حمید شریف نیا

Various dimensions of bullying occur in academic environments, which experience negative consequences for students in psychological and academic fields. Therefore, this study aimed to determine the relationship between bullying behaviors in educational environments and the intention to dropout among nursing students of Alborz and Mazandaran University of Medical Sciences in 2023.

Methods and Materials: 

In this cross-sectional study, 386 undergraduate nursing students were included using convenience sampling method. The link of online questionnaire was sent to the students along with the explanation of the study objectives. The data collection scales in this research included three sections of demographic and educational information, bullying behaviors in nursing education environments and the intention to dropout. Data analysis was done using multiple linear regression.

In this study, most of the students were female (65.2%). The mean of their age and GPA was 22.63±2.2 years and 17.26±1.2, respectively. About 34% of students reported that they experienced bullying behavior from their nursing professors. According to the results, the bullying behavior has a positive and significant relationship with nursing students’ intention to dropout (p<0.001, β=0.55)..

It is worth mentioning that the importance of experiencing bullying behavior for nursing students is twofold because the way nursing students are treated during training shapes the process of becoming a nurse. It is suggested that university managers provide solutions to increase the awareness of nursing professors about the negative consequences of such behaviors and create a culture of respect and professional behavior in universities.

Missed nursing care refers to all aspects of nursing care needed by the patient that are forgotten or delayed. One of the factors affecting the occurrence of missed care is the general health of nurses. This study was conducted with the aim of determining the relationship between missed nursing care and general health among emergency department nurses of university hospitals in Alborz province.

In this cross-sectional study, data were collected from 228 nurses working in the emergency department of Alborz University of Medical Sciences hospitals from March to May 2024.The scale used to collect information was a questionnaire consisting of a demographic section, a general health questionnaire (GHQ12), and nursing duties in the emergency department (reported by the Deputy Minister of Nursing of the Ministry of Health).

The average age of the nurses was 34.10 years and the majority of them were women (%84.2) and they worked in general emergency (%57) hospitals. The mean (±SD) of missed nursing care and general health of nurses were 19.4±43.18 and 3.5±18.34, respectively. In the general health variable of nurses, the highest mean was related to being under stress (0.68±2.25) and the highest mean of missed care was related to “emotional support of the patients and their relatives” (1.22±2.69). In examining the relationship between demographic, occupational and general health variables with missed nursing care, only the age variable had a negative and significant relationship (ß=-0.196, P=0.02).

Due to the high work pressure, nurses prioritize nursing care to reduce missed nursing care. It is suggested to reduce the working hours and increase the number of personnel in each shift. The description of personnel duties and division of work should be done correctly.

Nurses, as frontline caregivers, have faced increasing psychological and physical pressures while caring for COVID-19 patients, leading to heightened stress, anxiety, and intent to leave their jobs. Perceived organizational support (POS) and nurses' willingness to care for COVID-19 patients can play a key role in alleviating these pressures. Therefore, identifying factors that predict these two variables is of great importance.

This study aimed to determine the level of perceived organizational support and nurses' willingness to care for COVID-19 patients and to analyze the role of certain demographic factors influencing these variables during the fifth wave of the pandemic.

This descriptive-analytical, correlational study was conducted in 2021. The study population included all nurses caring for COVID-19 patients in public hospitals in Amol, Iran. A total of 215 nurses were selected through convenience sampling. Data were collected using a three-part form, including a demographic characteristics checklist, Eisenberger's Perceived Organizational Support Questionnaire, and a nurses' willingness-to-care questionnaire. Data analysis was performed using descriptive and inferential statistical tests, including chi-square, Fisher's exact test, independent t-test, Pearson correlation, and linear regression in SPSS version 26.

Despite moderate levels of perceived organizational support, COVID-19 vaccination history and greater clinical experience were predictors of perceived organizational support, while marital status was the only predictor of willingness to care for COVID-19 patients in this study. These findings highlight the importance of considering demographic factors and individual experiences of nurses when designing supportive policies. Policymakers and healthcare managers can use these insights to develop effective strategies for managing future crises and improving organizational performance among nurses.

Despite moderate levels of perceived organizational support, this variable was not significantly related to willingness to care. COVID-19 vaccination history and greater clinical experience were predictors of perceived organizational support, while marital status was the only predictor of willingness to care for COVID-19 patients in this study.

Most of the brain-injured patients hospitalized in the Intensive Care Unit (ICU) are not able to report their pain. In order to assess their pain, the CPOT-Neuro has been developed. Actually they may indicate different pain behaviors according to clinical conditions. Therefore, this study was conducted with the aim of comparing pain behaviors in brain-injured patients based on their clinical characteristics.

This cross-sectional study was carried out on 132 brain-injured patients in Amol city, Iran who were enrolled in the study from December 2023 to March 2024. Data were collected using a demographic checklist and a Critical-Care Pain Observation Tool Neuro (CPOT-Neuro). Patients' behaviors were evaluated before, during and after change position (nociceptive procedure).

