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Yahya Safari,1 Alireza Khatony,2 Mohammad Rasoul Tohidnia3 1Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Department of Radiology and Nuclear Medicine, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Yahya SafariResearch Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, IranTel +989181324798Email y.safary@kums.ac.irBackground: Medical ethics is a vital quality for the doctors which has been seriously taken into consideration in recent years. Identifying the factors affecting medical ethics may help to develop more effective ways to promote this quality in medical education. This study was aimed to explain the challenges of hidden curriculum in learning the professional ethics among Iranian medical students.Materials and Methods: This qualitative study was performed on 15 medical interns of Kermanshah University of Medical Sciences in 2019 using grounded theory (GT). Sampling was started by purposive sampling and continued through theoretical sampling until complete data saturation. Data collection and analysis were done simultaneously. Data were interpreted by the constant comparative method according to Strauss and Corbin’s approach.Results: The results showed that the challenges of hidden curriculum for learning the professional ethics by medical students included a number of key concepts. Analyzing these concepts and taking into account the commonalities, we obtained six subthemes using a reduction inductive method, the main theme of which was “the challenge of hidden curriculum in learning the professional medical ethics”. The subthemes included “decreased interest in medicine”, “false beliefs”, “curriculum weakness”, “materialism and economic problems”, “avoidance of responsibility”, and “underlying problems of the medical profession”.Conclusion: The findings indicated six challenges in the hidden curriculum for learning the professional medical ethics. These challenges can be considered a threat or an obstacle to achieving the goals of professional ethics. Therefore, curriculum planners, education policymakers, and teachers should plan and implement the professional ethics curriculum based on these factors.Keywords: professionalism, medical education, professional ethics, curriculum

Lida Menati,1 Yousef Torabi,2 Bahare Andayeshgar,1 Alireza Khatony3 1Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Alireza KhatonyClinical Research Development Center, Imam Reza Hospital, Kermanshah, IranTel/Fax +98 38 279 394Email Akhatony@gmail.comObjective: The purpose of this study was to investigate the relationship between care burden and coping strategies in caregivers of hemodialysis patients.Methods: This cross-sectional survey was conducted from September to December 2018 in Kermanshah, Iran. A total of 130 caregivers of patients admitted to the hemodialysis wards of Imam Reza and Imam Khomeini hospitals of Kermanshah, Iran were selected via convenience sampling. Data-collection tools included a demographic information form, caregiver-burden inventory, and coping inventory for stressful situations. Data were analyzed using descriptive and analytical tests.Results: The mean age of the caregivers was 35.8± 13.7 years, and 71 (54.6%) were patients’ children. The mean caregiver-burden score was 58.5± 20.5 out of 96. Mean scores of time-dependent, evolutionary, physical, social, and emotion-dependent care burdens were 17.5± 5.3, 12.2± 6.3, 9.1± 4.7, 8.2± 4.0, and 11.4± 5.1, respectively. Mean scores of problem-focused, emotion-focused, and avoidance-oriented coping strategies were 46.0± 80.8, 43.1± 9.0, and 48.9± 9.5, respectively. Among the strategies, only the avoidance-oriented one had a significant positive relationship with total care burden and all its subscales.Conclusion: Caregivers of hemodialysis patients experienced a relatively high care burden. However, they did not use appropriate coping strategies; therefore, they should be trained to select an effective coping strategy.Keywords: avoidance-oriented coping strategy, burden, coping, family caregiver, hemodialysis

Hamid Reza Mozaffari,1 Maryam Janatolmakan,2 Roohollah Sharifi,3 Fatemeh Ghandinejad,4 Bahare Andayeshgar,5 Alireza Khatony6 1Department of Oral and Maxillofacial Medicine, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Medical Surgical Nursing, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Department of Endodontic, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran; 4Kermanshah University of Medical Sciences, Kermanshah, Iran; 5Statistic, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 6Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Alireza KhatonyClinical Research Development Center, Imam Reza Hospital, Kermanshah, IranTel/Fax +9883382793949Email akhatony@gmail.comBackground: Learning style is a factor influencing academic achievement. There are contradictory results in studies on the relationship between learning styles and academic achievement. The current study aimed at investigating the relationship between learning styles and academic achievement in dental students.Methods: In the current descriptive-analytical study, 184 dental students were selected by simple random sampling. The VARK questionnaire was used as the data collection tool. The grade point average (GPA) of previous semester was used as an indicator of academic achievement, and accordingly, students were divided into two groups of strong (GPA ≥15) and weak (GPA ≤14.99).Results: The most common learning styles in strong students were unimodal (n = 55, 42%) and bimodal (n = 41, 31.3%), while they were unimodal (n = 28, 47.2%) and bimodal (n = 24, 45.3%) in the weak students. There was no significant relationship between learning styles and academic achievement in the two groups of strong and weak students.Conclusion: No significant relationship was found between learning style and academic achievement. Further studies with larger sample sizes are recommended. Further studies with larger sample sizes are recommended.Keywords: academic performance, dental, learning, model, students

