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Background & Aim: Decreasing mechanical ventilation and early extubation after cardiac surgery are the important scientific subjects that their clinical and financial benefits had been demonstrated. There are some variables that are associated with extubation time so, determination of them will help nurses to plan appropriate care aimed at doing an early and safe extubation. Methods & Materials: The purpose of this descriptive-analytic study was to determine whether any preoperative variable had a significant effect on extubation time after CABG. The research was conducted in one of hospitals in Tehran city. In this retrospective study, data were collected by reviewing of files of eligible patients who were undergoing CABG from December 2003 to March 2005. 93 files reviewed by convenience sampling method. Collecting data tool was a checklist consists of three parts: 1) demographic characteristics 2) health and disease history 3) physiologic status. Samples divided into two groups: early and delayed extubation (>6h). Data analysis was performed by descriptive methods, chi square, fisher exact test and regression analysis. Results: Mean and standard deviation of duration time of intubation was 7.19±3.00 with range of 3-18.25 hours in all samples. Totally 43% of subjects extubated in ≤6h and 57% of them in >6h. Age was the only preoperative variable that was found to be statistically significant to extubation time (p=0.01). Conclusion: According to our findings age is associated with postoperative intubation time after CABG. It means older patients need to be under long mechanical ventilation. So, nurses should make a decision on extubation in older patients, carefully.

Objectives: This study evaluated the validity and reliability of the Persian version of the Disaster Resilience Measuring Tool (DRMT-C19)., Methods: The research was a methodological, psychometric study. Standard translation processes were performed. Face validity and content validity were determined along with construct and convergent validity. To determine the final version of the questionnaire, 483 health care rescuers were selected using a consecutive sampling method. Other resilience-related questionnaires were used to assess concurrent validity. All quantitative data analyses were conducted using SPSS 22 and Jamovi 2.3.28 software., Results: The content validity and reliability were indicated using Scale's Content Validity Ratio (S-CVR) = 0.92 and Scale's Content Validity Index (S-CVI) = 0.93. The comprehensiveness of the measurement tool = 0.875%. Cronbach's α = 0.89 and the test re-test reliability using interclass correlation coefficients (ICC) = 0.68 to 0.92. Exploratory factor analysis determined 4 factors which accounted for more than 58.54% of the variance among the items. Confirmatory factor analysis determined 12 factors. The concurrent validity between the DRMT-C19 and the Connor-Davidson Resilience Scale (CD-RISC) was r = 0.604 (P ≤ 0.0001)., Conclusions: The DRMT-C19 has satisfactory psychometric properties and is a valid, reliable, and valuable tool for assessing resilience against disasters in Iran's Persian-speaking health care rescuers.

