from elderly-friendly health centers in Tabriz-East Azerbaijan, who were randomly assigned to either an intervention or control group with an equal ratio. The intervention group received a family-centered healthy lifestyle intervention weekly for 10 sessions, while the control group received standard care from elderly-friendly centers. The mean score of mental health using a three-part questionnaire of demographic-anthropometric characteristics and a mental health questionnaire (GHQ) were assessed before the intervention, 4 and 8 weeks after the intervention through SPSS/version 13 using, ANCOVA, independent t‑test, and repeated measure analysis at a significant level of p 0.05). In the intragroup analysis, there was a significant decrease in the physical subscale score (the mean change was − 1.7, with a 95% CI from − 2.9 to -0.2, and a p-value of 0.038) and anxiety symptoms (the mean change was − 1.8, with a 95% CI from − 3.4 to -1.0, and a p-value of 0.033) compared to the baseline in the intervention group. Conclusion An education based on family-centered empowerment model could improve the overall mental health score in elderly women. Hence, it may be recommended to regard this approach as a practicable educational strategy for improving the well-being of the elderly. Trial registration Iranian Registry of Clinical Trials; https://irct.behdasht.gov.ir/trial/30535 (IRCT20161126031087N2), registered (03/08/2018).

Abstract Background Self-efficacy of patients on hemodialysis is considered a main component of the successful management of chronic kidney diseases. The self-efficacy of these patients may be influenced by many individual and social factors. This study aimed to assess the association between perceived self-efficacy and social support by patients on hemodialysis treatment and the resilience of their families. Methods This cross-sectional study was conducted on 183 patients and 183 families of hemodialysis patients in the largest hemodialysis center in northwest of Iran. Data was collected from July to December 2021 using chronic kidney disease self-efficacy, multidimensional perceived social support (MSPSS), and the Walsh family resilience questionnaire (WFRQ). The collected data were analyzed by SPSS software using descriptive and inferential statistical tests. Results The findings showed that the mean score of patients’ self-efficacy was 171.63 ± 38.19 in a possible range of 25 to 250. Moreover, the mean score of perceived social support was 62.12 ± 16.12 in a possible range of 7 to 84. The mean total score of family resilience was 119.08 ± 26.20 in a possible range of 32 to 84. Also, the results of the study showed a positive and significant relationship between the self-efficacy of patients with their perceived social support and the resilience of their families (p

Abstract Background Premature infants need to be hospitalized in the neonatal intensive care unit (NICU) for long periods of time, which can increase anxiety and stress in their mothers. Additionally, the breastfeeding rate is lower among preterm infants. This study aimed to determine stress levels and emotional intelligence in mothers of preterm infants and their relationship with breastfeeding self-efficacy. Methods This descriptive-correlational study was performed with a convenience sampling of 210 mothers of premature infants admitted to the neonatal intensive care unit in Tabriz, Iran in 2021. Data collection tools included socio-demographic checklist, perceived stress scale (PSS14), Dennis’ breastfeeding self-efficacy scale, and the Schering emotional intelligence questionnaire. Data were analyzed using SPSS software version 16 via descriptive and inferential statistics (Pearson correlation and one-way ANOVA and modified general linear model). Results Study findings demonstrated that most of the mothers had low stress (75.2%) and high breastfeeding self-efficacy (61.9%). The mean (SD) of emotional intelligence of the participants was 88.18 (16.60), ranging from 33 to 165. The results of the general linear model by modifying the demographic characteristics showed that the variables of emotional intelligence (B = 0.23, P = 0.03), stress (B=-0.56, P = 0.01), gestational age (B = 2.81, P < 0.001) and number of deliveries (B = 9.41, P < 0.001) were predictors of breastfeeding self-efficacy. Conclusion The findings showed that mothers of preterm infants had low emotional intelligence, and the majority of them had low perceived stress and high breastfeeding self-efficacy. Findings highlight the importance of addressing maternal stress and enhancing emotional intelligence to promote successful breastfeeding in mothers of preterm infants. Healthcare providers and managers are encouraged to offer support and educational programs to mothers of preterm infants, aiming to enhance their emotional intelligence. Further research and interventions focusing on these factors are warranted to improve the overall well-being of both mothers and infants in the neonatal intensive care unit.

