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Because students are important elements and the main audience of higher education, their satisfaction with how nursing education can be provided can be considered an indicator of student satisfaction. In this regard, a study has been conducted on the satisfaction of undergraduate nursing students with how-to education. This study is a qualitative study conducted with the participation of ten nursing students (second to the fourth year). Data were collected using semi-structured interviews, and the contractual content analysis method was used to analyze the data. The findings of the study showed that the students were dissatisfied with how provided nursing education. The most important causes of student dissatisfaction are academics/educators and educational environments. According to the findings of the study, to reform and upgrade the educational system, the quality of educational environments and professors must be constantly reviewed and evaluated.

Background: Nursing organizations are an essential part of the nursing profession. The main mission of nursing organizations is to establish new nursing roles based on changes in societal needs. This study conducted a situational analysis of the nursing organizations' life cycle and their effects on nursing role development in Iran. Methods: This study used a grounded theory methodology called situational analysis based on the Clack framework (2018). The sources of data collection included interviews, analysis of documents at Dr Madah Association and the National Library of Iran, statistics, government documents, international reports, and historical articles about nursing organizations, as well as reports on the role of licensed practical nurses (LPNs) and registered nurses (RNs). Data were collected through semi-structured and in-depth interviews with 33 nurses. Interviews continued until data saturation was reached. Results: Researchers identified 7 trends that reflect the evolution of nursing organizations and the health care system, as well as the factors that influenced the development of nursing roles. The 7-step trends were marked with letters A to G. Each letter indicated a map of concepts related to the role of nursing. Conclusion: The process of developing the role of nurses in Iran, at the senior management level, struggles with the unbalanced distribution of budget in the health system. Therefore, nursing leaders need to foster their interaction and diplomacy to be able to strike a balance between the micro, middle, and macrostructures of nursing.

ObjectivesAlthough nurses work and live in special and stressful conditions due to the nature of their profession, in periods of crises and pandemics, when the work pressure on nurses and the public’s need for professional services increases to extraordinary and incomparable levels compared to customary conditions, their work and life situation becomes entirely different. Therefore, what nurses experienced in the COVID-19 pandemic went beyond the typical challenges of their work environment. This study was conducted to discover nurses’ perceptions of work and life during the COVID-19 pandemic.MethodsThis qualitative study was conducted with a conventional content analysis approach on 16 nurses working in the inpatient wards during the COVID-19 pandemic in Iran. Data were collected through unstructured, individual, and in-depth interviews between August 2020 and June 2023 and were analyzed using content analysis with the conventional (inductive) approach of Granheim and Lundman.ResultsData analysis led to the extraction of 11 subcategories, namely, “feeling a lack of support and understanding from managers,” “team cooperation and communication challenges in difficult work conditions,” “shadow of burnout,” “shortage inequity,” “dissatisfaction with unfair wages and benefits,” “not having their work and sacrifices appreciated,” “suffering and fatigue of using personal protective equipment (PPE),” “deprivation of entertainment and rest,” “fear of illness and imminent death,” “low resilience,” and “deteriorating life conditions” These 11 subcategories led to the following themes: “unsafe work environment” and “the shadow of suffering and death.”ConclusionNurses working in COVID-19 wards in Iran worked in an unsafe work environment during the COVID-19 pandemic and had to deal with suffering and fear of death. It is necessary to pay attention to the needs and problems of nurses, and healthcare organizations must provide the required support to maintain the physical and mental health of nurses during epidemics.

Abstract Aim This study aimed to explore the barriers to the implementation of patient‐centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. Design This study was performed with a descriptive qualitative study approach. Methods In this study, the data were collected through face‐to‐face in‐depth semi‐structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. Results After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.

Abstract Aim Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon. Design This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis. Methods Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach. Results Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho‐emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.

Background: Most parents consider adolescence to be the most difficult stage of parenting. Parental practice is a determining factor in adolescents’ outcomes. Mothers play the main role of parenting in Iran. Coinciding the transition of adolescence with the transition of middle-aged mothers can affect the mothers’ parenting practice. The present study aimed at explaining the Iranian mothers’ practice in parenting an adolescent child. Methods: This qualitative conventional content analysis was conducted from July 2018 to November 2019 in Kashan. 21 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. The data were analyzed through conventional content analysis. Data collection and analysis were performed simultaneously using MAXQDAv10 software. Results: Regarding the study objectives, two themes and six main categories were identified. The theme of ‘laying the groundwork for upbringing’ was detected by two main categories: ‘meeting the needs and ‘effective interaction with the adolescent’; also, the theme of ‘individual-social capacity building’ was explained by four main categories: ‘helping to gain independence’, ‘modeling individual-social behavior’, ‘socializing the adolescent’, and ‘preparing to accept future roles’. Conclusion: Mothers’ practice was mainly focused on adolescents’ independence, college education, career prospects, and marriage preparation and respect for older adults. Consistent with this transition to modernity, and contrary to the collectivist values of Iranian society, mothers’ practice was in line with developing adolescents’ independence and building their self-confidence, which is close to the authoritative parenting style.

