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Pressure ulcer (PU), as a long-term disabling condition, is an important indicator for patient safety and quality of nursing care in hospitals. This systematic review aimed to evaluate the knowledge, attitude, and practice of Iranian nurses towards PU prevention.A systematic search was conducted on PubMed, Web of Science, Scopus databases, Google Scholar Search Engine, as well as Magiran, Iranmedex, and Scientific Information Database (SID) Persian databases using the relevant keywords, from the earliest date available to August 21, 2020. Studies were appraised using the appraisal tool for cross-sectional studies (AXIS tool).Among a total of 1,543 Iranian nurses included in the 9 studies, 80.53% were female with a mean age of 31.14 (SD = 5.52) years. The mean work experience of the participants was 7.94 years (SD = 5.44). The knowledge and practice of Iranian nurses toward PU prevention were insufficient and relatively desirable, respectively. Also, the present study showed that nurses' attitudes toward PU prevention were contradictory. Age, gender, level of education, work experience, and participation in previous educational workshops were possible factors related to nurses' knowledge about PU prevention. Women with higher work experience had a more positive attitude.This review found inappropriate knowledge, attitude, and practice of Iranian nurses toward PU prevention and highlights the importance of regular upgrading of nurses' knowledge and practice related to PU prevention.

Nursing students experience a number of emotional challenges during their educations, leading to high levels of stress among them. One of the strategies of stress management in nursing students is the use of mindfulness. This study aimed to assess mindfulness and related factors among Iranian nursing students. In a cross-sectional study, 100 nursing students studying at Nasibeh Faculty of Nursing and Midwifery affiliated to Mazandaran University of Medical Sciences, Iran was enrolled. Data were collected via census sampling from May to June 2018. Data were collected using a three-part questionnaire including demographic characteristics, Kentucky Mindfulness Skills scale, and Spielberger State Anxiety scale. Data analysis was performed using descriptive statistics, t-test, Chi-squared, and ANOVA tests. The mean score of mindfulness of nursing students was 117.35 ± 12.89. The mean scores of mindfulness in the dimensions of observation, description, act with awareness, and acceptance without Judgment was 36.33 ± 6.0, 25.68 ± 4.91, 28.17 ± 4.49, and 27.17 ± 3.80, respectively. The mean score of anxiety in nursing students was 14.17 ± 3.78. There was a significant relationship between age and dimension "description" of mindfulness (r = 0.22, p = 0.029). There was a significant relationship between dimension "observation" of mindfulness and experience stressful events during the last six months (t = 2.327, df = 96, p = 0.022). Therefore, due to the importance of mindfulness among nursing students, it is possible to reduce the risk factor by creating the necessary conditions such as continuing education.

This meta-analysis aimed to summarize the evidence regarding attitudes of Iranian nurses and related factors towards end-of-life (EOL) care. PubMed, Web of Science, Scopus, Magiran, Iranmedex, Scientific Information Database, and Google Scholar search engine were searched using Persian and English appropriate keywords from the earliest records up to September 11, 2020. A total of 849 nurses were included in six studies. After a meta-analysis of the mean score of nurses' attitudes, the pooled mean was 80.07 out of 120 (Q(5)=4.32, I-squared=0.00%; 95%CI: 73.53–86.60; p < 0.001). Marital status, ward type, education level, a history of participating in EOL care workshops, personal study of EOL care, experience of caring for a dying family member or close people, natural and approach acceptance, fear of death, and professional autonomy had a significant positive relationship with nurses' attitudes towards EOL care. Therefore, further large-scale studies considering potential confounding variables are needed to confirm our findings.

Background and Purpose: Fatigue control in hemodialysis (HD) patients requires a multidisciplinary approach. This study aimed to comprehensively review the available research literature regarding the nonpharmacological interventions used for reducing fatigue among Iranian HD patients. Methods: In this systematic review, an extensive search of the literature was conducted on PubMed, Web of Science, and Scopus databases, using the keywords related to the purpose. Also, the Persian equivalent of these keywords was searched in Iranian databases, such as Iranmedex and Scientific Information Database (SID) from the inception to June 16, 2020. Results: Of 2,761 articles, 25 studies were included in the review. Among a total of 1,748 Iranian HD patients with a mean age of 54.17 (SD = 12.27) years, 61.38% were male. Interventions such as educational-based programs (n = 5), nutrition-based programs (n = 2), massage therapy (n = 3), exercise-based programs (n = 4), relaxation technique (n = 3), combination of relaxation technique and inhalation aromatherapy (n = 1), energy therapy (reflexology and acupressure) (n = 3), and mind-guided imagery (n = 1) were effective in reducing fatigue in Iranian HD patients. Discussion/Conclusion: These simple, low-cost, and practical interventions can be used for the reduction of fatigue among HD patients by nurses. However, future well-designed studies are recommended to confirm the efficacy of these and other potentially effective interventions for reducing fatigue in HD patients.