Abstract Aim To develop the general population knowledge, attitudes and practices (KAP) questionnaire towards the COVID‐19 outbreak. Design A methodological study. Methods The general population KAP questionnaire items were designed using a literature review. A panel of experts was used to calculate content validity ratio (CVR) and content validity index (CVI). Construct validity was examined using exploratory factor analysis (EFA) and hypothesis testing. Internal consistency of the questionnaire was measured using Cronbach's α coefficient. Eight hundred forty‐seven patients referred to health centres in Tabriz, Iran completed the questionnaire in 2021. Results The developed questionnaire consisted of three parts, including knowledge, attitudes and practices. EFA identified three dimensions for the knowledge (ways of transmission and prevention, high‐risk groups, and symptoms and treatment), three dimensions for the attitudes (hope, fear and view of the vaccine) and three for the practices (adherence to personal and public hygiene, limiting their presence in society and protecting yourself in the community). The Kaiser–Meyer–Olkin index for knowledge, attitudes and practices was 0.733, 0.725 and 0.886, respectively, with a significant Bartlett's test of sphericity (p

Background: This study investigated the association between internalized stigma and hope, self-esteem, self-efficacy, and treatment adherence and explored the most influential and predictive factor of internalized stigma among patients with severe mental disorders. Materials and Methods: This correlational descriptive study was conducted on 257 outpatients diagnosed with severe mental illness according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnostic criteria. The participants were seeking treatment at outpatient and affiliated clinics of Razi Hospital, Iran, from October 2018 to May 2019. We used a convenient sampling design. Internalized Stigma of Mental Illness scale, Dispositional Hope Scale, Rosenberg's Self-Esteem Scale, General Self-Efficacy Scale, and Drug Attitude Inventory were used to gather data. The data were analyzed using inferential statistics (Pearson correlation, coefficient logistic, and regression analyses) at a 0.05 significance level. Results: The mean (standard deviation) score of internalized stigma was 1.57 (0.49), and 58% of the participants reported moderate to high internalized stigma. A negative significant relationship was found between internalized stigma and hope (r = −0.55, p < 0.05), self-esteem (r = −0.66, p < 0.05), and self-efficacy (r = −0.64, p < 0.05). Treatment adherence was not found to be significantly associated with the internalized stigma. In the final regression model, self-esteem and self-efficacy significantly predicted internalized stigma. Conclusions: Given the crucial role of self-esteem and self-efficacy in predicting internalized stigma, nurses should devote special attention to these factors and use strategies to improve individuals' self-esteem and self-efficacy.

Abstract Background Covid-19 has had significant effects on the quality of life of individuals around the world. Research highlights many negative impacts related to Covid-19; however, there are also potential positive impacts. The current study aimed to identify both the perceived negative and positive effects of Covid-19 among the residents of Tabriz, Iran. Materials & methods The descriptive cross-sectional study was conducted in 10 health centers in Tabriz city in 2021. Cluster random sampling was used to select the 861 study participants. A questionnaire was developed to collect demographic and Covid-19 impacts. Data were analyzed with descriptive and inferential statistics using SPSS 16 software. Results The mean (SD) of negative and positive impacts of Covid-19 was 37.7 (5.10) and 36.35 (5.31), respectively. Significant negative impacts included restriction in participation in cultural (90.4%) and religious (88.9%) activities. Positive impacts were increased attention to personal hygiene (88.7%) and attention to elders (87.6%). Gender (p = 0.006), work status (p = 0.004) and age (p = 0. 01) had significant association with the mean of negative impacts and work status (p = 0.01), age (p

Abstract Background There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women. Methods A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention. Results After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001]. Conclusion Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.

Purpose: Due to necessity of immediate support strategies for nurses during COVID-19 pandemic and lack of comprehensive and applied standard guidelines, the present study was conducted to develop stress management protocol for nurses working in COVID-19 wards with an approach based on the best scientific evidences. Methods: This descriptive methodological and validation study was conducted with evidence-based approach based on Stetler model in two hospitals of Iran in 2020. In order to identify the resources of stress and the solutions provided to deal with it to design the protocol, a comprehensive literature review was performed. After extracting evidence, they were ranked based on the levels of evidence and designed as a protocol. Quality appraisal of guideline was done using AGREEII instrument by an expert panel. The applicability of the protocol was assessed by a group of nurses through focus group discussion. Results: Out of 184 studies, 28 articles related to the topic were selected. According to the expert panel, in the AGREEII domains, Scope and Purpose (87.5%) and Applicability (70.5%) were the highest and the lowest scores respectively. The “Stress Management Protocol for Nurses Working in COVID-19 Wards” was designed in six sections, which was elaborated relative to each stress resources. Members of the focus group mostly considered the evidence-based recommendations feasible by making suggestions to some items. Conclusion: This study emphasized the important role of proper planning by health care system officials according to the designed protocol to manage stress and increase the self-efficacy of nurses in critical situations.

