ali fakhr-movahedi

Clinical nurses often encounter situations that challenge their professional integrity and values. In the face of these issues, many nurses have been subjected to moral outrage (MO) in response to moral violations by others, which can have different outcomes. This scoping review aimed to synthesize and summarize findings from existing articles regarding the consequences of moral outrage among nurses.

This paper presents a scoping review based on the Joanna Briggs Institute (JBI) methodology. PubMed, Springer, Scopus, and ScienceDirect databases were systematically searched using the keywords “moral outrage”, “nurses or nursing” and “consequences or outcomes or impacts or effects or influences of moral outrage” (viz., moral OR ethical AND outrage AND nurse*). The PRISMA checklist was used for the scoping review to evaluate articles thoroughly. The results were summarized using the inductive content analysis suggested by Elo and Kyngäs.

In total, 1014 articles were identified as potentially relevant to this study with 34 articles synthesized, including 24 qualitative studies, 5 quantitative studies, and 5 reviews focused on the consequences of moral offenses in nursing. Negative consequences such as mental exhaustion, job burnout, and interpersonal failures were observed, alongside positive consequences like nurses’ altruism, callousness, and professional solidarity.

These findings underscore the importance of addressing MO among nurses to prevent negative consequences such as burnout and moral degradation. Moreover, recognizing and fostering the altruistic and resilient aspects of nurses in response to moral outrage can lead to a more positive work environment and improved patient care.

Emergency department nurses face patients and their companions with different cultures and expectations in a highly stressful and critical environment, which exposes them to more job burnout. Establishing effective communication and providing optimal care to patients with different cultures requires cultural intelligence.

The present study aimed to investigate the relationship between cultural intelligence and job burnout in emergency department nurses.

This descriptive-analytical study was conducted on 230 emergency department nurses of nine hospital in Semnan province with questionnaires of personal information, Ang and Earley's cultural intelligence, and job burnout of Maslach from October to March 1401. Data were analyzed with SPSS version 26 software at a significance level of P < 0.05.

Cultural intelligence was higher in men, subjects aged 30 - 39, married and without children, subjects with a bachelor's degree, familiar with more than one language, 20 - 16 years of work experience, and 15 - 11 years of work experience in the emergency department. Job burnout was higher in women, subjects aged 40 - 49, married and with children, familiar with more than one language, in project personnel, and people with work experience of 20 - 16 years and work experience of 15- 11 years in the emergency department. The average score of cultural intelligence was 86.34 ± 16.02 and the average score of burnout was 74.55 ± 15.50. Cultural intelligence negatively correlated with job burnout (r = - 0.123).

Since cultural intelligence had a negative correlation with job burnout of nurses in the emergency department, nursing officials and managers must consider variables such as gender, marital status, number of children, level of education, familiarity with more than one language apart from the Persian language, and their work experiences.

Abstract Using an effective method to enhance nurses’ knowledge of ECG interpretation is one of the most essential requirements for nursing managers. Self-directed learning approaches can help to introduce lifelong learning in learners, especially in clinical settings. This study purposed to detect the effect of the implementation of the clinical teammate nurse program on the critical care nurses’ knowledge of ECG interpretation on cardiac arrhythmia.  A pilot study was performed by a quasi-experimental design with a nonequivalent control group. The participants were 32 critical care nurses divided into two groups: the clinical teammate nurse program and control groups. The data were collected by a knowledge assessment questionnaire that measured nurses’ knowledge of ECG interpretation of cardiac arrhythmia. The nurses’ knowledge was measured three times: initial study, one month, and six months later. The mean and standard deviation of age of participants was 32.38±7.03 years. There was a significant difference between three scores of repeated measurement of nurses’ knowledge (p<0.001), as the nurses’ knowledge one month after the study was significantly higher than in the initial test six months later. Also, pairwise comparisons showed that nurses in the clinical teammate program had higher knowledge scores than the control group (p<0.001).  The clinical teammate nurse program can be used as an easy and economical way to improve nurses’ knowledge in interpreting ECG. This method can also be an excellent alternative to formal and traditional methods such as lecturing programs in continuing education programs.

The rapid growth of technology, demographic changes, increasing patients’ demand, and changes in the nature of diseases, increased competition among hospitals and healthcare providers, and constraints in budget allocation necessitate adopting a novel approach to the management of medical centers based on international standards.