Introduction: As the COVID-19 pandemic ravages the world, nursing resources, and capacities play an essential role in disease management. This literature review focuses on the central issues related to the nursing care of patients affected by COVID-19. Material and methods: This literature review was conducted with an extensive search of databases, including PubMed, Web of Science (WOS), and Scopus, using the keywords “COVID19”, “2019-nCoV disease”, “2019 novel coronavirus infection”, “Nurse”, “Nursing Care”, and “Nursing management.” The span of the literature search was between December 01, 2020, and January 12, 2021. A total of 28 original and English-language articles were selected for inclusion in the review. Results: Nursing interventions such as monitoring, oxygen therapy, and the use of Extra Corporeal Membrane Oxygenation (ECMO) in the care of COVID-19 patients, caring for ICU patients with COVID-19, rehabilitation of COVID-19 patients, nurses' experiences and barriers in the care of patients with COVID-19, and also the ethical challenges in the care of patients with COVID-19, were found to be valuable in managing COVID-19 patients. Conclusion: Nurses have a pivotal role to play in the care of patients with COVID-19. Therefore, providing comprehensive and quality nursing care supported by experience and research is necessary to successfully reduce the length of hospital stay and decrease the morbidity and mortality rates of COVID-19. © 2021 EDP Sciences. All rights reserved.

BackgroundMoral distress is a complex and challenging issue in the nursing profession that can negatively affect the nurses’ job satisfaction and retention and the quality of patient care. This study focused on describing the resources and constraints, consequences, and interventions of moral distress in nurses.MethodsIn a literature review, an extensive electronic search was conducted in databases including PubMed, ISI, Scopus as well as Google Scholar search engine using the keywords including “moral distress” and “nurses” to identify resources, constraints, consequences, and interventions about moral distress in nurses, from the earliest records up to 26 December 2020. The required data were extracted from 61 relevant studies by two independent reviewers.ResultsResources and constraints in the occurrence of moral distress among nurses can be divided into three general categories including internal factors, clinical factors, and external factors. The consequences of moral distress on nurses and the medical system reduced moral sensitivity, development of psychological and physical health problems, and the intention to leave the profession. The potential effective interventions were the implementation of integrated communication programs, strengthening physician–nurse collaboration, nursing involvement in clinical decision-making and end-of-life issues, social support, using a resiliency bundle, interdisciplinary discussion, and promoting nurses’ ethical and communication skills.ConclusionThere are a wide range of resources and constraints impacting moral distress in nurses that could lead to negative consequences. Further studies are necessary to identify, evaluate, and implement a range of potential effective interventions for the management of moral distress in nurses.

The present systematic review was conducted to examine self-esteem and related factors in burns patients.A comprehensive search was conducted from the first to the April 1, 2022 at the international electronic databases such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Burns", "Self-confidence", "Self-perception", "Self-esteem", and "Self-concept".A total of 762 burn patients were included in this review from ten cross-sectional studies. The mean score of self-esteem in burn patients based on Rosenberg Self-Esteem Scale, State Self-Esteem Scale, Cooper Smith's self-esteem questionnaire, and Rifai's self-esteem scale were 17.77 (SD = 5.55) out of 30, 65.91 (SD = 5.49) out of 100, 56.68 (SD = 5.49) out of 100, and 109.77 (SD = 9.55) out of 145, respectively. Factors associated with self-esteem in burns patients were gender, occupation, the location of the burn, type of burn, site of burn, burn scar, and quality of life had a significant relationship with burn patients' self-esteem. Factors such as social support, family support, friends support, and supporting others, had a significant positive relationship with self-esteem of burns patient. However, self-esteem in patients with burn had a significant negative relationship with grade of burn injury, percentage of burn, depth of burn, facial burn, post-traumatic stress disorder, psychiatric morbidity, major depressive, and suicidality factors.Overall, patients with burns had moderate levels of self-esteem. Therefore, it is recommended that health professionals use interdisciplinary approaches to better manage burn patients.