Background: The attitude of nursing students towards their profession is one of the important factors that have many effects on students and their professional future. A positive attitude leads to academic progress, and in the future, nurses with professional commitment will enter the labour market, and on the contrary, a negative attitude can lead to withdrawal from education and job burnout. The aim of the present study was to investigate factors affecting the formation of negative attitudes in undergraduate nursing students towards their profession., Methodology: This study was conducted with a qualitative research method and with a content analysis approach in 1400 in nursing and midwifery schools in Tehran. In order to collect data, 21 people were selected by purposeful sampling and semi-structured interviews were conducted with them. The interviews were recorded and transcribed on paper and analysed., Findings: Information in 4 main categories and 11 sub-categories, including defects in the structure of the organisation (including the sub-categories of discrimination, job problems, financial problems, defective organisational management, unfavourable professional communication), inefficient educational system (including the sub-category of defects in clinical education and educational supervision), individual factors (including the sub-classes of lack of interest and low self-esteem), and community beliefs (including the sub-classes of low social value and ignorant society), was included., Conclusion: Various reasons are involved in the formation of a negative attitude towards the nursing profession, and in most cases, these factors are related to the problems of the profession and the educational problems of the profession, which can be solved by adjusting some factors and paying more attention to the profession from upstream organisations. It has raised the nursing profession and improved the conditions of nurses, and in the future, the attitude towards the nursing profession will be improved and can lead to the improvement of the health of the society., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: During the COVID-19 pandemic, the sudden transition to virtual learning led to several challenges for nursing students. This study aimed to synthesis nursing students' experiences of teaching and learning during the COVID-19 pandemic., Content: A meta-synthesis of qualitative articles were conducted. Three online databases were searched from December 2019 to December 2022. Qualitative studies and qualitative sections of mixed method studies were included., Summary: Twenty-four qualitative studies and seven mixed-method studies were included in the review. The findings consisted of one main theme "educational transformation", and three categories "challenging face-to-face clinical training", "transition from face-to-face to virtual education", and "support continua". The evidence indicated that during this health-related crisis, most of the training was provided as distance learning in various forms. According to the findings, distance education alone cannot replace face-to-face education and is suggested to be considered as a supplementary learning method., Outlook: This study provides a comprehensive understanding of nursing students' experiences during the COVID-19 pandemic, offering practical implications for educators and institutions globally. The lessons learned can inform strategic decisions, policies, and practices to enhance the resilience and adaptability of nursing education in the face of unforeseen challenges., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: The coronavirus (COVID-19) pandemic changed and disrupted education at medical universities. Educational managers face new challenges and special complexities to manage this situation. This study aimed to explain the experiences of educational managers of Iranian medical universities in the early COVID-19 pandemic., Materials and Methods: This descriptive-qualitative study was conducted at the Tehran University of Medical Sciences, 2020-2021. The study population included all educational managers in one of the positions of the dean of the faculty, educational Vice-Chancellor, head of the department, and other relevant educational directors in medical sciences universities during the COVID-19 pandemic. Data collected from semi-structured interviews were analyzed in MAXQDA2020 software using the thematic analysis approach., Results: Four main themes and nine subthemes were identified: "The ups and downs of the transition from face-to-face training to virtual training," "Crisis in educational management," "Testing and Evaluation: Obstacles and Problems," "Education and lessons learned from COVID-19.", Conclusion: Themes identified from the experiences of educational managers provide new information about the negative and positive effects of the COVID-19 pandemic on the learning and teaching process of medical sciences students. Lessons learned and experiences of educational managers in medical sciences universities amid the COVID-19 pandemic will help health education policymakers so that they can create transformation and innovation in the education of medical science students. Strengthening the e-learning infrastructure will help to create a foundation for a rich way of educating medical students in the post-corona era and when the outbreak of other emerging diseases is inevitable in the future., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

