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Abstract Background The global nursing shortage was a well-known issue before the Covid-19 pandemic, but the Covid-19 pandemic has exacerbated the current nursing workforce shortage and reduced nursing retention. This systematic review aimed to explore factors affecting retention of nurses. Methods The PubMed, Web of Science, Scopus and Proquest databases were searched for relevant primary studies published on nurses retention during Covid-19 pandemic. Finally, Google Scholar was searched for retrieving more related documents that may not be indexed in other searched databases. Inclusion criteria were research articles and gray literature related to nursing retention in Covid-19 pandemic, articles published in English, access to the full-texts, and without time limitation. Both qualitative and quantitative studies focusing on factors affecting the nurses retention were included. The Joanna Briggs Institute checklists were used for assessing quality of quantitative and qualitative studies. Qualitative and thematic content analysis methods based on Braun and Clark’s model were used to analyze the data. Results Eighteen studies were identified through a systematic search of the literature. The results showed that seven factors include personal, interpersonal, organizational, social media, educational, emotional, and protective factors are the factors affect the nurses retention. Conclusion The findings of this study showed that retention of nurse is complex and multi-factorial issue that factors from micro to macro-level affect it. Managers and health policy-makers based on the results obtained from this study can plan appropriate measures to increase the retention of nurses.

Introduction Patient safety culture is a critical factor in improving the quality of home healthcare and preventing adverse events in patients receiving care in home health centres. However, the concept of patient safety culture in home healthcare centres is not clearly defined, and its dimensions and characteristics are still largely unknown. The aim of this scoping review is to provide a comprehensive overview of research on patient safety culture in home healthcare centres, identify related definitions and characteristics, and focus on key factors to fill the existing knowledge gaps.Methods and analysis This review will follow Arksey and O’Malley’s methodological framework, updated by the Joanna Briggs Institute (JBI), which comprises five stages: identifying the research question, identifying relevant studies, selecting the studies, charting the data, and collating, summarising and reporting the results. The inclusion criteria will be based on the Population, Concept and Context framework. A comprehensive search of PubMed, Embase, Scopus, ProQuest, Web of Science, Cochrane and grey literature sources, with no date restrictions, was conducted with the assistance of a qualified research librarian to include all relevant published study designs and ensure a thorough understanding of the topic. The search will be continuously updated until the study is completed. In addition, we will review the reference lists of the final included studies and their citations to find further relevant studies. Studies that are duplicates and those not written in Persian or English will be excluded. The selection of studies based on the eligibility criteria will carried out by two independent reviewers who will perform a title/abstract screening followed by a full-text screening. Data extraction will be conducted using a standardised form from the JBI. Descriptive and content analyses will be conducted to identify key concepts in the literature reviewed.Ethics and dissemination No ethical review is required for this study. Results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Background: People with HIV/AIDS face numerous challenges, including the effect of the disease on their personal relationships with family, friends, colleagues, and healthcare professionals. The purpose of this qualitative study was to investigate social interactions among patients with HIV/AIDS. Materials & Methods: This qualitative content analysis study was conducted on 12 patients with HIV/AIDS referring to the Behavioral‌ Disease Counseling Centers of Tehran and Rasht (Iran) in 2018. Semi-structured, face-to-face, and audio-recorded interviews were used to collect data. Purposive sampling with maximum variation was used to select participants. The duration of the interview was between 40 to 75 min. MAXQDA10 software was used for data organization and management, and conventional content analysis was used for data analysis. Results: From the analysis of interviews with 12 individuals with HIV/AIDS (7 men and 5 women), 51 codes were extracted in three categories: disease disclosure (disclosure to important people in life, disclosure to public and health services, and dealing with the challenges of disclosure), social support (impairment in interpersonal relationships and relationships with peers), and acceptance (social acceptance and acceptance by health care providers). Conclusion: Despite significant progress in HIV/AIDS prevention, treatment, and education, the stigma caused by this disease remains high and has a negative impact on the interpersonal relationships of PLWHA with their families, relatives, friends, colleagues, and healthcare providers.

Background: Fear of cancer recurrence (FCR), as a commonly reported problem among prostate cancer survivors, has not been fully understood. This study aimed to explore the experience of FCR and relevant coping strategies among Iranian prostate cancer survivors. Methods: Qualitative research was conducted on 13 men who completed treatments for prostate cancer in the last 24 months. The participants were selected through purposeful sampling, and in-depth semi-structured interviews were used for data collection. Conventional content analysis was used for data analysis. Results: Data analysis led to the emergence of three themes. “Living with insecurity” describes the participants’ experiences regarding what triggers FCR with two categories, including “fear of incomplete cure” and “fear of cancer return.” In addition, “struggling to cope” with two categories, including “psychological strategies” and “spiritual coping,” presents coping strategies used by the participants for reducing FCR. Furthermore, “trying to prevent cancer recurrence” with two categories, “seeking health” and “lifestyle modification,” indicates coping strategies used by the participants to prevent cancer recurrence. Conclusions: Healthcare providers need to consider the cultural characteristics of prostate cancer survivors when assessing their FCR, encourage them to disclose their concerns and fears, and provide tailored interventions in order to reduce FCR among them.

Abstract Aim The aim of this study was to explore the process of error recovery (ER) by nurses in intensive care unit (ICU). Design This qualitative study was conducted in 2018–2020 using the grounded theory methodology. Methods Participants were 20 staff nurses, head nurses and nursing managers recruited from the ICUs. Sampling was started purposively and continued theoretically. Data were collected using semi‐structured interviews and were analysed using the approach proposed by Corbin and Strauss. Results The findings indicated that nurses' primary concern was for the patient and their own personal/professional identity. Five strategies were found including evaluating situation, identifying error, analysing error and situation, determining the agent for error correction, and reducing error effects. Contextual factors were also highlighted as being important in the error recovery. “Attempting to protect self and patient” was the core category of the study. Nurses' concern about protecting patient life and their own personal/professional identity make them use unprofessional approaches for ER.

Abstract Background The home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care. Design The aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015. Method In total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015. Results The results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care. Conclusion The results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.

Abstract Background Characteristics of nursing care in the oncology ward depend on this ward’s specific context. This study aimed to investigate the nursing care in the oncology ward regarding the culture of this ward. Methods This qualitative study was conducted in an oncology ward using a focused ethnographic approach. The whole nursing team of the selected ward (N = 16) participated in the study through purposeful sampling. Three methods of observation, interview, and field documents were used for data collection. Data were analyzed by Spradley’s (1980) ethnographic method. Results ‘Nursing in the oncology ward with intertwined roles’ emerged as the main theme. This theme included the following subthemes: ‘Robin Hood nurse,’ ‘a secretive nurse,’ ‘a negligent nurse,’ ‘a snitching nurse,’ ‘a complaining nurse,’ ‘an apathetic senior nurse,’ ‘a stigmatized training nurse,’ ‘a brazen-bodied nurse,’ ‘a compassionate nurse,’ ‘a moonlighting nurse,’ and ‘a drug bartender.’ Conclusion This study provided a deep cultural insight into nursing care in the oncology ward, considering the particular culture of this ward and emphasizing the nurses’ intertwined roles. These roles are on a spectrum, with positive roles, such as compassion, on one side and negative roles, such as negligence, on the other. The results of this study can be provided to nursing managers; therefore, by being aware of nurses’ roles considering the specific subculture of the oncology ward, they can provide psychological interventions to improve the mental health of reluctant and complaining nurses and ethics-based training for secretive, negligent, and snitching nurses to provide quality care to the patient.