According to the frequency of pain behaviors observed during nociceptive procedure, a total of 105 patients indicated changes in facial expression, 13 patients in autonomic response, 88 patients in body movements, 46 patients in vocalization/ventilator tolerance and 31 patients indicated changes in muscle rigidity. By comparing the frequency of these behaviors during nociceptive procedure based on clinical characteristics, the chance of observing body movements during nociceptive procedure in non-traumatic patients was 60% lower than in traumatic patients (P<0.05). The probability of observing the autonomic response, vocalization/ ventilator tolerance and muscle rigidity during the nociceptive procedure decreased with the improvement of the level of consciousness (P<0.05). In addition, the chance of observing the autonomic response, body movements, vocalization/ ventilator tolerance and muscle rigidity during nociceptive procedure increased with the change in patients' sedation (P<0.05). The possibility of observing a change in muscle rigidity during nociceptive procedure in patients under mechanical ventilation was 74% lower than in patients without mechanical ventilation (P<0.05).

This study showed that pain behaviors in brain-injured patients were different based on the type of brain-injury, the level of consciousness, the level of sedation and the way of breathing. These findings highlight consideration of clinical characteristics when evaluating and managing pain in these patients.

Effective management of endotracheal tube cuff pressure is crucial in preventing complications such as pneumonia and airway trauma. Despite recommendations for using a manometer to, cuff pressure monitoring, adherence remains suboptimal. Since intention is the most significant predictor of actual behavior, understanding the factors influencing it through a valid tool can help identify barriers and facilitators more accurately. Therefore, this study aimed to develop and psychometrically evaluate of a Scale for Assessing Factors Influencing Nurses' Intention to Use a Manometer for Endotracheal Tube Cuff Pressure Monitoring.

This methodological study was conducted in 2024 on 186 nurses working in the Intensive Care Units (ICUs) of public hospitals in Amol, Iran. The tool was developed based on the Theory of Planned Behavior using the framework and examples provided by Ajzen, and the psychometric process followed Eccles' guidelines. First, the target behavior was defined. Then, an initial set of items was generated through a literature review and clinical experience of the researchers. The content and face validity of the tool were evaluated using both qualitative and quantitative approaches. The construct validity of the tool was assessed through exploratory factor analysis, and its internal consistency was examined using Cronbach's alpha and McDonald's omega coefficients. The test-retest method was used to assess stability.

During the item generation phase, 41 items were developed based on a review of relevant literature. After qualitative and quantitative assessments of face and content validity, the number of items was reduced to 25. Exploratory factor analysis indicated an acceptable fit for the data, with a Kaiser-Meyer-Olkin (KMO) sampling adequacy index of 0.853 and a significant Bartlett's test. Four factors with eigenvalues greater than one were identified, accounting for 22.50%, 10.95%, 9.30%, and 10.60% of the total variance, respectively (53.35% cumulatively). In the final stage, six items with factor loadings less than 0.3 were removed, resulting in 19 items categorized under four factors: "Positive Behavioral and Control Beliefs," "Normative Beliefs," "Perceived Control Beliefs Strength," and "Motivation to Comply. Cronbach’s alpha and McDonald’s omega coefficients ranged from 0.827 to 0.900, with ICC = 0.95.

The tool demonstrated acceptable validity and reliability for assessing factors influencing the intention of ICU nurses to use manometers. Therefore, its application in future research could help identify additional barriers and facilitators in nurses' behavior, leading to the development of more effective training programs. It is also recommended that this tool be tested among different groups of nurses and in various hospital settings to further refine and improve it.

Postpartum bonding disorder is a significant impairment in the mother-infant relationship during the postpartum period. The present study aimed to translate and validate the Postpartum Bonding Questionnaire (PBQ) in Iranian mothers.

A descriptive, cross-sectional survey design was employed in the current investigation. With the developer's permission, a back-translation procedure was used to translate the original questionnaire from English to Persian. Then, following qualitative face validity, a sample of primiparous mothers completed the questionnaire, and construct validity was assessed using exploratory factor analyses. Moreover, reliability was evaluated using internal consistency analysis (average inter-item correlation, Cronbach’s alpha, and McDonald’s omega) and construct reliability.

A total of 263 primiparous mothers completed the questionnaire. Exploratory factor analysis revealed the 13-item version of the PBQ with a three-factor (‘general factor,’ ‘rejection and anger,’ and ‘anxiety about care’) structure, which explained 49.19% of the overall variance observed, and this confirmed the construct validity of the tool. Cronbach's alpha coefficient for the subscales was equal to 0.744. In addition, the test-retest reliability (0.850-0.952) of the questionnaire with a two-week interval indicated an acceptable range of reliability.

The findings indicate that the Persian version of the 25-item PBQ is a reliable and valid tool for screening and identifying the postpartum bonding disorder among Iranian mothers.

 The quality of life of patients with chronic kidney failure undergoing hemodialysis is influenced by physical, psychological, and social factors. Accurate assessment of these dimensions using standardized tools is of great importance. This study aimed to determine the psychometric properties of the 12-item Quality of Life Questionnaire in patients undergoing hemodialysis in the Iranian population.

