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Introduction: Previous research has indicated that community‐based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards. Aim: This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran. Method: An explanatory mixed‐methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi‐structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis. Results: The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper‐vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'. Discussion: MHNs employ a hyper‐vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance. Implications for mental health nursing: According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards. [ABSTRACT FROM AUTHOR]

Introduction: Maintaining patient dignity in a caregiving environment is one of the most important moral responsibilities for caregivers. Nonetheless, there are vulnerable groups, specifically teenagers, who in their final stages of life are prone to their dignity being threatened. Moreover, dignity is an abstract concept and there is no studies done on teenagers' dignity in the final stages of life available in Iran. Purpose : The purpose of this study is to describe the caregivers' experiences regarding teenagers' dignity in the final stages of life. Research design : This study is a descriptive phenomenological qualitative research project. The data was collected using deep individual and semi-structured interviews as well as taking notes. The Colaizzi analysis method was used to analyze the data. Participants and research context : 22 caregivers working with teenagers in the final stages of life in a public health centers in Iran who had the criteria to enter the study were selected using a purposeful sampling method and invited to join the study from August 2018 to June 2019. The sampling continued until data saturation. Findings : The findings of the present study were presented in the form of three main themes including "private," "respecting individual identity," and "attention to teenagers' needs" and an additional eight categories. Ethical Considerations: The study's protocol was approved by the Research Ethics Committee of the Shiraz University of Medical Sciences and all ethical principles were followed throughout the study. Discussion and conclusion : Based on the present study from the caregivers' point of view, teenagers in their final stages of life required to be cared for and taught in an environment that their privacy was maintained and their individual identity was respected as well as getting attention from the caregivers and companions. In such situations, the teenagers felt calm and their dignity was maintained; therefore, providing a cultural, professional, and organizational setting where all the components of maintaining dignity in teenagers are supported and prioritized is necessary. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nurses' clinical competence (CC) is critical in providing high-quality and safe nursing care. Assessment of nurses' CC and its predictors is a key step to improve their CC and the quality of their services. The aim of this study was to determine the predictors of CC among hospital nurses in Iran. METHODS: This analytical cross-sectional study was conducted from September 2020 to May 2021. Participants were purposively selected from four university hospitals in Hamadan, west of Iran. A demographic questionnaire and the 73-item Nurse Competence Scale were used for data collection. A total of 300 questionnaires were distributed and 270 questionnaires (response rate: 90%) were completed and returned to the researcher. Data were analyzed using the SPSS software (v. 16.0) and the one-way analysis of variance, the independent-sample t, the Mann-Whitney U, and the Kruskal-Wallis tests, the Pearson and the Spearman correlation analyses, and the linear regression analysis. RESULTS: The mean score of CC was 40.28±8.6 (in the possible range of 0-100) and the highest and the lowest dimensional mean scores were for the situation management (56.13±11) and the ensuring quality (25.3±8.1) dimensions, respectively. The mean score of CC had significant relationship with age, work experience, and ward of working and these variables significantly predicted 77% of the variance of CC (adjusted R = 0.778, P<0.05). CONCLUSION: According to the results of this study, age, work experience and ward of working weresignificant predictors of CC in hospital nurses. Nursing managers should employ strategies such as reducing nurses' workload, improving their employment status, and providing them with quality in-service education in order to improve their CC and the quality of their services. [ABSTRACT FROM AUTHOR]

Objective: Breast cancer is a multidimensional crisis for women and their spouses that affects every aspect of their life. Coping with this disease requires investigating and resolving the challenges faced by all those affected by it. The present study was conducted to clarify these challenges on the basis of lived experiences of the spouses of women with breast cancer. Method: The present qualitative research performed an interpretive phenomenological analysis in Iran. Purposive sampling was employed to select twenty spouses of women with breast cancer. The data collected through unstructured face-to-face interviews were analyzed using van Manen's method. To ensure the rigor of the study, Lincoln and Guba's criteria were evaluated in the qualitative process. Results: Lived experiences of the spouses of the women with breast cancer in coping with challenges included the four themes of emotional confusion, shouldering the burden of care, psychophysical suffering caused by the disease and life without cohesion. Conclusion: Spouses of the women with breast cancer in the Iranian community faced several challenges and issues. The socioeconomic support provided by supporting organizations and medical personnel appear to help moderate these challenges and improve coping in this group. [ABSTRACT FROM AUTHOR]

BACKGROUND: Making appropriate decisions for cardiopulmonary resuscitation (CPR) is very challenging for healthcare providers. This study aimed to evaluate knowledge, attitude, and decision making about do-not-resuscitate (DNR) and termination of resuscitation (ToR) among nurses in the resuscitation team. METHODS: This descriptive cross-sectional study was conducted in April-September 2020. Participants were 128 nurses from the CPR teams of two hospitals in Kermanshah and Hamedan, Iran. A valid and reliable researcher-made instrument was used for data collection. Data were analyzed using the Chi-square, Fisher's exact, and Mann-Whitney U tests, the Spearman's correlation analysis, and the logistic and rank regression analyses. RESULTS: Only 22.7% and 37.5% of participants had adequate knowledge about ToR and DNR. The significant predictor of DNR and ToR knowledge was educational level and the significant predictors of decision making for CPR were educational level, gender, and history of receiving CPR-related education (P<0.05). When facing a cardiac arrest and indication of DNR or ToR, 12.5% of participants reported that they would not start CPR, 21.5% of them reported that they would terminate CPR, and 14.8% of them reported that they would perform slow code. The DNR decision had significant relationship with educational level, DNR knowledge, and ToR knowledge (P< 0.05), while the ToR decision had significant relationship with educational level and ToR knowledge (P<0.05). CONCLUSION: Nurses' limited DNR and ToR knowledge and physicians' conflicting orders and documentation can cause ethical challenges for nurses. Clear guidelines for DNR orders or TOR is necessary for nurses, in order to prevent any potential confusion, legal or psychosocial issues and concerns surrounding CPR and improve their involvement in CPR decision making process. [ABSTRACT FROM AUTHOR]

