faranak jabbarzadeh tabrizi

Diagnostic thinking and clinical competence are the two main domains of efficient nursing care. This study assessed the association between diagnostic thinking and clinical competence among emergency nurses.

The present correlation study was conducted in 2020 on 113 nurses working in emergency departments in a northwestern province of Iran over two consecutive years. A stratified random sampling method was used for recruiting nurses. Data was gathered via a demographic questionnaire, the Diagnostic Thinking Inventory, and the Nurse Competence Scale and analyzed using the SPSS 18 software. Pearson's correlation assessed the association between the nurses' diagnostic thinking and clinical competence at a significance level of 0.05.

According to the findings, the nurses’ diagnostic thinking abilities were poor (154.15 ±15.73, range of 150-155), while their clinical competence was good (61.62±18.97, range of 51-75). Significant correlations emerged between thinking flexibility, work role (r=0.22, p=0.017), and memory structure. In addition, thinking flexibility was significantly associated with work role (r=0.22, P=0.017), and memory structure was correlated with teaching-coaching function (r=0.22, P=0.015), diagnostic functions (r=0.25, P=0.006), management of situations (r=0.45, P=0.0001), therapeutic interventions (r=0.42, P=0.0001), regimens (r=0.18, P=0.056), and work role (r=0.4, P=0.0001).

Amplifying thinking procedures and using diagnostic thinking patterns enhance emergency nurses' practice, performance, and clinical competence and promote nursing care. Lecturers and planners must employ modern educational methods to increase nurses' thinking skills and clinical competence.

Awareness of Emergency Medical Services (EMS) procedures is important for the general public to receive emergency services in a timely manner. Understanding public expectations is essential for providing therapeutic interventions and managing expectations. This study aimed to determine the relationship between public awareness and expectations regarding pre-hospital EMS in Tabriz, Iran, in 2020. This cross-sectional study was conducted at the School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran, in 2020. In this study, 1100 EMS callers were randomly selected. Data were collected through telephone interviews using a questionnaire assessing public awareness and expectations of pre-hospital emergency care services and analyzed using descriptive and inferential statistics using SPSS v.16 software. The average interviewers’ awareness score was 65.72±14.98. The highest awareness was related to the area of medical emergencies (75.56±6.87) and the lowest awareness was related to contacting emergency service (58.59±21.65). The total expectation was high (79.99±8.90). Moreover, the expectations regarding emergency facilities and response time was 80.16±8.97 and the expectations from emergency staff was 79.82±9.95. Men's awareness and women's expectations of emergency services were high. In this study, there was a significant relationship between awareness and expectation (P=0.001 & r=0.15). Moreover, there was a significant relationship between the level of awareness and expectations regarding demographic variables, including gender, age, marital status, education and income levels (P<0.05). Findings show that public awareness and expectations regarding EMS services were medium and high, respectively. There was a significant relationship between public awareness and expectations from pre-hospital EMS services. Therefore, it is better to make plans to inform the general public about EMS through social media and mass media. Additionally, appropriate, timely education at different ages can foster a dynamic and constructive interaction between awareness and expectations in the community regarding pre-hospital emergency.

 In introducing and using technology in nursing, there is a risk that the focus will be on technology over patient care. This issue is more important in the emergency department which requires quality care in order to save human life. This study was conducted with the aim of determining nurses' perception and practice of technological competency as caring in nursing and its predictive factors in emergency nurses.

 In this cross-sectional research, 218 nurses working in the emergency departments of educational hospitals of Tabriz were included by stratified random sampling method. The data was collected using the instruments of perception and practice of nurses about technological competency as caring in nursing.

 The mean age of the nurses was 36.77 ± 7.92 years and most of the nurses (55%) were female. The mean and standard deviation of perception and practice scores were 138.13 ± 16.19 and 134.97 ± 15.27, respectively. According to the results, for one-unit increase in perception, practice significantly increased by 0.764 units.