This qualitative study was conducted in two stages by a content analysis approach in the year 2022 in teaching hospitals affiliated with the Islamic Azad University nationwide. The statistical population in the first stage included all studies addressing various aspects of the factors affecting the optimal management of hospitals. In the second stage, it included 10 executive managers of hospitals purposively selected as experts until reaching data saturation. The validity and reliability of the interviews were confirmed using the Lincoln and Guba methods. The data analysis method involved a comprehensive review of studies to identify factors affecting the optimal management of hospitals and a contractual content analysis to identify, analyze, and report themes.

In the first stage, a comprehensive review of studies was conducted, encompassing a total of 96 research papers, including 36 in Persian and 60 in English. Following the examination of the titles and abstracts of these research papers and aligning them with the predefined inclusion and exclusion criteria, a total of 18 studies were selected for final analysis, comprising 11 in Persian and 7 in English. After identifying the factors affecting the optimal management of hospitals, three main dimensions were extracted, including strategic planning (12 components), reengineering (8 components), and supply chain engineering (14 components) for the optimal management of hospitals affiliated with the Islamic Azad University using the content analysis method.

Managers should implement each of the identified components of strategic planning, reengineering, and supply chain engineering for the optimal management of hospitals in line with the hospitals’ structure. By examining the excellence and efficiency of hospitals over time, as well as evaluating the trends of each of them, they should take steps towards adopting reform policies and their experiences should be utilized in other hospitals.

Carspecken’s critical ethnography method has gained prominence in nursing research, necessitating a fresh perspective on its practicality and advantages. This study aims to provide a unique viewpoint on using critical ethnography as a foundational methodology to uncover health disparity culture in intensive care units.

Methods & Materials: 

While emphasizing its review design with original examples, this perspective piece provides a practical explanation of Carspecken’s five-stage critical ethnography approach. Grounded in the ontological and epistemological paradigm, this essay examines critical ethnography as a crucial approach to illuminating the discursive culture surrounding health disparities. Also, this study presents original instances of monological and dialogical data, reconstructive analysis, and findings from a study that was carried out to provide more perspective on implementation. It also mentions how it relates the findings to social factors and sociopolitical theories.

The study reveals nuanced insights into the practicality and advantages of Carspecken’s method, shedding light on social processes contributing to health disparities in intensive care units. This method allowed us to identify how external powers extend to the intensive care unit, revealing a concealed culture that disrupts service provision balance. It exposed individual, organizational, and systemic roots contributing to disparities. Additionally, it highlighted how individual diversities can lead to disparity.

This study highlights the significance of Carspecken’s critical ethnography in nursing studies within the critical theory tradition. It is argued that Carspecken’s approach to critical ethnography is particularly instrumental in elucidating the social structures contributing to health disparities.

Intuition plays an essential role in caring for children with high-risk diseases and making appropriate decisions in critical situations. Understanding the context of intuition will lead to a more appropriate use of intuition. This study was proposed to explore pediatric nurses’ experiences of contextual factors influencing intuition formation in pediatric nursing. This qualitative content analysis was conducted on 16 nurses and 2 pediatricians in pediatric settings of Bandar Abbas hospitals, Iran, in 2020. Participants were purposefully selected with maximum variation in job position, age, and work experience. Data were collected through semi-structured interviews that focused on the occurrence of their intuition experiences and influencing factors. The interviews were transcribed and analyzed using the Graneheim and Lundman method of content analysis. To increase the trustworthiness of the data, the codes extracted were peer-checked, member-checked, and external-checked. The theme of "competence in the shadow of limitation and uncertainty" represented the context in which intuition occurred and was used in pediatric nursing. This theme was derived from the two categories “the limited scope and inexplicability of intuitive actions” and “rational mastery.” Despite the belief in the role of knowledge and experience in forming intuition, pediatric nurses were mostly reluctant to intervene based on their intuition. Organizational issues such as the limited and ambiguous nature of Iranian nurses' independent practice and the inexplicable nature of intuitive actions have limited pediatric nurses' use of intuition. Hospital leadership should moderate barriers to using intuition by changing mindsets, culture, and legislation.

 Nurses' job stress can affect their physical and mental health. If sexual health is endangered, the sexual health of the sexual partner might be in trouble.