This systematic review aimed to summarize the evidence regarding death anxiety (DA) and related factors among nurses. Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) databases were extensively searched using purpose-related keywords from the earliest to October 5, 2021. A total of 6819 nurses were included in 31 studies. The DA of nurses based on the Templer’s Death Anxiety Scale was moderate. Factors such as personal anxiety, frequency and severity of job stress, burnout, dying patient avoidance behavior, euthanasia, sex, mental health status, social desirability, attitude toward the elderly, humor, social maturity, psychological hardiness, quality of life, lack of social activity, self-efficacy, coping with death, and life satisfaction were associated with nurses’ DA. Therefore, nursing policymakers can promote nurses’ health to improve the quality of nursing care by considering these related factors.

BACKGROUND: Coronavirus disease-19 (COVID-19) is the first pandemic infectious disease caused by a novel coronavirus. Viral pneumonia is a severe complication of COVID-19. AIM: Due to the high prevalence of this disease globally, especially in Iran, the aim of this study was to determine the clinical features of seven patients with probable COVID-19 infected pneumonia in Rasht, North Iran. MATERIALS AND METHODS: In this retrospective case series study, we described the clinical, laboratory, and radiological features of seven patients with probable COVID-19 infected pneumonia at Razi Hospital, Rasht, north of Iran, from February 27 to March 16, 2020. RESULTS: In this study, the most common clinical symptoms during hospitalization in patients with COVID-19 were poor appetite (seven cases), dehydration (seven cases), cough (six cases), dyspnea (six cases), fatigue (six cases), fever above 38°C (five cases), myalgia (five cases), Chills (five cases), feeling fever (five cases), sore throat (five cases), and nausea (five cases), respectively. The average body temperature in these patients was 39.32°C. In laboratory findings, erythrocyte sedimentation rate was elevated in three patients. Contrary to most of the evidence, C-reactive protein was not elevated in five patients. All patients received antibiotic and antiviral medications and received symptomatic treatment. Finally, four patients responded to the treatments and were discharged from the hospital; two patients were still hospitalized and only one patient died. CONCLUSION: Patients with COVID-19 associated pneumonia can be treated by evaluating and implementing appropriate therapeutic management. However, at the moment the disease progression for patients with COVID-19 cannot be accurately predicted.

Moral distress (MD) has received considerable attention in the nursing literature over the past few decades. It has been found that high levels of MD can negatively impact nurses, patients, and their family and reduce the quality of patient care. This study aimed to investigate the potentially effective interventions to alleviate MD in critical care nurses. In this systematic review, a broad search of the literature was conducted in the international databases including PubMed/MEDLINE, Web of Science, and Scopus, as well as Google Scholar search engine using keywords such as moral distress, intensive care unit, ICU, nurses, and critical care nurses from 1984, when the concept of MD was first introduced in the nursing literature, up to 29 October 2020. Studies focusing on the interventions for managing MD in critical care nurse were evaluated. The quality of eligible papers was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 8 studies fulfilled the eligibility criteria. Three studies had RCT design and five studies had quasi-experimental design. All studies were conducted in the United States or Iran. Educational workshop, moral empowerment program, social work intervention, nursing ethics huddles, and multifaceted resiliency bundle intervention were effective interventions for managing of MD among critical care nurses. There is limited but promising research evidence evaluating the efficacy of educational interventions for managing of MD among critical care nurses. Although some positive results have been reported, there is limited generalizable evidence due to the variability of interventions. These findings highlight the need for further studies to validate the efficacy of these interventions or develop more potent and efficient interventions for reducing MD in critical care nurses.

The aim of this study is to investigate death anxiety (DA) and related factors among critical care nurses. Using a cross-sectional research design, 325 critical care nurses in eight hospitals in Iran enrolled in the study. Multiple logistic regression analysis showed that deputy head nurse (OR = 18.299; CI: 1.764–189.817; p = .015), shift morning fixed (OR = 8.061; CI: 1.503–43.243; p = .015), surviving parents (OR = 3.281; CI: 1.072–10.037; p = .037), number of children (OR = 1.866; CI: 1.157–3.010; p = .011), years of working experience (OR = 1.143; CI: 1.048–1.246; p = .003), number of end-of-life patient care in the last 3 months (OR = .900; CI: .828–0.977; p = .012), age (OR = .809; CI: .732–.893; p < .001), CCU nurses (OR = .250; CI: .100–.628; p = .003), and mild stressful life events (SLEs) (OR = .167; CI: .046–.611; p = .007) were significantly related to high DA. Therefore, nurse managers and policymakers should pay special attention to these related factors in developing programs to maintain and promote the health of critical care nurses to improve the quality of nursing care.