Objectives: In elderly care provided by health centers, healthy elderly are neglected in care and education. This qualitative study aimed to standardize healthy ageing care. Methods & Materials: This community-based participatory research with 4 steps (problem detection-design of change programs-implementation of interventions-evaluation) was conducted from 1395 to 1397 in Motahari Health Center of Mashhad, with the participation of 11 health care provider, 54 healthy elderly and 54 family members. The Mean±‌SD age of caregivers was 32.4‌±2.7 years and their mean work experience was 8.3 years. The Mean±‌SD age of the elderly was 64.3‌±‌3.9 years. Data were collected through SERVQUAL questionnaire, interviews, focus group discussions, and field notes. After identifying problems through interviewing 8 staff and 19 seniors, Group discussion sessions were held to design the program. After implementing the change plans, 30 interviews with the participants were conducted again and the comparisons were done and evaluated before and after the change plans. For qualitative content analysis, the method of describing reality was used, and for analyzing quantitative data, descriptive statistics and paired t-test were used. Results: Designed program care could be improve healthy aging care in the health center environment by modifying attitudes, skills and staff empowerment. The Mean±‌SD of quality of care for the elderly and their families in the pre-intervention phase was 63.02‌±‌9.46 and 61.83‌‌‌±‌9.05, respectively. In the post-intervention phase, these values reached 130.19‌±‌14.75 and 122.65‌±‌13.56, respectively, which were statistically significant (P=0.001). Conclusion: The community-based participatory research promoted the quality of elderly services with features such as active, participatory, continuous, comprehensive and supportive care. So this model can be used in other health centers.

Introduction: Breast cancer is a multidimensional crisis that affects not just the patient, but the spouse and other family members. Coping with this phenomenon, as one of the important challenges for the families and spouses, requires investigation. Understanding more about how spouses of women with breast cancer cope with this crisis could lead to better performance of spouses in front of their wives and raise their wives’ quality of life.Purpose: The study was conducted to explore the concept of coping based on the lived experiences of spouses of women with breast cancer.Methods: This qualitative study was conducted with a phenomenological approach in Hamedan and Rasht cities in Iran in 2019. Participants included 20 spouses of women with breast cancer selected by a purposive sampling method. Data were collected through unstructured face-to-face interviews and analyzed using van Manen’s six-stage phenomenological method. Results: The lived experiences of participants showed that the phenomenon of coping in spouses of women with breast cancer included five themes: Emotional pain, Shouldering the burden of care, Striving for family life cohesion, Future in ambiguity, and Sense of loss of self concept. Understanding the concept of coping in the spouses of women with breast cancer in health strategies can help wives achieve effective adaptation and also help professionals take effective measures in the field of medical care for patients and their spouses.

Introduction : Le cancer du sein provoque une crise multidimensionnelle qui ébranle non seulement la patiente, mais aussi le conjoint et les autres membres de sa famille. Il convient donc d’étudier l’adaptation à ce phénomène, qui constitue l’une des principales difficultés pour les proches. En comprenant mieux comment les conjoints de femmes atteintes d’un cancer du sein font face à cette crise, ces derniers pourraient mieux prendre soin de leurs épouses et améliorer leur qualité de vie. But de l’étude : L’étude visait à explorer le concept d’adaptation à partir d’expériences vécues par les conjoints de femmes souffrant d’un cancer du sein.Méthodologie : Cette étude qualitative a été réalisée en 2019 selon une approche phénoménologique dans les villes de Hamadan et Rasht, en Iran. Le groupe de participants comptait 20 conjoints de femmes atteintes du cancer du sein, recrutés grâce à une méthode d’échantillonnage par choix raisonné. Les données ont été recueillies au moyen d’entretiens non structurés en personne; elles ont été analysées à l’aide de la méthode phénoménologique en six étapes de van Manen. Résultats : Les expériences vécues par les participants ont montré que le phénomène d’adaptation des conjoints au cancer du sein de leur femme se décline en cinq thèmes : souffrance émotionnelle, fardeau des soins, maintien de la cohésion familial, incertitude de l’avenir et sentiment de perte du concept de soi. La compréhension du concept d’adaptation chez les conjoints de femmes atteintes du cancer du sein dans les stratégies de santé peut aider les femmes à bien s’adapter, tout en aidant les professionnels à adopter des mesures efficaces dans le domaine des soins médicaux, pour les patientes et leurs conjoints.

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

Abstract Background Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. Method For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman’s method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. Results From content analysis, 3 main categories; considering patient’s spirituality, maintaining patient’s dignity during care, and reducing patient’s suffering, were found. The essence of these categories reflect on the care-providers’ consideration and effort in “inducing a sense of worthiness” in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. Conclusion For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.

