eesa mohammadi

Essential hypertension remains a significant global health challenge. Self-care is among the most effective strategies for managing this condition. Understanding patients' perspectives and experiences regarding self-care behaviors can significantly aid nurses in enhancing these behaviors.

This study aims to explore self-care behaviors in patients with essential hypertension.

This qualitative study employed conventional content analysis to examine 16 patients and three healthcare providers associated with urban healthcare centers affiliated with Shahroud University of Medical Sciences in Semnan province, Iran, during 2023 - 2024. Participants were selected through purposive sampling. Data were collected via individual, semi-structured, in-depth interviews, which were recorded and transcribed. The transcripts were analyzed using the method proposed by Elo and Kyngäs (2008).

The study identified "Yo-Yo-like" self-care behaviors as the main concept, with four primary categories and 12 subcategories extracted. The main categories included fluctuating patterns in medication adherence, dietary adherence, exercise, and smoking.

The self-care behaviors of patients with essential hypertension exhibit coordinated fluctuations, correlating with the disease's severity. As the disease subsides, adherence decreases, and vice versa. This fluctuating pattern has created a vicious cycle in disease control. Interventions, particularly by nurses, are essential to break this cycle and effectively manage hypertension.

Different methods of cancer treatment can lead to the destruction of fertility. Preserving fertility before starting treatment provides an opportunity for future fertility. This study aimed to explain how to provide fertility preservation services and the barriers to receiving them for breast cancer patients in Iran.

This qualitative study was conducted using the conventional qualitative content analysis method. Participants included service providers and breast cancer survivors who were purposively selected. Sampling continued until data saturation. Data were collected through the use of unstructured, in-depth interviews with participants. Data analysis was performed using the Granheim and Landman method (2004).

Data analysis led to the emerging theme entitled insufficient coverage of fertility preservation services in breast cancer patients. It means that despite access to different fertility preservation methods by the latest technology in the world, there are obstacles, such as lack of equal access to services, high costs, lack of insurance coverage, urgency in starting treatment, priority to save the patient's life, and lack of information to some patients, prevents some eligible people from receiving fertility preservation services.

Considering the importance of having children in improving the quality of life of breast cancer survivors, it seems necessary to remove the barriers to fertility preservation in breast cancer survivors.

Schizophrenia is a severe mental disorder characteristics by abnormal thoughts, patterns, cognitive impairments, and either a diminished or exaggerated expression of emotions. This disorder follows a chronic clinical course, with many many individuals experiencing symptoms over extended periods. Patients with schizophrenia often lack insight into their condition, leading to frequent relapses and multiple hospitalizations. mental disordrs Mental disorders, in general, impose a significant burden on caregivers; however, schizophrenia presents unique challenges. Beyond the decline in individual and social functioning of patients and the direct impact of symptoms on caregivers’ quality of life, the early onset and debilitating nature of schizophrenia further exacerbate the strain on family caregivers. This policy brief outlines strategies aimed to reducing the caregiving burden for for families of individuals with schizophrenia.

Reduction of the fertility rate is one of the most critical concerns of policymakers in Iran. Women expressed concerns about the feeling of incompetence in raising children. This study was conducted to provide an intervention program of parenting skills training based on the theory of planned behaviour to increase pregnancy intention.

Through a qualitative study on barriers to childbearing, feelings of inadequacy were identified as an important factor in preventing women to have a child. After searching reliable sites, the educational intervention program on the art of parenting was compiled based on the theory of planned behaviour, with the content of self-awareness skills, the art of parenting by UNICEF, and the Islamic thoughts. Qualitative content validity was used to validate the program. For this purpose, the program was sent to 10 experts. The program consisted of 6 sessions; at the end of each session, there was an evaluation form. After collecting opinions and modifying the program, it was reviewed for final approval.

In this 6-session program, goals, educational strategy and educational content have been developed for each session. The program has been written in a way that teachers can implement the program easily. The program was planned for use by single, married, childless or childbearing women.

Health service providers can use this program to educate women and increase their sense of empowerment to facilitate pregnancy.