Abstract Introduction With rising age, the incidence of physical and mental problems increases. Physiological and social changes occur across the lifespan that can affect an individual’s health and ability. The present study was aimed to determine older adult’s ability to recognize cognitive changes and its relation with mental health status. Materials and Methods A descriptive correlational design was used to recruit 423 older adults who were referred to health centers in Tabriz, Iran in 2019 to receive primary health care. A systematic random sampling method was used for selecting participants. Data collection tools included a demographic-social questionnaire, General Health Questionnaire for assessing mental health (with 4 subscales) and a questionnaire of ability to recognize cognitive changes (with 8 sub-scales). Data were analyzed using descriptive statistics and inferential statistics. Results The mean score of mental health of the older adults was 56.35 (8.40) which shows moderately impaired mental health. The most impaired aspect of mental health detected was the social function dimension 13.20 (2.67). The average of the total ability score was 41.19 (4.78) and the physical strength dimension had the highest average of 9.08 (1.80) and the empowerment obligation dimension had the lowest average of 3.06 (1.08). There was significant relationship between dimensions of depression (r = 0.21, p

Abstract Background The problem of students’ gaming addiction has been related to the individual student’s characteristics and the influence of family environment. Researchers aimed to investigate if and how internet gaming disorder (IGD) of the elementary school boys and girls is related to behavioral disorder and their mother’s parenting style in Iran. Methods This is a descriptive correlational study, involving 657 fifth and sixth-grade elementary school students in 2019. Researchers used a multistage stratified random sampling of students, their parents and their teachers. Data were collected using internet gaming disorder questionnaire (IGD 20), Rutter teacher behavioral disorder questionnaire and Baumrind Parenting Styles questionnaire (PSI). Obtained data were analyzed using SPSS version16 for descriptive statistics and Pearson correlation coefficient test. Results Findings showed that IGD prevalence was 5.9% among primary school students with significant relationship between IGD and behavioral disorder among all participants (r = 0.23, p = 0.04); although it was insignificant among boys (r = 0.13, p = 0.11). Also the relationship between IGD and mother’s parenting style was significant in the total sample (r = 0.12, p = 0.03), in particular for girls and their mothers (r = 0.2, p = 0.001). Conclusions The results of this study indicate the importance of family and parental involvement in prevention and management of IGD chiefly among girls. Healthcare professionals will benefit from knowing the problematic consequences of online gaming among school-age children and try to promote safe and healthy online behavior supported by a supervised family environment.

Abstract Introduction:Electroconvulsive therapy (ECT) is the oldest procedure among the early biological treatments introduced in psychiatry. However, the most debated and treatment-limiting adverse effect of ECT is amnesia. Therefore, due to the restriction of the use of drugs to manage amnesia in patients undergoing ECT, the present study investigated the effect of reflexology on amnesia. Methods:In this randomized controlled trial, 68 patients who met the inclusion criteria were randomly allocated to intervention and control groups. The intervention group received foot reflexology with olive oil 20 minutes a day for 3 days, while the control group was given a gentle foot rub with olive oil 20 minutes a day for 3 days. The amnesia rate of all patients was measured by the Galveston Orientation and Amnesia Test (GOAT) 30 minutes after the end of ECT. The data were analyzed using SPSS software version 11.5 and t-test, chi-squared test, and repeated measures ANOVA. Results:The results showed that reflexology significantly increased recalling scores in the intervention group compared to the control group. Foot reflexology seems to be effective in managing amnesia in patients after ECT. Conclusion:Foot reflexology, as a relatively simple, inexpensive, and non-invasive technique with few side effects, can be used to manage amnesia in patients after ECT.