This systematic review aimed to qualitatively synthesize recent randomized controlled trials (RCTs) regarding the effect of topical application and oral intake of herbal products on the healing of diabetic foot ulcer (DFU). Also, we sought to pool the obtained findings in a meta-analysis using a random-effects model, if RCTs were relatively comparable and homogenous. A comprehensive search was performed on five electronic data sources from their inception through 23 January 2024. The RCTs, without restriction on the country of origin, were included if they compared the effect of administering standard treatments and/or placebo (i.e. control condition) to applying standard treatments and/or herbal products in topical or oral routes (i.e. experimental condition). Out of 1166 retrieved records, 28 RCTs were included. Studies used different poly and single herbal formulations. Based on the meta-analysis, administration of standard care plus daily dressing of the ulcer site with olive oil for 28 days significantly increased the total ulcer healing score (3 RCTs; weighted mean difference [WMD] = 89.30; p < 0.001), raised frequency of complete ulcer healing (2 RCTs; risk ratio [RR] = 12.44; p = 0.039) and declined ulcer degree (3 RCTs; WMD = -22.28; p = 0.002). Also, daily use of the bitter melon leaf extract in oral form for 28 days significantly increased the total ulcer healing score (2 RCTs; WMD = 0.40; p = 0.001). Additionally, based on qualitative synthesis, the adjuvant use of herbal agents seems an intriguing choice to manage DFU. Nonetheless, considering the undesirable methodological quality of most studies and the high heterogeneity in administered herbal formulations, more robust trials are required to build a solid conclusion regarding the use of herbal products for healing DFU., (© 2024 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Introduction: One of the most important wards of the hospital is the emergency department (ED). Due to the increasing number of referrals, overcrowding has become a significant problem. It means an increase in patients' referrals and swarms at the ED, limiting their medical staff access. This study investigates the nurses' experiences and perceptions about the reasons for ED overcrowding., Materials and Methods: Twelve emergency nurses were purposefully selected to take part in this study. Data collection was through face-to-face semi-structured interviews until data saturation was finalized. Data analysis was conducted using Graneheim and Lundman's conventional content analysis., Results: Nurses' experiences with the reasons for ED overcrowding came into two main categories. The first was "increased referral to the emergency department," which had three subcategories: "increased referral due to health system reform plan," "increased referral due to corona pandemic," and "improper triage." The second was "increased patients' length of stay at the ED" with seven subcategories including "shortage of bed," "shortage of nursing staff," "lack of physical space," "turtle para-clinic," "on-call specialists' delay," "timely medical record documentation requirements," and "delaying in patients' transfer from the ED to the ward.", Conclusion: The results showed ED overcrowding is inevitable. Intentional or unintentional changes in the health system, such as implementing the health system reform plan or the corona pandemic, can also increase overcrowding. Findings showed ED overcrowding increased referrals and patients' length of stay. This study suggests the health system authorities pay more attention to this phenomenon and look for solutions., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: During the Covid-19 pandemic, nursing schools worldwide were forced to deliver nursing courses in ways other than the traditional face-to-face classroom setting. Numerous lessons were learned by nurse educators regarding the use of electronic and online learning strategies. It is necessary to be aware of the factors affecting e-learning and identify the strengths and weaknesses to improve the student learning experience and process in nursing school., Aim of Study: The present study aimed to identify the abilities, attitudes, challenges, and preferences of nursing students regarding e-learning during the Covid-19 pandemic. Recognition of these factors can help nurse educators make needed modifications to teach more effectively., Methods: In this cross-sectional study, 228 undergraduate nursing students participated. The random sampling method used a standard questionnaire that students completed voluntarily. SPSS version 22 was used for data analysis., Results: During the Covid-19 pandemic, the majority of nursing students of Zanjan University of Medical Sciences participated in electronic classes at home using mobile phones. Students reported that logistical problems increased by participating in e-classes by their phones due to difficulty typing and frequent internet outages. Online classroom management for instructors was difficult due to students spontaneously leaving the virtual online classroom rather than attending the entire learning session. Despite the technical challenges, the attitudes of students towards the e-learning format were positive. There was a noted correlation between student attitude by gender and educational background. Students preferred that professors used more PowerPoint, showed instructional videos, and had interactive group discussion sessions rather than lecture only. Students objected to attending more than two online classes in one day if the duration lasted more than 60 min and had a rest time of fewer than 30 min between classes., Conclusion: Despite the overall positive student satisfaction with e-learning, this method of education is still far from student preferences and requires planning for an effective learning experience that meets their priorities and preferences. Using a hybrid of face-to-face and e-learning approaches together can be a more effective teaching method than either strategy alone., (© 2024. The Author(s).)

Background: Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes., Methods: Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software., Results: Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials., Conclusion: More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care., Trial Registration: PROSPERO Registration No: CRD42023399626., (© 2023. The Author(s).)

Background: Although feedback has a major impact on teaching and learning, the type and way of providing it can have diverse effects. The purpose of this study was to compare the effect of two types of verbal and written feedback on nursing students' performance quality and satisfaction., Materials and Methods: This experimental study, that carried out in 2019, has a crossover design. The participants included 30 bachelors of science in nursing at Shushtar Faculty of Medical Sciences, who were assigned to two groups of 15. The first group received first verbal feedback and then written, during basic nursing skills training. The second group received first written feedback and then verbal. At the end of each half of the training sessions, students' performance and their satisfaction were assessed by, researchermade observational checklists, and a satisfaction questionnaire, respectively. Data were analyzed using SPSS16 software and analyzed using Chi-square and paired t test. Significance level < 0.01 was considered., Results: The mean scores of students' performance in the stages of verbal and written feedback were 15.7 ± 2.5 and 17.7 ± 2.3, respectively. Written feedback was more effective in students' performance ( P = 0.001) and students were more satisfied with this type of feedback ( P = 0.001)., Conclusions: According to the present study, using written feedback can improve the quality of students' performances and is associated with high satisfaction. Thus, professors should pay more attention to feedback in their educational processes and use different types of feedback, especially written feedback, in line with the context., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Aim: The purpose of this study was to evaluate the impact of using a performance checklist on knowledge and satisfaction of intensive care nurses., Method: This study was a quasi-experimental study and performed on 70 intensive care nurses in two groups. Performance checklists had to be filled by the nurses in experiment group during central venous pressure (CVP) measurement procedure. Knowledge and the nurses about standards of CVP measurement and their satisfaction were evaluated in both groups by a researcher-made questionnaire. The data were analysed using the SPSS software., Results: In the experiment group, the level of knowledge significantly increased after the intervention (p = .001) and the majority of nurses (85.7%) had a high level of satisfaction. Also, there was a significant difference between mean knowledge scores of the two groups after the intervention (p = .006)., Conclusion: This showed that applying performance checklists can influence nurses' knowledge and should consider a simple indirect educational method., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Aim: This research was conducted to study the factors affecting nurses' retention in Iranian hospitals., Background: Health care systems should pay attention to their human resources' retention to deliver health care services and maintain their organizational values. This issue becomes more significant when we consider the human and financial limitations in place., Method: Data were analysed using conventional qualitative content analysis based on the model developed by Elo and Kyngäs. Forty-two managers and nurses were selected by purposive sampling. Data were obtained through 45 semi-structured interviews until data saturation was reached., Results: The data analysis resulted in four main categories and 17 subcategories. The main categories included dignity and respect, ethics and spirituality, empathy, and flourishing. The main theme extracted was 'maternal management'., Conclusion: The present study proposes 'maternal management' as a strategy to increase the retention of nurses., (© 2022 John Wiley & Sons Ltd.)