Abstract Background Caring for a person with Alzheimer’s disease is stressful for caregivers. So that, considering all the emotional and financial costs imposed on the families of Alzheimer’s patients, stress from caring is an issue that cannot be ignored and plans need to be developed to help these caregivers to manage the care properly. The current study was designed to develop a valid and reliable care stress management scale for family caregivers of patients with Alzheimer’s. Methods This study is a methodological study with a sequential-exploratory mixed-method approach that was performed in two-phase: develop the caring stress management scale and evaluate the psychometric properties of the scale. In the first phase, 14 semi-structured face-to-face interviews were performed with family caregivers of patients with Alzheimer’s. The interviews were transcribed immediately and an item pool with 275 items was prepared. After removing the duplicate or overlapping code, the initial format of the caring stress management scale (CSMS) was designed. In the second step, the items of the CSMS were evaluated using face and content validity. After that, the construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis, and convergent and divergent validity respectively. Finally, the reliability was assessed by stability and internal consistency. The sample size was 435 and data was gathered via an online form questionnaire. Results This study designed the CSMS with two factors including emotional-focused coping (4 items) and problem-focused coping (4 items) that explained 51.00% of the total variance. The results of the confirmatory factor analysis showed a good model fit. Furthermore, the internal consistency and stability of this scale were acceptable. Conclusion The results showed that the care stress management scale has two factors in Iranian family caregivers and it is valid and reliable and can be used by therapists and researchers.

Introduction Patients receiving home care are often elderly people with chronic illnesses that increasingly experience patient safety barriers due to special care needs.Objective The present study was conducted to determine the factors involved in the safety of elderly patients with chronic illnesses receiving home care.Methods A qualitative study with a conventional content analysis method was conducted in home care agencies of Tehran, Iran from August 2020 to July 2022. For data generation, semistructured interviews were conducted with 11 nurses, 2 nurse assistants, 1 home care inspector (an expert working at the deputy of treatment) and 3 family caregivers. Moreover, four observational sessions were also held. Data analysis was done using the five-step Graneheim and Lundman method.Results According to the results, the facilitators of the safety of the elderly patients with chronic illnesses included the family’s participation, nurse’s competence, efficiency of the home care agency management and patient’s participation in patient safety. The barriers to patient safety included problems created by the family, nurse’s incompetence, inefficiency of the home care agency, patient’s prevention of patient safety, home care setting limitations and health system limitations.Conclusion The majority of the factors involved in the safety of elderly patients with chronic diseases receiving home care had dual roles and could serve as a double-edged sword to guarantee or hinder patient safety. Identification of the facilitators and barriers can assist nurses and the healthcare system in planning and implementing patient safety improvement programmes for elderly patients with chronic illnesses.

Background and objectives: Despite significant advances in the diagnosis and treatment of cancer, many people across the world still suffer from this chronic disease and its complications. Chamomile as an herbal medicine has gained an increasing attention for relieving cancer complications. This study aimed to integrate and synthesize current international evidence regarding the effect of chamomile on cancer complications. Methods: A systematic review was undertaken. Five online databases including Web of Science, PubMed [including MEDLINE], Cochrane Library, Scopus, and Embase were searched and articles published from inception to January 2023 were retrieved. All clinical trials and similar interventional studies on human subjects examining the effects of chamomile on cancer complications were included in the review and research synthesis. Relevant data were extracted from eligible studies after quality appraisals using proper methodological tools. The review results were presented narratively given that meta-analysis was impossible. Results: A total of 2240 studies were retrieved during the search process, but 18 articles were selected. The total sample size was 1099 patients with cancer of which 622 participants were female. Fifteen studies used an RCT design. Various forms of chamomile were used such as mouthwash, topical material, tea, capsule, syrup and aromatherapy massage. Chamomile effectively reduced oral mucositis, skin complications, depression, and vomiting and also improved appetite and quality of life among cancer patients. Conclusion: The use of chamomile as a non-pharmacologic and safe method can be helpful for mitigating cancer complications in patients with cancer. Therefore, it can be incorporated into routine care along with other therapeutic measures to reduce patients’ suffering related to cancer. Systematic review registration number (PROSPERO): CRD42022307887

Introduction: Given that children in Pediatric Intensive Care Unit (PICUs) are more vulnerable to safety risks, health care officials are required to identify the weaknesses and strengths of care and ensure the safety of these children. In this study, the safety status in PICUs of selected educational children’s hospitals in Tehran, Iran, was examined and compared with standards proposed by the World Health Organization (WHO). Methods: In this descriptive study, the performance of nurses with a bachelor’s degree or higher and minimum work experience of six months in the PICU was examined. The study environment included four selected educational hospitals located in Tehran, Iran. Data collection tools were eight safety observation checklists based on the safety standards of WHO. Data collection took five months and the nurses’ performance was categorized into three groups of undesirable, relatively desirable, and desirable. The data were analyzed using SPSS software version 13, descriptive statistics, and regression analysis. Results: Consistency of nursing care for the safety of hospitalized children was found undesirable in hand hygiene in accordance with the WHO standards. Nurses’ performance was relatively desirable in the fields of being more cautious about drugs with similar names or spelling to avoid medication errors, communication during patient hand-over, and performance of correct procedure at correct body site. Regarding other fields, the consistency was at a desirable level. Conclusion: Children’s safety in the PICUs is not desirable in terms of observing health codes and there is a long way to go to meet the international standards.

Abstract Background Caring for patients during a pandemic can be difficult for healthcare workers, the patients themselves, and healthcare systems. Nurses are expected to recognize ethical dilemmas and make sound judgments when confronted with them. Sensitizing nurses to ethical issues strengthen their ability to identify ethical dilemmas and make ethical choices. As a result, this study aimed to determine a relationship between moral sensitivity and caring behavior among nurses during the coronavirus (COVID-19) pandemic. Method The current study is a cross-sectional study of 406 nurses who worked in a single hospital during the COVID-19 epidemic. We used a demographic questionnaire and the caring behavior inventory (CBI) tool to collect data online. The data were analyzed using descriptive and correlational statistics. Findings Eighty-three point seven percent of participants in this study were female, and 71.9% were married. 47.5% reported caring for a COVID-19 patient for longer than a month; their average work experience was 13.1 years. Additionally, Moral Sensitivity correlated positively with caring behavior and its dimensions (r = 0.164, P = 0.001). However, a significant and inverse link existed between the dimension "following the rules" and the nurse's caring conduct (r = -0.117, P = 0.019). Conclusion During the pandemic, nurses' moral sensitivity was moderate and significantly connected with their caring behavior. Because nurses encounter numerous obstacles while caring for patients in critical conditions, they require ethical empowerment to perform correctly, as caring behavior improves with increased moral sensitivity.