This study aimed to identify strategies for enhancing the quality of home care for trauma patients. Using a conventional qualitative content analysis approach, this study was conducted from September 2023 to September 2024 in Hamadan, located in northwest Iran. A total of 18 participants, including home care managers, nurses, trauma patients, and the family members of trauma patients, were selected through purposive sampling. Data were collected using semi-structured interviews and analyzed using Graneheim and Lundman’s method with the assistance of MAXQDA software (version 20). Analysis of the data yielded 430 initial codes, which were categorized into 36 subcategories and 6 main categories: patient-centered care, safe care provision, spiritual care, effective educational program development, service effectiveness enhancement, and dynamic service delivery. The study results showed that nurses employed various strategies to improve the quality of home care services for trauma patients. Key strategies included adhering to the principle of patient-centered care, providing safe care for trauma patients, providing spiritual care, developing effective educational programs, enhancing service effectiveness, and ensuring dynamism in service delivery. Implementing these strategies could guide policymakers and home care nurses to improve care quality for trauma patients and increase satisfaction. The findings of the present study can enhance the planning and implementation of home care services, facilitating the transition from hospital to home for trauma patients.

Currently, birth experience is considered an indicator for evaluating the quality of care provided during labor and birth. This study examined the effect of the Iranian positive birth experience guideline on the birth experience of primiparous women.

This randomized controlled clinical trial was conducted at Taleghani Hospital, Tabriz, Iran (2019). Thirty pregnant women admitted to labor after checking the eligibility criteria were randomly assigned to intervention (developed guidelines) and control (routine hospital care) groups. Women’s birth experience was evaluated 24 hours postpartum using the Childbirth Experience Questionnaire (CEQ 2.0). An independent sample t-test was employed to compare the average scores between the groups.

The mean (standard deviation) of the total score of birth experience in the intervention and control groups was 3.0 (0.4) and 2.1 (0.5), respectively. The average score of the childbirth experience in the intervention group was significantly greater than that of the control group [Mean difference: 0.9; 95% confidence interval: 0.5–1.2; P < 0.001].

The Iranian guideline for improving birth experiences was able to improve primiparous women’s birth experiences more effectively than routine care. Practical Implications. The findings of this study can be considered in the policies and management of healthcare centers.

Breast cancer survivors often encounter significant challenges in sexual and reproductive health, which necessitates specialized care. The present study aimed to develop and validate clinical practice guidelines for delivering tailored sexual and reproductive health services to breast cancer survivors in Iran.

The present work is part of a three-phase study conducted using sequential exploratory mixed methods. The first phase aimed to identify the sexual and reproductive health needs of breast cancer survivors and the ways in which they receive related services. The results of the qualitative research conducted in this phase were published earlier. In the subsequent steps, which have been mentioned in the current work, the authors first did a systematic review to find the clinical practice guidelines available in the world that deal with the sexual and reproductive health of breast cancer survivors. Then, the draft of the clinical practice guidelines was developed using the findings of the qualitative study, systematic review, and the opinions of the expert panel members. The validity of guidelines was determined using the AGREE II (Appraisal of Guidelines for Research & Evaluation II) instrument.

The developed clinical practice guidelines encompass 76 recommendations across six sections: general recommendations, sexual health, body image, early menopause, contraception, and reproductive health. The guidelines scored over 86% in all domains of the AGREE II instrument; all assessors recommended the guidelines for use, with or without minor modifications.

These clinical practice guidelines are not only tailored and validated but also provide a comprehensive framework for addressing the specific sexual and reproductive health needs of breast cancer survivors in Iran. These guidelines can serve as a valuable scientific and practical resource.

We aimed to investigate the relationship between lifestyle status and metabolic syndrome (MetS) components across gender and age groups of the older population, specifically focusing on identifying the as-sociation between MetS and lifestyle factors in classified age groups in older individuals.

Overall, 582 older people with MetS in Yazd (Iran) urban primary health care centers were randomly included from 10 health centers and invited to participate in the study in 2022. During the phone invitation, eligible interested people were asked to refer to health care centers for clinical assessments by trained health researchers. MetS components, dietary intakes using validated frequency food questionnaire, and physical activ-ity by International physical activity questionnaire (IPAQ-short form) were measured.