 This study aimed to investigate sexual dysfunction and related factors in hospital emergency male nurses and its relationship with their spouses' sexual function.

 This study was a descriptive-analytic cross-sectional study. Data collection tools were the International Men's Erectile Performance Questionnaire and Women's Sexual Performance Index Questionnaire. Male nurses and their spouses completed the questionnaires separately and mailed them.

 One hundred and ten people participated in this study. The prevalence of sexual dysfunction in emergency male nurses and their spouses was 40% and 92.7%, respectively. There was no significant relationship between the sexual dysfunction of male nurses and the sexual dysfunction of their spouses (P = 0.324). There was a statistically significant relationship between the mean score of male nurses' sexual dysfunction and the number of children (P = 0.002) and between the spouses of emergency male nurses' mean scores of sexual dysfunction and their employment (P = 0.032).

 Being a male emergency nurse could not play a role in developing sexual dysfunction in their spouses. The prevalence of sexual dysfunction in male nurses is almost equivalent in other men and their spouses higher than in other women in the community. While sexual dysfunction in the male emergency nurses was related to the number of children, their spouses' sexual dysfunction was related to their jobs.

Mint and chamomile can effectively reduce the gastric residual volume (GRV). This study aimed to determine the effect of mint extract and chamomile drops on the GRV of trauma patients under mechanical ventilation and nasogastric tube feeding in the intensive care unit. This study was a triple-blinded randomized clinical trial with a 2×2 crossover design. Eighty patients were randomly divided to receive mint extract and chamomile drops. Five drops of mint extract and 11 drops of chamomile were gavaged every 6 hr. GRV was measured using a syringe-aspiration method before and 3 hr after each intervention. After a 24-hour washout period, the two groups changed places. In the first phase of the study, before the interventions, the GRV in the mint and chamomile groups was 14.60±7.89 and 13.79±7.12 ml, and after the interventions were 8.13±6.31 and 6.61±4.68 ml, respectively. In the study's second phase, before the interventions, the GRV in the mint and chamomile groups was 10.03±4.93 and 11.46±7.17 ml and after the interventions, GRV was 4.97±4.05 and 6.98±4.60 ml, respectively. The difference in the GRV before and after the intervention was not significantly different between the two groups. Both herbal drugs effectively reduced the GRV (p=0.382). Mint extract and chamomile drops are similarly effective in reducing the GRV in trauma patients under mechanical ventilation and nasogastric tube (NGT) feeding in the intensive care unit.

Intuition is one of the key factors in decision-making leading to timely recognition of problems and quality care.

The purpose of this study was to determine the extent of intuition and the factors influencing it in pediatric nurses.

A cross-sectional study was conducted in 2020 with 100 pediatric nurses working in hospitals of Bandar Abbas, Iran. Smith Intuition Instrument was used to collect data. Descriptive statistical methods, t-test, and analysis of variance were used for data analysis.

Most nurses (59%) demonstrated moderate use of intuition whereas the others (41%) showed high use of intuition. Nurses with less than 10 years of work experience and those working in pediatric intensive units scored significantly higher on the reassuring feelings subscale (P<0.001).

The pediatric nurses’ intuition was appropriate. Nurses are encouraged to confidently use their intuition without fear of blame in the difficult and sensitive situations of pediatric care.

It is challenging to implement evidence-based care and update and improve health care policy. Adhering to evidence-based Clinical Practice Guidelines (CPGs) serves as a guide for making decisions based on the best evidence and making an attempt to improve the quality of patient care and outcomes. Despite the need for implementing CPGs in Iranian hospitals, the concept and implementation method of CPGs are not clear yet. This action research aims to propose the soft systems methodology (SSM) to facilitate the implementation of CPGs in a general hospital in Iran.

We employed the SSM to conceptualize the situation for the implementation of CPGs. Semi-structured in-depth interviews and group discussions with different stakeholders were used to define the purposeful activity model. The SSM tools and techniques were used to identify the main areas of change and select necessary measures to facilitate the implementation of CPGs. Flexible qualitative methods for data collection and analysis were utilized throughout the study.

Applying SSM for implementing CPGs could generate knowledge by recognizing hyper-complexity in healthcare setting, adopting an attitude of inquiry, and fostering dynamic changes in diverse and numerous worldviews of professionals in the accommodation process. This knowledge can provide a model for the successful implementation of CPGs at a macro-system level and facilitate the persuasion process for its implementation at the mesosystem level. More importantly, adopting SSM can create iterative learning loops over time and, thus, help the clinical microsystems face future healthcare complexities.