Maryam Janatolmakan,1 Bahare Andaieshgar,1 Amir Aryan,2 Faranak Jafari,1 Alireza Khatony3 1Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Health Institute, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Alireza KhatonyClinical Research Development Center, Imam Reza Hospital, Nurse Blvd., Kermanshah, IranTel/Fax +988338279394Email Akhatony@gmail.comBackground: Depression can affect nursing students’ quality of life, academic performance, and clinical self-efficacy and may interfere with their relationship with patients. The purpose of this study was to compare of depression rate between the first- and final-year nursing students in Kermanshah, Iran.Methods: In this descriptive–analytical study, 60 first-year and 42 last-year nursing students were enrolled. The participants were chosen using the census sampling method. The data collection tool was Beck’s Depression Inventory. Data were analyzed using descriptive and inferential statistics.Results: In our study, 61.7% (n = 37) of the first year and 38.1% (n = 16) of the last year students had varying degrees of depression. The rate of depression was significantly higher in first-year students than last-year students (p = 0.013).Discussion: Given the relatively high rate of depression among nursing students, the need for targeted planning to control their mental health, especially in the first year of study, is of importance.Keywords: prevalence, depression, nursing, students

Tahereh Nikseresht,1 Alireza Abdi,2 Alireza Khatony3 1Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Health Institute, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Alireza KhatonyClinical Research Development Center, Imam Reza Hospital, Nurse Blvd., Kermanshah, IranTel/fax +98 83 3827 9394Email Akhatony@gmail.comPurpose: To compare the effectiveness of polyethylene cover versus polyethylene cover with artificial tear drop to prevent dry eye in critically ill patients.Methods: In this clinical trial, 208 patients were randomly assigned into two groups of polyethylene cover, and polyethylene cover with artificial tear drop. In each of the two groups, one eye was randomly selected as a control eye and the other was considered as an intervention eye. In the polyethylene cover group, the eye was covered with polyethylene. In the polyethylene cover and artificial tear drop group, an artificial tear drop was applied every 8 hrs to the eye, and then it was covered with polyethylene. The control eye received the routine intensive care unit eye care (washing the inside of the eye and the eyelids with distilled water). In both groups, the eyes were examined for eye dryness by an ophthalmologist for 5 days.Results: The incidence of dry eye after the use of both polyethylene cover and polyethylene cover with artificial tear drop methods was lower than that of a conventional method. Both methods of polyethylene covering and polyethylene covering with artificial tear drop were effective, but clinically, the method of polyethylene cover with artificial tear drop was more effective.Conclusion: Both methods of polyethylene covering and polyethylene covering with artificial tear drop were more effective than a conventional method, but the method of polyethylene cover with artificial tear drop was clinically more effective. Therefore, it is recommended for use in critically ill patients.Keywords: artificial tear drop, dry eye, intensive care unit, polyethylene cover, prevention

Fatemeh Akbari,1 Mansour Rezaei,2 Alireza Khatony3 1Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Alireza KhatonyNursing Department, School of Nursing and Midwifery, Doolat Abaad, Kermanshah, IranTel/fax +98 83 3827 9394Email Akhatony@gmail.comBackground: The effects of the peppermint essence on the pain and anxiety caused by intravenous catheterization have not been studied yet. The aim of this study was to determine effect of inhaling peppermint essence on the pain and anxiety.Methods: In this study, 80 cardiac patients were selected through convenient sampling and randomly allocated to aromatherapy and control groups. Data gathering tools were numeric pain rating scale and visual analogue scale for anxiety. The aromatherapy and control groups received inhaled aromatherapy with peppermint essence and distilled water, respectively.Results: Mean severity of the pain in the aromatherapy and control groups was 2.95±0.98 and 3.42±1.33, respectively. The difference was statistically significant (p=0.048). The mean score of anxiety before the intervention in the aromatherapy and control groups was 3.75±1.08 and 4.70±1.43, respectively; these figures after the intervention were 2.32±0.97 and 2.10±1.42, respectively. The two groups were not significantly different before and after the intervention in terms of the level of anxiety. However, the level of anxiety before and after the intervention was significantly different in each group (p