Objectives: To investigate the effect of teach-back education on patient asthma control and family care pressure of patients with asthma., Methods: The present study is a clinical trial and the study population was patients referred to Shahid Faghihi and Shahid Motahhari clinics in Shiraz, Iran. 58 patients with asthma and their caregivers were randomly assigned to the intervention and control groups, for a total of 29 subjects in each group. In the intervention group: the teach-back method was delivered individually to the patient and his or her primary caregiver in three sessions of approximately 60 minutes at one-day intervals. each session included presentations, practical techniques and a booklet. In this study, patients and caregivers in the control group were not trained. Before the intervention, 4 and 8 weeks after the intervention, asthma control test and spirometry test were performed to evaluate asthma control; Also, before the intervention and 8 weeks after the intervention, Zarit test was performed to evaluate the care burden., Results: The findings of repeated measures tests showed that, compared to the control group, the intervention group obtained a greater increase in the vital capacity index (p=0.028) and in the disease control score (p=0.001), as well as a reduction in the burden of care on family members (p<0.001)., Conclusions: The present study showed that teaching asthma related topics to the patient and her caregiver along with the follow-up and supervision of the nurse improves the asthma control of the patient and also reduces the caregiver pressure., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright� by the Universidad de Antioquia.)

Aim: This study aimed to investigate the effects of competency-based education on the clinical performance of health care providers., Background: Having in mind the importance of developing an intervention to enhance the clinical performance of health care providers, the researchers carried out the present study to investigate the effect of competency-based education on the clinical performance of health care providers., Methods: This was a systematic review and meta-analysis carried out by searching six international electronic databases including PubMed, Ovid, Cochrane Library, Web of Science, ProQuest, Scopus and Google Scholar, as well as two national electronic databases including IranMedex and SID. The studies relevant to the research aims were included in the study. To assess the quality of the studies, the Cochrane Collaboration's Risk of Bias Tool was used., Results: Based on the random effects model, competency-based education could enhance the clinical performance of the health care providers in the intervention group compared with that of the control group (standardized mean difference [SMD] = -2.717, 95% CI: -3.722 to -1.712). However, more recent studies have shown that competency-based education has little effect on clinical performance (β = -.255, 95% CI: -0.319 to -0.192, P < .001)., Conclusion: Competency-based education can enhance the clinical performance of health care providers. However, there is increasing concern over the attenuation of the positive effect of competency-based education on the clinical performance of health care providers, which deserves further studies., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Asthma is one of the most common chronic diseases that cause respiratory problems. Different training programs can effectively alleviate its symptoms and minimize the complications. This study aimed to determine the effect of a training program on asthma control., Materials and Methods: This interventional study was performed on patients referred to clinics affiliated with Shiraz University of Medical Sciences. Cases were selected by convenience sampling and divided into two intervention and control groups, each consisting of 29 patients. Before the training program, data were collected using an asthma control questionnaire and a spirometry test, and they were analyzed using statistical tests and software., Results: The results showed that after the intervention, the mean of all spirometry test indices and asthma control scores of the questionnaire increased in the experimental group. Alterations in the mean scores of the clinical manifestations and spirometry indices (FEV1, FVC, FEV1/FVC, and FEF25%-75%) before and after the intervention in the experimental group were significant. After the intervention, all spirometry indices were increased in the experimental group compared to the control group (p<0.05)., Conclusion: The results showed the effectiveness of teach-back training in managing asthmatic patients. Therefore, this intervention can be used as an effective method to control asthma along with other methods such as exercise and medications., Competing Interests: Conflict of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright© 2022 National Research Institute of Tuberculosis and Lung Disease.)