Background: Standard precautions are a basic strategy to prevent occupational exposure in prehospital emergency staff. The Health Belief Model (HBM)-based education can be used to promote and educate health behavior. The aim of this study was to investigate the effect of the HBM-based education on infection control standard precautions in prehospital emergency technicians. Materials and Methods: This clinical trial study was conducted on 84 prehospital emergency staff of Hamadan who were randomly assigned to two groups: Experimental (n: 42) and control (n: 42) using a cluster method. The data were collected by a researcher-developed questionnaire. Before education, the questionnaires were completed by both groups, and then three educational sessions were held for the experimental group within one month. Two months after the intervention, the two groups completed the questionnaire and the data were analyzed by SPSS 21 software. Results: Before education, there was no significant difference in the mean scores on HBM constructs and performance between the two groups (p > 0.05). The results of the Analysis of Covariance (ANCOVA) after educational intervention showed there was a significant difference in the mean scores of all constructs and performance between the two groups (p < 0.05). Conclusions: HBM-based educational intervention could affect the scores of the model's constructs and improve the use of standard precautions in emergency medical technicians. In-service training is recommended to be developed for the staff based on HBM. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spiritual health is one of the important dimensions of the elderly's health, which plays an important role in other dimensions of their health. This study aimed to explain the process of spiritual health of the elderly living in nursing homes. METHODS: This grounded theory study was conducted in 4 nursing homes in the city of Arak Iran between October 2019 and September 2020. The participants were 24 elderly people living in nursing homes, two health care providers, one nurse and one family member, first selected through purposive sampling and then, through theoretical sampling. The data were collected through semi-structured interviews and field notes. All the interviews were transcribed verbatim and analyzed based on Strauss and Corbin approach (2008). RESULTS: Six main categories were identified, including helplessness, inefficient supportive environment, spiritual distress, seeking support, relative improvement of spiritual health and factors affecting spiritual health, each of which explains a part of the whole process of spiritual health of the elderly living in nursing homes. CONCLUSION: Supporting the elderly living in nursing homes is necessary in order to meet their spiritual needs and preserve and promote their spiritual health. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a problem that affects not only the individual's health and quality of life, but also the functionality of the family system. Caregivers experience stress when their patients cannot cope with the symptoms of their disease. The stress experienced by caregivers gives rise to psychological and physical symptoms in them. This study seeks to present a complete set of tools for assessing coping in the spouses or caregivers of women with breast cancer and evaluate the various instruments developed within these lines of inquiry. Methods: A search was carried out in PubMed, Scopus, Web of Science, CINAHL, PsycINFO, Medline, ProQuest, Scopus and Google Scholar and also in the reference lists of the key articles retrieved for any coping assessment instrument targeting family caregivers' needs that had acceptable psychometric properties and was published until September 2019. The instruments used to assess coping in the spouses and caregivers of women with breast cancer were thus identified and their properties were described. Results: Overall, 88 adaptation assessment tools related to family caregivers of patients with breast cancer were identified in 28 related articles. The tools examine different dimensions of adaptation such as satisfaction, stress, burden and needs of spouses and caregivers of patients with breast cancer. Conclusion: Assessing family caregivers' coping is essential for providing them with the appropriate sources of support. Although several instruments have been used to assess coping in the spouses and caregivers of women with breast cancer, the properties of these instruments have to be examined before they can be more widely implemented. [ABSTRACT FROM AUTHOR]

Background: Sleep quality is one of the main human factors related to urban road traffic crashes. This study aimed at determining the relationship between sleep quality and road traffic crashes in urban drivers. Methods: This correlational study was conducted in Hamadan, a city located in the western part of Iran. The study samples consisted of 309 Hamadan drivers (i.e., 103 with road traffic crashes (RTCs) and 206 without RTCs), who were referred to police centers to change or renew their driving licenses. The data collection tool was a two-part questionnaire including demographic information and the Pittsburgh Sleep Quality Index (PSQI). The questionnaire was filled out in a self-administered manner. Statistical analysis was done using the SPSS-16 software and applying logistic regression, Fisher's exact test, and Chi-square test. Results: The comparison of sleep quality scores between two groups, using the adjusted logistic regression test, showed a statistically significant difference between them (P = 0.019). This means that the sleep quality of drivers without RTCs was 1.8 times better than drivers with RTCS (OR=1.8; 95% CI, 1.1 - 3.07). Conclusions: There was a significant association between poor sleep quality and the occurrence of RTCs in urban drivers. As a result, it is recommended paying more attention to the sleep quality of urban drivers to prevent and control RTCs. [ABSTRACT FROM AUTHOR]