 The mean score of perception and practice for emergency nurses in regards to technological competency as caring in nursing was above median. This reveals that the emergency nurses have the required knowledge and skills in order to use technology.

The concept of age-friendly cities has been introduced by the World Health Organization (WHO) in an attempt to pay more attention to the elderly. In Iran, this issue is more important due to demographic changes and age conditions. This study aimed to investigate the views of the elderly people living in Tabriz about the indicators of age-friendly cities.

In this cross-sectional descriptive-analytical study, 351 elderly people were selected from six age-friendly centers in Tabriz by simple random sampling method. The data collection tool was the standard questionnaire of the WHO in an age- friendly city. To analyze the data, both descriptive statistics (frequency, frequency percentage, mean, and standard deviation) and analytical statistics (analysis of variance and t-test) were used. Also, the Statistical Package for the Social Sciences (SPSS) software version 16 was used and significance level was considered as 0.05.

Among the four studied indicators, the health component had the highest average (44.57 (11.81)), followed by the components of social respect (38.5 (11.5)), participation in social relations (34.8 (9.12)), and the cultural and recreational index (32.86 (10.54; range 1-100)). We also observed a significant relationship between gender and marriage with cultural and recreational component (P = 0.002).

Since none of the four indicators of age-friendly cities in Tabriz were standard, the managers of aging-related organizations should plan to standardize these indicators to achieve the desired conditions.

 
Many nurses are uncertain when making clinical decisions, and this can lead to burnout and professional dissatisfaction. However, no study has addressed facilitators of uncertainty in clinical decision-making among Iranian nurses.
 
This study aimed to explore Iranian nurses' experiences of facilitators of uncertainty in decision-making.
 
This qualitative content analysis study was conducted from June to December 2020. Participants were 17 nurses with bachelor's or higher degrees who were purposively recruited from three hospitals affiliated with Tabriz University of Medical Sciences. Data were collected through semi-structured interviews and analyzed through a content analysis method.
 
Participants' experiences were categorized into three main categories, namely, an unconfident nurse, complex situations, and unclear guidelines and policies. Each category included three to four subcategories.
 
Nurses may experience uncertainty in clinical decision-making when confronted with ambiguous clinical situations or lack sufficient decision-making skills. Nurse leaders are suggested to develop educational programs and support interventions to promote nurses' decision-making skills and help them manage ambiguous situations.

Nurses of the emergency department experience stressful events that affect their mental health and reduce the quality of their work life. Career adaptability is considered a personal capability that enables employees to adapt to changes and avoid the negative consequences of job mismatch. This study was conducted to study career adaptability and its correlation with the quality of work life in the emergency department.

This descriptive-correlational study was conducted on 104 nurses in the emergency department of teaching–therapeutic hospitals in Tabriz who were selected using random stratified sampling. Data was collected using a demographic checklist, the Career Adapt-Abilities Scale (CAAS) by Savickas, and the Quality of Nursing Work Life (QNWL) scale by Brooks & Anderson. Data were analyzed in SPSS using descriptive statistics (frequency, mean and standard deviation) and inferential statistics (independent t-test, one-way analysis of variance, Pearson’s correlation coefficient, and linear regression analysis).

The total scores of career adaptability and the quality of nursing work life were 88.55±25.01 from the achievable range of 24-120 and 141.15±22.56 from the achievable range of 42-252, respectively, which were moderate. In this study, 85.6% of nurses enjoyed a moderate quality of work life. Furthermore, the results of Pearson’s correlation indicated a significant positive correlation between career adaptability and scopes with the quality of work life score (p=0.05). Regression analysis results indicated that career adaptability significantly predicts the quality of nursing work life (p=0.000).

In this study, nurses experienced moderate career adaptability and quality of work life. Given the above factors, and considering adaptability as a variable predicting quality of work life, it is suggested to take measures to increase career adaptability in nurses through training or consulting interventions to improve the quality of nursing work life.