Objectif : Plusieurs survivants du cancer souffrant de troubles cognitifs liés à la maladie se tournent vers des approches non pharmacologiques pour soulager leurs symptômes. La présente revue systématique avait pour objectif d’évaluer l’effet des « exercices corps-esprit » sur les fonctions cognitives des survivants du cancer.Devis de l’étude : Les bases de données PubMed, Embase, Scopus et Web of Science ont été interrogées afin de trouver des études pertinentes sur le sujet. L’échelle du Joanna Briggs Institute et l’échelle de Jadad ont servi à évaluer la qualité des études sélectionnées.Résultats : Onze études comptant 1 032 participants et publiées entre 2006 et 2019 ont été choisies pour la revue à partir de certains critères d’inclusion. Nos résultats indiquent que les activités comme le yoga, le tai-chi et le qi gong peuvent améliorer de manière objective et subjective la fonction cognitive des survivants du cancer.Conclusion : Les survivants du cancer qui présentent des symptômes cognitifs peuvent bénéficier d’exercices agissant sur le corps et l’esprit. Il faudra cependant mener des essais contrôlés randomisés ayant la puissance statistique nécessaire pour établir les effets à court et à long terme de ce type d’exercices sur les facultés cognitives.

Objective: Cancer-related cognitive impairments experienced by cancer survivors cause many to seek non-pharmacological intereventions to manage these symptoms. The aim of this systematic review was to evaluate the effects of one such intervention, mind-body exercise (MBE), on cognitive function in cancer survivors.Design: Searches for relevant studies were conducted in four electronic databases, including PubMed, Embase, Scopus, and Web of Science. The Joanna Briggs Institute and Jadad scales were utilized to evaluate the quality of the selected studies.Results: Eleven studies including 1,032 participants, published between 2006 and 2019, were selected for review based on specific inclusion criteria. Our results indicated that interventions including, yoga, tai chi, and qigong may improve objective and subjective cognitive function in cancer survivors. Conclusion: Cancer survivors experiencing cognitive symptoms may benefit from participation in MBE. Adequately powered randomized controlled trials are required to establish the short- and long-term effects of MBE on cognitive functioning.

Abstract Aim To determine the psychometric properties of the Persian version of the MUSIC Inventory in nursing students. Design Cross‐sectional psychometric study. Methods Transcultural adaptation of the MUSIC Model of Academic Motivation Inventory was carried out using translation to Persian and back‐translation. Then, the qualitative and quantitative face and content validity of the inventory were evaluated. Construct validity was assessed by exploratory factor analysis. To perform construct validity and reliability, a convenience sample of 360 undergraduate nursing students was recruited. Cronbach's alpha was used to assess internal consistency reliability. Results Cronbach's alpha for all items of the MUSIC inventory was .94, and each factor was between .72–.93. Exploratory factor analysis supported the 5‐factor structure of the MUSIC inventory. These 5 factors explain 66.59% of the overall extracted variance. Three items of the MUSIC inventory, which were related to the empowerment component, were deleted. Conclusion Based on the findings of this study, the Persian version of the MUSIC Model of Academic Motivation Inventory is a valid and reliable tool for Persian language nursing students.

Background & Aims: Epidemiological changes have made chronic diseases increasingly important. Hypertension is also known as a chronic disease. The high prevalence of hypertension has made the disease a significant health problem in communities. Spiritual health has been proposed as one of the health indicators and predictors of self-care in chronic diseases. This study aimed to determine the relationship between spiritual health and adherence to the treatment regimen in patients with hypertension. Materials & Methods: In this descriptive correlational study, 121 patients with hypertension were selected by continuous sampling method from cardiac clinics affiliated with Iran University of Medical Sciences, Iran, in 2020. The study data were collected through demographic information form and validated Ellison and Paloutzian spiritual health and Hil-Bone diet adherence questionnaires. For data analysis, we performed the statistical tests of the Spearman, independent t test, Chi-square, and analysis of variance in SPSS version 16. Results: This study shows a significant and negative relationship between spiritual health and adherence to the treatment regimen in patients with hypertension (P=0.001, r=-0.05). Conclusion: As spiritual health increases, adherence to the treatment regimen in patients with hypertension decreases. Spiritual health in this group of patients leads to less adherence to the treatment regimen.

Background Patient safety in home care is a fundamental and complex concept in nursing. This concept includes a number of challenges in patient care. Studies have shown that there is no clear and uniform definition for this concept.Objective The objective of the present study was to analyse patient safety in home care in Iran.Methods The study was done using a hybrid model at three phases, including theoretical, field work and the final analysis. We searched valid databases including MEDLIN and CINHAL; electronic references including Web of Science, Scopus, Ovid, ProQuest, PubMed and Persian databases including Magiran, IranDoc and SID during 2008–2022, using these Persian and English keywords: Patient Safety, Safety, Home Care Service, Domiciliary Care, Home Care and Home Health Care. A total of 16 articles were searched in the theoretical phase and then analysed by content analysis. In field work phase, nine participants were interviewed (nurse, family and patient) and then the interviews were analysed by the content analysis method. In the final analysis phase, a general analysis of the previous two phases was performed and after determining the attributes, antecedents and consequences, a final definition of patient safety in home care in Iran was presented.Findings Based on different studies, patient safety in home care is a multifaceted concept, which encompasses physical, mental, social and practical dimensions. Evaluation, prevention, participation and commitment to the safety culture are the core features of this concept. The patient care concept depends on the commitment of the involved participants, adequate resources, environmental conditions, support of the involved centres (home care agency, hospital and the insurance), self-efficacy and the ability of the caregivers (nurses).Conclusion Defining the concept of patient safety in home care provides a basis for the development of a safe patient care system at home. This concept analysis for patient safety in home care could be a guide for future studies.

Abstract Background Older adults duo to circumstances of aging such as relationship losses, medical morbidities, and functional declines, are prone to social isolation and loneliness more than any other age group. Furthermore, with The recent outbreak of the COVID-19 pandemic and the need to quarantine, the possibility of feelings of loneliness, especially in older adults, became an important nursing priority. Therefore, it is important to quickly identify loneliness and respond appropriately to prevent, reduce, or treat it. The aim of this study was to translate the De Jong Gierveld loneliness scale into Persian for older adults. Methods The sample was 400 adults aged 65 and older with a mean age of 71.32 (SD= ± 6.09) years. Recruitment and data collection was done via online methods. The original scale was translated into Persian using the World Health Organization (WHO) protocol of forward-backward translation technique. Face validity and content validity; was followed by exploratory and confirmatory factor analysis. Lastly, reliability was assessed using the Average Inter-Item Correlation, Cronbach’s alpha, and McDonald’s Omega. Results The results showed that the Persian version of the loneliness scale had two factors namely social loneliness (5 items) and emotional loneliness (3 items) and the combined score explained 45.66% of the total variance of this scale. In addition, all goodness of fit indices confirmed a two factors model fit and all of the reliability indices were excellent. Conclusions The Persian version of the loneliness scale is useful and suitable for detecting social loneliness and emotional loneliness in older Iranian adults.