Objectives: In the geriatric care provided in health centers, the healthy elderly are neglected. This qualitative study aims to improve the quality of geriatric care for the healthy elderly. Methods & Materials: This community-based participatory study was conducted from 2016 to 2018 with the participation of 11 healthcare providers, 54 older people and 54 family members in Shahid Motahari Comprehensive Health Center in Mashhad, Iran. The mean age of healthcare providers was 32.4±2.7 years with a work experience 8.3 years. The mean age of the elderly was 64.3±3.9 years. Data were collected using the SERVQUAL questionnaire and interviews, focus group discussions, and field note taking. After identifying the problems through interviews with 8 personnel and 19 older people, group discussion sessions were held to design the change programs. After implementing the change programs, 30 interviews were conducted with the participants and comparisons were made before and after the programs. Descriptive statistics was used to analyze the qualitative data, and descriptive statistics and paired t-test were used to analyze the quantitative data. Results: The mean total score of service quality according to the elderly and their families in the pre-intervention stage was 63.02±9.46 and 61.83±9.05, respectively. These values reached 130.09±14.75 and 122.65±13.56 in the post-intervention stage, and this difference was statistically significant (P=0.001). The presented dynamic care model was able to improve geriatric care for the healthy elderly in the comprehensive health center by modifying the attitude, skills and empowerment of staff. Conclusion: The dynamic care model can improve the quality of geriatric services for the healthy elderly with features such as active, participatory, continuous, comprehensive and supportive care. It can be used in other health centers.

Background: The elderly health care services provided in public health centers neglect the care and education of the healthy elderly. Aim: This qualitative study aimed to improve the quality of public health services for the healthy elderly. Method: This participatory action research was conducted on 11 health care workers, 54 elderly participants, and 54 family members in Motahhari Comprehensive Health Services Center of Mashhad, Iran, within 2016-2019. Data collection tools were the SERVQUAL questionnaire, interview, focus group discussion, and field note-taking. After the identification of the problems through interviews with participants, the sessions of focus group discussions were held to design the program. After executing the change programs, evaluations were repeated to compare pre-change and post-change situations. Qualitative content analysis was performed using the reality description method, and quantitative content analysis was conducted by descriptive statistics and paired t-test. Results: The mean values of age and work experience of the health care workers were reported as 32.4±2.7 and 8.1±1.7 years, respectively. Using the developed care files, the non-specialist routine care was transformed into standardized organized care based on the needs of the healthy elderly. In the pre-intervention phase, the mean scores of service quality from the perspective of the elderly participants and their families were 63.0±9.4 and 61.8±9.0, respectively. In the post-intervention phase, the aforementioned figures statistically increased (P=0.001) to 130.1±14.7 and 122.6±13.5, respectively. Implications for Practice: The quality of health care services for the healthy elderly improved by encouraging the participation of the elderly and their families in the care process. This approach can be used in other public health centers.

Background: Understanding nurse managers' supportive strategies for managing nursing errors can facilitate the improvement of nursing care quality and patient safety. Objectives: This study aimed to explore nurse managers' supportive strategies for nursing error management (NEM). Methods: This descriptive qualitative study was conducted on twenty nurse managers and two nurses purposively recruited from teaching hospitals affiliated to Urmia University of Medical Sciences, Urmia, Iran. The data were collected via in-depth semistructured interviews and concurrently analyzed via conventional content analysis. Results: Nurse managers' supportive strategies for NEM were overlooking nurses' errors to promote their obedience, prioritizing nursing care measures to reduce errors, error prevention training rounds during shift handover instead of error reporting, and alternative disciplinary measures instead of error reporting. These strategies were conceptualized as protective disciplinary exchange. Conclusion: Protective disciplinary exchange denotes that nurse managers prefer to manage nursing errors with flexibility. This situational communicative strategy helps nurse managers protect their staff resources and maintain their positions.

Background: The health system in Iran faces specific challenges as the managerial role of head nurses have changed. The importance of this role cannot be underestimated for the healthcare organizations' success. The present study was conducted to explore the meaning of managerial competence of head nurses in intensive care units (ICU) in Iran. Materials and Methods: This study used a qualitative approach. We extracted the lived experience of ten Iranian ICU head nurses. Data were collected through unstructured in-depth interviews from 2014 to 2015. Interviews were recorded and transcribed verbatim and were interpreted using Van Manen's six-step approach. Results: The expansion and clustering of 442 initial themes led to the emergence of 35 secondary themes, nine subthemes, and three main themes. Managerial competence – theme included “self-excellence,” “ward excellence,” and “intensive care excellence.” Conclusions: The “managerial competence of ICU head nurses” is a dynamic concept that reflects the psychological and functional capability of head nurses in contributing towards excellence in their own critical care practice as well as that of the ward. A competent head nurse has outstanding personal and nursing attributes and holistic knowledge, and is also committed to the ongoing professional improvement of him/herself. Using their ability to facilitate interpersonal and interprofessional communication effectively, a head nurse seeks the psychological, physical, and human optimization of the ward in which he/she works. Therefore, the goal of providing insightful critical care through smart organization and planning of nurses and other personnel can be achieved.