The application of systems thinking approaches, especially SSM is recommended for implementing CPGs and addressing complex issues in healthcare settings and other system levels.

Identifying the challenges in clinical guidelines implementation from the perspective of clinical care providers can provide valuable information for implementers and policymakers providing clinical care services at the local and national levels. The present study aimed to identify the challenges of implementing clinical guidelines from the perspective of clinical care providers. 

The present study was conducted with a qualitative approach. The statistical population of the study included a number of key stakeholders and aware of how to provide clinical care in Allameh Behlool Gonabadi Hospital affiliated to Gonabad University of Medical Sciences in 2020, which were purposefully selected by snowball method. Data collection was continued through semi-structured interviews and focus group discussion sessions until the data saturation stage was reached. A total of 30 interviews were conducted. The four criteria of Lincoln & Guba were used for the accuracy and robustness of the study findings. Data were analyzed by content analysis method and Graneheim & Lundman content analysis method.

542 meaning unit and 71 condensed meaning unit were extracted. After aggregating them, 3 categories and 12 subcategories were identified as effective challenges in implementing clinical guidelines.

Challenges of implementing clinical guidelines include procedural, process, and structural challenges. Therefore, it is suggested to pay attention to these challenges in writing, developing and implementing clinical guidelines at all different levels of clinical care providers.

In a pre-hospital emergency, identifying high-risk medical patients and appropriate decision making is very important. The classifying of life-threatening risks in pre-hospital settings can improve the decision-making process. This study was purposed to classify the risk level of death in patients in pre-hospital emergency settings.

This study was a descriptive longitudinal study design that performed on the patients requesting the pre-hospital emergency services. This study was a descriptive longitudinal descriptive study that lasted from May 1 to the end of August 2017. 675 patients participated in this study. A demographic questionnaire and pre-hospital internal emergency alert scale were used for data collection. Then the patients' condition was followed up until discharge from the emergency department.

The mean score of the Pre-Hospital Internal Emergency Warning Scale was 11.95 ± 6.21. The odds ratio for each Prehospital Medical Early Warning Scale (Pre-MEWS) score was 1.193, which indicated for each unit increase in Pre-MEWS scores, the risk of death of patients increased by 19.3%. Then, the patients classified into three levels of green, yellow, and red based on Pre-MEWS scores. The Area Under the Rock curve for Pre-MEWS scores to identify death and the need for hospitalization in intensive care units was equal to 0.847 (CI=0.793-0.901), and0.755 (CI= 0.711-0.799) respectively).

The Pre-MEWS scale can use for classifying and triage of patients in pre-hospital emergencies, especially in times of disaster. According to the Pre-MEWS scale, patients who are in the third level or green color can transfer to the hospital with more delay, and this can improve the quality of pre-hospital emergency services in times of disaster.

The World Health Organization (WHO) has considered the ideal rate for cesarean sections to be 10 - 15%. The Iran Ministry of Health introduced the promoting natural childbirth program (PNCP) in 2014 to lower cesarean sections.

This study presents a model for the implementation of the PNCP.

A mixed study was conducted to determine and prioritize the factors affecting the implementation of PNCP and present a model. We conducted a qualitative study to determine the effective factors of the program by examining the views of 15 gynecologists, anesthesiologists, midwives, and managers in 2019 at Zabol Medical Sciences University. Semi-structured individual and group interviews were used and analyzed with MAXQDA16. In the quantitative phase, a questionnaire of themes was prepared and ranked by 10 experts based on the Likert scale. Then, we used the technique for order performance by similarity to ideal solution with BT TOPSIS solver software to confirm and rank the themes and design a model.

The model included six main themes extracted from the qualitative phase. In the quantitative phase, they were approved and prioritized by experts in the following order: 1) Creating a Culture for Natural childbirth, 2) Strong and committed leadership, 3) Empowerment, 4) Education, 5) Comprehensive support, and 6) Optimization.

The model can provide useful insight for policymakers and care providers to make more qualified decisions, determine the status quo, allocate resources, and enforce policies.

Quality of life (QoL) is a complicated phenomenon in patients with thalassemia major. This study was conducted to clarify the concept of QoL in patients with thalassemia major.