In this cross-sectional study conducted in 2023, 411 hemodialysis patients in Mazandaran were selected through convenience sampling. After translating the Short Form-12 Quality of Life Questionnaire, its psychometric properties were assessed through exploratory factor analysis, network analysis, and confirmatory factor analysis, along with construct validity (convergent and divergent validity). Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients.

The results of the exploratory factor analysis indicated that two factors—physical health status and mental health status—accounted for 44.55% of the variance in the quality of life among hemodialysis patients. Furthermore, confirmatory factor analysis showed that the hypothesized model had a good fit (CFI= 0.930, IFI= 0.931, RFI= 0.936, TLI= 0.954). The extracted mental health factor in men demonstrated convergent validity (AVE above 0.5), and both factors exhibited appropriate divergent validity. Ultimately, the internal consistency of the Quality of Life Questionnaire was found to be within an acceptable range (greater than 0.7).

The psychometric analysis of the Quality of Life Questionnaire indicates that patients with chronic kidney failure undergoing hemodialysis perceive their quality of life through two primary dimensions: physical and mental health status. This study confirmed the psychometric properties (validity and reliability) and the appropriate factor structure of the Persian version of the Quality of Life Questionnaire for patients undergoing hemodialysis. Healthcare providers can use this tool in various studies to assess and improve the quality of life of hemodialysis patients The use of this questionnaire allows researchers and healthcare professionals to more accurately and comprehensively evaluate the different aspects of quality of life in hemodialysis patients. Employing this tool can enhance treatment processes and improve patient satisfaction, serving as a valuable instrument for future research. This study emphasizes the importance of using valid and reliable tools to assess quality of life and recommends that nurses and other healthcare professionals integrate the Persian version of the 12-item Quality of Life Questionnaire into their treatment and research programs to help improve the quality of life of hemodialysis patients and achieve better treatment outcomes.Future studies are recommended to investigate the impact of factors such as nutrition, social support, and rehabilitation programs on the quality of life of hemodialysis patients. Additionally, utilizing this questionnaire in different populations and therapeutic contexts can contribute to the generalizability of the findings and offer a more effective tool for quality of life assessments. Overall, the findings of this study indicate that the 12-item Quality of Life Questionnaire is a reliable and valid tool for assessing the quality of life in hemodialysis patients, making it valuable for both research and clinical programs. Using this tool can help improve patients' quality of life and treatment outcomes while providing essential data for clinical decision-making.

 Moral distress occurs when an individual feels dissatisfaction due to ethical conflicts and an inability to adhere to their moral principles, which can lead to depression and decreased job satisfaction. Measuring moral distress is crucial. Moreover, ensuring the validity and reliability of credible tools for assessing moral distress is essential. Therefore, the aim of the present study was to evaluate the psychometric properties of the Moral Distress Scale.

 In this scoping study, databases including PubMed, Scopus, Web of Science, Google Scholar, SID, and Magiran were systematically searched between 2001 and 2023 using keywords such as "Psychometric," "validity," "reliability," "moral," "distress," "scale," and their Persian equivalents ("روان سنجی," "روایی," "پایایی," "اخلاق," "پریشانی," "مقیاس"). Four researchers independently assessed the quality of the studies based on the Standards for Reporting Diagnostic Accuracy (STARD) checklist and the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2).

 Out of 2677 articles (321 Persian articles, 2356 English articles) retrieved, eight articles were ultimately evaluated. The quality of the studies was acceptable. The findings indicated that the number of factors extracted varied across studies, and both the Moral Distress Scale and the Revised Moral Distress Scale demonstrated appropriate validity and reliability. The internal consistency of the studies, as reported by Cronbach's alpha, ranged from 0.385 to 0.97. The lowest total variance of extracted factors was 19.38%, while the highest was 68.99%.

 There were evident limitations in the application of validation methods in the scales under review, and the Moral Distress Scale has not been widely used across different populations. Hence, the lack of application in various cultural contexts limits confidence in the scale's performance. The use of robust techniques for validation and further investigation of the validity and reliability of the Moral Distress Scale in future studies is recommended.

Thirst distress is a common complication in the final stage of kidney disease. The aim of this study was to analyze the network and psychometric properties of the thirst distress scale in the Iranian hemodialysis patients.

In this cross-sectional study in 2023, 411 hemodialysis patients in Mazandaran were selected using the convenience sampling method. After translating the scale, its psychometric properties were evaluated through exploratory factor analysis, network analysis, and confirmatory factor analysis, and the structural validity (convergent and divergent validity) was assessed. Internal consistency was calculated using Cronbach's alpha coefficient, McDonald's omega, and composite reliability.