Background: The provision of optimal care is the most important goal in nursing, the fulfillment of which requires the identification of clients’ problems and needs. However, based on the review of the literature, no review study has investigated the problems and needs of the infertile patients in Iran. Aim: The purpose of the present study was to investigate the problems and needs of the infertile patients referring to the assisted reproduction centers. Method: This review study was based on the traditional review procedure developed by Cronin et al., which entails five steps including: 1) choosing the topic of the review, 2) searching the manuscripts, 3) collecting, reading, and analyzing the texts, 4) writing the review, and 5) providing references. The articles published within 2003-2017 were searched in such valid databases as Google Scholar, Pub Med, Science Direct, Ovid, and Cochran. The inclusion criteria in this study were articles in Persian and English with the keywords referring to problems and needs of clients. Out of the 350 original articles, 31 cases were finally selected for this review study. Results: In general, the infertile patients’ problems were placed under four domains of mental-psychological, social, marital, and financial factors. The needs of the infertile individuals were grouped into six domains of physical, care, informational, financial, mental-psychological, and spiritual factors. Implications for Practice: The identification of the patients’ problems and needs can lead to the conceptualization of strategic points targeted toward the delivery of effective interventions facilitating the provision of patient-centered infertility care. This can enhance the quality of life and lower the levels of stress during the course of treatment.

Introduction: Governments and professional organizations have called for new partnerships between health care providers and academics to improve clinical education for the benefit of both students and patients. To develop a substantive grounded theory on the process of forming academic-service partnerships in implementing clinical education, from the perspective of academic and clinical nursing staff members and managers working in Iranian settings. Methods: The participants included 15 hospital nurses, nurse managers, nurse educators, and educational managers from two central universities and clinical settings from 2009 to 2012. Data were collected through 30 in-depth, semi-structure interviews with the individual participants and then analyzed using the methodology of Strauss and Corbin’s grounded theory. Results: Utilizing “balancing power” as the core variable enabled us to integrate the concepts concerning the partnership processes between clinical and educational institutes. Three distinct and significant categories emerged to explain the process of partnership: 1) divergence, 2) conflict between educational and caring functions, and 3) creation of balance between educational and caring functions. Conclusions: In implementing clinical education, partnerships have been formed within a challenging context in Iran. Conflict between clinical and educational functions was the main concern of both sides of the partnership in forming a collaborative relationship, with our findings emphasizing the importance of nursing educators’ role in the establishment of partnership programs.

Background: Regarding nurses' significant role in improving quality of marital life in mastectomy patients and their families, implication of the adaptation model can help nurses reaching this goal. Aim: This study aimed to determine Effect of an educational-supportive program based on Roy This quasi-experimental study was performed on 69 mastectomy patients receiving chemotherapy in 2013 in clinical services in Tehran, Iran. The samples were randomly allocated to two groups. The data collection instrument was ENRICH Marital Satisfaction scale (2011). In the experimental group, maladaptive behaviors and their stimuli were determined by the questionnaire, and then adaptive strategies were implemented in 45 days. The program was based on support (patients instruction), peer group, weblog, meeting with the participants’ spouses, and three-month follow-up using behaviors checklist. Control group patients received the regular treatment sessions. T-test, Pearson’s correlation coefficient, Spearman's rank correlation coefficient, and Chi-square tests were run, using SPSS version 19. Results: In experimental group, paired sample t-test reflected an increase in marital satisfaction from 24.7±2.6 before to 32.9±3.5 after the intervention (P=0.03). However, no significant differences were observed in the control group from 26/7±4/6 before to 26/5±4/8 after the intervention in this regard (P=0/63). Implications for Practice: Roy Adaptation Model can be used as a framework for designing educational-supportive programs to improve quality of marital life in mastectomy patients receiving chemotherapy.

Introduction: Nursing students require highly specialized competencies to accurately determine patients' states and to predict and cope with problems that may occur during nursing care. This study explores the definition, domains, and levels of nursing students' competency. Methods: This study was a systematic review of nursing students’ competencies in English (ISI, SCOPUS, Ovid, Proquest, Iranmedex, Google scholar, PubMed) and Persian (Scientific Information Database) databases (1985–2015), according to the University of York Center for Reviewers and Dissemination Guidance approach, 2008. Results: From a total of 13,115 articles, 20 were retrieved in the final step. The individual experiences, dynamic process, and positive interactive social and beneficial changes in the equality of one’s professional life that cause meta-cognitive abilities, touch reality, motivation, decision making, job involvement, professional authority, self-confidence, knowledge and professional skills formulated the definition of nursing students' competency. Educational, cultural, individual, professional and inter-professional, research, clinical and practical domains were defined as belonging to nursing students' competency. Seven nursing student competency levels were identified. Conclusion: Although the definitions of competency, its domains, and its levels vary by profession and country, this systematic review demonstrated the comprehensive ones in three scopes. However, more research is needed to examine the three scopes in the nursing student competency concept.