This study was performed using Roger’s evolutionary method. Electronic databases: Cochrane Library, Web of Science, Scopus, Science Direct, ProQuest, and Medline. The inclusion criteria were papers published in English up to March 2017 with no time limit for publication. The keywords searched in titles, abstracts, and keywords of the studies included quality of life, health-relatedquality of life, thalassemia, thalassemia major, beta thalassemia, and beta thalassemia major.

67 studies were included. QoL in most studies had been evaluated using the SF-36 and PedsQL. The terms QoL, HRQoL, and QL were used interchangeably in most of the studies. In this concept analysis, HRQoL and well-being were recognized as surrogate terms for the QoL in patients with thalassemia major. The concepts related to the QoL in patients with thalassemia major included satisfaction, indicator of health care, individual’s own view of health, and health status assessment. Five antecedents identified in this concept analysis were: professional figure mainly involved, clinical-care interventions, medicinal and therapeutic approaches and response to them, disease characteristics and presence of comorbidities, ability and characteristics of patient. Seven attributes of the QoL in patients with thalassemia major were objective, subjective, multidimensional, measurable, dynamic, predictable, and processable.

Consequences of the concept were effects on physical functioning and improvement of psychological conditions, compliance with regular chelation therapy, iron overload, continuing education, having an appropriate job and marriage, patients’ economic and social status, and finally, motivation and life expectancy.

The growing number of children with chronic diseases is a global issue. Cancer is one of the most important chronic diseases in children. According to WHO, the number of children with cancer varies from 50 to 200 cases per million children worldwide .However, the incidence of childhood cancers in Iranian girls and boys is reported to be 48-112 and 51-141 per million children, respectively .Cancer has many psychological and physical consequences for both the child and his or her family. One of the most important concerns about children with cancer is attention to their quality of life and its promotion Palliative care is one of the most important and effective ways of improving the quality of life .Children's palliative care is unique in each age group due to their certain developmental stages. For this reason, WHO has provided a separate definition for it: “palliative care for children is the active total care of the child's body, mind, and spirit, and also involves giving support to the family” .In Iran, the main problem in the treatment-care system in palliative care of cancer patients is the lack of a structure and framework for the members of the health group, such as nurses .In Iran, palliative care is a new concept, and there is no systematized program for this type of service in accordance with current needs .Palliative care for children with cancer in Iran is very important. Currently, the only institution that provides palliative care for pain management in children with cancer is The Mahak Society to Support Children Suffering from Cancer.Considering that there is no palliative care system for children in Iran, and since the number of children with cancer is on the rise, the establishment of a palliative care system for children with cancer is an apparent and important need.

Nine equivalents of nursing manpower use score (NEMS) is one of the scoring systems used in some studies to determine the severity of the status of patients in the ICU. The present study was conducted to investigate the application of NEMS to identify patients at the end stages of life.

This study was a prospective design where 420 patients were selected from the intensive care unit (ICU) of a referral hospital. Data collection tools were demographic, disease-related, and NEMS questionnaires. The last calculated NEMS score for patients was used to detect their need for end-of-life care. After completing the sampling, the data were analyzed by descriptive statistics and Cox regression at 95% confidence interval.

The relative risk of death in the ICU was 1.027 (95% CI = 1.015 - 1.042). All patients with NEMS ≥ 38 died, however, all patients who had a NEMS score ≤ 15 were discharged from the ICU with a satisfactory general health. The death rate was 22.1% in the 15 ≤ NEMS ≥ 34 scores. Finally, the patients admitted to the ICU were divided into three groups. The first group was the patients with a mortality risk < 41%, the second group had a mortality risk between 41% and 99%, and the third group were the patients with the mortality risk of 100%.

The present study presented a numerical criterion (NEMS > 34) for identifying the patients in need of end-of-life care instead of life-saving measures. However, further studies should be carried out in this area to argue the exact NEMS score requiring life-saving measures in ICU patients.