BackgroundAlzheimer's disease (AD) is a progressive and debilitating disorder that strongly affects people with AD and their families. The changes in signs of the disease and its treatment lead to many challenges in people with AD that affect the performance and the ability of caregivers, their social life, and physical, emotional, and psychological aspects of caregivers' health. Therefore, this study was designed to develop and validate the Care Challenge Scale (CCS) for family caregivers of people with AD in the care context of Iran.MethodThis is a cross-sectional study, and the primary scale was based on 14 semi-structured interviews with family caregivers of Iranian people with AD. In the next phase, the psychometric features were assessed, including the face validity (qualitative and quantitative), content validity (qualitative and quantitative), item analysis, structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity). Finally, the reliability was assessed using internal consistency (Cronbach's alpha, McDonald's omega coefficient, and the average inter-item correlation), stability (intraclass correlation coefficient), and absolute reliability.ResultsTotally, 435 Iranian family caregivers filled out online questionnaires, with a mean age of 50.26(±13.24) years. Based on the results of the qualitative phase, an item pool was generated with 389 items, and after deleting overlapping and unrelated items, the CCS with 14 items was created. The results of the quantitative phase showed that the CCS consists of two factors with 10 items each, which are named effective role-play challenge and lack of social–financial support, and they explained 42.23% of the total variance. Furthermore, the results of confirmatory factor analysis showed a good fitness of the scale structure model, and it had convergent and discriminant validity. The reliability indexes showed this scale has internal consistency and stability.ConclusionThe most care challenge among Iranian family caregivers of people with AD is effective role-play challenges and lack of social–financial support. The scale as designed has good validity, internal consistency, and stability that can be used by therapists, nurses, and researchers for the assessment of the challenges of this population.

BackgroundHardiness is one of the personality traits that can help individuals in stressful situations. Since human beings are constantly under stressful situations and the stresses inflicted on people in each situation are different, various scales have been developed for assessing this feature among different people in different situations. Hence, it becomes necessary for researchers and health workers to assess this concept with valid and reliable scales. This systematic review aims to rigorously assess the methodological quality and psychometric properties of hardiness scales.MethodIn the first step, the databases including Scopus, PubMed, Web of science, and Persian databases were searched using suitable keywords without limitation time. We select eligible suitable studies after screening titles and abstracts. The quality of studies was evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the Terwee quality criteria.ResultOf the 747 articles identified, 33 articles were entered in this study. Based on the COSMIN checklist, the most reported properties were as following structural validity (84%), hypothesis testing (56%), content validity (42%), and internal consistency (39%). Furthermore, 12 studies reported cross-cultural validity, three studies criterion validity, and one study reported measurement error.ConclusionThe “family caregivers’ hardiness scale,” “Japanese Athletic Hardiness Scale,” “Occupational Hardiness Questionnaire,” and “Children’s Hardiness Scale” are the best tools for assessing hardiness in family caregivers, athletes, employees, and children respectively. In addition, the “Dispositional Resilience Scale” (DRS-15) and The Personal Views Survey (PVS III-R) are the most frequently used scales with suitable features for measuring hardiness in the general population.

Abstract Background Stroke can impose a heavy burden on caregivers. Caring for stroke patients at home is more challenging than in hospitals with facilities. The purpose of this study was to evaluate the effect of a supportive home care program on caregiver burden with stroke patients. Methods This was an experimental study. One hundred sixteen caregivers of stroke patients were recruited using convenience sampling from two university-affiliated hospitals in Tehran from June 2019 to February 2020. They were randomly allocated into two groups (supportive home care program and routine hospital education program) using a randomized block design. The supportive home care program included eight educational sessions delivered in the hospital before discharge, and with home visits after hospital discharge. Caregiver burden was measured using Caregiver Burden Inventory. The data were analyzed using independent samples t-test and Analysis of Covariance. Results Caregiver burden in the routine education group increased significantly after 2 weeks, from 52.27 ± 23.95 to 62.63 ± 22.68. The mean of caregiver burden scores in the supportive home care program decreased from 44.75 ± 17.21 to 40.46 ± 17.28. The difference between the scores of the two groups before the intervention was not significantly different (t = 1.941, df = 114, p = 0.055). There was a significant difference between the two groups regarding caregiver burden scores after the intervention period (η2 = 0.305, P

Abstract Background Apathy in patients with epilepsy is associated with a wide range of consequences that reduce the patient’s ability to perform social functions and participate in self-care and rehabilitation programs. Therefore, apathy is one of the important diagnoses of the healthcare team in the process of caring for epileptic patients and its dimensions need to be examined and recognized. Therefore, appropriate instruments with the sociocultural milieu of each community should be provided to health care providers. The aim of the present study was to design and measure epilepsy–related apathy scale (E-RAS) in adults with epilepsy. Methods This study of sequential exploratory mixed methods design was conducted in Iran from April 2019 to December 2019. In the Item generation stage, two inductive (face-to-face and semi-structured interviews with 17 adult epileptic patients) and deductive (literature review) were used. In item reduction, integration of qualitative and literature reviews and scale evaluation were accomplished. For Scale Evaluation, face, content, construct [exploratory factor analysis (EFA) (n = 360) and confirmatory factor analysis (CFA) (n = 200)], convergent and divergent Validity and reliability (internal consistency and stability) were investigated. Results The results of EFA showed that E-RAS has four factors, namely, motivation; self-regulatory; cognition and emotional-effective. These four latent factors accounted for a total of 48.351% of the total variance in the E-RAS construct. The results of CFA showed that the 4-factor model of E-RAS has the highest fit with the data. The results of convergent and divergent validity showed that the values of composite reliability (CR) and average variance extracted (AVE) for the four factors were greater than 0.7 and 0.5, respectively, and the value of AVE for each factor was greater than CR. The Cronbach’s alpha coefficient for the whole scale was obtained 0.815. The results of the test-retest showed that there was a significant agreement between the test and retest scores (P

Background: Readmission of patients with Acute Coronary Syndrome (ACS) causes many problems for them and their family. This study aimed to improve the quality of care provided to patients with ACS and discover solutions to reduce the rate of readmission among them. Materials and Method: This participatory action research study was done based on Streubert and Carpenter approach. This study included 45 participants (31 patients and 14 stakeholders) and carried out in a hospital affiliated to Isfahan University of Medical Sciences, Iran, from 2013 to 2014. Solutions with high and moderate feasibility, flexibility, and suitability were implemented in each cycle until reaching

ObjectiveCaring for patients with Alzheimer’s disease (AD) is a stressful situation and an overwhelming task for family caregivers. Therefore, these caregivers need to have their hardiness empowered to provide proper and appropriate care to these older adults. From the introduction of the concept of hardiness, few studies have been conducted to assess the hardiness of caregivers of patients with AD. Presumably, one reason for this knowledge gap is the lack of a proper scale to evaluate hardiness in this group. This study was conducted to develop a reliable and valid Family Caregivers’ Hardiness Scale (FCHS) to measure this concept accurately among Iranian family caregivers sample.MethodsThis study is a cross-sectional study with a sequential-exploratory mixed-method approach. The concept of family caregivers’ hardiness was clarified using deductive content analysis, and item pools were generated. In the psychometric step, the samples were 435 family caregivers with a mean age of 50.26 (SD ± 13.24), and the data were gathered via an online form questionnaire. In this step, the items of the FCHS were evaluated using face and content validity. Then, the factor structure was determined and confirmed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) followed by convergent and divergent validity, respectively. Finally, scale reliability, including stability, and internal consistency were evaluated.ResultsThe finding revealed that FCHS consists of five factors, namely, “Religious Coping” (5 items), “Self-Management” (6 items), “Empathic Communication” (3 items), “Family Affective Commitment” (3 items), and “Purposeful Interaction” (4 items) that explained 58.72% of the total variance. The results of CFA showed a good model fit. Reliability showed acceptable internal consistency and stability.ConclusionBased on the results of the psychometric evaluation of the FCHS, turned out that the concept of hardiness in Iranian family caregivers is a multidimensional concept that is most focused on individual-cultural values, emotional family relationships, and social relationships. The designed scale also has acceptable validity and reliability features that can be used in future studies to measure this concept in family caregivers.