Haleh Jafari,1 Abbas Aghaei,2 Alireza Khatony31Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran; 3Health Institute, Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranPurpose: Study habits have been the most important predictor of academic performance and play a special role in the academic achievement of students. The aim of this study was to investigate the status of study habits and its relationship with academic achievement in medical sciences students in Kermanshah-Iran.Materials and methods: This cross-sectional study was carried out on 380 medical sciences students at Kermanshah University of Medical Sciences. The samples were randomly assigned to the study. The Palsane and Sharma study Habit Inventory was the tool used for data collection. Data were analyzed by descriptive and inferential statistics.Results: The mean of students’ grade point average was 15.73±1.5 out of 20 and the mean of total status of study habits was 45.70±11.36 out of 90. The status of study habits in 81.3% of the students was at moderate level. There was a direct and significant relationship between study habits and academic achievement.Conclusion: The status of study habits was at moderate level for most students. Therefore, it is recommended to consider and assess students’ study habits at the time of entry into university, in addition, specific training should be offered to students in order to help them learn or modify study habits to increase their academic achievements.Keywords: academic achievement, student, study habit

Abstract Background Previous studies have reported varying levels of self-directed learning readiness and time management skills among nursing students, and the relationship between these two skills has not been extensively explored. Consequently, this study aimed to assess self-directed learning readiness and its influencing factors, with a specific emphasis on the role of time management skills among nursing students. Methods This cross-sectional study involved the participation of 110 undergraduate nursing students who were conveniently recruited for the research. The data collection tools included a demographic information form, Fisher’s Self-Directed Learning Readiness questionnaire, and the Time Management Inventory developed by Britton and Tesser. The collected data were analyzed using STATA-14 statistical software. Results The findings revealed that 96.4% of the nursing students demonstrated readiness for self-directed learning. The mean overall score for self-directed learning readiness was 162.3 ± 6.1 out of 200, indicating a relatively high level of readiness. The mean score for time management skills was 98.1 ± 5.0 out of 135, suggesting satisfactory proficiency in this area. In terms of the relationship between self-directed learning readiness and its associated factors, time management skills, academic probation history, grade point average, place of residence, and level of interest in the field of study collectively accounted for 9.2% of the variance in self-directed learning readiness. Among these factors, academic probation history, grade point average, and place of residence emerged as statistically significant predictors (P

Abstract Patient death can be a stressful experience for nursing students, leading to various undesirable psychological and emotional effects. However, research documenting these experiences remains limited. This study explores the experiences of Iranian nursing students when facing patient death. This qualitative study employed a purposive sample of 14 undergraduate nursing students. Data was collected through semi-structured interviews and analyzed using conventional content analysis. Lincoln and Guba’s (2004) criteria guided the data management process. Data analysis revealed three primary categories with six corresponding subcategories. These categories encompassed the significance of death, reactions to death, and the transformation of professional perspectives. Subcategories included positive and negative meanings attributed to death, emotional and behavioral responses, and the positive and negative effects on participants. The findings reveal that experiencing patient death significantly impacts nursing students psychologically and emotionally. Consequently, it is recommended that nursing curricula incorporate essential training modules addressing appropriate responses to death and effective communication with bereaved families. Further research should explore strategies to mitigate negative impacts and optimize positive outcomes related to this phenomenon.