The prevalence of fatigue in patients receiving hemodialysis is high. This study aimed to investigate the effect of Rosa damascena oil on fatigue severity in patients receiving hemodialysis.

This randomized controlled trial was performed on 74 patients receiving hemodialysis in Tabriz, Iran from January 21 to February 21, 2019. The patients were conveniently recruited and assigned into two groups of intervention and control using a block randomization method with block sizes of four and six and a sequence of 1:1. Patients in the intervention group were trained to inhale three drops of R. damascena oil each night for one month. We used the Fatigue Severity Scale (FSS) for data collection and analyzed the data using the independent samples and paired t tests.

No significant difference was found between the two groups respecting the mean baseline fatigue scores (P=0.12). However, at the end of the study, the mean fatigue score was significantly lower in the intervention group compared to the control group (P=0.001).

We witnessed that R. damascena oil aromatherapy significantly reduced the severity of fatigue in patients receiving hemodialysis. This useful and inexpensive technique can be utilized as a complementary method to relieve fatigue in patients receiving hemodialysis.

Coming back into existence is a concept coined relatively recently in a grounded nursing theory of post-burn patients. However, the nature of this concept has not been thoroughly clarified. In order to improve nurses’ and others’ understanding of and communication about coming back to existence, this study aimed to clarify the concept.

This study was performed qualitatively using Rodgers’ evolutionary concept analysis to clarify the concept of coming back to existence. Multiple computerized databases (PubMed, Scopus, ProQuest, Google Scholar, Iran Mede, and SID) were searched for their titles and abstracts to select full-text English papers published without time limit. A total of 20 articles were selected to be reviewed.

The key attributes of coming back into existence identified in this study were providing opportunities for thinking and self-reflection on living affairs, releasing the mind to focus on the inner life, and making conscious efforts to explore and discover the original dimensions of one’s being. Antecedents included the bitter and unforgettable experience of physical pain, psychological suffering, failure and hopelessness in interactions, and doubts about one’s self-identity and philosophy of being. Consequences included self-acceptance, a sense of liberation and freedom, and positive and creative development in life to achieve more transcendent goals. 

The results of this study can be helpful in identifying the needs and problems of clients and developing appropriate care plans and nursing interventions.

The emergency department (ED) is a multidisciplinary department and seriously needs interprofessional collaboration (IPC).

The purpose of this study was to examine the emergency nurses’ attitudes toward IPC and teamwork and their affecting factors.

A cross‑sectional study was conducted on 138 emergency nurses working in teaching hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, from January to April 2019. Data were collected using a three‑part questionnaire including a demographic data sheet, the Jefferson Scale of Attitudes toward Physician‑Nurse Collaboration, and the Testing Team Attitude Questionnaire. The data were analyzed using descriptive statistics, Pearson’s correlation coefficient, analysis of variance, and multivariate regression analysis.

The majority of the study participants were female (68.1%), in the age range of 30–40 years old (44.2%), and had a working experience of 1–5 years in the ED (63.8%). The mean scores of nurses’ attitudes toward IPC and teamwork were 48.68 ± 5.14 and 96.15 ± 8.97, respectively. A direct and strong correlation was found between nurses’ attitudes toward IPC and teamwork (r = 0.594, P = 0.001). Regression analysis showed that, among all variables, only the participants’ employment status (compulsory governmental services, P < 0.031 and B = 2.356), overall work experience between 1 and 5 years (P < 0.001 and B = -3.769), and the attitude toward teamwork (P < 0.001 and B = 0.350) could significantly predict nurses’ attitude toward IPC.

The attitudes of emergency nurses toward IPC and teamwork were at an optimal level. Nurses’ belief in IPC and especially belief in nurse–physician collaboration plays an important role in providing quality care and keeping patient safety in ED. Joint in‑service workshops on the philosophy and principles of IPC and teamwork for nurses and physicians working in EDs can further strengthen the IPC.