Women with Mets under 75 yr had significantly higher BMI, weight, and FBS than men and men had significantly higher WC than women. Among patients over 75 yr old, women had significantly higher weight than men had and lower WC and lower HDL_C than men. There were significant differences between gender groups of the aging patient under 75 yr old in terms of vigorous physical activity, total metabolic equivalent of activity, total fat intake, PUFA, and sodium intake, with men reporting level of mentioned lifestyle factors than women.

There were significant gender differences between two aged groups (>75 and <75 yr old) of patients for MetS components and lifestyle risk factors. Weightand WC showed noteworthy gender differences, with variations in both age groups.

With the prolonged COVID‑19 disease control time, concerns about the caring ability of clinically exposed nurses have increased. This study aimed to investigate Compassion Satisfaction (CS), Burnout (BO), and Secondary Traumatic Stress (STS) as elements of Professional Quality of Life among nurses in COVID‑19 settings.

In this descriptive online national survey, 427 clinical nurses who had worked in the COVID‑19 wards from all Iran provinces answered the Persian version of the Professional Quality of Life Scale as the profile tool with three subscales, including CS, BO, and STS. Data were collected using email, Short Message Service (SMS), and social networks from December 2020 to February 2021.

The mean (SD) score of CS was 38.86 (9.00), the mean (SD) score of BO was 18.60 (4.08), and STS was 34.74 (7.02). STS was substantially more prevalent among married nurses whose Polymerase Chain Reaction (PCR) tests were positive for themselves or at least one family member (p < 0.05).

Clinical nurses who respond to the COVID‑19 crisis are at risk of STS and BO. In pandemic situations like COVID‑19, it is necessary to consider supportive interventions to increase satisfaction and reduce burnout and secondary traumatic stress in nurses.

 This study was conducted to develop and validate a Motivation for Healing Scale (MHS) in Cancer.

 in this methodological study, the MHS draft was developed based on the approach of Waltz and colleagues using existing scales and concept analysis. The psychometric features, including face validity (qualitative and quantitative), content validity (qualitative and quantitative), structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity) were assessed. Finally, the reliability was evaluated using internal consistency, and stability.

 Based on the results of the qualitative phase, an initial item pool was generated with 55 items, Exploratory and confirmatory factor analyses were performed on the data collected from 404 patients. 25 Items were excluded during the psychometric evaluation phases. Reliability assessment and internal consistency assessment revealed that Cronbach’s alpha value of the 25-item MHS was 0.912. The results of intraclass correlation coefficient (0.93, 95% CI: 0.86– 0.96) showed the stability was strong.

Conclution:

 The 25-item MHS is a valid and reliable scale for the assessment of motivation for healing in patients with cancer.

 Sexual health is a significant concern for cancer survivors. This study aims to understand how breast cancer survivors and service providers in Iran perceive and experience sexual health services for breast cancer survivors.

The present study used a qualitative approach and conventional content analysis method. Data were collected through the use of unstructured in-depth interviews with participants. The main interview question was how the sexual health of patients is addressed and what services are provided in this regard.

Data analysis led to the emergence of two themes entitled passivity in providing sexual health services and physically oriented services  provided in the field of body image disorder.

The results showed that the sexual health services provided to breast cancer survivors are passive and limited to their expressed complaints. Moreover, while providing body image services is desirable and aligns with global standards in the physical aspect, there appears to be a deficiency in the psychosocial aspect. Providing services using a multidisciplinary approach, training employees about the late effects of cancer, and paying attention to the biopsychosocial aspects of sexual health can improve breast cancer survivors' quality of life.

The Fertility rate is decreasing in most countries and the total fertility rate (TFR) has reached its lower replacement level, and negative population growth is observed in some countries, including Iran. This study aimed to explore the childbearing barriers among women living in northern Iran.

This qualitative study was performed with a conventional content analysis approach in Gorgan, Iran, from November 2018 to October 2019. A total of 23 women participated in this study. Of these, ten women had delayed childbearing at least four years after marriage, nine experienced induced abortion (without medical reasons), and four were voluntarily childless. Three childbearing politicians were also interviewed. Data were collected via face-to-face interviews and analyzed following recommendations by Hsieh & Shannon. The four criteria of credibility, dependability, conformability, and transferability were used to achieve trustworthiness.