The results of exploratory factor analysis showed two factors of distress due to thirst and dry mouth were extracted, explaining 80.46% of the variance in thirst distress among hemodialysis patients. Additionally, confirmatory factor analysis showed that the assumed model had a good fit (CFI = 0.971, IFI = 0.971, RFI = 0.923, NFI = 0.969). The extracted factors demonstrated good convergent validity (AVE above 0.50 for both factors) and high reliability (composite reliability above 0.70), and were appropriately divergent (HTMT ratio of 0.512). Finally, the internal stability of the thirst distress scale was deemed acceptable (Cronbach's alpha and composite reliability above 0.70).

The psychometric results of the thirst distress scale indicated that chronic kidney disease patients undergoing hemodialysis experience and perceive distress with two concepts of thirst and dry mouth. This study confirmed the psychometric properties (appropriate validity and reliability) and suitable factor structure for the Persian version of the thirst distress scale in hemodialysis patients. It can be stated that healthcare providers can utilize it in future studies.

Diabetic foot ulcers are among leading causes of disability in diabetic patients, often resulting in amputation and disability. Proper foot care can prevent diabetic foot ulcers. One assessment tool is the Nottingham Assessment of Functional Footcare (NAFF). This study aimed to assess the psychometric properties of the Persian version of the Nottingham Assessment of Functional Footcare.

This cross-sectional study was conducted in the winter of 2023 on 517 patients with type 1 and type 2 diabetes who were referred to the diabetes clinics in Bam, Hamadan, and Asadabad cities, Iran. Patients were selected using convenience sampling. The instruments were examined to assess their psychometric properties, including face validity, content validity, construct validity, internal consistency, and stability.

The mean age and duration of diabetes in patients were 50.01±18.14 years and 10.70±9 years, respectively. Most samples were female (54%) and married (80.9%). More than one-third of the patients (36.4%) were taking hypoglycemic tablets. The exploratory factor analysis identified five factors: general foot self-care, foot examination, shoe examination, wound management, and use of appropriate shoes. Together, these factors accounted for 52.381% of the total variance. The internal consistency of all extracted factors was above 0.70, as measured by McDonald's Omega coefficient. The stability reliability of the questionnaire was 0.790 for the whole instrument with a two-week interval.

The Persian version of the Nottingham Assessment of Functional Foot-care tool is a valid and reliable tool for measuring the foot care of diabetic patients. It allows domestic researchers to use this tool along with other available tools to check and measure the concept of diabetic foot self-care based on their facilities and preferences.

Accurate assessment of cardiorespiratory function, muscular strength and endurance seems necessary for awareness and for providing exercise interventions and prevention of subsequent diseases. Therefore, the aim of the current research was to develop a comprehensive tool for assessing cardiorespiratory, muscular strength and endurance function in people with intellectual disabilities.

The current research is fundamental and has practical implications in terms of its purpose. In this study, the psychometrics of 51 specific tests of intellectual disability people were used to develop a tool for measuring cardiorespiratory function, muscular strength and endurance. The face validity of the instrument was examined through a 51-test questionnaire by 15 experts and 15 intellectually disabled educators, the content validity by a 51-test questionnaire by 15 experts, and the construct validity through a 19-test questionnaire by 243 intellectually disabled educators. The reliability of the tool was checked through internal, intra-rater and inter-rater consistency. Internal consistency was estimated with Cronbach's alpha. The intra-rater and inter-rater reliability were also checked through the implementation of the tests by 18 people with intellectual disability in three times and with three raters through the internal correlation index (ICC), confidence interval (CI) and standard error of measurement (SEM). Data analysis was done through exploratory and confirmatory factor analysis with AMOS26 and SPSS22 software.

Based on the results of estimating the content validity ratio (CVR), 19 out of 51 tests had a content validity ratio higher than 0.49 and the rest of the tests were excluded. In terms of construct validity, 10 out of 19 tests were removed and the final 9 tests were approved for evaluating cardiorespiratory function, muscular strength and endurance. Exploratory factor analysis extracted three latent factors that explained 46.21% of the total variance. Confirmatory factor analysis confirmed the final construct model. From the results of factor analysis, KMO=0.829, BT=4706.93 and p<0.0001.

The current study provided a special set of tests for people with intellectual disability in the fields of cardiorespiratory assessment (one test), strength (four tests) and muscular endurance (four tests). after psychometry, 51 specific tests were presented in this field. By using this set of tests, it is possible to make an accurate assessment of the physical fitness related to the health of people with intellectual disability.

Intellectual disability is associated with many comorbidities, such as epilepsy, cerebral palsy (CP), and anxiety disorders, and can affect the health status of the individual. The physical fitness (PF) of people with intellectual disability is lower than typical developing peers, making them particularly vulnerable to health problems in adulthood. People with intellectual disabilities show lower aerobic capacity in childhood (8–10 years), adolescence (11–14 years), and youth (15–18 years) than healthy counterparts, and this difference gradually increases with age increases. With this in mind, PF assessment is a simple, safe, and low–cost tool that allows several health indicators to be evaluated. Based on the PF level of children, educational and public health strategies and policies can be developed. Accurate evaluation of cardiorespiratory fitness seems necessary to prepare and present training interventions to prevent subsequent diseases. Therefore, this study aims to examine and summarize a set of tests and specific field tests related to cardiorespiratory fitness in people with intellectual disabilities.