Objective The aim of this study was to examine parents’ and healthcare professionals’ experiences and perceptions of parental readiness for resuscitation of their child in a paediatric hospital.Design This exploratory descriptive qualitative study used content analysis. Participants shared their experiences and perceptions about parental readiness for cardiopulmonary resuscitation through semi-structured and in-depth interviews. MAXQDA 2020 software was also used for data analysis.Setting The setting was two large teaching paediatric hospitals in Iran (Este Azerbaijan and Mashhad).Participants Participants were 10 parents and 13 paediatric healthcare professionals (8 nurses and 5 physicians). Selection criteria were: (a) parents who experienced their child’s resuscitation crisis at least 3 months prior and (b) nurses and physicians who were working in emergency rooms or intensive care wards with at least 2 years of experience on the resuscitation team.Results Participants shared their experiences about parental readiness for resuscitation of their child in four categories: awareness (acceptance of resuscitation and its consequences; providing information about the child’s current condition and prognosis), chaos in providing information (defect of responsibility in informing; provide selective protection of information; hardness in obtaining information), providing situational information (honest information on the border of hope and hopeless; providing information with apathy; providing information as individual; dualism in blaming; assurance to parents; presence of parents to better understand the child’s situation) and psychological and spiritual requirements (reliance on supernatural power; need for access to a psychologist; sharing emotions; collecting mementos).Conclusion The results of this study provide insight on the needs of parents and strategies to use to prepare them for their child’s resuscitation crisis, which can be used to enhance family centred care practices in paediatric acute care settings.

Background: Happiness is a positive feeling that is vital and significant to maintain health. Nursesare working in difficult conditions which may heavily affect their level of happiness and ability toprovide care. Job burnout is a mental reaction against some persistent source of workplace stress. Thepurpose of this study was to identify happiness and its relationship with job burnout in nurses workingat Tabriz’s educational hospitals.Methods: This descriptive-correlational study was conducted on 344 nurses working at Tabriz’s hospitalsin 2018. The subjects were selected by means of proportionate stratified random sampling. Data werecollected using three questionnaires (demographic information, job burnout with 22 items and threesubscales and Oxford happiness with 29 items) and analyzed in SPSS version16 using descriptive statistics.Statistical tests such as Pearson correlation coefficient, independent t-test, one-way ANOVA, and multiplelinear regression analysis were used to analyze the data.Results: The age range of the participants was 23–57 years with a mean of 35.9±7.5. The mean score ofhappiness was 64.2±11.5, (score range 35 to 116), which suggests an average level of happiness amongthe nurses. There was a negative correlation between happiness and total job burnout (r=-0.29, p This negative correlation remained significant (B=-0.15, p health status (B=-5.24, P=0.01), history of illness (B=-4.47, P=0.04), job position (B=-6.61, P=0.001),and type of employment (B=3.56, P=0.03) as potential confounding factors were adjusted.Conclusion: Considering the reverse relationship between job burnout and happiness, it is suggestedthat managers try to improve the workplace by managing condition which could lead to job burnout,and therefore use the results to increase the happiness of nurs.

Introduction: The quality of care affects patients’ satisfaction. To provide high quality care, nurses face ethical challenges in daily practice. Moral sensitivity is the first phase in moral implementation. This study aimed to determine the relationship between nurses’ moral sensitivity and patients’ satisfaction in medical wards. Methods: In descriptive correlational study 198 nurses and 198 patients in 17 medical wards filled out the "Moral Sensitivity Questionnaire (MSQ)" and "Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ)", respectively. Nurses were sampled by the census method. For each nurse, a patient was selected randomly from the same ward. Data were analyzed using SPSS ver13. Results: The highest scores were in the dimensions of "Relational orientation" and "Following the rules", and the lowest scores were in the dimensions of "Autonomy" and "Experiencing moral conflicts". The highest level of patients’ satisfaction was with "nurses’ professional performance" 3.98 (1.09), and the lowest level was with "nurses’ routine work" 2.69 (1.22). There was no significant relationship between the mean of patient satisfaction and moral sensitivity of nurses. Conclusions: Considering that nurses had a higher score in dimension of "Following the rules" and a lower score in dimension of "Autonomy", It seems ethical performance in the real situation is not merely due to the nurses’ moral sensitivity and It seems the complexity of the organization causes nurses face difficulties in making decisions related to clinical practice; therefore, policy makers in the health system should be able to identify barriers.

Background: Smoking is one of the most common causes of mortality in the world. Emotional intelligence is the adapting ability to respond to the environment and people appropriately. It plays an important role in various aspects of life such as facing stressful situations and consequently, smoking. This study aimed to investigate the relationship between nicotine dependency and emotional intelligence among male smokers. Methods: This study was conducted on 350 male smokers working at Urmia University of Medical Sciences. The study tools were Cyberia Shrink emotional intelligence questionnaire and Fagerstrom nicotine dependence test. Results: The Mean±SD of nicotine dependency and emotional intelligence were 3.33±2.31 (ranged from 0-10), and 110.26±16.24 (ranged from 33-165), respectively. Overall, the results showed a significant reverse relationship between emotional intelligence and its dimensions with nicotine dependency. Individuals with higher emotional intelligence had a lower degree of nicotine dependency. Conclusion: Emotional intelligence acts as a guard against harmful behaviors such as smoking. Nicotine dependency can be reduced by teaching emotional intelligence skills.