Poor medication adherence (MA) is a significant concern in patients with cardiovascular disease (CVD) in low and middle-income countries. Thus, understanding the factors affecting this concern is the first step in designing effective interventions in such societies. In this regard, the purpose of this study was to investigate MA in a sample of Iranian patients after coronary angioplasty and to identify prediction factors based on the World Health Organization framework.

This descriptive-correlational research was conducted on 203 patients post carotid artery (CA) who were recruited from the Cardiology Clinics of Tabriz between November 2016 and February 2017. Data were collected based on socio-demographic characteristics and the Persian version of the Morisky Medication Adherence Scale (MMAS), and the Charlson comorbidity index was used as well. Finally, the multiple linear regression method was applied to identify the significant predictors of MA.

The mean (standard deviation) MMAS score was 5.85 (±1.83). A multivariable model (adjusted R2=0.136) predicted adherence using experienced medication side effects (B=-1.094, a 95% confidence interval (CI)= -1.700– -0.489, P<0.001) and having a recall (B=0.658, 95% of CI=0.153-1.163, P=0.011) and hospitalized history due to current disease (B=-0.537, 95% of CI=-1.031–-0.043, P=0.033).

The results of this study provide a better conception of the role of patients’ experiences about medication side effects and the presence of a recall member in the family for MA after angioplasty. Patients’ problems and concerns related to the side effects of medications must be resolved to improve MA.

Developing new training methods for improving the health of diabetic patients has always been a concern for nurses. The present study aims to investigate the effects of empowerment-based interventions with or without telenursing on self-efficacy and HbA1c level in diabetic patients.

In this randomized clinical trial, 156 patients with type-2 diabetes were randomly assigned into two intervention groups (empowerment with/without telenursing) and one control group. All subjects in the intervention groups participated in two sessions of the empowerment program. However, only the group of empowerment with telenursing received telephone counseling for 12 weeks. The patients in the control group did not receive any intervention programs. Self-efficacy was measured by diabetes-specific self-efficacy scale. The HbA1c level was measured using Bionic kit. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, Ill., USA).

After 14 weeks, while the changes in self-efficacy scores of the control group were not statistically significant, they were significant in the two intervention groups. Comparison of the two intervention groups showed that self-efficacy was higher in the group of empowerment with telenursing. It was only in the empowerment with telenursing group that the reduction of HbA1c was significant.

Training based on empowerment models and emphasis on the strengths of clients in solving their own problems can play a major role in increasing self-efficacy and reduction of HbA1c level. In addition, a continuous training program, along with telephone follow-ups can result in higher self-efficacy and lower HbA1c level.

Workplace violence (WPV) is a detrimental factor affecting nurses’ health and performance. Individual protective factors such as resilience can assist nurses in coping with and adapting to workplace adversity.

The present study was aimed to determine the relationship between resilience and exposure to WPV in emergency nurses.

This cross‑sectional study was carried out on 118 emergency nurses in Tabriz educational hospitals, Iran. The participants were selected through a convenience sampling method. A demographic questionnaire, the Conner‑Davidson Resilience Scale, and the Modified Questionnaire of Workplace Violence in the health sector were used for data collection. The data were analyzed using descriptive statistics, logistic regression analysis, t‑test, and one‑way analysis of variance.

The mean resilience score of nurses was 25.05 ± 5.79 in the possible range of 0–40. Most of the cases of violence were verbal threats (80.5%), and 56.7% of the exposures occurred during the night shift. Logistic regression showed that lower resilience predicted verbal threats (P = 0.001) and physical attacks (P = 0.038) against the individual. In addition to resilience, working on the night shift significantly predicted verbal threats (P = 0.008) against nurses.

The resilience score was lower in nurses who exposed to violence. Empowerment programs are suggested to improve the resilience of nurses.

There are some side effects such as the restenosis of the coronary artery resulted from the failure to follow the medication regimen. Considering that patients" beliefs have a great role in their lifestyle, this study aimed at investigating the relationship between beliefs in medication and self-reported medication adherence in patients with coronary angioplasty (CA).