The present study was a systematic review. The relevant data were selected, collected, and analyzed from studies on physical fitness and the health of people with mental disabilities. Databases of PubMed, Web of Science, Medline, Google Scholar, and Scopus, as well as Persian databases, Jahad Daneshgahi Scientific Information Center database, MedLib (Comprehensive Database of Medical Articles), IranMedex, Iran Research Institute of Information Science and Technology (IRANDOC) and the country's publications database (MAGIRAN), were searched until 2021. The articles searched should include a set of PF tests. The search was performed in each database based on predefined keywords. The data extraction process and literature results were evaluated according to PRISMA (preferential reporting items for systematic and meta–analysis) guidelines. After collecting studies from databases, duplicate items were removed. Two authors screened the remaining articles, considering their 'Titles' and 'Abstracts' to identify studies that met the inclusion criteria. During the study selection process, one researcher blindly analyzed the 'Titles' and 'Abstracts.' As the 'Titles' and 'Abstracts' did not contain enough information to make an informed decision, a researcher reviewed the full text. Related articles were retrieved for the whole study. Then, two authors reviewed the full text of the potential studies, and consensus made decisions to include or exclude the studies. Disputes were resolved by consensus; if necessary, the third arbitrator, as a judge, assisted in the review and selection.

A total of 1086 articles were identified, and with the removal of duplicates, the number reached 448 articles. The analysis of the articles 'Titles' and 'Abstracts' showed that 332 articles did not meet the required criteria, and led to their deletion. The full text of the remaining 116 articles was studied, and 98 articles were deleted. Finally, 18 articles met the inclusion criteria for the final study. Of these 18 articles, ten studies were related to a set of health–related fitness tests in people with intellectual disability that examined cardiorespiratory fitness with functional tests, and 8 studies were articles that examined cardiorespiratory fitness in people with intellectual disability with functional tests. In addition, the tests of these articles did not exist in the set of physical fitness tests of people with intellectual disability and were not repetitive. About 53 sets of physical fitness tests were found, of which 10 were related to people with disabilities (intellectual disability) according to the study criteria. According to the PF factors evaluated in this set of tests and the large volume of material, the important factor of PF in people with intellectual disability and the cardiorespiratory fitness factor were studied to examine the content more accurately. Through this set of tests and articles, 18 functional tests of cardiorespiratory fitness related to people with intellectual disabilities were identified.

Given the relationship between physical fitness and health and the opportunity provided by the school environment to assess physical fitness in people with intellectual disabilities, we need to standardize and reach a consensus on specific physical fitness assessments for people with intellectual disabilities in this environment

Despite the impact of hemodialysis on patients’ lives, religious strategies are effective in reducing dependence and maintaining self-esteem. Additionally, a positive body image can enhance the quality of life (QoL). This study investigates the association between religious coping and body image in hemodialysis patients to predict their QoL.

This descriptive-correlational study was conducted from March to June 2023 on 280 hemodialysis patients. The participants were selected through purposive sampling. The data collection instruments included a demographic form, Littleton’s body image concern inventory (BICI) and the religious coping questionnaire (RCOPE). The associations between variables were analyzed using linear regression in SPSS software version 26.

The participants had an Mean±SD age of 56.92±13.42 years. The results indicate that increasing age (B=0.128) and female gender (B=3.356) are associated with reduced body image concerns. In contrast, marital status (B=-4.246) and religious coping (B=-0.578) effectively decrease body image concerns.

Religious coping serves as a predictor of positive body image among hemodialysis patients, highlighting the significance of religious beliefs and values in how patients perceive their bodies. Enhanced levels of religious coping assist patients in adapting to physical challenges and fostering a more positive body image. This discovery can be valuable in crafting psychological interventions to enhance body image and boost the mental well-being of patients. Acknowledging spiritual dimensions proves effective in managing chronic illnesses.

Self-management in kidney transplant patients leads to increased tissue survival time, reduced graft rejection, early identification of drug side effects, and increased quality of life. Kidney transplant patients have poor self-management behaviors. Knowing how kidney transplant patients should encounter and manage them will improve transplant outcomes. This study was conducted to explain the self-management behaviors of kidney transplant recipients.

This qualitative study was done with eighteen participants. Participants were selected through purposive sampling. Data were collected through in-depth and semi-structured interviews and analyzed through qualitative conventional content analysis.

The findings included a theme of trying to achieve balance and stability in life and six main categories of lifestyle modification, physical self-care, self-efficacy, resilience, adaptation to new roles and treatment management.

The results showed the participants tried to achieve balance and stability after a kidney transplant. A kidney transplant can be considered an event that initiates a period of instability after a long period of illness and health deterioration. Therefore, self-management programs should focus on supporting patients in restoring stability in their lives after kidney transplantation.