This study aims to assess the psychometric properties of the Persian version of the Attitudes Toward Plagiarism Questionnaire (ATPQ) among Iranian medical sciences postgraduate students and faculty members. In this study, the ATPQ developed by Mavrinac et al. in 2010 was translated into Persian. After assessment of face and content validity, we distributed the ATPQ draft among 286 Iranian medical science postgraduate students and faculty members. Explanatory and confirmatory factor analysis were applied, and Cronbach's alpha was used to measure the reliability of the ATPQ. All the items of our English version of the ATPQ were approved by the developer of the original ATPQ, and two were revised in the cognitive interview. Construct validity assessment showed that three items were not seriously involved in the extracted factors. The Persian version of the ATPQ had 26 items, five factors and a Cronbach's alpha of 0.81%, and the combined value explained 38.24% of the total variance of this scale. Two new factors of “perceived control” and “attitude toward self-plagiarism” were extracted and incorporated into the Persian version. To conclude, the ATPQ is a valid, reliable, and convenient instrument to determine attitudes toward plagiarism among Iranian medical science postgraduate students and faculty members.

Patient safety is a major health concern throughout the world, and medical errors are the most important factor threatening patient safety, especially in the Intensive Care Unit (ICU). To prevent errors and improve patient safety, it is necessary to identify the underlying causes of error from the perspective of nurses working in ICUs. This study aimed to explore nurses’ experiences of factors contributing to medical errors in the Intensive Care Unit. The present qualitative study was conducted using conventional content analysis. The participants included 17 nurses working in ICUs in two educational hospitals affiliated with the Iran University of Medical Sciences in Tehran. Data were collected using in-depth semi-structured interviews and were analyzed through the conventional content analysis approach based on Graneheim and Lundman's model. Four main categories (a) extra-organizational challenges; (b) Organizational position; (c) The specificity of the care environment, (d) Individual reason and nine subcategories: (accreditation problems, non-native care standards, organizational management, organizational Features, critical condition of patients, physical structure of unit, neglect in the process of care, lack of clinical knowledge and experience, and physical and psychological problems) were identified. From the nurses' perspective, a series of factors associated with the health system, the organization, the ICUs, and the individual play a role in the occurrence of errors; therefore, it is necessary for planners, policy-makers, nursing managers to think about these underlying factors and with in-service training, and a positive, supportive atmosphere; lead nurses to support the patient and improve patient safety.

Abstract Introduction Good quality of care is dependent on nurses’ strong clinical skills and moral competencies, as well. While most nurses work with high moral standards, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The study reported in this paper aimed to explore the experiences of nurses regarding negative changes in their moral practice. Materials and methods This was a qualitative study utilizing an inductive thematic analysis approach, which was conducted from February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews. Results The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: (1) feeling discouraged; (2) normalization; (3) giving up; (4) becoming a justifier; and (5) moral indifference. Conclusions Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both patients and health systems. Some unethical behaviors in nurses can be explained by this process.

Abstract Background The high burden of care associated with older stroke patients is a factor that threatens the health of family caregivers. Identifying the needs of family caregivers in this group of patients can help provide effective solutions. The present study aimed to determine the needs of family caregivers of older stroke patients. Methods The sample size of this longitudinal study included 200 family caregivers of older stroke patients from two hospitals in Iran. Data collection included demographics, responses to family caregivers’ needs questionnaires, and the Barthel Index which was taken in four stages including admission time, pre-discharge, two weeks and 12 weeks post-discharge. Results The results showed that all participants at all stages of the study identified “respect for the patient when providing education, treatment, or rehabilitation” as one of their needs. There was a statistically significant relationship between the older adult survivor’s age and the number of family caregivers’ needs two weeks post-discharge (p = 0.012) and 12 weeks post-discharge (p = 0.008). There was a significant relationship between the patient’s hospitalization period and the number of caregivers’ needs three months after the patient’s discharge (p = 0.028), and a significant statistical relationship between the pre-discharge physiotherapy of the patients and the number of their caregivers’ needs during the two weeks post-discharge (p = 0.018). There was also a statistically significant relationship between the patient’s level of dependence and the number of caregivers’ needs (p = 0.0001). On the contrary, there was no significant relationship between the sex, place of living, and underlying disease history of the patient and the number of caregivers’ needs (p > 0.05). Conclusion The results of the present research indicate that the total number of caregivers’ needs decreases with increasing duration of the disease. However, respite and care provision planning by other family members, seeking assistance from professional caregivers, and the search for community support resources can help reduce the burden of care of caregivers and give them the opportunity to meet their needs in different dimensions of patient care provided.

Objective: This study was designed to describe the experiences of family Caregivers' hardiness in caring for Alzheimer's Patients.Methods: The deductive content analysis method was performed between April 2020 and February 2021 in one of the teaching hospitals in Iran. Fourteen family caregivers of Alzheimer's patients were selected using purposive and snowballing sampling and the data were collected by semi-structured interviews. After that, data were analyzed using Elo and Kingas steps.Results: The results of this study showed that based on the experiences of family caregivers, the family caregivers' hardiness in caring for Alzheimer's patients is a feature of cognitive ability to deal with stressful care situations and consists of five dimensions of commitment, control, challenge, communication and culture with 22 generic categories that they were nested into this five dimension.Conclusion: Family caregivers' hardiness is a trait related to the individual and environmental factors, and the prevailing social and cultural conditions affect the individual's perception and experience of hardship and threats, as well as his/her understanding of protective factors and how to use them. Therefore, hardiness should not be interpreted as a simple approach regardless of culture.

Background & Aim: Iranian elderly population is increasing, and a high percentage of this population suffers from diabetes. Considering that the concept of active aging has not been developed in the context of chronic diseases that are common in aging (such as diabetes), the purpose of this study was to analyze the concept of active aging in diabetic elderly patients based on a hybrid model. Methods & Materials: Three stages of hybrid model (theoretical, field work and final analysis) were used in this study. In the theoretical phase, 35 articles (published in 1990-2016) from scientific databases were analyzed. In the field work phase, 10 participants were interviewed and then a qualitative content analysis was performed. In the final phase, the findings of the two previous stages were merged and analyzed. Results: The definition of active aging for the diabetic elderly is a comprehensive, dynamic, multidimensional and culturally dependent process that requires a sense of satisfaction, happiness, well-being, security, and physical and mental health, that is achieved through social participation, providence of appropriate health and employment services, awareness of diabetes, and financial, emotional, family, and governmental support that brings subjective and objective benefits to the international, national and individual levels (such as adaptation to illness, a sense of worth and self-esteem). In order to achieve this, paying attention to the whole life span from childhood to old age is needed. Conclusion: The results of this study suggest that health, security, satisfaction, participation, access to health services, support and knowledge of diabetes play an important role in activating elderly people with diabetes in Iran.