Abstract Corneal abrasion is a frequent complication in critically ill, intubated patients, potentially leading to visual impairment. This study compares the efficacy of three ocular care methods in preventing corneal abrasion among this vulnerable population. We conducted a randomized controlled trial involving 156 intubated adult patients admitted to the ICU. Participants were randomly allocated to one of three intervention groups (n = 52 per group): (1) polyethylene cover only, (2) polyethylene cover with artificial tear drops, and (3) polyethylene cover with Lubratex eye ointment. One eye per patient was randomly assigned as the control, receiving standard ICU eye care. Daily assessments over five days included a standardized dryness and corneal abrasion checklist, graded strip evaluation of eye dryness, and documentation of corneal abrasion incidence. Data were analyzed using descriptive and inferential statistics (SPSS-18). The incidence of corneal abrasion was significantly lower in the group receiving polyethylene cover with Lubratex eye ointment (4%) compared to the polyethylene cover with artificial tears group (36%, p

Simin Asadian,1 Alireza Khatony,1 Gholamreza Moradi,2 Alireza Abdi,1 Mansour Rezaei,3 1Nursing and Midwifery School, Kermanshah University of Medical Sciences, 2Department of Anesthesiology, 3Biostatistics & Epidemiology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran Introduction: An accurate determination of body temperature in critically ill patients is a fundamental requirement for initiating the proper process of diagnosis, and also therapeutic actions; therefore, the aim of the study was to assess the accuracy and precision of four noninvasive peripheral methods of temperature measurement compared to the central nasopharyngeal measurement. Methods: In this observational prospective study, 237 patients were recruited from the intensive care unit of Imam Ali Hospital of Kermanshah. The patients’ body temperatures were measured by four peripheral methods; oral, axillary, tympanic, and forehead along with a standard central nasopharyngeal measurement. After data collection, the results were analyzed by paired t-test, kappa coefficient, receiver operating characteristic curve, and using Statistical Package for the Social Sciences, version 19, software. Results: There was a significant meaningful correlation between all the peripheral methods when compared with the central measurement (P

Abstract Background Head lice infestation is a prevalent dermatological condition among adolescent girls, which has wide-ranging adverse physical, psychological, and emotional effects on their lives. However, these experiences have been sparsely documented. This study aimed to investigate the lived experiences of Iranian adolescent girls regarding head lice infestation. Methods In this phenomenological study, a purposive sampling technique was employed to select 15 adolescent girls who were experiencing head lice infestation. Collaboration was established with local schools to identify and recruit the participants. Subsequently, the purpose and nature of the study were explained to the identified participants and their guardians. Semi-structured in-depth interviews were conducted to gather the necessary data. The collected data underwent analysis using Colaizzi’s seven-step method. To enhance the credibility of the findings, Lincoln and Guba’s (2004) criteria were applied. The management of the data was facilitated through the utilization of MAXQDA software version 0.9.5. Results The average age of the participants, aged 12 to 17, was 14.5 (standard deviation = 1.7). In terms of education, the majority of them had completed upper secondary education (n = 8, 53.3%), followed by lower secondary education (n = 4, 26.6%). The participants’ experiences were categorized into four main themes and 15 sub-themes. The main themes included living in the shadow of fear, torment of infestation, “struggling with head lice, and disturbing ramifications. The sub-themes encompassed social fear, fear of harm, fear of beauty decline, stigma, bullying behavior, self-blame, adversity, challenging struggle, effective coping, nonconforming behavior, family disruption, academic disruption, health threats, and confused mental state. Conclusion During head lice infestation, adolescent girls endured negative experiences and extensive fears, considering it a significant ordeal. They encountered multiple challenges while dealing with lice and utilized both adaptive and maladaptive strategies to cope with the infestation. It is recommended to enhance public awareness regarding head lice infestation, and healthcare providers should offer emotional support and counseling services to affected girls and their families.

Abstract The COVID-19 pandemic has significantly impacted the working conditions of nurses, leading to a detrimental effect on their sleep quality. This cross-sectional study aimed to investigate the prevalence of poor sleep quality and its associated factors among nurses working in COVID-19 wards in Kermanshah, Iran. A total of 97 nurses were selected through simple random sampling from COVID-19 wards. Data was collected using a demographic information sheet and the Pittsburgh Sleep Quality Index. Descriptive and inferential statistical methods, including chi-square and multiple logistic regression, were used for data analysis. The results showed that 74.2% (n = 72) of the nurses experienced poor sleep quality. Significant associations were found between poor sleep quality and work experience (p = 0.045) as well as the type of work shift (p = 0.001). However, no significant relationships were observed between poor sleep quality and factors such as age, sex, body mass index, overtime hours per month, physical activity, or underlying diseases. The high prevalence of poor sleep quality among nurses working in COVID-19 wards underscores the necessity of implementing targeted interventions to address this issue. In this regard, in addition to periodic shift schedule changes and reductions in working hours, it is necessary to adopt purposeful measures to improve working conditions and enhance the physical and mental health of nurses. These measures may include providing sufficient human resources to reduce the workload and fatigue of nurses, appropriate scheduling of working hours, and the implementation of stress management programs.