Background: Nausea and vomiting are the worst and the most prevalent complications experienced by 70–80% of patients. Complementary treatments including therapeutic touch are cost-effective and low-risk, independent nursing interventions. Present research aims at investigating the effect of therapeutic touch on the intensity of acute chemotherapy-induced vomiting in these patients. Materials and Methods: As a single-blind, randomized clinical trial, the present research was carried out on women with breast cancer undergoing chemotherapy in Isfahan, Iran. The subjects were divided into three groups of control, placebo, and intervention. The intervention was applied to each patient once for 20 min on the aura (human energy field) focusing on solar chakra. Data gathering instruments included demographic questionnaire and acute vomiting intensity scale. Results: There was a significant difference among the three groups (and also after the intervention) (P < 0.0001). Paired comparisons among the groups using Mann–Whitney test showed that there was a statistically significant difference between the control group and the intervention group and between the control group and the placebo group (P < 0.0001). However, there was no significant difference between the placebo and intervention groups (P = 0.07). Conclusions: Therapeutic touch was effective in reducing vomiting in the intervention group. However, the patients experienced lower-intensity vomiting which may be because of presence of a therapist and probably the reduced anxiety related to an additional intervention. So, further research is recommended considering the placebo group and employing another person in addition to the therapist, who is not skilled for this technique.

Introduction: Today, interprofessional collaboration and team care as well as interprofessional education are inevitable necessities for addressing healthcare needs of societies. Due to a contradiction between the need to provide team care at health centers and the lack of prioritization and implementation of team-based and interprofessional approaches to education in the health system, this study was conducted to explain the barriers to implementation of team care and interprofessional education in Iran from the viewpoints of educational managers of the health system. Methods: This qualitative content analysis study with a conventional approach was carried out from August 2013 to Jul 2014. The data were collected through semi–structured individual interviews with 16 educational managers and researchers in universities of medical sciences and medical education development centers who were selected by purposive sampling. All interviews were transcribed word by word and then analyzed using MAXQD software. Results:Two categories and eight subcategories were identified explaining the barriers to implementation of team care and interprofessional education from educational managers’ viewpoints. The two main categories included cultural-attitudinal barriers and structural-functional barriers. The first category consisted of subcategories such as weakness of systemic thinking, individualistic culture, profession-orientedness, physicians’ predominance, and role models. The second category included subcategories of management structure, stunted growth of educational management, inadequate understanding and weak evidence. Conclusion:Existent barriers and their influence on each other have prevented the implementation of team care and interprofessional education by creating a vicious cycle. Since the cultural and attitudinal changes occur over a long period, it is necessary to move towards changing the culture and attitudes and implementing team care and interprofessional education through restructuring the educational management as well as implementation of interprofessional education pilot programs and developing research and evidence accordingly.

Background and Objective: Emphasizing on technology progress and growth in medical sciences on cardio-pulmonary resuscitation, unfortunately, the survival rate of patients and the resuscitation outcomes are still poor. Accordingly, it seems that education for nursing promotion in emergency department is paramount importance. Thus, the present study was conducted on evaluating the effect of competency-based-Training program on resuscitation outcomes. Material and Methods: This pre-experimental study was carried out in medical-training hospitals of Golestan University of Medical Sciences, 2011. The nurses selected via convenience sampling were allocated to case (n=15) and control group (n=15). The instruments were the forms of registration and report of cardio-pulmonary resuscitation. Competency-based-Training program was conducted for case group. The data recorded in before program and after four months was analyzed by SPSS16 software, using descriptive (Frequency, mean, standard deviation) and inferential statistics (Wilcoxon, Mann-Whitney, Chi-square). Results: The short and long term resuscitation outcomes in case group were increased from 8.8% and 4.6% to 20% and 15.6%, respectively. wilcoxon test showed that the difference was significant (p=0.001).Also, Mann-Whitney test revealed that the difference between short and long term resuscitation outcomes was significant between two groups following 4-months (P=0.03). Conclusion: Based on the results , competency-based-Training program can be effective in short and long term resuscitation outcomes. Hence, it is recommended that this program be performed to upgrade nursing level.

Introduction: There are many challenges and ambiguities on family of grounded theory (GT) notwithstanding their reputation. Learners of bases and methods and commitment to a specific method are necessary because of the vying nature of different approaches. The aim of this article is to know the traits of Classic GT and to help to differentiate Classic GT from other similar methods. Methods: This article is a traditional review on some of key articles and books of Glaser about Classic GT. Seventeen of Glaser’s books and articles have been used in this article. Results: Two Main concerns of Glaser are “avoidance of force” and “differentiation between classic method and qualitative research methods and other GT methods too”. He has tried to solve these two concerns providing proper strategies in any stage. Conclusion: For doing a quality GT research, knowing and commitment to basic principles and details of this method is necessary. Setting the assumptions aside and avoiding the generalization of qualitative research and other members of GT family to classic GT is one of important basic principles for doing successful classic GT research.