Background: Despite the decisive role of nurses in patient’s education, they have limited ability to carry out this responsibility. One of the reasons for this incompetence is insufficient nursing education programs. This study aimed to compare and contrast the effects of multiple teaching methods and conventional methods on knowledge, satisfaction, and performance of bachelorette nursing students. Methods: We conducted a quasi-experimental study with pre-test, post-test design. A sample of 154 nursing students from Tehran University of Medical Sciences was selected and then randomized into experimental (77) and control groups (77). The control group received conventional teaching, and the experimental group received multiple teaching methods, including scenario writing, role playing, videotaping, and analyzing, in 12 weekly sessions. The obtained data were analyzed by the Chi-square and Mann-Whitney tests in SPSS V. 18. Results: Multiple teaching methods did not affect nursing students’ knowledge. However, it resulted in higher student satisfaction (P=0.001) and improved performance with regard to patient’s education (P=0.001). Conclusion: Multiple teaching methods may help students to educate, interact, communicate, and cooperate with patients more effectively.

Objective: To determine the effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery. Methods: This randomized clinical trial study was performed on 96 patients undergoing knee replacement surgery, who were randomly divided into two groups: the control group and the intervention group, with 48 patients in each group. In the intervention group, the patients received educational intervention in four stages (one day before surgery, 24 h and 48 h later, upon discharge from the hospital. In the control group, only the routine of the hospital was performed. Questionnaires were completed before and 6 weeks after the intervention. Results: The mean scores of pain, knee stiffness and performance difficulty were significantly decreased in the intervention group (P=0.01). Compared to the control group, the intervention group had a better outcome of the illness, including pain, knee stiffness and performance difficulty (P=0.001). Conclusion: Rehabilitation education could be a suitable way to improve the surgical outcomes of patients undergoing total knee replacement.

BACKGROUND: Despite new anticoagulants' developments, warfarin is still one of the most commonly used medicines, particularly in the cardiovascular system. One of the significant challenges with warfarin is the prevalence of dangerous side effects such as bleeding and drug and food interactions, which can negatively affect patients if not adequately controlled. As health-care team members, nurses have a crucial role in prescribing this medicine and educating patients. In this regard, this study was conducted to determine the knowledge and practice of nurses working in the cardiovascular wards regarding warfarin. MATERIALS AND METHODS: In this cross-sectional, descriptive study, knowledge and practice of 239 nurses working in the cardiovascular wards of teaching hospitals affiliated to Iran University of Medical Sciences have been investigated using European Cardiovascular Nurses Knowledge questionnaire on anticoagulants and the checklist for high-risk drugs safety instructions. The sampling was performed through the stratified sampling method with proportional allocation. Data were analyzed using the SPSS software version 16 through descriptive and inferential statistics (independent t-test, one-way analysis of variance, and Pearson correlation coefficient) (Inc., Chicago, IL, USA). RESULTS: The mean scores of knowledge (18.51 ± 3.87) and practice (10.53 ± 2.12) were slightly higher than the median, and the lowest mean score was related to knowledge on drug interactions (7.62). The practice had a statistically significant relationship with knowledge (P < 0.001). Regarding demographic variables, there was a statistically significant relationship between nurses' knowledge and the education level (P = 0.009) and nurses' practice and age (P = 0.022), work experience (P = 0.032), and work experience in cardiovascular wards (P = 0.036). CONCLUSIONS: Based on the findings of this study, the knowledge of nurses working in the cardiovascular wards about warfarin was not sufficient, and their practice was of poor quality. Nurses' lack of knowledge and improper practice can jeopardize drug safety in patients and cause serious side effects such as bleeding. Proper training of nursing students and nurses about warfarin as a high-risk drug, its side effects, and drug-food interactions, and the emphasis on patient education in patients receiving this medicine can effectively reduce the incidence of side effects.

Background: Patients with degenerative knee joint disease may ultimately undergo Total Knee Replacement (TKR) surgery. However, they need enough knowledge about self-care. The current study aimed at determining the knowledge score of patients undergoing TKR. Methods: The current descriptive, cross sectional study was conducted on 140 patients underwent TKR referring to selected hospitals affiliated to Iran University of Medical Sciences by convenience sampling. Data were collected by Received Knowledge of Hospital Patients (RKHP) and analyzed by descriptive statistics with SPSS V. 19. Results: The mean total knowledge score was 2.09±0.28 that was close to the average level. Patients got the highest score in financial dimension and the lowest score in ethical dimension. Conclusion: Knowledge score was higher than average showing inadequate knowledge of patients; however, a comprehensive educational program should be tailored for patients undergoing total knee joint replacement.

Introduction: Classroom management is leading the class by setting the class schedule, organizing the procedures, supervising the learners’ progress, and predicting and solving their problems. Students’ disruptive behaviors and classroom management are the most important challenges and concerns of the teachers. The current review aimed to analyze the classroom management techniques and strategies used to cope with the students’ disruptive behaviors. Methods: The present study was systematic review. The articles in Science Direct, PubMed and Scopus databases and Google Scholar search engine were searched using the keywords of classroom management, students’ disruptive behaviors, difficult students, and confrontation strategies during 2000-2017. A total of 31 articles were included in the study for analysis. Results: The results showed all the techniques and strategies used and teachers’ challenges in dealing with students’ disruptive behaviors were included in conflict management strategies, which were classified into three categories, i.e. cooperative and problem solving strategies, avoidance strategies and punishment strategies. Moreover, the studies mostly emphasized the use of cooperative and problem solving strategies, and the most highlighted methods were making effective mutual communication with students to correct their negative behavior, training and preparing the teachers for dealing with the students’ disruptive behaviors and using various teaching methods and approaches based on the classroom situation. Conclusion: To cope with the challenges of students’ disruptive behaviors, the teachers can use different strategies. Also, sufficient knowledge and skills about teaching, familiarity with the relevant and influential disciplines in dealing with students and making effective communication in the class can be helpful in developing and enjoying more effective skills in classroom management.

Background: Chronic Heart Failure (CHF) is a syndrome that negatively affects a person’s Quality of Life (QOL). The efficient self-management education program increases the individual’s abilities and skills for following and participating in a long-term healthcare plan. Objective: The aim of this study was to determine the effect of the self-management education program on QOL in people with CHF. Methods: This randomized controlled trial study was conducted on 60 people with CHF and without sensory- cognitive problem from April-August 2015. They were selected using the convenience sampling method, and were randomly assigned into the intervention and control groups. The control group received the routine education presented to participants at discharge. However, besides the routine education, the intervention group received the self-management education program consisting of three sessions followed for a 3-month period. The Iranian heart failure QOL questionnaire was used for data collection before and after the intervention. The independent-samples and paired-samples t-tests, Chi-square and Fisher exact tests were used for data analysis via the SPSS v.16 software. P

Background: The rights of patients admitted to the Intensive Care Units (ICUs) are threatened more than the ones admitted to other hospital wards due to the nature of ICU and special health conditions of the patients admitted such as lower consciousness and their need for invasive and noninvasive care practices. Awareness of obstacles and observance of patients’ rights are of particular importance. Therefore, the current study aimed at determining the observance of patients’ rights and the organizational facilitators and deterrents influence them from the viewpoint of nurses working in ICUs of educational and therapeutic centers affiliated to Iran University of Medical Sciences, Tehran, Iran. Methods: The current descriptive, cross sectional study included 160 nurses working in ICU, surgery and general wards selected by the census method. Data collection instruments included the 3-section demographic characteristics questionnaire, the Client Observation Checklist (COC) as well as patient safety culture questionnaire. Data were analyzed using SPSS V. 21. Results: Based on the results of COC, the client observation was 76.16% in the current study. The highest amount of satisfaction and desirable observance belonged to the information receipt axis (78.34%) and the lowest observance belonged to the selection and decision making axes (67.17%). The most important facilitating organizational and deterrent factors to observe the client’s rights were identified as reduction of working hours of nurses (96%), handling nurses’ amenities (94.6%), inappropriate nurse/patient ratio (92.6%), and lack of job security and mental safety in nurses (90.6%). Conclusion: Several factors, such as inappropriate nurse/patient ratio, socioeconomic problems, working hours, and heavy workload in a limited time were among the factors influencing the quality of nursing practices, based on the charter of patients’ rights.