ABSTRACT Aim The aim of this study is to explore Iranian nurses' experiences regarding the consequences of bullying. Design A qualitative descriptive study is carried out using conventional content analysis and Granheim and Lundman's method. Methods Data for this study were collected through 12 in‐depth, semi‐structured individual interviews with nurses employed at a teaching hospital in REDACTED, western Iran. Purposeful sampling was employed until data saturation was achieved. Data management was conducted using MAXQDA software. Results The participants consisted of 12 nurses, with a mean age of 36.1 ± 8.6 years. Their experiences of workplace bullying were analysed and categorised into a main theme called ‘Consequences of Workplace Bullying’, with two categories identified as ‘Organisational Consequences’ and ‘Individual Consequences’. The organisational consequences were further elaborated through two subcategories: ‘work performance consequences’ and ‘patient care consequences’. The individual consequences category included subcategories including ‘psychosomatic consequences’, ‘psychological consequences’ and ‘family consequences’. Conclusion Workplace bullying among nurses can have negative impacts on patients, nurses and organisations. In order to mitigate these effects, nurse managers can take proactive measures by implementing management strategies and fostering a positive work culture. By addressing the underlying factors and promoting a supportive environment, the adverse consequences of workplace bullying can be reduced or prevented. Patient or Public Contribution Yes.

Introduction Sleep is one of the most crucial basic human needs in Maslow's hierarchy, while sleep disorders are the most commonly occurring complications of chemotherapy. Objective This study was conducted to determine the effect of progressive muscle relaxation techniques on the sleep quality of patients with cancer undergoing chemotherapy. Methods This study was a randomized clinical trial performed on patients with cancer undergoing chemotherapy. Ninety cancer patients were selected by the convenience sampling method and randomly assigned into two groups; the progressive muscle relaxation group and the control group. Before the intervention, the Pittsburgh Sleep Quality Questionnaire (PSQQ) was completed for patients in both groups. In the intervention group, progressive muscle relaxation was performed for 4 weeks (twice daily and 20 min each time). In the control group, patients only received routine care. After the intervention, the PSQQ was completed again for patients in both groups. The data were analyzed using SPSS version 23. Results The mean and standard deviation of age were 45.95 ± 10.26 years. The samples of the intervention and control groups were homogeneous in terms of demographic characteristics. The results showed a significant improvement in the Pittsburgh Sleep Quality Index in the intervention group before and after the intervention ( P

Abstract Background Multiple gestations present numerous physical, psychological, social, and economic challenges for women. Understanding the problem-solving experiences of pregnant women carrying multiple can be invaluable. This study aimed to explore the experiences of Iranian women with multiple gestations. Methods This descriptive phenomenological study utilized purposive sampling and continued until data saturation. Data collection involved in-depth semi-structured interviews, with analysis performed using Colaizzi’s 7-step method. MAXQDA software was employed for data management. Results This study involved 12 women with multiple gestations. The average age of the participants was 33.76 ± 6.22 years, and 9 were pregnant with triplets. The data were categorized into four primary themes: the paradox of emotions, the pregnancy prison, immersion in fear, and the crystallization of maternal love, encompassing 17 sub-themes. Conclusion Pregnant women with multiple gestations undergo various changes and experience conflicting emotions. Enhancing their ability to adapt to and accept numerous pregnancies can be achieved through supportive, personalized, and family-centered care, along with improvements and revisions in care policies for multiple gestations.