Today, one of the major ethical challenges facing the world's health care system, and in particular nurses in the intensive care unit, is euthanasia or death out of pity. The aim of this study was to investigate the attitude of Iranian nurses in the intensive care unit toward euthanasia. This was an analytical cross-sectional study using census sampling. The data collection tool was the Euthanasia Attitude Scale. A total of 206 nurses working in the intensive care unit in 4 hospitals in the Mazandaran province of Iran were included in this study. The mean of total Euthanasia Attitude Scale score in intensive care unit nurses was 2.96. The mean euthanasia dimensions were ethical consideration, practical considerations, treasuring life, and naturalistic beliefs, 3.03, 2.92, 2.98, and 2.99, respectively. There was significant but low negative correlation between age and total Euthanasia Attitude Scale score, ethical considerations, and practical considerations. Male nurses exhibited significantly higher Euthanasia Attitude Scale scores, specifically in regard to ethical and practical considerations compared with female nurses. The most Iranian nurses in the intensive care unit had a negative attitude toward euthanasia for patients in the later stages of the disease. However, this opposition was less than similar studies in Iran in the past.

Cardiovascular disease (CVD) is one of the leading causes of premature death in the world.1 Recent advances in medical technology have led to lower mortality and better relative recovery in CVD patients. Today, various invasive procedures are used in cardiovascular interventions such as percutaneous coronary interventions (PCIs), which have led to improvements in the outcomes of CVD patients. However, despite the benefits of cardiovascular interventions, patients need to change their lifestyles. Therefore, patients with CVD need rehabilitation after cardiovascular interventions for complete recovery, which is often overlooked.2 Meanwhile, patients' perception of recovery after cardiovascular interventions is one of the key factors in predicting lifestyle changes in CVD patients. These patients should have a full awareness of a healthy lifestyle about physical activity, alcohol and tobacco use, and diet, as well as a proper perception of recovery after cardiovascular interventions.3 Hence, the results of a randomized controlled trial in the UK that assessed the impact of educational and rehabilitation programs on patients 'perceptions after myocardial infarction (MI) showed that educational and rehabilitation programs can lead to positive changes in patients' perceptions of recovery after cardiovascular interventions and lifestyle after MI, especially after three months of intervention. Also, patients in the intervention group reported fewer symptoms of angina compared to patients in the control group. Overall, educational and rehabilitation programs were effective in changing the perception of CVD patients and improving the functional outcome of patients after MI.4 In contrast, the results of another study in the Netherlands that evaluated the effect of a lifestyle intervention on CVD risk indicators in patients with familial hypercholesterolemia showed that there was no significant improvement between the intervention and control groups (usual care).5 The importance of this issue becomes clearer when these patients undergo invasive cardiovascular interventions. Despite the benefits of cardiovascular interventions, patients need to change their lifestyles. On the other hand, there is a link between patients' perceptions of recovery after cardiovascular interventions and lifestyle changes. Therefore, there is a need for serious attention to patients' perception of recovery after cardiovascular interventions. Obviously, patients' perceptions of recovery after cardiovascular interventions can be an important predictor of their lifestyle changes. However, to our knowledge, studies in this field are very limited. Therefore, it is suggested that researchers in future studies pay special attention to the perception of CVD patients of recovery after cardiovascular interventions as an important predictor of lifestyle changes in them after cardiovascular interventions. References Woringer M, Nielsen JJ, Zibarras L, Evason J, Kassianos AP, Harris M, et al. Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme. BMJ Open. 2017;7(9):e014413. Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, et al. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology. Euro Intervention. 2013;8(11):1242-51. Organization WH. Technical package for cardiovascular disease management in primary health care: healthy-lifestyle counselling. World Health Organization; 2018. Petrie KJ, Cameron LD, Ellis CJ, Buick D, Weinman J. Changing illness perceptions after myocardial infarction: an early intervention randomized controlled trial. Psychosom Med. 2002;64(4):580-6. Broekhuizen K, van Poppel MN, Koppes LL, Kindt I, Brug J, van Mechelen W. No significant improvement of cardiovascular disease risk indicators by a lifestyle intervention in people with familial hypercholesterolemia compared to usual care: results of a randomised controlled trial. BMC Res Notes. 2012;5(1):1-9.