Introduction: Due to the increasing prevalence of arteriosclerosis and the mortality caused by this disease, Coronary Artery Bypass Graft (CABG) has become one of the most common surgical procedures. Utilization of patient education is approved as an effective solution for increasing patient survival and outcomes of treatment. However, failure to consider different aspects of patient education has turned this goal into an unattainable one. The objective of this research was to determine the effect of utilizing the organizational culture improvement model of patient education on CABG patients’ anxiety and satisfaction. Methods: The present study is a randomized controlled trial. This study was conducted on eighty CABG patients. The patients were selected from the CCU and Post-CCU wards of a hospital affiliated with Iran University of Medical Sciences in Tehran, Iran, during 2015. Eshpel Burger’s Anxiety Inventory and Patients’ Satisfaction Questionnaire were used to collect the required information. Levels of anxiety and satisfaction of patients before intervention and at the time of release were measured. The intervention took place after preparing a programmed package based on the organizational culture improvement model for the following dimensions: effective communication, participatory decision-making, goal setting, planning, implementation and recording, supervision and control, and improvement of motivation. After recording the data, it was analyzed in the chi- square test, t-independent and Mann-Whitney U tests. The significance level of tests was assumed to be 0.05. SPSS version 18 was also utilized for data analysis. Results: Research results revealed that variations in the mean scores of situational and personality anxiety of the control and experiment group were descending following the intervention, but the decrease was higher in the experiment group (p≤0.0001). In addition, the variations of the mean scores of patients’ satisfaction with education were higher in the experiment group than the control group (p≤0.0001). Conclusion: Utilization of the organizational culture improvement model of patient education reduces stress in CABG patients and increases their satisfaction with the provided education considering the factors involved in patient education, which were incorporated in the designed model.

Background: Studies suggest that family caregivers of hemodialysis patients experience a high level of burden, which could lead to numerous physical and psychological problems. Despite the need for adequate training and support, these caregivers are mostly neglected, and few studies have been performed in this regard. Aim: to evaluate the effect of educational programs on the home care of hemodialysis patients and burden of their family caregivers. Method: This randomized controlled clinical trial was conducted on 76 caregivers of hemodialysis patients referred to Shahid Hasheminejad Hemodialysis Center of Tehran, Iran in 2015.­ Subjects were divided into two groups of intervention and control (n=38). The intervention group received four training sessions on the home care of hemodialysis patients for two weeks, and the control group received routine care. Data were collected using the Caregiver Burden Inventory (CBI) at the beginning and six weeks after the intervention­. Data analysis was performed in SPSS V.21 using Chi-square, Fisher’s exact test, independent and paired T-test, and Mann-Whitney U test. Results: In this study, no significant difference was observed between the two groups in terms of demographic characteristics. At the baseline, mean score of caregiver burden in the intervention and control groups was 88.5±11.7 and 84.9±15.1, respectively, and no significant difference was observed between the groups in this regard (P=0.30). Six weeks after the intervention, the results of independent T-test revealed a significant difference between the mean scores of caregiver burden in the intervention (58.7±6.6) and control groups (87.8±11.7) ­(P

INTRODUCTION: Iran's Health System Reform Plan (HSRP) were initiated in public and hospitals affiliated to Medical Sciences Universities in June 2015. The purpose of the present paper is to provide a critical analyse of the HSRP and its outcomes. METHODS: The study was carried out as a review critical analyse in 2019. The pertinent articles were searched for in Science Direct, PubMed, Ovid, and Google Scholar using keywords “health sector,” “reform plan,” “health system reform,” “health services,” “health care system,” and “Iran.” Published articles in scientific national and international journals in Persian and English language, of which the full-texts were available, were entered into the study. Finally, from a total of 75 articles obtained, 45 studies were carefully reviewed. RESULTS: Several factors, which impact in the success of Iran's HSRP such as social-economic and political outlooks, lack of official information and a comprehensive management system, in addition to failure to extend continuous performance control, economic sanctions against Iran. Other factors are limitations on financial transactions between Iran and the rest of the world due to the sanctions, relying merely on a few instructions, and negligence of the required infrastructures. In terms of advantages of the plan, relative decrease in patient's share in medical expenses, improvement of emergency wards, and relative decrease in the rate of C-section operations are notable. CONCLUSION: Better implementation of Iran's HSRP entails the provision of resources and facilities such as stable and adequate resources, proper management of available resources, payment mechanisms reform, attracting, and facilitating private sector's participation.

BACKGROUND: Total knee arthroplasty (TKA) can cause operational anxiety in patients. The purpose of this study was to determine the effects of a hospital rehabilitation program on operational anxiety in patients following TKA. MATERIALS AND METHODS: A nonrandomized clinical trial was conducted on 96 patients who were total knee replacement (TKR) candidates in Milad Hospital, Tehran, Iran. The participants were allocated to two groups of control and experiment each with 48 participants. A rehabilitation training program was implemented in the experimental group and the routine care program was administered to the control group. The data collected through demographic form and Spielberger anxiety questionnaire. The collected data were analyzed using Fisher's exact test, covariance, independent t-test, and paired t-test (P = 0.5). RESULTS: The results of the paired t-test indicated that the mean score of anxiety in both groups was decreased. Independent t-test showed that there was a significant difference between the two groups in terms of the mean scores of anxiety so that it was significantly higher in the control group compared to the experimental group (P < 0.001). CONCLUSIONS: The implementation of the rehabilitation education by a rehab nurse can improve the surgical outcomes in patients under TKR. Despite the positive results in this study, the results should be interpreted and clinically used with caution given the small number of participants and the specific circumstances of this study.

Background: The family caregivers of patients undergoing hemodialysis have a major role in the care of patients at home. The study results indicate that these caregivers face with multiple problems regarding responsibilities and issues arising from the care and treatment of the patients.These issues decrease their quality of lives. However, these caregivers are mostly neglected andno studies are available on the effectiveness of educational program on their quality of lives. Therefore, this study aimed to examine the effects of educational program on the quality of life of family caregivers of patients undergoing hemodialysis. Methods: This research was a randomized controlled clinical trial, conducted on 76 family caregivers of patients undergoing hemodialysis referred to Shahid Hasheminejad, a medical and educational center in Tehran, Iran. The subjects were equally allocated into 2 groups of 38 patients.The caregivers of the patients who referred in even or odd days of the week were randomly assigned into the intervention and control groups, respectively. The intervention group received 4 training sessions on home care training program during 2 weeks, but the control group just received the routine training at the center. Both groups answered demographic information and “quality of life” (SF-36)questionnaires before and 6 weeks after the intervention. Then, the obtained data were analyzed in SPSS, 21. Descriptive statistics, the Chi-square and Fisher exact tests, as well as independent samples t-test, t-couple, and Mann-Whitney U test were used to analyze the data. Results: The majority of caregivers (54%) were in the age range of 35-55 years. About 68.4% were female and 70% were married. No significant difference was found between the baseline mean scores of “quality of life” of the intervention and the control groups (45.95±14.94 vs. 45.08±11.02, P=0.775). However, the mean scores of quality of life of the intervention group increased at the end of the study and the 2 groups were significantly different in this regard (63.51±11.55 vs. 41.74±10.51, P