This was a descriptive cross-sectional correlational study. Based on the inclusion criteria, qualified participants were chosen from among the patients who referred to heart specialty hospital using a convenience sampling method. The applied questionnaire in this study included three sections encompassing the demographic information, a 5-item Medication Adherence Questionnaire (MARS), and BMQ-S questionnaire containing two aspects of "necessity" and "concerns about taking medications".

The mean of participants" age was 56.99 (SD=12.80) and the majority of the participants were males (78.7%), married (89.3%), and mostly illiterate (30.7%). The study results showed that 70% (n=105) of the participants had a weak medication adherence. The results of the Pearson correlation demonstrated a statistically significant relationship between the beliefs in medication and adherence to it.

After CA, nurses and family members can pave the way for the patients to adhere to medication by influencing their beliefs

The proper levels of critical thinking (CT) and professional self-concept (PSC) both have key roles in the academic achievements of nursing students. The present study was conducted to examine a possible correlation between PSC and CT.

This descriptive-correlational study was conducted on 154 eligible nursing students, selected through the stratified random sampling technique. For this purpose, two instruments were utilized: the Persian version of nurses’ self-concept questionnaire and Ricketts’ Critical Thinking Disposition Assessment Scale. Pearson’s correlation coefficient was employed to analyze data using SPSS 16.

Although levels of CT vary in different semesters, the correlation coefficient between CT and PSC among nursing students was -0.46 (P<0.001). Therefore, there was a significant, inverse, moderate correlation between these two variables.

The correlation between the total scores of PSC and CT was significant and negative, indicating increasing professional self-concept in students decreases their levels of CT. It seems that modern teaching methods based on problem-solving are less used in nursing students’ education, which leads to greater development of CT. It is believed that other underlying factors may have contributed to the negative correlation between PSC and CT. Further studies in this regard are recommended.

Due to the characteristics of their work, nurses experience high levels of stress and burnout. Alexithymia (defined as the inability to identify and express emotions) and personality traits can be risk factors for burnout. However, there is limited information about the relationships of alexithymia and personality traits with job burnout among Iranian nurses.

This study examined the relationships between alexithymia, personality traits, job burnout, and shift work among hospital nurses in Iran.

This cross‑sectional study was conducted in 2017 on a random sample of 225 nurses recruited from 10 hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. Data collection instruments were the Toronto Alexithymia Scale, the Maslach Burnout Inventory, the Neuroticism, Extraversion, Openness Five‑Factor Inventory, and a demographic questionnaire. Pearson’s correlation analysis, independent‑samples t‑test, one‑way analysis of variance, and multiple linear regression analysis were used for data analysis.

The mean scores of alexithymia and burnout were 56.78 ± 8.64 and 49.78 ± 13.67, respectively, and these two variables were significantly correlated (r = 0.258; P < 0.001). Alexithymia also had significant relationships with gender (P = 0.035), employment status (P = 0.045), and personality trait (P < 0.01) but had no significant relationship with shift schedule (P > 0.05).

Nurses with higher levels of alexithymia are more at risk for burnout. As alexithymia has significant relationships with gender and employment status, interventions are needed, especially for women, to alleviate their alexithymia and burnout.

There is always the possibility of mistakes for nursing students, given the nature of the clinical wards. Nursing educators are the primary figures responsible for the nursing students’ performance in clinical wards. The present study intended to describe nursing educators’ experiences in relation to clinical mistakes made by nursing students.

The present research was conducted using a descriptive phenomenological approach in 14 nursing educators. Deep semistructured interviews were performed to gather data, and triangulation and member checking were utilized to ensure data integrity. The data were analyzed using Colaizzite seven‑stage method.