Background: Due to the characteristics of their work, nurses experience high levels of stress and burnout. Alexithymia (defined as the inability to identify and express emotions) and personality traits can be risk factors for burnout. However, there is limited information about the relationships of alexithymia and personality traits with job burnout among Iranian nurses. Objective: This study examined the relationships between alexithymia, personality traits, job burnout, and shift work among hospital nurses in Iran. Methods: This cross-sectional study was conducted in 2017 on a random sample of 225 nurses recruited from 10 hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Data collection instruments were the Toronto Alexithymia Scale, the Maslach Burnout Inventory, the Neuroticism, Extraversion, Openness Five-Factor Inventory, and a demographic questionnaire. Pearson's correlation analysis, independent-samples t-test, one-way analysis of variance, and multiple linear regression analysis were used for data analysis. Results: The mean scores of alexithymia and burnout were 56.78 ± 8.64 and 49.78 ± 13.67, respectively, and these two variables were significantly correlated (r = 0.258; P < 0.001). Alexithymia also had significant relationships with gender (P = 0.035), employment status (P = 0.045), and personality trait (P < 0.01) but had no significant relationship with shift schedule (P > 0.05). Conclusion: Nurses with higher levels of alexithymia are more at risk for burnout. As alexithymia has significant relationships with gender and employment status, interventions are needed, especially for women, to alleviate their alexithymia and burnout.

Background: Literature indicates high levels of burden in primary caregivers of children with attention-deficit hyperactivity disorder (ADHD). Identifying the related factors might help in planning the interventions to reduce it. Objective: This study aimed to identify the caregiver burden and its related factors in Iranian mothers with children suffering from ADHD. Methods: In this correlational study, 246 mothers with children and adolescents suffering from ADHD referred to psychiatric clinics of Tabriz University of Medical Sciences were included through a convenient sampling method. Data were collected using a demographic information form, Zarit Burden Interview, Swanson Nolan and Pelham Parent Rating Scale-IV, and the Kiddie Schedule for Affective Disorders and Schizophrenia-present and lifetime version. Data were analyzed using descriptive statistics, t-test, Pearson's correlation coefficient, analysis of variance, and multiple linear regression analysis. Results: A majority of children (66%) were in the combined subtype. The mean of the disorder severity was 1.91 ± 0.79, 1.76 ± 0.70, and 1.81 ± 0.61 in impulsive, inattentive, and combined subtypes, respectively. The mean of mothers' caregiver burden was 40.43 ± 1.38. A significant relationship was found between the mean severity of the disorder subtypes and caregiver burden. The correlation coefficient was 0.36, 0.29, and 0.29 for the impulsive, inattentive, and combined subtypes, respectively. The mother's age, existence of ADHD in the child's brother, family member's cooperation in caregiving, and the child's birth rank could significantly predict the caregiver burden. Conclusion: Given the role of family-related factors in the burden of care in mothers of children with ADHD, family-centered care and home visits are recommended to assist mothers of these children.

Purpose: Domestic violence against women is a common hidden problem worldwide. Previous studies showed that it provides severe physical and psychological health problems for them. In addition, it imposes many costs to the health system of countries. The identification of risk factors of domestic violence is the first step of strategy for its managing and preventing. The purpose of this study is determined the prevalence and chronicity of domestic violence and its relationship with socio-demographic characteristics of women who refer to Health Centers.Materials and Methods: This cross-sectional descriptive study was conducted on 547 women referring to Health Centers. Sampling was done in the conventional method and data collection tools were demographic and CTS2 questionnaire.Results: Most of the participants (98.5%) had experienced violence in a past year. The highest and lowest of violence was the dimension of negotiation (97.7%) and injury (10.5%) respectively. The family income sufficiency, marital satisfaction was an important predictor for domestic violence against women.Conclusion: Domestic violence had a high prevalence. Empowering of the staff of Health Centers, using standard screening tools and preventive interventions are recommended.