Background: Exploring emergency medical technicians' (EMTs) experiences of COVID-19 epidemic, help to identify the challenges they face in their daily work and develop strategies that address these challenges. This study aimed to explore EMTs' experiences of the challenges of prehospital care delivery during the COVID-19 pandemic., Methods: This qualitative study was conducted in March-July 2020 using conventional content analysis approach. Fifteen EMTs were purposively selected from the Emergency Medical Services (EMS) Center in Qom, Iran. For data collection, semi-structured interviews were conducted until data saturation was reached., Results: EMTs' experiences of the challenges of prehospital care delivery during the COVID-19 pandemic were classified into three main categories including "restless society", "difficult care delivery conditions", and "unprepared organization". The emergent subcategories were "need for information", "limited perception of the COVID-19 risk", "obsessive use of disinfectants", "fear over the transmission of COVID-19 to self and others", "burnout due to heavy workload", "altered communication with hospital staff", "ethical conflicts", "lack of a definite treatment plan", "lack of protective equipment", "staff shortage due to the affliction of EMTs by COVID-19", and "inadequate support by authorities"., Conclusion: During COVID-19 pandemics, EMTs face many challenges including emotional and occupational stress, social strains, risk of affliction by infections, heavy workload, and ethical conflicts and hence, experience difficulties in quality care delivery. Developing appropriate strategies, guidelines, and policies are needed to effectively manage these challenges and improve the quality of prehospital care delivery in COVID-19 epidemic., (© 2021 Parvaresh-Masoud M., et al.)

Background: In the turbulent and stressful work environment of prehospital emergencies, the conflict among emergency medical technicians (EMT) and other health-care providers is inevitable. This study aims to examine the concept of workplace interpersonal conflict (WIC) in prehospital emergencies., Materials and Methods: The eight-step Walker and Avant's concept analysis approach was adopted to define the concept. Iranmedex, SID, Magiran, ISC, PubMed, Scopus, Embase, and Web of Science searched with keywords such as WIC and hospital emergencies. After an extensive review of online national and international databases, one dictionary, nine books, and 25 articles in English and Persian were retrieved for the purposes of the study., Results: The antecedents, attributes, and consequences of the concept identified. EMT must learn how to eliminate their destructive effects while enhancing constructive effects., Conclusion: Conflict is an inevitable part of life, and EMT must learn how to reduce their destructive effects while increasing constructive results., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Introduction: Hospitalization of patients in the intensive care units always has negative consequences such as anxiety and concern for patients and their families. This study aimed to investigate the effect of programmed family presence in intensive care units on patients' and families' anxiety. Methods: This was a quasi-experimental study conducted in Iran. The eligible patients and a member of their families were assigned into two groups (N = 80) through convenience sampling. The family members in the experimental group were allowed to attend twice a day for 15 minutes in a planned way beside the patient and contribute to their clinical primary care. In the control group, the family members had a strict limitation to visit their patients based on the usual policy. Anxiety in both groups at the beginning and on the third day of patient's admission was measured, using Spielberger's questionnaire. The data were analyzed with SPSS version13. Results: The mean score of anxiety in the control group did not show significant difference in patients and in families, however it had decreased significantly in the experimental group after the intervention for both patients and families. The results showed that mean differences between the two groups was statistically significant in patients and families. Conclusion: The planned presence of the family of patients in coronary care unit (CCU) played a crucial role in reducing the anxiety of patients and their family. Furthermore, it is recommended that strategies of visiting policy in intensive care units (ICUs) should be revised and the possibility be provided for the families' planned presence and participation in the patient care., (© 2020 The Author(s).)