The themes extracted through comparison and analysis included three main themes “encountering an unpleasant event”, “internal confrontation” and “the change in the effectiveness of teaching” besides 6 sub-themes including “emotional excitement”, “honest reaction to the issue”, “struggling with the fear of recurrence of the mistake” “coping with the event”, “passive teaching” and “trying to be enhance one’s capabilities in teaching”.

Regardless of the possibility of gaining fruitful experiences from a clinical mistake, its occurrence could be followed by negative experiences and consequences for the educators. It is thus essential that appropriate packages in this regard be provided in the empowerment programs for young educators to prepare them for correct confrontation with mistake occurrence. It is suggested that further qualitative studies be conducted to extract the steps educators take in confrontation with nursing students’ clinical mistakes.

Professional self-concept is the individual’s perception of himself/herself as a professional person. Stress is considered a common phenomenon in nursing education due to the nature of clinical environments. However, the relationship between these two variables is unclear in the review of the literature. Accordingly, this study aimed to assess the correlation between professional self-concept and stress among nursing students in clinical environments. The present descriptive correlational study was conducted, between the second and the eighth semesters, on 154 nursing students who were selected using the stratified random sampling technique. Based on the purpose of the study, the Cowin’s 36-item questionnaire of professional self-concept and Cohen’s perceived stress scale (PSS) were used to collect the required data. Finally, data were analyzed by SPSS using the Pearson correlation coefficient (or Spearman correlation coefficient in case of non-normality of the variables). The overall mean score of professional self-concept in nursing students was 210.80 ± 37.41. In addition, the highest and lowest scores were related to the seventh and second semesters, respectively. Further, the correlation coefficient of the total score of professional self-concept with the total score of stress was equal to -0.31, which is considered significant (P < 0.001). In general, a statistically significant correlation was observed between the professional self-concept and stress among the nursing students. In other words, a higher professional self-concept was associated with a reduction in the level of stress. Therefore, lower professional self-concept can be one of the possible causes of stress among the students. As a result, designing and implementing interventions are considered essential in promoting professional self-concept among nursing students.

Despite being aware of the importance of nurses’ role in providing clinical training to nursing students, studies show that sufficient research has not yet been conducted on the experience of clinical nurses who are engaged in training nursing students outside their normal working hours. The present study aim to describe the experience of these nurses who are training outside their routine working hours.
This study was conducted using descriptive-phenomenology method. Twelve nurses was participated in this research. Data were collected using purposive sampling method and face to face interviews based on nurses’ real life experience of students’ learning in clinical settings through answering open-ended questions. Spiegel burg analysis method was used to analyze the data.
The result of data analysis was the derivation of four themes and eight sub-themes. Themes included "nurses as teaching sources", "changes in the balance of doing routine tasks", "professional enthusiasm", and "nurses as student's professional socialization source of inspiration". Sub-themes included "efficient education", "poor education", "support", "interference in the role," "self-efficacy development", "inner satisfaction", "positive imaging" and "being a model".
It is necessary that academic centers plan for teaching nurses working on a contractual basis in the field of the evaluation method and various methods of teaching. The findings also suggested the development of individual self-efficacy in clinical nurses who train students.

Investigation of supportive care needs of cancer patients is important to implement any supportive care programs. There is no relevant studies investigated supportive care needs of Iranian cancer patients and factors affecting such needs. So, the aims of present study were to determine the unmet supportive care needs of Iranian cancer patients and its predictive factors.
In this descriptive- correlational study 274 cancer patients in one referral medical center in North West of Iran participated. For data collection, demographic and cancer related information checklist and Supportive Care Needs Survey (SCNS) was used. Logistic regression was used for data analysis of un-adjusted and adjusted Odds Ratios (ORs) for patients needs and analysis of variables of study based on Backward LR procedure SPSS Ver.13.
More than fifty percent of participants reported unmet needs in 18 items of SCNS. Most frequent unmet needs were related to health system and information domains and most meet needs were related to sexuality and psychological domains. The result of logistic regression identified predictors of each domain of supportive care needs. The variable such as sex, age and living situation were most important predictors of unmet needs.
The results showed that Iranian cancer patients have many supportive care needs in different domains. In general female cancer patients are at risk of more unmet supportive care needs. So, health care professionals should be more sensitive to fulfillment of supportive care needs of female.