Background and aims: Damaged nurses’ professional identity is caused dissatisfaction for nursing students in learning environment. Then, their behavioral disorders will be weak clinic care function, motivation decrease, a little attempting for learning in nursing care and a low pleasure in learning environment. The aim of this study was to explore the effects of professional identity on nursing students’ clinical learning. Methods: In this analytic-discriptive study, a purposive sample of 25 nursing students was selected from the Faculty of Nursing and Midwifery of Tehran and Shahid Beheshti Universities. Data were collected using the semi- structured interview method. Study data were analyzed by employing the conventional qualitative content analysis approach. Results: The current findings fell into one main theme entitled damaged professional identity. This theme consisted of two categories: ‘trampled individual and social status’ and ‘nurses’ inability to make their voices heard’. Conclusion: Nursing educators and managers can use the study findings to develop strategies for promoting students professional identity and clinical learning using damaged professional identity model.

Introduction: Extensive changes in the health field have compelled many organizations of health sciences education to seek for the most effective educational approaches. Meanwhile, interprofessional education as a novel and efficient approach has recieved attention internationally. We conducted this study for introducing interprofessional education with a focus on its backgrounds and formation in health sciences. Methods: This integrative review study was performed during years 2012-2013 using an integrated search in PubMed, CINHAL, Ovid, and Science Direct databases. Moreover, google search engine was also used for searching in various information sources such as validated journals and conference proceedings and reports of educational organizations and assemblies, using main key words such as interprofessional education and interprofessional learning, limiting the results from 1995 to 2013 and mainly in English. We obtained more than 2000 titles including original articles, reports, web pages, letters to editor, and books. Having titles and abstracts assessed, 120 documents that were more appropriate and directly related to the study question were selected and analyzed through qualitative content analysis. Then the text contents were retrieved and final results were categorized and managed by MAXQDA software. Results: Two themes were obtained indicating the formation of interprofessional education in the health system. The challenges theme containing 4 categories: dynamic changes in all aspects of human society, poor quality of care services, staffing crisis, and failures of uniproffessional education. The second theme named constructive strategies containing 4 categories: improvement of interprofessional interactions, promotion of interprofessional collaborations, patient centered team care, and changing in professional socialization process of health sciences students. Conclusion: Interprofessional education with focus on interprofessional interactions and promotion in professional socialization process of health sciences students provides necessary competency and ability for developing interprofessional collaborations and comprehensive patient-centered team care among graduates for addressing challenges in health systems.

Introduction: Self-management education is the key component of diabetes care. Furthermore, high levels of patient non-compliance or non-adherence to the treatment regimen suggest that patient education for self-management is faced with some shortcomings. This study aimed to identify barriers to effective diabetes self-management education. Methods: This is a traditional review of published studies during 1990-2010 on barriers to diabetes self-management and control. Electronic search through Iranian and international databases was done. Results: Barriers to effective diabetes self-management education were put in two main categories including patient-related barriers and caregiver-related barriers. The most common patient-related barriers are demographic barriers (such as age, sex, education, and health literacy), financial problems, lack of attention to the disease, psychological problems, and insufficient knowledge. Patient-caregiver relationship, inadequate knowledge, and high workload were caregiver-related barriers. Conclusion: The results of this review introduced a variety of factors that can affect the effectiveness of diabetes self-management education. Patients and caregivers are facing serious challenges due to these barriers. Understanding and attemping to overcome these barriers may help us to empower patients to achieve self-management.

Background & Aim: Implementation of the motivational program by nurse managers can improve nurses&apos performance and behaviour, provide better care for patients, and promote patients&apos satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients&apos satisfaction. Methods & Materials: This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed (α=0.72). Fourty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1) determining nurse managers&apos expectancies from nurses, assessing nurses&apos attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses&apos performance 2) implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses&apos performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16. Results: There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention (P

Background & Aim: Implementation of the motivational program by nurse managers can improve nurses' performance and behaviour,provide better care for patients, and promote patients' satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients' satisfaction.Methods & Materials: This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed (α=0.72). Fourty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1) determining nurse managers' expectancies from nurses, assessing nurses' attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses' performance; 2) implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses' performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16.Results: There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention (P