Seven themes emerged as childbearing barriers: undesirable society, economic hardship, work-family conflict, changed value of motherhood and childbearing, self- interest and convenience, feeling of inadequacy about parental role, being worried about child suffering and loneliness.

It seems that societal and personal concerns are the most important childbearing barriers among Iranian women. Perhaps some barriers such as economic and social problems could be resolved by advancing women's status in society, equality policies and paid parental leave. However, personal concerns might be reconciled by implementing appropriate educational interventions ensuring that assist couples in making informed decisions about childbearing.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women worldwide, affecting their sexual and reproductive health (SRH).

This integrative review aimed to identify SRH aspects in women with PCOS by consolidating the findings from previous studies.

The present integrative review was conducted through an electronic systematic review search of 1052 manuscripts published from April 2000 to March 2020 using PubMed, SCOPUS, Web of Science, Embase, Google Scholar, MEDLINE, Science Direct, Ovid, and the Cochrane Library. After at least 2 researchers evaluated the articles based on the inclusion and exclusion criteria, 27 papers were accepted. The data were analyzed by thematic analysis.

9 main themes of SRH were obtained: 1) the impact of PCOS-related complications on reproductive health; 2) the lifelong effect of PCOS on reproductive patterns; 3) PCOS and adverse reproductive and pregnancy outcomes; 4) women's need for understanding complications; 5) the financial burden of the disease; 6) women's life experiences and quality of life; 7) sexual disorders; 8) psychological concerns and issues; and 9) femininity feelings and roles.

We were able to identify and categorize various aspects of SRH needs for women with PCOS. These categories can facilitate a more comprehensive assessment of SRH, including previously neglected areas. We suggest that these aspects should be considered in the health plans of women with PCOS.

Adipokines play essential roles in the human body, including regulating the inflammatory process, the immune system's activity, the vascular system, and reproductive function, and performing glucose homeostasis. Adipokine levels change during pregnancy and postpartum, and these hormones play an important role in fetal growth and development. This study aimed to compare maternal leptin and omentin-1 serum levels in vaginal and cesarean deliveries and their relationship with anthropometric indices.

This descriptive-analytical study was performed in 2020 on 90 women (45 patients with vaginal delivery and 45 patients with elective cesarean delivery) admitted to the Mahdieh Hospital in Tehran, who were selected conveniently. Intravenous blood samples were taken in the first 24 hours after delivery to measure maternal leptin and omentin-1 serum levels.

The mean age was 25.8±4.6 and 29.5±4.5 in women with vaginal delivery and elective cesarean delivery, respectively. The results showed that maternal leptin and omentin-1 serum levels were higher in vaginal delivery than in cesarean delivery, although the difference was significant only in leptin serum levels (p<0.001). Also, no significant relationship was observed between fetal sex and anthropometric indices with maternal leptin and omentin-1 serum levels (p>0.5).

Leptin serum levels were significantly higher in the first 24 hours after vaginal delivery than after cesarean delivery Vaginal delivery can be recommended as the preferred method due to its critical role in metabolic and anti-inflammatory activities and reproductive function regulation.

Artistic nursing care is defined as combining knowledge, skills, and judgment to provide the best care. Different studies have introduced different and even contradictory characteristics for this concept. Therefore, nurses are confused about it. This study aimed to clarify artistic nursing care.

Rodgers' evolutionary method was used to clarify the concept of artistic nursing care. This method included the initial phase, core analysis phase, and further analysis phase. Literature from 1990 to 2020 was sought using Springer, PubMed, Scopus, Web of Science, OVID, and SID databases. In general, 28 articles and two books were selected and analyzed.

The attributes of artistic nursing care included discovering a unique way to establish a happy and integrated relationship with the patient, paying intuition attention to the patient individuality to recognize all their needs, creating a positive image of the patient's condition, manifesting love in caring behaviors, and creating opportunities for a healing presence. The antecedents for artistic nursing care include having knowledge and experience, commitment to ethical principles, altruism, and active presence in the field of care. Artistic nursing care improves the patient's physical and mental health, increases the patient's sense of well-being and happiness, increases patient and nurse satisfaction.