Self-esteem among nursing students is important in providing high-quality serviceto clients, yet each study in this field has described only a portion of existing relevant knowledge.Integrative review studies are the best practice for identification of existing nursing knowledge.The purpose of this study was to determine self-esteem challenges among nursing students.
An integrative review was conducted in this study. The databases ProQuest, Medlineon PubMed, Science Direct, Google Scholar and Iran Medix were used for the review. The articleswere retrieved in three steps, including searching by search terms, reviewing the proceedingsbased on inclusion criteria and final retrieval and assessment of the available full texts. We used alist of keywords, including nursing, self-esteem and challenges and mixed them with "AND" and"OR" as a search strategy. Papers were included and eligible if they were associated with problemsrelated to nursing students’ self-esteem. Those studies that focused only on the self-esteem ofregistered nurses or patients were excluded. Search results were limited to the years 1960-2014.
Our findings showed three major challenges, including challenges associated withinconsistency in determining the level of students’ self-esteem, self-esteem associated challengesin professionalism of students, and the psychosocial challenges pertaining to the consequences oflow self-esteem.
The findings suggest there is a need for more qualitative research to explore thefactors that contribute to self-esteem in nursing students with a particular focus on the factorsthat increase or decrease self-esteem. In addition, strategies to maintain and increase self-esteemneed to be designed, implemented and evaluated.

Patients with hematologic malignancies often experience many emotional reactions which are different based on patient’s culture. Indeed culture determines the different ways that patients understand cancer. Accordingly, the aim of this study was to determine the relationship of self-esteem and hope among Iranian cancer patients. This descriptive-correlational study was undertaken among 85 leukemic patients admitted to Shahid Ghazi hospital in East-Azerbaijan province, Iran. They were selected using consecutive sampling method. Persian form of Hearth Hope Index and Coppersmith Self-Esteem Inventory were used to identify patients’ hope and self-esteem. The data were analyzed using SPSS version 13.0. The overall scores of hope and self-esteem were 33.05 (5.24) and 94.61 (11.51), respectively. There was a positive correlation between hope and self-esteem (rs = 0.73, n = 85, P < 0.001). Although culture determines the different ways that patients understand cancer, but it seems that the self-esteem and hope relationship could be similar in different cultures. The findings of this study indicate that nurses could be helpful through designing and implementing appropriate educational programs in order to enhance hope and self-esteem of leukemia patients.

Nursing process is a scientific approach in the provision of qualified nursing cares. However, in practice, the implementation of this process is faced with numerous challenges. With the knowledge of the challenges associated with the implementation of the nursing process, the nursing processes can be developed appropriately. Due to the lack of comprehensive information on this subject, the current study was carried out to assess the key challenges associated with the implementation of the nursing process. To achieve and review related studies on this field, databases of Iran medix, SID, Magiran, PUBMED, Google scholar, and Proquest were assessed using the main keywords of nursing process and nursing process systematic review. The articles were retrieved in three steps including searching by keywords, review of the proceedings based on inclusion criteria, and final retrieval and assessment of available full texts. Systematic assessment of the articles showed different challenges in implementation of the nursing process. Intangible understanding of the concept of nursing process, different views of the process, lack of knowledge and awareness among nurses related to the execution of process, supports of managing systems, and problems related to recording the nursing process were the main challenges that were extracted from review of literature. On systematically reviewing the literature, intangible understanding of the concept of nursing process has been identified as the main challenge in nursing process. To achieve the best strategy to minimize the challenge, in addition to preparing facilitators for implementation of nursing process, intangible understanding of the concept of nursing process, different views of the process, and forming teams of experts in nursing education are recommended for internalizing the nursing process among nurses.