The knowledge and skills of midwives as the most effective team providing health and preventive care can affect the behavior and performance of maternal care. Therefore, the present study was conducted with aim to examine the psychometric properties of the Persian version of midwives' knowledge and skills questionnaire to assess and promote maternal health literacy.

This methodological and cross-sectional study was conducted from November 2022to February 2023. In this study, 314 midwives working in hospitals and health centers or public and private clinics in the central cities of Mazandaran province completed the 13-item questionnaire. The face validity, content validity and construct validity of the questionnaire was evaluated. The reliability was obtained using Cronbach's alpha and test-retest reproducibility. The structure of the questionnaire was analyzed using factor analysis.

Based on the results of exploratory factor analysis, three factors of performance, knowledge and skills were extracted. The model fitness indices confirmed the questionnaire. (PCFI=0.684, PNFI=0.651, CMIN/DF=2.438, RMSEA=0.068, AGFI=0.905, IFI=0.923, CFI=0.922). Also, the internal consistency and reliability of the questionnaire were confirmed (<0.7).

The three-factor questionnaire of midwives' knowledge and skills to assess and promote maternal health literacy produced good validity and reliability. Due to its suitable psychometric properties, this tool can be used in future studies designed to evaluate midwives' knowledge and skills to assess and promote maternal health literacy.

As a chronic disease with many complications, diabetes requires adherence to treatment regimen. Despite the importance of adherence, it is not done completely in these patients. Non-adherence to treatment has many personal and social consequences. Adherence in diabetic patients can lead to mortality reduction and success in the treatment of diabetes. Considering that adherence to the treatment regimen is challenging among diabetic patients and less attention has been paid to it in Iran, the present study aims to identify the factors related to adherence to treatment regimen among diabetic patients in Sari, Iran.

This descriptive cross-sectional study was conducted in 2021 on 226 adults with Type 2 diabetes referred to Baghban clinic affiliated to Mazandaran University of Medical Sciences in Sari, Iran who were selected using a continuous sampling method. Data were collected using a demographic form and the diabetes activities questionnaire. Questionnaires were prepared online using Google Forms. Data analysis was performed in SPSS software, version 26.

The mean age of participants was 53.06±10.81 years. Most of them were female (61.9%) and married (85.8%) with a high school diploma (26.5%) and moderate economic status (69%). Economic status, age, and BMI had a significant relationship with adherence to treatment regimen (P<0.05); Economic status and age had a positive significant relationship while BMI had a negative significant relationship with adherence to treatment regimen. Diabetic patients with better economic status, higher age, and lower BMI had better adherence.

 This study provides a basis for expanding knowledge of adherence to treatment regimens in diabetic patients in Iran. It is necessary for healthcare providers, especially nurses, to pay attention to the factors related to adherence to treatment in diabetic patients in providing care and education to them to have better treatment.

The biggest threat to human health and life is the Covid-19 virus in these days, and until today no cure has been identified for it. Compliance to preventive behaviors is the best and only way to control and prevent its spread. The present study was done with the aim of investigating the predisposing factors of nursing studentchr('39') compliance of preventive behaviors of COVID-19 based on health belief model.

This descriptive cross-sectional study conducted in the period from September to October 2016, with the participation of 225 nursing students from a medical university with a census sampling. The tool of study was   seven questionnaires that completed   through cyberspace. Data were analyzed with descriptive statistic and   Prediction was also performed based on the Health Belief model with simple regression and adjusted with the softwar SPSS v23.

Most of the samples were undergraduate students (83.6%) and women (67.1%). The mean age of students was 24.73 (SD = 8.28) years and the mean score of nursing studentschr('39') compliance of Covid-19, was 39 (SD = 4.5). Univariate regression showed that the variables of age, gender, educational status, economic status, and cues to action, perceived benefits and self-efficacy were predictors of   compliance to preventive behaviors of Covid 19. In multivariate regression, only the variables of gender (<0.001), cues to action (0.032) and perceived benefits (0.033) remained as the final predictors. These variables predicted a total of 22.6% of changes in compliance of preventive behaviors

Gender, cues to action and perceived benefits were strongest predictors of student behavior from compliance to Covid-19. Therefore, more attention to male students as well as planning based on the Health Belief Model with emphasis on strengthening the cues to action and perceived benefits in order to improve preventive behaviors of Covid-19 in nursing students is recommended.

Intruduction: 

Hesitancy about vaccination has grown, and the World Health Organization now considers it a major threat to global health. Hesitancy about vaccination and not doing it in people who have not been vaccinated yet and those who have a weak immune system and are vulnerable to infection reduce immunity against the disease. This psychometric study was the Persian version of the Covid-19 vaccination Hesitancy scale in Iranian adolescents and children.