In this study, the antecedents, attributes, and consequences of artistic nursing care are presented objectively and practically, which can be used to teach the methods of providing artistic nursing care and design tools for measuring this concept.

There is sufficient information about female sexual function, but few studies have investigated postpartum female sexual function. Postpartum women’s sexual function may be dramatically affected by childbirth. This study aimed to explore women's perceptions and experiences of the concept of postpartum sexual function.

This qualitative study was conducted using a directed content analysis approach based on Female Sexual Function Index (FSFI) between 2018 and 2019. Data were collected through semi-structured interviews with 13 women referred to the health centers of Babol University of Medical Sciences, Babol, Iran and were selected, purposively. The data were analyzed manually using directed content analysis adopted by Hsieh and Shannon (2005).

Overall, eleven categories emerged from the analysis. The six emerged categories were related to the predetermined components, namely sexual desire, arousal, lubrication, pain, orgasm, and satisfaction. The remaining five newly emerging categories included changes in the frequency of sexual intercourse, disturbed situation, changes in intimacy and relationship, physical (anatomical) changes, and psychological consequences.

The results showed some new categories, in addition to the components of FSFI, which could be added to the concept of sexual function in postpartum period. Therefore, health service providers should consider these new additional concepts in the assessment, care, and treatment of female sexual dysfunction in postpartum women.

Despite the importance and prominent role as a clinical, theoretical, and research approach in nursing practice, humanistic care nature and boundaries are not explicit and challenging for nurses to understand. This study was conducted to clarify the concept of humanistic care in nursing.

Based on Rogers’s evolutionary concept analysis, keywords such as “humanistic car *,” “caring behave *,” “humanistic nurs *,” “humanistic model of care,” were searched in PubMed, SCOPUS, Science Direct, Web of Science, WILEY, Springer, SAGE, ProQuest, SID, Iranmedex without time limit until November 2018. Sixty‑five documents in nursing and ten documents in the medical discipline were finalized for thematic analysis.

Nine attributes of the humanistic care, including “excellence in clinical literacy,” “creating a healing environment,” “a comprehensive and unique viewpoint,” “contribution to clients’ adaptation and flourishing of their talents,” “unrequited love and affection,” “preservation of human dignity,” “real presence,” “constructive dynamic interaction,” and “nurse’s self‑care,” were recognized. Assessing the historical and evolutionary course of the concept’s semantic tendency revealed three periods: The focus in first, second, and third was on the nurse‑patient relationship, quantitative tendency/ measurement, and metaphysics/spiritual humanism, respectively. The comparison of interdisciplinary differences indicated greater semantic comprehensiveness and depth in the nursing discipline.

Clear and practical definition and identification of humanistic care in nursing can be helpful in the further development of existing knowledge, instrumentation, designing guidelines, clinical interventions, knowledge translation, and correction of concept misuse. The identified antecedents and consequences can be in various aspects of clinical management.

Studies have revealed that motivation plays a vital role in a person’s ability to heal. The nature of motivation for healing in cancer patients is unknown. The aim of this study was to explore the meaning of motivation for healing in cancer patients.

A qualitative research approach was used as the study design. Data were collected using individual semi‑structured interviews and the themes were derived from the data using the inductive content analysis method. The patients consisted of 34 cancer patients, 4 family members, 1 psychologist, 1 oncologist, and 3 nurses. The participants were interviewed in the cancer clinics or chemotherapy wards.

Based on the results of the interviews, three main themes and seven categories were determined. The themes were identified as (i) the desire to survive, (ii) a spirit of optimism, and (iii) belongingness and responsibility.

The results of this study could be used by researchers to develop tools to measure motivation in cancer patients, and to design intervention mechanisms to enhance the patients’ motivation in cancer care. Moreover, a better understanding of motivation can improve psychosocial support in oncology nursing

Recovery of children does not appear on its own after cochlear implantation. Coherent, thoughtful, and comprehensive rehabilitation is needed to achieve complete success. The purpose of this study was to identify the types of rehabilitation interventions for children with cochlear implants that have been performed in Iran.