Promoting critical thinking skills is an essential outcome of undergraduate and postgraduate nursing education..
The current study aims at comparing critical thinking skills of bachelor students of nursing (BSc) and master’s students of critical care nursing (MSc) in the academic year 2014 - 2015..
The current cross-sectional study was conducted on 79 BSc students of nursing and 44 MSc students of critical care nursing in 3 universities of medical sciences including Semnan, Tehran, and Kashan. The California critical thinking test, form B, was used for data collection. Analysis of variance Mann-Whitney, and Kruskal-Wallis tests were used for statistical analyses..
The mean scores of BS and MSc nursing students were 11.14 ± 3.01 and 10.05 ± 3.33, respectively, which were not significantly different. The mean scores of students in Semnan, Tehran, and Kashan universities of medical sciences were 9.84 ± 3.13, 9.66 ± 3.32, and 11.79 ± 2.92, respectively, and the total mean score was 10.46 ± 3.24. The scores of critical thinking domains showed that students in Kashan University gained higher scores in interference, and deductive and inductive reasoning domains compared with the students in other universities..
The level of critical thinking in BSc students was higher. The overall level of critical thinking skills was low in nursing students. It is suggested that appropriate and effective methods should be employed to create and improve critical thinking in nursing education.

Scoring systems are considered as a guideline for caring personnel in intensive care units (ICU) to evaluate patients’ status or estimate recovery chance. Nine Equivalents of Nursing Manpower Use Score (NEMS) is one of these systems. Considerably, the credits of obtained scores of NEMS in different days after patients’ admission or deciding about current status of patients according to previous scores of NEMS are not clear properly. So, this study was performed to evaluate the mean alteration trends and credit of Nine Equivalents of NEMS in internal patients’ admission in intensive care units.
In a descriptive-prospective study, the information of 156 patients that admitted in critical care units of Edalatian hospital of Mashhad city, were calculated and recorded until 7 days according to demographic questionnaire and NEMS. A purposeful sampling method was adopted and all eligible patients were included. Then using the ROC curve, the validity of daily NEMS scores of patients were demonstrated.
The curve of mean alteration trends of NEMS of expired patients was increased and for discharged patients was decreased during seven days of admission in ICU. Also, the ROC curve showed that with increasing duration of hospital stay, NEMS ability to diagnosis of critically ill patients was improved.
The credit of NEMS increases with duration of hospital staying. So, it is suggested when using the NEMS, the scores of final days of hospitalization in ICU be considered more seriously.

Coronary artery diseases (CAD) are associated with psychological problems such as anxiety and depression in patients. Thus, management of these problems can consider as an important intervention by health care workers, especially nurses.. The purpose of this study was to investigate the effectiveness of patient-focused clinical pathway on anxiety, depression and satisfaction of patients with CAD..Patients and In this quasi-experimental study, 138 patients suffering from CAD in a coronary care unit of a referral teaching hospital affiliated to Semnan University of Medical Sciences in Semnan, Iran, were recruited using a convenience sampling method. The participants were assigned to two groups: Clinical pathway (CP) and routine (RUT) care. The level of anxiety and depression of patients were measured in admission and discharge in both groups. Also, the level of patients’ satisfaction was measured at the time of discharge. Data were analyzed using descriptive and inferential statistics.. Prevalence rates of anxiety and depression in total of patients were 7.2% and 8.7%, respectively. In terms of anxiety, the mean of difference between pretest and posttest scores in the CP group (0.52 ± 1.39) was higher compared to the RUT group (-0.17 ± 1.69) and there was a significant difference between the two group (P = 0.009). In terms of depression, the mean of this difference in the CP group (0.75 ± 2.05) was higher compared to the RUT group (0.00 ± 1.08), as there was a significant difference between the two group (P = 0.024). Also, the mean of patients’ satisfaction scores in the CP group (3.69 ± 0.39) was higher compared to the RUT group (3.45 ± 0.47) and there was a significant difference between the two groups (P = 0.002).. According to the positive effects of CP on patients with CADs, it can be considered as a useful, safe and simple instrument for the improvement of patients’ outcomes. Thus, the findings of this study can provide a new insight in patient care for clinical nurses..

Learning basic issues in nursing requires new strategies that can enhance knowledge retention among nurses. This study aimed to determine the effect of lecturing by peer-nurses on critical units nurses’ retaining knowledge of electrocardiogram (ECG) interpretation.

In this experimental study، two units (as test and control groups) were selected randomly from among critical care units of Semnan University of Medical Sciences hospitals. First، a pretest was performed on nurses in both groups. Then، the nurses of test group were trained by a peer-nurse how to interpret ECGs. A posttest was performed on the two groups both a week and a year later. Finally، the data were analyzed using Pearson’s correlation coefficient، t-paired and t-tests.