Abstract Background Caring for recommended patients creates work and emotional challenges for nurses. Nurses are obligated to provide care regardless of the patient’s situation. Therefore, knowing the experiences of nurses in dealing with recommended patients in order to provide quality and effective care can be the basis for increasing patient satisfaction. The present study was conducted aimed to explain nurses’ experiences of caring for recommended patients. Methods This was a qualitative study with descriptive phenomenological approach. Participants were 12 nurses working in different wards of hospitals affiliated to Kermanshah University of Medical Sciences, selected by purposive sampling method with maximum diversity. The data collected using semi-structured interviews in face-to-face and audio-recorded methods. MAXQDA 2020 software was used for data management. The analysis of the data was done using the Colaizzi’s 7-step method. In order to verify the trustworthiness of the data, Lincoln and Guba criteria were used. Results After continuous data analysis, 110 initial codes were extracted. These codes emerged in 18 sub-themes and 6 main themes including: catastrophe, be in decline, be in progress, discrimination, work overload, and poor prognosis. Conclusions The results showed information about the presence of recommended patients in the hospital, which can have consequences for patients and nurses. Therefore, it is advised that nurses provide standard care and avoid any kind of discrimination against all patients regardless of whether the patient is recommended or not.

Abstract Background The progression of the nurse prescribing role encounters numerous challenges, with physician resistance being a significant obstacle. This study aims to assess physicians’ perspectives regarding the expansion of the nurse prescribing role within critical care and emergency departments. Methods This cross-sectional study employed convenience sampling to enroll 193 physicians. Data collection instruments included a demographic information form and a researcher-developed questionnaire. Descriptive and inferential statistics were used to analyze the data using SPSS-22 software. Results A total of 193 physicians participated in the survey, with a mean age of 41.9 ± 10.7 years. Among physicians from various age groups, genders, educational backgrounds, and clinical experiences, more than 60% acknowledged prescribing medicine as an essential component of their professional responsibilities. However, a significant majority of physicians in these categories agreed that in emergency situations, nurses should be allowed to prescribe medication to save patients’ lives. It is worth noting that, unlike specialist and fellowship physicians, a majority of general practitioners (83.3%) held the view that nurse-prescribed medications do not contribute to the professional development of nursing. The nurse prescribing role encountered several predominant obstacles, namely legal consequences (78.8%), interference of duties between physicians and nurses (74.1%), and a legal vacuum (77.2%). Conclusion The majority of physicians expressed a favorable attitude towards nurse prescribing in emergency and critical care departments. To facilitate the development of the nurse prescribing role, it is essential to ensure the acquisition of scientific qualifications and implement necessary changes in nursing curricula across bachelor’s, master’s, and doctoral programs.

Abstract Aim To explore predictors of care burden among the caregivers of patients with COVID‐19. Design The findings of this cross‐sectional study were presented in accordance with the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology statement. Methods The samples included 172 caregivers in Imam Reza and Farabi Hospitals, located in Kermanshah, Iran, who were enrolled in the study using convenience sampling. A demographic information form and the Caregiver Burden Inventory were administered. The data were collected between 13 May 202 and 20 August 2021. Results Of the caregivers, 62.8% (n = 108) were male and 71.5% (n = 123) were over 40 years old. Furthermore, 66.3% (n = 114) of caregivers had severe and very severe care burden, with a mean care burden of 78.9 ± 20.4 out of 120. A statistically significant difference was found between care burden and the variables of monthly income, health status, number of patients under care and residence status (p

Abstract Background Test anxiety is a prevalent issue among students, including those in the medical field. The present study aims to examine the impact of auricular acupressure on reducing test anxiety specifically among medical students. Methods In this single-blind randomized parallel-group trial, a total of 114 medical students from Kermanshah, Iran, were allocated into two groups: intervention and control. Each group consisted of 57 students. The data collection instruments included a demographic information form and the Sarason Anxiety Inventory. In the intervention group, bilateral auricular acupressure was administered on the Shen Men point for a duration of 10 min. On the other hand, the control group received bilateral auricular acupressure on the Sham point, located in the earlobe, as a placebo, also for 10 min. Results The mean test anxiety scores in the Shen Men acupressure group exhibited a significant reduction from 18.4 ± 5.3 before the intervention to 13.3 ± 4.8 after the intervention (P = 0.001). Conversely, in the Sham acupressure group, the mean test anxiety scores showed no significant change, with values of 16.36 ± 6.4 before the intervention and 16.4 ± 6.1 after the intervention (P = 0.963). Prior to the intervention, the majority of participants in both the intervention group (87.7%) and control group (86.0%) exhibited moderate to severe levels of test anxiety. Following acupressure, a significant improvement was observed in the intervention group, with 52.6% of participants experiencing a reduction to mild anxiety levels (P = 0.001); however, no notable change in anxiety levels was observed in the control group. Furthermore, a statistically significant difference in anxiety intensity after the intervention was found between the two groups (P = 0.001). Conclusion Shen Men auricular acupressure demonstrates efficacy in reducing test anxiety among medical students. However, to validate its effectiveness, further research using objective measures is warranted.