Introduction: One of the important factors in determining success in life is emotional intelligence. It could be considered as a protective factor against health threatening behaviors, including smoking. Considering the effect of emotional intelligence on the health of people and the amount of smoking in smokers, the present study aimed to investigate the relationship between emotional intelligence and general health in the male smokers. Methods: In this descriptive-correlational study, 350 male smokers who were working in Uremia University of Medical Sciences were recruited, using convenience sampling. The instruments used in this study were demographic information questionnaires, Cyberia Shrink standard questionnaire, and 28-Question General Health Questionnaire (GHQ-28). Results: The mean score (SD) of emotional intelligence and the mean score (SD) of general health were 110.26 (16.24) and 23. 60 (13.27), respectively. There was a significant negative relationship between emotional intelligence and general health scores. Conclusion: Individuals with higher emotional intelligence scores had a better physical and mental health status. Therefore, teaching emotional intelligence can increase physical and mental health of the individuals through reducing risky behaviors.

Background: Parents play a vital role in the assessment and management of pain. There is limited knowledge about parental viewpoint or their participation in the pain management of the neonates admitted to the intensive care units. The present study aimed to assess the viewpoints of mothers about the pain management of neonates/ infants admitted to Tabriz hospitals. Methods: It was a descriptive cross-sectional study. A total of 255 mothers whose infants had been admitted to Neonatal Intensive Care Units (NICU) were recruited by convenience sampling method from September 2016 to August 2017. The required data were collected using a demographic questionnaire and PAIN questionnaire-Neonatal Intensive Care. The obtained data were analyzed using descriptive statistics in SPSS. Results: The Mean±SD age of the mothers was 28.38±6.10 years, and the majority of them (39%) had diploma. Among the mothers, 73% believed that their infants had experienced pain during admission to NICU. However, only 19% of the mothers stated that nurses tried to find the signs of pain in their infants; the majority of mothers (80%) indicated that to some extent, they were satisfied with the information they received from the treatment team regarding pain control for their newborns. Conclusion: Despite the prevalence of pain phenomenon in neonates, mothers’ education for the symptoms of pain in their infants was inadequate. It seems that the mothers’ participation in the pain management of their newborns makes them more capable of caring after discharge from the hospital. The study makes important findings available for future research.

Background & Aim: Moral sensitivity has various dimensions including personal sentiments, scientific competency, and reasoning and decision making capabilities. To achieve this, some personal traits and educational preparedness are needed. The aim of this study was to determine nurses’ moral sensitivity and its relationship with demographic and professional characteristics in hospitals affiliated to Tabriz University of Medical Sciences. Methods & Materials: This descriptive, correlational study was conducted on 198 nurses working in the medical wards of hospitals affiliated to Tabriz University of Medical Sciences in 2016. Census sampling method was implemented. Data were collected through a demographic and professional characteristics form and the Moral Sensitivity Questionnaire (MSQ). The data were analyzed by the SPSS software version 13 using descriptive statistics, T test, Pearson correlation coefficient and ANOVA. Results: The mean score for nurses’ moral sensitivity was 4.84±0.48 (out of 7). The highest scores were related to the domains of “Interpersonal orientation” and “following the rules”. The lowest scores were related to the domains of “experiencing moral conflict” and “modifying autonomy”. There was a significant and inverse correlation between age and “modifying autonomy” (P=0.008, r=-0.193) and also between age and “following the rules” (P=0.034, r=-0.156). Moreover, there was a significant and inverse correlation between work experience and “following the rules” (P=0.009, r=-0.187). Conclusion: Given that the nurses gained a low score in the domain of “modifying autonomy”, it is suggested that client centered care and patient’s autonomy be emphasized in developing nursing curriculum and in service training programs.

Purpose: This study aimed to determine factors associated with caregiver burden among primary caregivers of women with breast cancer in Iran. Methods: This was a descriptive correlation study conducted in 2012 on 150 main caregivers of patients with breast cancer who came to the oncology clinic of Shahid Ghazi hospital in Tabriz, Iran. A questionnaire which included caregiving-related factors and the Zarit Burden Interview was used for data collection after its validity and reliability were determined. Data was analyzed using SPSS 13.0 software with descriptive and analytic statistics. The association between significant variables and the dependent variable with an observation of the effects of other variables was assessed using the multiple linear regression model. Results: The mean age of caregivers was 39.60 ± 13.80 years old, and 77 (51.3%) of them were men. The mean score of the Zarit Burden Interview was 30.55 ± 19.18. In the regression model, the mean score of activities of daily living, level of education, gender, and financial status were identified as the determining factors of the burden of caregivers. Conclusions: Primary caregivers need to be financially supported by the relevant organizations. Care skills training and providing palliative care seem helpful in reducing the pain and the burden of family caregivers for patients with breast cancer.