A scoping review study was conducted. An electronic search was carried out both in English and Persian. In English, the following keywords were used: cochlear implantation, child, cochlear implants, auditory rehabilitation, deaf, hearing loss, comprehensive, interventions, rehabilitation, and telerehabilitation and a combination of them in ProQuest, PubMed, Science Direct, and Scopus databases, Web of Sciences, Medline and Embase. Persian electronic search was conducted in the Scientific Information Database (SID) of Jihad Daneshgahi, Iran Journals Database (MagIran), and Islamic World Science Citation Database (ISC). Searches were done using articles published until September 25, 2020, and a total of 902 articles were found, of which 14 were directly related to the purpose of the study. Interventional studies were included in the study, and the quality of studies was measured using the Structured Effectiveness Quality Evaluation Scale.

The results showed that using music and rehabilitation equipment, different methods of speech therapy and auditory training, story-based instruction, creative play, family-centered instruction, and occupational therapy are interventions in cochlear implant rehabilitation. Speech therapy accounts for 54% of the rehabilitation share. The mean number of rehabilitation sessions was 26. These interventions were all somehow effective in children with cochlear implantation; the longer the training duration, the better the results.

The process of cochlear implant rehabilitation in children is multi-professional; auditory training and speech therapy possesses the highest share of rehabilitation. Therefore, it is recommended to develop speech therapy centers in Iran.

Neurofibromatosis Type 1 (NF1) is a common autosomal disorder; the criteria for the  diagnosis of NF1 includes café au lait spots, freckling, and Neurofibromas (NF). Skin symptoms  have a major impact on patients’ Quality of Life (QOL) but little is known about the burden of  the disease on patients. The aim of this study was to explore the experiences of patients with NF.

Using purposive sampling, 20 participants were enrolled in this qualitative  content analysis study. The study was carried out between 2019 and 2020. Unstructured interviews  and field notes were used to gather data. Data collection was stopped when data saturation was  achieved.

Data analysis revealed 14 subcategories and 4 categories including “failing and  falling behind in life”, “deprivation and restriction”, “social isolation”, and “ineffective adaptation  to the disease”, which indicate the perception of patients with NF.

In addition to  the physical burden due to physical complications and problems, NF imposes a high degree of  psychological and social burden on patients causing mental conflicts, which in turn results in them  failing and falling behind in life. These findings illustrate the need to develop strategies and use  multidisciplinary approaches to support patients, and thus to reduce the burden of NF.

Context:

 Neurofibromatosis type 1 (NF1) is one of the most common genetic skin disorders that impose significant psychological and social pressure on patients.

The objective of the study was to explore the experiences of patients with neurofibromatosis. Setting and Design: Iran - qualitative study

This qualitative study was conducted in 2020. Eighteen patients with Neurofibromatosis type 1 (NF1) entered the study with maximum variation through purposeful sampling. Semi-structured interviews were used to collect data. Statistical Analysis Used: Conventional content analysis method was used for the data analysis.

Based on analyzed data, five categories including “Feeling defective and incompetent,” “Succumbing”, “Perceived social deprivation”, “Encountering oppression and violation of rights”, and “Rejection” were found.

It was shown that patients with NF1 had unpleasant experiences. Besides the challenges that they had to tolerate with the nature and symptoms of the disease, the disease imposed severe social and psychological pressures on them. Based on findings, it is essential to establish supportive strategies that would help patients deal with problems of the disease effectively

To determine the effect of applying collaborative care model on the intensity of fear of falling, the frequency of falls of the elderly.

This is a clinical trial study with a sample of 72 elderly people averagely aged at 71.34 ± 7.47 who went to the comprehensive health service centers of Isfahan in 1398, and were selected through easy sampling. Sample units were randomly divided into two test groups and participated in a collaborative care program for 12 weeks. Moreover, the control group attended two sixty-minute training sessions. The data were collected through the completion of questionnaires by the sample units in three phases, namely before, immediately, and after three months. The entry criteria included: the age of 60 and above, no psychological problems, non-participation in previous studies, having experienced fall. On the other hand, exit criteria included decreased consciousness after entering the study, unwillingness to continue, and death. SPSS software 21 was applied to carry out data analysis through χ2 test, Mann–Whitney test, independent t test, and ANOVA with repeated observations.