This methodological and cross-sectional study was performed using a simple sampling method with a sample size of 1260 people. The instrument used in the study was a questionnaire including demographic questions and a translated vaccination Hesitancy scale (VHS) that was sent to eligible individuals through social media. The completed scale data were analyzed using SPSS-AMOS26 software

Exploratory factor analysis revealed two-factor structures that generally explained 49.73% of the total variance of parents' desire to receive the Covid 19 vaccine in children and adolescents. According to the findings of the Confirmatory factor analysis, all fit indices were appropriate and the model fit was confirmed. The convergent and divergent validity showed that both factors have good convergent and divergent validity. The results of internal consistency showed that Cronbach's alpha and omega McDonald's combined reliability and maximum reliability of the two extracted factors are excellent (> 0.77). In addition, the scale had good reliability values (> 0.3). According to these results, it also had a good internal consistency scale.

The Persian version of the vaccination Hesitancy scale had acceptable construct validity and reliability. It has two factors with 9 items that explain 49.73% of the total variance of vaccination Hesitancy in the parents' desire to get the Covid 19 vaccine in children and adolescents. This scale can be useful for researchers and healthcare providers in identifying and screening parents who are skeptical about vaccinating children and adolescents

Valid and reliable tools are needed to assess the health literacy of heart failure. This study was performed to validate the Persian version of Heart Failure-Specific Health Literacy Scale (HF-Specific HL Scale).

In this methodological study, 360 patients with heart failure completed the Persian version of HF-Specific HL Scale in two medical centers affiliated with Mazandaran University of Medical Sciences. Factor structure was evaluated using structural validity, convergent and divergent validity. The scale reliability was evaluated by internal consistency (Cronbach’s alpha) and construct reliability.

The results of exploratory factor analysis showed that the scale has two factors: difficulties in understanding prescriptions and hospital pamphlets and understanding the disease and trying to improve knowledge about it, which account for 42.20% of the variance. Cronbach's alpha of the scale was higher than 0.7 and factor loading of the items was more than 0.5 indicating significant correlation coefficient of the items. The fit indices of the model showed that the extracted factor structure was suitable.

Factor structure of the HF-Specific HL Scale in patients with heart failure showed a two-factor structure. In addition, considering the acceptable validation results of the scale, the Persian version can be used as a reliable tool for measuring health literacy in patients with heart failure.

Chronic Kidney Disease (CKD) is a globally prevalent and often life-threatening disease that carries immense psychological burdens, such as body image concerns. Therefore, identifying protective psychological factors affecting body image concerns in CKD patients is of strong relevance. This study investigates the potential mediating role of religious coping in the relationship between self-care behavior and body image concerns among Iranian patients undergoing hemodialysis.

A cross-sectional design was used to evaluate body image concerns, religious coping, and self-care behavior in a convenience sample of 280 hemodialysis patients. Measurements included demographic factors, health characteristics, and valid instruments of study structures. Path analysis was used to evaluate mediating models.

The results showed a significantly negative relationship between self-care behavior and body image concerns (B=-0.162, β=-0.140, P=0.020). Additionally, variables of age (B=-0.164, β=-0.163, P=0.07), gender (B=4.169, β=0.154, P=0.011), and self-care behavior (B=-0.162, β=-0.140, P=0.020) were found to predict body image concerns in patients undergoing hemodialysis. These variables explained 7.5% of the predictors. The findings indicated a direct path from self-care behavior (β=-0.015, P=0.002) to body image concerns. However, when religious coping was introduced as a mediating variable, the relationship between self-care behavior and body image concerns became significant (β=0.020, =0.012, P).

In this study, religious coping clarified the relationship between self-care behavior and concerns about body image to some extent. In countries such as Iran, where religiosity is an important psychological construct, the findings can explain why religious people experience less concern about their body image changes.

Mitral valve prolapse (MVP) is one of the most common valvular heart disease in humans. The general health of patients with chronic diseases is important for health care providers. Since a valid tool is needed to general health assessment, this study was conducted to validation of general health questionnaire-28 (GHQ-28) in patients with mitral valve prolapse.

Construct validity was performed in 190 patients with mitral valve prolapse.  Factors were extracted with exploratory factor analysis with maximum likelihood and Promax rotation method. 190 other patients with mitral valve prolapse were studied for confirmatory factor analysis. In this part, with maximum likelihood estimation method was evaluated model fitness.

Exploratory factor analysis after removal of 7 items showed a four-factor construct for GHQ-28. Four factor are respectively, depressive symptoms, physical symptoms, social functioning and anxiety symptoms.  These four factors explain 47.9% of the total variance of the general health in patients with mitral valve prolapse. Due to all regression coefficients in confirmatory factor analysis models and fitness indices of confirmatory factor analysis were high (>0.5), the assumed model had a good fit. Cronbach's alpha, omega McDonald, CR and the maximum reliability of the four factors extracted from the 21-item general health questionnaire were greater than 0.7.

Based on the study results, the validity and confidence of the 21-item Persian version of the General Health Questionnaire has been confirmed. This tool can be used in screening and clinical studies related to the general health dimensions of patients with mitral valve prolapse.