Introduction: Several adjustment scales are available for Diabetes, but, unfortunately most of them focused on the limited dimensions of diabetes and are not specific for type 2 diabetes. The aim of this study was to develop a multidimensional scale for Diabetes type 2 Adjustment Assessment and to test preliminary validity, reliability and clinical utility of the scale for this population. Methods: In this methodological design study, the Diabetes Adjustment Assessment Scale was developed and the psychometric properties of this scale was assessed in patients with Type 2 diabetes. This study included internal consistency, content validity and exploratory factor analysis. Results: 1000 patients with type 2 diabetes completed the 45-item Diabetes Adjustment Scale. After eliminating two item, the 43-item measure demonstrated good internal consistency (Cronbach’s α= 0.75). Factor analysis identified eight factors including; reshape (11 questions), seek to acceptance of illness (7 questions), normal life with the disease (6 questions), initial self-management (2 questions), comparing (4 questions), initial imaging of illness (4 questions), return to resources(3 questions), and advanced self- management (6 questions). Conclusion: Considering that validity and reliability indexes of the scale are reported in an appropriate level, it can be used as a valid and reliable tool in measuring level of adjustment with type2 diabetes.

OBJECTIVE: The purpose of family-centered care interventions is to enhance the abilities of family members in certain areas that overcome the barriers to health and well-being, The purpose of the present research was to determine the effect of education based on family-centered empowerment model on health-promoting behaviors and some serum metabolic indicators in elderly women. MATERIALS AND METHODS: In this stratified randomized controlled trial, 60 elderly women aged 60 years and older referring to elderly-friendly health centers in Tabriz-East Azerbaijan were divided randomly into intervention and control groups in 2019. Intervention group received a family-centered healthy lifestyle intervention once a week for 10 sessions and the control group received the routine care. The mean score of health-promoting behaviors using the Health Promoting Lifestyle Profile-II questionnaire, glycemia and serum lipid profile, liver and renal function, 25-hydroxy Vitamin D, and calcium serum levels were assessed before the intervention, 2 and 6 months after the intervention through SPSS/version 23 using independent t-test, ANCOVA, and repeated measure analysis. RESULTS: The ANCOVA test showed a significant increase in total lifestyle score in the intervention compared to the control group, 2 (adjusted mean difference [aMD]: 13.7; 95% confidence interval [CI]: 5.6–21.8) and 6 months (aMD: 17.2; 95% CI: 7.7–26.7) after education. The score of the nutrition and health responsibility domains significantly increased two (P < 0.05) and 6 months (P < 0.001) after the intervention in the intervention group compared to control. In both groups, serum levels of total cholesterol, low-density lipoprotein cholesterol, urea, and creatinine showed a significant decrease, and high-density lipoprotein cholesterol and calcium levels showed a significant increase (P < 0.05). CONCLUSION: A healthy lifestyle education based on family-centered empowerment model increased the total lifestyle score. So, it is recommended as an effective educational approach to improve the health of elderly.

Introduction: Professional ethics and moral reasoning are among the critical factors influencing professional nursing practice, the quality of patient care, and the patient’s health outcome. Aim: This study aimed to determine the relationship between demographic characteristics of nurses and their ethical reasoning in the medical wards. Materials and Methods: This was a cross-sectional study with descriptive-analytical approach that was conducted in 2016. The study participants consisted of 180 nurses working in the medical wards of hospitals affiliated to Tabriz university of Medical Sciences. The census sampling method was implemented. Data collection tools included a demographic questionnaire and the Nursing Dilemma Test questionnaire (NDT) designed to measure the ethical reasoning among nurses in pre-conventional, conventional and post-conventional levels. Data were analysed by using SPSS version 21.0 with, one-way ANOVA, t-test and Pearson correlation tests. Results: The results indicated that the mean score for ethical reasoning among nurses in medical wards was 45.7±6.1, where nurses scored 37.5%, 35.08%, and 27.42% for preconventional, conventional and post-conventional levels respectively. Researchers found a statistically significant relationship between nurses ethical reasoning and nurses’ shift (p-value 0.05). Conclusion: Nurse’s ability to accurately identify and manage ethical dilemmas was among the factors that influenced their ethical decision making process. The relationship between nurses’ shift and type of work contributed to the way ethical reasoning was applied. These findings are essential for healthcare administrators to design strategies towards the highest quality nursing care.