The results showed that in the test group, the average scores of fear of falling, were significantly different between the three times (P <0.05). The results of LSD post hoc test showed that in the test group, the mean score of fear of falling immediately after entering was significantly less than that of before entering. Furthermore, it showed that three months after entering, the mean score of fear of falling was less than that of immediately after the intervention (P <0.001).

According to the results, the implementation of collaborative care model reduced fear of falling, prevented falls, of the elderly. Therefore, it is recommended to apply this model in order to educate patients and their families.

Caring for brain dead patients is the heaviest of duties for nurses, and despite tremendous stress, there are no theories/models to support nurses in this situation. This study designed a supportive model for nurses to provide care for potential organ donors.

This qualitative study was conducted in two stages. In the first stage, semi‑structured interviews with 31 nurses and other stakeholders, observation and field notes continued until data saturation, (on 2018), were analyzed using continuous and comparative analysis through Corbin–Strauss method. In the second stage, theory synthesis of Walker and Avant’s strategies for theory construction (2011) was used to design a supportive model/theory. The theory synthesis includes three stages: (i) selection of focal concept (the concept of “moral obligation to provide holistic care until the last minute” was selected); (ii) review of studies to identify the factors related to focal concept relevant studies (42 articles were reviewed, statements and concepts related to focal concept were then extracted and classified, and their relations were specified); and (iii) organization of concepts and statements within a relevant general and effective manifestation of the phenomenon under study which led to developing of a model.

In this supportive model/theory, “improving psychological security and empowerment” was conceptualized within the conceptual framework. This supportive model entails three main components, including (i) informational and educational support, (ii) systematically support, and (iii) management support.

According to the results, nurses with moral obligation to provide holistic care were faced with several challenges. Therefore, it is recommended that the healthcare system take supportive proceedings for nurses in various fields of the care for brain dead patients to resolve educational, moral, and legal challenges. This supportive model is essential for maintaining the nurses’ health, increasing the quality of nursing care and the health of potential transplant organs.

Discrimination in health care is a common phenomenon whose complete understanding has always been a major concern of health-care systems to control and reduce it. This study aimed to explore the experiences of unintentional discrimination and related factors in health-care providers.

This qualitative study was conducted with a content analysis approach in 2019. Data were collected through semi-structured interviews with 13 health-care providers including two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling. The obtained data were analyzed by Graneheim and Lundman method.

Three main categories and eight subcategories were obtained from the data analysis: (1) forced discrimination (superiors’ pressures and executive orders, occupational concerns, and fear of the superiors); (2) guided discrimination (professional challenges, managers’ policymaking, and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of medical equipment).

The results of this study suggest that health-care providers such as doctors and nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing the factors that lead to superiors’ pressures and occupational forces and improving the medical ethics knowledge should be considered by health-care managers.

Cardiovascular diseases (CVDs) are one of the most common chronic illnesses and the leading cause of mortality worldwide. This study aimed to design and assess the psychometric properties of questionnaire to examine the care needs of patients with coronary artery disease (CAD) in phase 1 of cardiac rehabilitation (CR).

This sequential exploratory study used a mixed method with two phases. In the first phase, qualitative study was performed by analyzing the concept of Schwartz-Barcott-Kim hybrid model; and in the second phase, quantitative data were obtained and analyzed for the psychometric parameters of the designed tool.

The questionnaire for care needs was based on the indicators of measurement, which was identified in the qualitative phase of the study, as a tool with 40 items. After conducting face validity qualitatively, all tool items were considered important and were retained for the next steps. After completing the steps for determining the content validity ratio (CVR) and content validity index (CVI) of 40 items, they were preserved for decision making at a later stage. The results of exploratory factor analysis revealed four factors; the factor analysis of three items was eliminated and the final version of the questionnaire CNCR-Q (Care Needs Cardiac Rehabilitation-Questionnaire) with 37 items remained.

The findings indicated that the questionnaire with properties, such as simple scoring, reliability and validity, is an appropriate tool for assessing care needs in Iranian patients with CAD. Moreover, the CNCR-Q is an effective instrument for assessing patient needs before discharge.