Introduction: Clinical education is the duty of academic and clinical organizations and its effectiveness is influenced by the interaction of both organizations. Since the commencement of nursing profession, this interaction has experienced different paradigms. This paper is an endeavor for identification and critical analysis of these paradigms as well as the current trends of the interactions between educational and clinical institutions. Exploration of these patterns and their advantages and disadvantages could help the administrators of educational and clinical institutions in designation and choice of appropriate relationship paradigms. Methods: For this narrative review, an electronic search within three phases was performed in January 2008 to retrieve studies published from 1990 to 2008 through these databases: ISI Web of Science, Medline, CINAHL, ERIC, and BNI. The key terms were clinical education, clinical practice models, clinical education model, models of shared learning in clinical practice, and partnership between university and clinical institutions. These articles were studied several times to identify and derive the type of communicational paradigm, significant characteristics, manners of communication, advantages, and disadvantages. Results: Four paradigms of communication between educational and clinical institutions in nursing profession were identified. These included service-orientation, organizational independence, shared models of clinical education, and intra-organizational partnership paradigm. Conclusion: A developing trend can be identified which is influenced by factors such as professional progress in nursing and changes in community expectations. The need for professionalism and expanding the body of knowledge in nursing makes it necessary to maintain nursing schools. The trend of communication paradigms is toward the establishment of partnership between these two independent organizations.

Introduction: Parthnership in clinical education is a duty for all those involved in providing health care. Nurses’ involvement in clinical education can reduce the gap between theory and practice. This study aimed to identify the mechanisms used by nursing educators to attract staff nurses’ parthnership in the delivery of clinical education. Methods: This is a qualitative content analysis study performed in year 2009. Fifteen nursing clinical educators, staff nurses, educational managers, and nurse managers of Mashhad University of Medical Sciences and Tehran University of Medical Sciences participated in this study. Data was collected through semi-structured interviews. Primarily, purposeful sampling was performed and continued using snowballing method and continued until data saturation. All interviews were recorded and subsequently transcribed. The analysis was carried out by qualitative content analysis method. Results: Six themes were discovered through rich and deep descriptions by participants. These include acquiring skillfulness supremacy, being realistic, commitment and responsibility, modesty, using other nurses’ experiences, and assertiveness. Conclusion: Nursing educators use their special approaches to make effective and appropriate personal and professional relationships with clinical nurses and transfer their experiences to the students. These personal mechanisms should be systematically supported through incorporation within organizational programs shared by academic and clinical institutes. This will enhance the efficacy of nursing educators in accomplishing their clinical role

Aims: Reforming and improving the patient education process need more insight into the strengths and weaknesses of the existing education process. There is little documentation on patient education in National Diabetes Prevention and Control Program in Iran, so the present study aimed to describe patient education process in diabetes centers in one of the provinces of Iran. Materials and Methods: This is a qualitative content analysis. Twelve nurses who work as diabetes nurse educators (DNEs) and an internal medicine specialist participated in this study. Data was obtained through semi-structured face-to-face interviews, a focus group, existing documents, field notes, and multiple observations. Data analysis was guided by the conventional approach of qualitative content analysis. Results: Three main themes including unequipped trainers (insufficient knowledge and experience, lack of appropriate educational facilities, lack of time, lack of patient′s interest), unstructured education (lack of educational need assessment, lack of evaluation, lack of continuing patient education), unmanaged education (lack of official planning for patient education and supervising the education process) emerged from qualitative content analysis. Conclusions: Although patient education is one of the important strategies in National Diabetes Prevention and Control Program, there however has not been necessary investment and adequate space to achieve it. Patient education was not structured and based on scientific principles. Training of diabetes nurse educators (DNEs) is neglected, and there is no supervision on patient education process.

Objective(s): To explore nursing staffchr('39')s perspectives about spiritual mode of job satisfaction. Methods: This was a qualitative study. Data was obtained through interviews, which were recorded and subsequently transcribed. The analysis was carried out by the qualitative content analysis. Results: Five mater themes emerged from the data analysis: spiritual joy & interest, patients as bless of God, spiritual assurance, spiritual remuneration, and spiritual repugnance. Conclusion: Spirituality as an important and integral aspect of nursing profession was supported in this study. Spirituality is the inner, intangible dimension that motivates staff nurses to search for meaning and purpose, and establish positive and trusting relationships with patients and God.

Introduction & Objective: Nowadays, families of patients with bipolar disorders are actively participating in the care of their relatives. Successful management of bipolar disorder in the community relies significantly on family caregivers. The needs and experiences of such caregivers have been little studied with respect to bipolar disorder. The aim of the study was to identify the family caregivers’ needs of patients with bipolar disorder. Materials & Methods: This study is a qualitative research of phenomenological methodology in which the caregivers taking care family members with bipolar disorder in Farshchian psychiatric hospital in Hamadan were selected through purposive sampling. In order to reach data saturation,we interviewd 12 persons . Data were gathered through in-semi unstructured interviews and analyzed by "Colaizzi” method. Results: Five groups were identified in this study analysis: illness management, counselling, economical needs, persistent care, and social attention & perception. Conclusion: Identification of the needs of caregivers taking care of family members with bipolar disorder let the health providers choose the specific caring interventions that are effective in sustaining family care giving cycle.