The mean of nurses’ scores of ECG interpretation in pretest was 9. 55±2. 73 in the test group and 10. 82±3. 43 in the control group. In the first posttest، mean scores of nurses’ knowledge in test and control groups were 15. 27±2. 57 and 11. 36±3. 29، respectively. In the second posttest، nurses’ mean scores in test and control groups were 10. 82±4. 07 and 11. 33±2. 95، respectively. There was a significant difference (p<0. 05) between the pretest and the first posttest in the test group، but there was no such difference for the second posttest (p>0. 05).

Lecturing by peer-nurses can enhance nurses’ knowledge about ECG interpretation in the short run، but it cannot enhance knowledge retention. So it is suggested that other educational methods be used in nurses'' in-service training programs designed for ECG interpretation.

Regulation of endotracheal tube cuff pressure is a caring challenge in patients with mechanical ventilation. There are different methods for regulation of cuff pressure. The aim of this study was to investigate the effects of regulation of cuff pressure with minimal occlusion volume (MOV) method on incidence of ventilator associated pneumonia (VAP). In this pilot and quasi-experimental study، 40 patients in intensive care units were selected purpose fully with specific criteria and randomly allocated in two groups (estimated and MOV). In the estimated group، one of experienced nurses estimated cuff pressure and in the MOV group، cuff pressure regulated with no leakage in peak of inspiratory pressure. Cuff pressure and score of clinical pneumonia was measured in four days. Findings showed that mean of cuff pressure in estimated group was 50. 35±9. 5 cmH2O and in MOV was 20. 78±1. 4 cmH2O. Patients in two groups were similar in VAP related factors (P>0. 05). In pneumonia scores two groups were not significantly different (P=0. 968). Findings showed that regulation of cuff pressure with MOV in patients under mechanical ventilation can cause seal endotracheal tube and prevented pneumonia without over-inflation and tracheal injury.

Patients under mechanical ventilation suffer agitation and lack of forbearance due to different reasons, which bring about changes in arterial oxygen saturation. Thus medicinal treatments are often used, which exact various complications. A touch could be an influential physiologic, non-medicinal stimulus in this procedure. Therefore this study conducted to determine the effect of touch on the level of arterial oxygen saturation in agitated patients under mechanical ventilation. The present study is an Interventional study of an after-and-before design, which was conducted on 35 patients under mechanical ventilation, who were hospitalized in the intensive care unit (ICU). These patients aged from 35 to 60. Sampling was carried out based on simple sampling of patients hospitalized in general ICU at Day Hospital, Tehran. In the way that in the intervention group, the nurse touched the patient while standing by him/her. Then the level of arterial blood oxygen saturation was measured by pulse oximeter before and after intervention. The achieved results were assessed by using software SPSS-16 and statistical tests and a significant level of less than 0.05 was accepted. According to the data analyzing, the difference of the changes in the arterial oxygen saturation level was significant before and after intervention (along with touch) (p< 0.001) but while there wasn’t any touch, this difference wasn’t significant (p= 0.071 Touch improves the respiratory status and raises the level of arterial oxygen saturation in patients under mechanical ventilation. Thus it is recommended non- medicinal measures such as touch be taken in order to improve the respiratory status of the patients under mechanical ventilation.

Communication is an important aspect of nursing care and much of nurses’ duties such as providing physical care, emotional support, and exchanging of information with patients can not be performed without communication. The quality of care is improved through nurse-patient relationship. Nurse and patient relationship in clinical settings is influenced by multiple contextual factors which recognize them can improve the important role of nursing. This study aimed to explore the contextual factors influencing nurse and patient relationship. The study was performed by qualitative research approach. Participants were 17(8 nurses and 9 patients) in medical and surgical wards of Imam Khomeini hospital of Tehran university of medical sciences that selected by purposive sampling method. Data were gathered by interview (unstructured and semi-structured) and observation. Data analyzed by content analysis approach. Three theme emerged form data analysis which influenced the nurse-patient relationship. Those were formative factors, continuative factors and deterrent factors. These themes were explained in detail in the main text of article. Findings showed that in spite of nurses’ positive attitude to communicate with patients and caring their needs, there were problems in nurse-patient communication that prevent from a patient-centered communication between nurses and patients