Abstract Introduction COVID-19 rapidly spread throughout the world. Stay-at-home and social distance strategies accompanied by fear of contamination with COVID-19 caused significant disruptions in daily life. The study focused on the impact of the COVID-19 pandemic on emergency visit and patients’ outcome in the emergency department (ED). Method Administrative and clinical data of 25-hospital EDs in Kermanshah province of Iran from February 20, 2020, to February 18, 2021, were retrospectively analyzed with the comparable periods in the previous year. The incidence rate ratio (IRR) was used to compare the differences between the pandemic and the pre-pandemic period. Result The number of ED visits decreased nearly 50% after the declaration of a national lockdown. Moreover, the proportion of patients triaged in ESI 1 and 2 levels increased by 40 and 52%, respectively. The ratio of patients admitted to intensive care units and discharged against medical advice also increased significantly. Conclusion Despite the number of ED visits sharply declining, the ratio of patients who came to EDs with higher acuity significantly increased. So, health authorities must sensitize the public about life-threatening signs and symptoms in such conditions.

Abstract Aim To investigate the intention to leave the profession and its related factors among nurses in Kermanshah, western Iran. Design Cross‐sectional study. Methods A total of 377 nurses were enrolled in a stratified random sampling method. Data were collected by the Anticipated Turnover Scale and a sociodemographic information form. and analysed by descriptive and inferential statistics (logistic regression analysis). Results The results showed that 49.6% (n = 187) of nurses tended to leave the profession and the mean score of intention to leave was 36.6 ± 0.5 of 60. There were no statistically significant differences between nurses who intended to leave and those who did not in terms of age, marital status, gender, type of employment, type of shift and work experience. But a statistically significant association was found between workplace (p = 0.041, adjusted OR = 2.07) and job title (p = 0.016, adjusted OR = 0.58) and intention to leave the profession. Patient or Public Contribution No

Abstract Aim To determine the prevalence of self‐medication and reasons for self‐medication (SM) for the prevention/treatment of COVID‐19 among the adult population. Design Cross‐sectional study. Methods This study was performed on 147 adults in Kermanshah, Iran. Data were collected by a researcher‐made questionnaire and analysed by SPSS‐18 software using descriptive and inferential statistics. Results The prevalence of SM in the participants was 69.4%. Vitamin D and vitamin B complex were the most commonly used drugs. The most common symptoms leading to SM were fatigue and rhinitis. Strengthening the immune system and prevention of COVID‐19 (48%) were the main reasons for SM. Factors related to SM included marital status [OR = 8.04, 95% CI = (3.62, 17.83)], education [OR = 0.16, 95%CI = (0.08, 0.35)] and monthly income [OR = 0.09, 95%CI = (0.03, 0.26)]. Patient or Public Contribution Yes

Abstract Background Information about web-based education outcomes in comparison with a face-to-face format can help researchers and tutors prepare and deliver future web-based or face-to-face courses more efficiently. The aim of this study was to compare the effectiveness of web-based and face-to-face continuing education methods in improving nurses' knowledge about AIDS. Methods A quasi-experimental method was used with a pre-test and post-test design. In this study 140 nurses with BSc degrees were chosen through a random sampling method and divided into a web-based and a face-to-face group by random allocation. For the former group the intervention consisted of a web-based course on AIDS; the latter received a 3-hour lecture course on the same subject. At the beginning and end of the course in both groups, the nurses' knowledge was measured by a questionnaire. Pre- and post-test scores were compared within and between the groups. Results The results show that there was no significant difference between the groups in either the pre-test (t(138) = -1.7, p = 0.096) nor the post-test (t(138) = -1.4, p = 0.163) scores in the knowledge test. However, there was a significant difference in the pre-test and post-test scores within each group (web-based, t(69) = 26, p < .001; face-to-face, t(69) = 24.3, p < .001). Conclusion The web-based method seems to be as effective as the face-to-face method in the continuing education of nurses. Therefore, the web-based method is recommended, as complementary to the face-to-face method, for designing and delivering some topics of continuing education programs for nurses.