Introduction: Professional identity development is one of the main concerns of nursing education. This study aimed to evaluate effective educational components on nursing students’ professional identity using Eisner’s model of criticism and connoisseurship. Methods: Eisner’s Criticism and Connoisseurship Model were used for a qualitative evaluation of the nursing education system. This model includes four steps of descriptive, interpretative, evaluative and thematic evaluation. Data were collected by semi-structured interview and observation. Participants were 15 students and faculty members of Mashhad University of Medical Sciences, Iran, who were selected by purposive sampling. Data were analyzed by Eisner’s model. Results: Four major themes included student admission, educational system defects, reality shock, and self-esteem. These themes that emerged from educational evaluation are effective in developing the professional identity of Iranian nursing students. Conclusion: It seems that changing the admission process, presenting the nursing discipline to students as much as possible, creating a more realistic education, making an exclusive body of knowledge, and following successful role models are helpful in students’ professional identity development.

Introduction: Development of nursing profession is faced with new challenges. Role of education is important for advancement of nursing. Faculty members are experienced in education, and they are authentic sources for determining of the educational challenges in nursing. The aim of this study was to determine the educational challenges in nursing from the viewpoint of faculty members of nursing and midwifery in University of Mashhad. Methods: This study is a cross- sectional study conducted on 31 cases from faculty members of nursing in Mashhad University of Medical Sciences by using census method in 2010-2011. A combination of data collection methods was used for collection of data in two phases: preparation of assessment tool (questionnaire) and survey of the desired construct among the samples. After determining the validity and reliability, a questionnaire was given to the samples to answer. Data were analyzed in SPSS software version 11.5 using statistical tests. Results: The most important threats in nursing include “Separation of fields such as anesthesia and operating room from nursing” (%93.6), “Increasing gap between clinical practice and education of nursing due to the increase in education of students and instructors” (%90.3), “Being Theoretical courses in master’s and PhD program” (%77.5), “Decreasing the students’ motivation” (%77.5) and “Establishing new schools of nursing” (%64.5). The most important opportunities in nursing include: “Need to informatics education in education of nursing” (%93.5), “localizing resources based on new issue and problems” (%84), and “Paying attention to evidence- based education in nursing education” (%83.9) and “adjusting the educational content according to ideals and standards of nursing” (%80.6). Conclusion: Based on the results, Returning of anesthesia and operating room branches to nursing after bachelors’, “Revising of educational content based on needs and localizing resources”, “Using new methods in nursing instruction”, “continuing the training based on clinical experiences” and “Using applied research in clinical environment” are suggested.

Introduction: Nursing and midwifery students are exposed to high stress as they face multiple stressors in their educational and clinical experiences. This can threaten their mental health, which in turn, can affect their function. Considering the impact of mental health on individual performance, this study examined mental health and its relationship with academic achievement in students of Tabriz nursing-midwifery faculty. Methods: In one descriptive-analytical study, a sample of 251 Nursing and Midwifery students of Tabriz University of Medical Sciences was selected. Data were gathered by mental health questionnaire (GHQ-28). The mean scores of final term were regarded as academic achievement of students. The data were analyzed by SPSS- 11.5 using descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (T-test, ANOVA and Pearson Correlation Coefficient). Results: Results showed that mean mental health scores of students participating in the study was 25.7 ±11.02. Findings showed that the highest mean was related to social function (11.84±2.9) and lowest to depression (3.5±3.83). Also a significantly negative correlation between scores of mental health and academic achievement was observed (P≤0/00, r=-0/229). Conclusion: According to the results, there was a significant relationship between mental health and academic achievement in students. It is necessary to conduct further studies about mental problems of students and activation of consultation centers.

Emotional intelligence skills help nurses to cope with the emotional demands of healthcare environment. The aim of this study was to identify the relationship between emotional intelligence and perception of job performance among nurses. Using a correlational descriptive design with stratified random sampling, 338 registered nurses from teaching hospitals in North West of Iran were surveyed. Emotional intelligence and perception of job performance were measured using validated self-report measures. The collected data were analyzed through descriptive and inferential methods using SPSS/13. The mean of nurses’ emotional intelligence and their perception of job performance was, respectively, 235.83±37.98 and 157.63±33.23. There was no significant relationship between nurses’ emotional intelligence and their perception of job performance. Although there was a significant relationship between intrapersonal subscale of emotional intelligence and job performance, there was none with other subscales. In order to get rid of the physical and psychological effects of stressful work in wards, it seems that nurses just do routine activities and refuse working closely with the patients. It seems that fitting the patient to nurse ratio, dividing work between nurses, and supporting each other are necessary.