Background: Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases., Aim: This review sought to describe the experiences of family members of patients admitted in adult ICUs., Data Sources: Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words., Methods: Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA)., Results: Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure., Conclusion: As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed., (© 2019 Nordic College of Caring Science.)

Background: Given the issue of caring critically ill patients, nurses are involved in the process of breaking bad news in critical care units, while little research has been conducted on this challenging issue., Objectives: The purpose of this study was to determine the role, perspective and knowledge of Iranian critical care nurses regarding breaking bad news., Methods: This descriptive study was conducted on a sample of 160 nurses working in critical care units of hospitals affiliated to Tehran University of Medical Sciences. Stratified and quota sampling methods were used. The data collection tool was a four-part questionnaire with validity and reliability confirmed via content validity and test-retest, respectively., Results: The study showed that most critical care nurses were involved in breaking bad news, with different roles. The majority of participants (91.2%) had a positive attitude towards involvement of nurses in breaking bad news. In this study, 78.8% of nurses had moderate knowledge about how to break bad news, and only a few had good level of knowledge (16.2%)., Conclusion: According to the findings, while critical care nurses took different roles in the process of breaking bad news and they had positive attitude towards participation in this process, yet their knowledge about this process was inadequate. Thus, designing educational programmes to enhance critical care nurses' knowledge and skills in this area seems necessary., (Copyright © 2015 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: Evaluation of achievement of learning objectives needs an accurate assessment program. Hence, nursing educators should move away from the use of individual assessment methods to apply a programmatic approach. The aim of this study was to develop a comprehensive assessment system for nursing students in their critical care rotation based on a programmatic approach., Methods: The population of this study was nursing students in their critical care course. The learning objectives of the course were determined using an expert panel and classified into three categories. Suitable assessment methods were identified for each category according to the consensus of experts. Then, the assessment tools were designed and the content validity was established using content validity ratio (CVR) and index (CVI). The reliability was determined by Cronbach's alpha coefficient. The satisfaction of the participants was investigated using a questionnaire., Results: According to the findings, all items of the assessment system had a high CVR (P < 0.05) and CVI ranged 0.93-0.97. The alpha coefficient of the whole system was more than 0.90 and for subsystems ranged 0.72-0.96. The findings showed that 87.5% of the instructors and 89.47% of students believed that the new assessment system had a positive impact on learning. In addition, the majority of them were satisfied with the new assessment system., Conclusion: A programmatic approach should be used for effective evaluation of clinical performance of nursing students in critical care settings because of high validity and reliability, multidimensionality, positive educational impact, and acceptability., (© 2015 Japan Academy of Nursing Science.)

Background: Educational Environment (EE) is considered as a key component of educational curriculum., Aim: The aim of this study was to evaluate the EE of Nursing and Midwifery School of Tehran University of Medical Sciences (TUMS) by using Dundee Ready Education Environment Measure (DREEM)., Methods: This cross-sectional descriptive study was conducted in 2013. Totally, 500 nursing or midwifery students were recruited to the study by using the quota sampling method. Study data were collected by using a demographic questionnaire and the Persian version of DREEM questionnaire. The reliability of questionnaire was confirmed by Cronbach alpha which was 0.876 and 0.68-0.866 for the whole questionnaire and its domains, respectively. The data were analyzed by using SPSS v. 21.0., Results: Totally, 350 completely-filled questionnaires were included in the final analysis. Most of the participants were nursing students (79.7%), female (74.6%), single (86.0%), bachelor (86.9%), first-year (36.9%), with mean age of 22.5 years. The mean item score of the DREEM was 2.09±0.49 (104.39 from 200). Moreover, the mean item scores of the domains were as follows, perception of learning: 1.93±0.61; perception of teachers: 2.42±0.56; perception of educational atmosphere: 2.05±0.59; academic-self-perception: 2.06±0.65; and social-self-perception: 2.17±0.62. All domains were statistically significant except the perception of learning and educational atmosphere (p<0.001) CONCLUSION: Although the educational environment of the study setting was found to be positive, it requires improvements. Strategies such as adopting student-centered approaches, revising the educational curriculum, strengthening student-teacher relationship, being sensitive and responsive to students' educational needs, providing constructive feedback to them, and creating a comfortable, friendly, and supportive atmosphere can improve the educational environment.