Aim: The aim of this study is to explore Iranian nurses' experiences regarding the consequences of bullying. Design: A qualitative descriptive study is carried out using conventional content analysis and Granheim and Lundman's method. Methods: Data for this study were collected through 12 in‐depth, semi‐structured individual interviews with nurses employed at a teaching hospital in REDACTED, western Iran. Purposeful sampling was employed until data saturation was achieved. Data management was conducted using MAXQDA software. Results: The participants consisted of 12 nurses, with a mean age of 36.1 ± 8.6 years. Their experiences of workplace bullying were analysed and categorised into a main theme called 'Consequences of Workplace Bullying', with two categories identified as 'Organisational Consequences' and 'Individual Consequences'. The organisational consequences were further elaborated through two subcategories: 'work performance consequences' and 'patient care consequences'. The individual consequences category included subcategories including 'psychosomatic consequences', 'psychological consequences' and 'family consequences'. Conclusion: Workplace bullying among nurses can have negative impacts on patients, nurses and organisations. In order to mitigate these effects, nurse managers can take proactive measures by implementing management strategies and fostering a positive work culture. By addressing the underlying factors and promoting a supportive environment, the adverse consequences of workplace bullying can be reduced or prevented. Patient or Public Contribution: Yes. [ABSTRACT FROM AUTHOR]

Introduction: Sleep is one of the most crucial basic human needs in Maslow's hierarchy, while sleep disorders are the most commonly occurring complications of chemotherapy. Objective: This study was conducted to determine the effect of progressive muscle relaxation techniques on the sleep quality of patients with cancer undergoing chemotherapy. Methods: This study was a randomized clinical trial performed on patients with cancer undergoing chemotherapy. Ninety cancer patients were selected by the convenience sampling method and randomly assigned into two groups; the progressive muscle relaxation group and the control group. Before the intervention, the Pittsburgh Sleep Quality Questionnaire (PSQQ) was completed for patients in both groups. In the intervention group, progressive muscle relaxation was performed for 4 weeks (twice daily and 20 min each time). In the control group, patients only received routine care. After the intervention, the PSQQ was completed again for patients in both groups. The data were analyzed using SPSS version 23. Results: The mean and standard deviation of age were 45.95 ± 10.26 years. The samples of the intervention and control groups were homogeneous in terms of demographic characteristics. The results showed a significant improvement in the Pittsburgh Sleep Quality Index in the intervention group before and after the intervention (P <.001, Z = 5.09). However, this rate was not different in the control group. The sleep level of the intervention and control groups was not different at the beginning of the study. However, at the end of the study, the sleep score in the intervention group had decreased significantly (P <.001, Z = 3.52). Conclusion: The results of the present study showed that progressive muscle relaxation improves the sleep quality of patients with cancer undergoing chemotherapy. Therefore, relaxation can be considered a useful and effective intervention for improving sleep quality of patients with cancer. [ABSTRACT FROM AUTHOR]

Background. Violence against emergency nurses is a global concern with undesirable physical and psychological consequences. This study was conducted to investigate the characteristics of physical and verbal violence against emergency nurses in Iran. Methods. In this cross-sectional study, 150 nurses working in seven hospitals affiliated to Kermanshah University of Medical Sciences were included in the study using the stratified random sampling method. The data collection tools included a personal information form and a researcher-made questionnaire. Violence-related characteristics were assessed using descriptive statistics. Logistic regression was used to identify factors related to physical and verbal violence. Results. The frequency rates of physical and verbal violence during the past 12 months were equal to 62% (n = 93) and 94.7% (n = 142), respectively. In both types of physical violence (49.5%, n = 46) and verbal violence (40.4%, n = 57), the nursing station was the most common place of violence. In both physical (n = 40, 43.0%) and verbal violence (n = 101, 71.1%), the most common perpetrator was the patient’s family. Most physical violence (57.0%, n = 53) and verbal violence (35.2%, n = 50) occurred in the night shifts. No statistically significant relationship was found between physical and verbal violence and gender, age, marital status, type of employment, and work experience. Discussion. The results indicate the seriousness of workplace violence against nurses. It is necessary to adopt a global approach along with providing sufficient manpower and psychological empowerment of nurses. Further studies with a forward-looking approach are suggested.