Background: The unplanned departure of endotracheal tube is one of the main complications for endotracheal intubation. In addition to endotracheal extubation, its movement can also lead to damage to the oral cavity. Stabilizing endotracheal tube is the most important factor that can prevent unplanned departure of endotracheal tube as well as its movement. The current study was done with the aim of determining and comparing the effect of stabilizing endotracheal tube by a holder with routine method on quality of airway care in patients hospitalized in ICU. Methods: This study was a clinical and quasi-experimental trial with a control group which was done on 100 patients having endotracheal tube attached to mechanical ventilation by a holder. The samples were selected randomly from patients hospitalized in ICU in Hazrat Rasoul Akram hospital. The samples were then divided into control group and test group. At the end of the study, the homogeneous samples were selected and studied. The endotracheal tube was stabilized by a holder in test group and by a routine method (gauze) in control group. The quality of managing airway was studied through 3 frequency indices: endotracheal tube extubation, frequency of linear movement of endotracheal tube, damage to oral mucosa. For the first two indices a self-designed tool was used and a modified version of Oral Assessment guide was used for the oral trauma assessment. The data were analyzed using descriptive statistics, qui square test and independent t-test by SPSS version 17. Results: The findings showed no significant statistical difference in frequency index of endotracheal extubation. Linear movement of endotracheal tube was lower in test group compared to control group. There was no significant difference regarding oral trauma in both groups. A difference was observed in both groups in comparing scores before and after using two methods in “lips” and “Gingiva”. Conclusion: According to the results of this study, it was indicated that using ETT holder for stabilizing endotracheal tube compared to routine method only has preference in movement of endotracheal tube on quality of airway management. While applying methods of stabilizing endotracheal tube, it should be noted that not only type of stabilizing, but also other nursing cares from patients in ICU can affect quality of airway management. Therefore, it is recommended to do further studies on other factors inflencing airway management.

BACKGROUND: Evaluation of educational courses is important for estimating the achievement of learning goals and identifying the best way to learn. The present study is an attempt to assess the effectiveness of education through role-playing on the learning outcomes in nursing students based on the Kirkpatrick's evaluation model. MATERIALS AND METHODS: A quasi-experimental study was conducted with participation of 74 nursing students at Iran University of Medical Sciences in 2016–17. The participants were selected through census and were randomly allocated to control (n = 35) and experimental (n = 39) groups. The common method of education was implemented for the control group, and the experimental group experienced role-playing educational method. In the next semester, each student was assigned to educate two patients at the hospital. The knowledge level of the participants at the end of the semester and patients' satisfaction with the educations by students in the next semester were measured as the outcomes of learning. Kirkpatrick's model was used to assess the learning outcomes. RESULTS: The mean score of students, at the second level of Kirkpatrick's model, in the experimental group (63.85 ± 13.88) was significantly higher than that of the control group (46.41 ± 16.22, P < 0.001). The mean score of patients' satisfaction with patient educational performance, at the fourth level of the model, in the experimental group (73.26 ± 3.47) was significantly higher than that of the control group (47.32 ± 6.83, P < 0.001). CONCLUSIONS: The evaluation by the Kirkpatrick's model showed that use of role-playing method improved learning outcome of nursing students.

Background & Objective: Hospitals and healthcare centers, like any other organizations, have some common norms and beliefs called as organizational culture. Organizational culture plays a key role in organization&aposs and staffs&apos performances. Nurses&apos perspectives on the organizational culture affect the way they play their role in. This study aimed to investigate the role of organizational culture from perspectives of nurses working in selected hospitals at Tehran University of Medical Sciences. Methods & Materials: In this cross-sectional study, 230 nurses working in different wards of selected hospitals of Tehran University of Medical Sciences were recruited to the study. Data were collected using a demographic characteristics checklist as well as the nurse and organizational culture questionnaire extracted from the Robbins criteria. Data were analyzed using descriptive statistical indexes, independent t-test, Pearson correlation coefficient and regression in the SPSS v.17. Results: Results showed that the existing organizational culture in the selected hospitals was in a moderately good level from nurses&apos perspectives. From the scores obtained for various dimensions of the organizational culture, the highest and lowest scores were for control (44.2%) and conflict tolerance (31.8%), respectively. Conclusion: The level of the organizational culture from the nurses&apos perspectives might lead them to decrease the quality of their performance. Optimizing the organizational culture can improve nurses&apos performance and motivate them to increase their quality of work.

Background & Objective: Hospitals and healthcare centers, like any other organizations, have some common norms and beliefs called as organizational culture. Organizational culture plays a key role in organization's and staffs' performances. Nurses' perspectives on the organizational culture affect the way they play their role in. This study aimed to investigate the role of organizational culture from perspectives of nurses working in selected hospitals at Tehran University of Medical Sciences. Methods & Materials: In this cross-sectional study, 230 nurses working in different wards of selected hospitals of Tehran University of Medical Sciences were recruited to the study. Data were collected using a demographic characteristics checklist as well as the nurse and organizational culture questionnaire extracted from the Robbins criteria. Data were analyzed using descriptive statistical indexes, independent t-test, Pearson correlation coefficient and regression in the SPSS v.17. Results: Results showed that the existing organizational culture in the selected hospitals was in a moderately good level from nurses' perspectives. From the scores obtained for various dimensions of the organizational culture, the highest and lowest scores were for control (44.2%) and conflict tolerance (31.8%), respectively. Conclusion: The level of the organizational culture from the nurses' perspectives might lead them to decrease the quality of their performance. Optimizing the organizational culture can improve nurses' performance and motivate them to increase their quality of work.

This study is among the few investigations that assesses knowledge and attitudes of faculty members of medical sciences universities regarding plagiarism. This investigation focused on the relationship between personal factors and knowledge and attitudes toward plagiarism among Iranian faculty members of medical sciences affiliated with the Ministry of Health. This descriptive cross-sectional study was performed on 247 participants using demographic questionnaires that collected data on attitudes toward plagiarism and knowledge of plagiarism. The questionnaires were uploaded on Porsline. The subjects were provided with the purpose of the study, informed consent, and the link to the questionnaire through WhatsApp. The mean scores of knowledge variables and different domains of attitude were calculated, and then, the obtained averages were compared in terms of age, gender, and participation in ethics workshop using univariate tests. Finally, the MANCOVA was used considering five dimensions of the questionnaire to assess attitude, as multiple response variables, and independent variables, including gender and participation in the ethics workshop and control of knowledge and age. The mean age of the subjects in this study was 38.9 ± 8.4. 79.4% of the participants were women. Overall, 79.8% of people participated in ethics workshops, of whom 78% were women, and 86.5% were men. The mean score of knowledge in men and women was 1.35 ± 0.19 and 1.56. ± 0.24, respectively, which was higher in women than men (PV <0.001). The mean score of total attitudes was 3.19 ± 0.46. There was a high level of knowledge of plagiarism and positive attitudes toward plagiarism avoidance or prevention among participants in this study, which may spread to students, and help to promote integrity in the educational and clinical environment in Iran. [ABSTRACT FROM AUTHOR]