The advantages of online learning are enhancing independence and incentive of students for learning, improving the connection between individuals and making flexibility in time and place for doing the activity. This study endeavored to determine factors affecting nursing students’ acceptance of online learning during the COVID-19 pandemic

This cross-sectional descriptive-analytical study that was done with a sample of students on Islamic Azad University of Gorgan and Neishaboor's. Convenience sampling was done and 368 of 500 students participated in the study. The questionnaire consisted of demographic questions, educational information and translated questionnaires that included student perceptions of an online course, University student engagement inventory and acceptance of online learning. Descriptive statistics were employed to assess demographic characteristics simple and multiple linear regression models were used to analyze the predictor variables of students' acceptance of online learning. Pvalue<0.05 was considered for all tests.

The effective factors on student's acceptance for online learning was widespread high-speed Internet access at home, increasing the quality of connection to Internet and increasing the quality of laptop, tablet or mobile phone. On the other hand, multiple linear regression results showed only the remaining variables in the model were increasing the score of the course content (β=0.18, P<0.001), teacher-student interaction (β=0.14, P=0.001), and the students' engagement (β=0.22, P>0.001). It is of note that this model had an explanatory power of 46%.

According to the results of the study, if teachers strengthen the content of the course and create the creativity in interaction and use of all the features of the online learning system, we can hope that the rate of online learning acceptance among students will increase.

Pain management is very important in patients in general intensive care units (G-ICU). Therefore, this study was conduct to investigate the validity and reliability of the Persian version of Critical Care Pain Observation Tool in patients admitted to this ward.

The present study is a methodological and clinimetery study that was conduct in inpatients in general intensive care units of Amol city during 2009-2010. The accordance between the two assessors was investigated using Lin’s Concordance correlation coefficient and the weighted kappa coefficient. The researcher evaluated Sixty-six patients in two positions of resting and painful action, using discriminant validity and the intended tool, to measure the validity of the tool.

The results showed the validity of the instrument through the validity of known groups, the score difference in the three indices of tool were meaningful (P<0.001). Also, the difference between the overall mean scores in the two positions of resting and rotation was meaningful, as well (P<0.001).  Reliability of the instrument through weighted kappa coefficient for quartet indices of the tool in the two resting and change position status varied between 0.38 and 0.60. The accordance between the two assessors in the overall score of the tool using Lin’s Concordance correlation coefficient was 0.68 in the resting position, 0.82 -0.47 in assurance interval, 0.67 in the rotation position in assurance interval, and 0.42 to 0.82 in assurance interval.

Although the Persian version of the CPOT could differentiate pain-causing situations from no pain-causing ones, but its rate was low. Besides, the accordance between the two assessors was weak to medium. Therefore, it is recommended to use it with more care and caution in different patients with different diagnoses; also, other criteria for pain in patients should not be ignored.

Routine use of episiotomy is not recommended for women giving birth naturally. However, several studies in the Middle East have reported that it has high prevalence, but there is no general estimate. This study was performed with aim to review the prevalence and met-analysis of episiotomy in the Middle East based on studies conducted in this field.

To search for articles, the databases of SID, Magiran, Medline, Science Direct, Scopus, Web of Science, Embase, ProQuest and google scholer search engines using the keywords of prevalence, epidemiology, frequency, incidence, rate and episiotomy in both languages of Persian and English and all possible combinations were searched with AND and OR operators. Calculation of heterogeneity of the studies was evaluated using I2 index and Bag test was used to examine the bias.

Twelve articles with a sample size of 69171 were reviewed. The overall prevalence of episiotomy was 67% (95% CI: 55-78). Using the random effect model, the risk of episiotomy in primiparous women was two times than multiparous women, which was statistically significant (RR = 2.01, 95% CI: 0.87-4.63, p <0.001; I2 = 99.99). Oxytocin use was also associated with an 80% (60-95%) prevalence of episiotomy.

Due to the high rate of episiotomy in the Middle East, despite the standard set by the World Health Organization, there is an urgent need for planning to reduce this rate. Therefore, it is recommended to use effective methods to reduce the need for episiotomy in primiparous women and to avoid unnecessary clinical interventions such as using oxytocin.

As proper communication is the key to a strong family and the couples must follow effective communication patterns in these relationships to strengthen the family foundation, improving these relationships has been very effective.

The purpose of this study was to review the strategies for enhancing the couple communication patterns.

In this scoping review, the SID, Barkat, PubMed, Cochrane, Scopus, Web of Science, Uptodate, Magiran, and Psych INFO databases were searched for interventional studies from 1990 to 2019 on Iranian couples. At the end of the search, 131 papers were obtained, and finally, 19 papers were included in the scoping review.

The classification was based on educational and therapeutic strategies. The educational strategies included training communication skills and training life skills and the therapeutic strategies included couple therapy, narrative therapy, and family therapy.

According to the results, it seems that to improve couple communication patterns, both life and communication skills are needed for all couples. Communication and life skills training can be more convenient and less costly than the rest. Each of Treatment methods need more specialized courses and one cannot reach useful results by some brief sessions, but training can be provided to couples even through the book.