Background & Aim: One of the primary tasks of the managers is staff motivation in order to improve their performance to a high level. It has been staff struggles to accomplish the organizational goals and decisions. The “goal setting theory” has designed for this aim. The purpose of this study was to examine the effect of implementing “Goal Setting Theory” by nurse managers on staff nurses’ job motivation. Material & Method: This study was quasi-experimental one in which 51 nurses from one hospital were allocated to either experimental (n=30) or control (n=21) group. The two groups were compared before and after intervention for their job motivation. The instrument, measuring job motivation with 48 items, was used after providing content validity and reliability ) r= 0.80 ( . In order to avoid exposure bias, at first, job satisfaction in control group in two times were measured. Then, the intervention (goal setting theory) was implemented by subjects of experimental group for three months in three stages a) nurse managers development, b) staff nurse development, c) implemented discharge planning as a “goal” by staff nurse. Data were analyzed by SPSS. Results: The results showed that the level of staff nurse job motivation in two groups before intervention were moderate and two groups were homogenous (P=1.000). After intervention, the level of staff nurse job motivation in control group did not changed (P=1.000), but in experimental group, the level of staff nurse job motivation was significantly increased to a higher level (P=0.000). Conclusion: Implementing the “goal setting theory” based on the methods used in this study showed that whenever nurse managers had a specific and clarified goal for nurses, the level of job motivation in staff nurse increased to a higher level.

Introduction: Fostering critical thinking and Metacognition is one of the most important objectives in nursing education. This study was designed to investigate the effect of guided reciprocal peer questioning on nursing students' critical thinking and Metacognition skills. Methods: In this quasi experimental study, the experiment group included 30 nursing students in their 6th semester in Birjand Islamic Azad University. Two credit courses were presented in this group using guided reciprocal peer questioning. In the control group which included 28 nursing students, those two credit courses were presented using the routine lecture method. California Critical Thinking Skills Test (CCTST) (form B) was used for evaluating critical thinking skills, and metacognition was evaluated before and after interven-tion by metacognitive awareness questionnaire. The statistical analysis was done by SPSS software. Descrip-tive statistics, t-independent test, paired t-test Chi-square, Mann Whitney, and Kappa were used in this study. Results: Performing guided reciprocal peer questioning led to a significant increase in critical thinking skills scores in the experiment group compared to the control group. In spite of the increase in the mean score of metacognitive awareness of the experiment group, comparing the mean difference of pre and post tests in the two groups showed no significant difference. Conclusion: Using guided reciprocal peer questioning in the education of nursing students may lead to developing critical thinking skills as one of the important missions of higher education.

Background and Aim: Clinical education is fundamental to nursing science. One of the most important domains in clinical education is clinical evaluation. Today, new methods in evaluation such as ”BARS” can measure expected behaviors in specific job better than old methods, because of their structure that focus on specific behaviors of job. So, they may be effective for quality improvement in clinical teaching. The purpose of this study was to examine the effect of implementing “BARS” method on student nurses’ managerial skills in nursing management practicum . Materials and Methods: This was a quasi-experimental study. All students (n=60) was randomly assigned to either experimental or control group. At first, the students in control group were trained and evaluated by their instructors. The next semester, the same instructors applied “BARS” method for experimental group. This method works based on critical events or special behaviors in nursing management practicum. At the end of practicum, students’ managerial skills in two groups were measured by checklist. The data were analyzed by SPSS . Results: The findings showed that managerial skills was significantly different between experimental ( =113.41) and control ( =83.83) group (P=0.005). Therefore, implementing “BARS” evaluation method is effective on improving managerial skills of nursing students. Conclusion: “BARS” as an evaluation method could evaluate specific and expected behaviors of student nurses in management practicum better than the old ones. Also, it could improve the quality of clinical teaching.

Introduction: Employing supervision methods which focuses on educational aspects may increase the effectiveness of nursing personnel's educational activities, especially patient education. The aim of this study was to investigate the effect of clinical supervision on the effectiveness of nurses' educational performance. Methods: This quasi-experimental study was conducted using static groups' comparison in which the control and experiment groups were compared by a post-test. Study samples included 72 patients who were matched and assigned into two distinct groups. Clinical supervision system was implemented through three steps in 3 wards of Samen-al-Aemme hospital in Mashhad for 6 months. The data gathering tool included patient information sheet, patient satisfaction from nurses' educational practice and rating scale of self-care knowledge and practice of patients. Data was gathered through interview and observation methods and analyzed by SPSS software. Results: The mean scores of self-care knowledge and practice of the patients were 30.6 and 57.1 out of 100, in the control and experiment groups, respectively. The mean score of patients' satisfaction from nurses' educational practice was 19.6 in the control group and 20.9 in the experiment group, out of 24. So that, independent t-test showed a significant difference between these two groups. Conclusion: Implementing clinical supervision system through observation, feedback, discussion, and investigation, may develop nurses' knowledge and professional skills in patient education. Therefore, this supervision method could be regarded as an effective model for in-service education. More studies are required in order to investigate the effect of this model on other aspects of nurses' practice.