Since December 2019, the COVID-19 pandemic has led to significant mortality in the world. Based on epidemiological data from China, 20% or more of COVID-19 patients had cardiovascular comorbidities. Life-threatening complications due to COVID-19 can develop in these patients. Meanwhile, the risk of complications may be higher in patients with heart failure (HF), who usually have older people and more comorbidities. COVID-19 can lead to myocardial injury and disease exacerbation in HF patients due to a cytokine storm-related hyper-inflammation syndrome.1 Hence, most studies only addressed the prevalence of the cardiovascular disease among COVID-19 patients and less specifically the prevalence of HF. A study in China found that 23% of COVID-19 patients had HF, of which 52% died.2 On the other hand, it has been suggested that COVID-19 may cause heart damage due to the specific condition of HF patients and the characteristics of this syndrome.3 Therefore, it is important to pay attention to the cardiovascular consequences of COVID-19. Despite, the effect of different drug therapies on the outcomes of COVID-19 patients with HF, management of potential interactions between cardiovascular and COVID-19 medication regimens among patients with HF remains an important and challenging clinical issue. In the early pandemic, antiviral drugs such as hydroxychloroquine were widely used to manage COVID-19 infection. Chloroquine and hydroxychloroquine are potassium channel blockers that can prolong QTc and play a role in sudden cardiac death. This process becomes especially dangerous when combined with other treatments, including the QTc prolonging azithromycin and lopinavir/ritonavir. Therefore, HF patients may be at particular risk for sudden cardiac death. In addition, in advanced treatments of HF patients, interactions may occur between COVID-19 and the cardiovascular medication regimen. For example, patients with left ventricular assist devices (LVAD) are usually treated with anticoagulation drugs such as warfarin. Warfarin is a vitamin k antagonist that can interact with some antiviral drugs in the treatment of COVID-19.4 Previous evidences have shown that chloroquine and hydroxychloroquine interactions with cardiovascular drugs such as digoxin and antiarrhythmic drugs are associated with the possibility of HF, QT prolongation, and cardiac arrhythmias.5,6 On the other hand, Remdesivir, which is made to treat Ebola, has shown little potential effect against SARS-CoV-2. Despite the lack of interaction of Remdesivir with HF drugs, it has been suggested that patients receiving Remdesivir be closely monitored due to the risk of QT prolongation and electrolyte disturbances. 1 In sum, previous evidence regarding the potential interactions between cardiovascular and COVID-19 medication regimens among patients with HF are limited and no strong evidence is available. Therefore, further studies are needed to identify these interactions. Given the increasing incidence of COVID-19 in HF patients, it is essential to better understand the interactions between this disease and SARS-CoV-2 in order to manage these patients. Also, a multidisciplinary approach including members of the HF team may lead to better management of HF patients in this pandemic. References Zhang Y, Coats AJ, Zheng Z, Adamo M, Ambrosio G, Anker SD, et al. Management of heart failure patients with COVID‐19: a joint position paper of the Chinese Heart Failure Association & National Heart Failure Committee and the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22(6):941-56. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol. 2020;5(7):831-40. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021;26(1):1-10. Chorin E, Wadhwani L, Magnani S, Dai M, Shulman E, Nadeau-Routhier C, et al. QT interval prolongation and torsade de pointes in patients with COVID-19 treated with hydroxychloroquine/azithromycin. Heart Rhythm. 2020;17(9):1425-33. Mercuro NJ, Yen CF, Shim DJ, Maher TR, McCoy CM, Zimetbaum PJ, et al. Risk of QT interval prolongation associated with use of hydroxychloroquine with or without concomitant azithromycin among hospitalized patients testing positive for coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(9):1036-41.

Ocular trauma is one of the most common causes of acquired blindness in children. The epidemiological parameters associated with ocular trauma vary in different populations, especially in children. The objective of this study was to assess the ocular trauma epidemiology in children less than 18 years of age. In this crosssectional study, 145 children (under 18 years) with ocular trauma who referred to the emergency department of Bu-Ali-Sina Hospital in Sari, Iran were enrolled from November 2017 to January 2019. Of the participants, 57.9% were men, 70.4% had blunt trauma, 97.2% had a unilateral eye injury, and 54.5% had a right eye injury. The most risk factor for trauma was stationery (51.0%). Almost half of the patients (52.9%) had corneal injuries. The most trauma locations were at home (67.4%). Most patients (95.0%) had normal relative afferent pupillary defects. Blunt (52.6% vs. 47.4%) and penetrating (72.5% vs. 27.5%) traumas was higher in boys than girls (p=0.03). Most frequent part of eye injuries in blunt and penetrating traumas was related to the cornea (P=0.04). It seems that parents should have more supervision on children at home and give adequate education in using of stationery to school-age children by considering the results of present study.