fatemeh bahramnezhad

AbstractDuring wars, hospitals, medical staff, and civilians are protected by International Humanitarian Law (IHL). However, this importance is not observed in some instances. We examined the killing of medical staff and attacks on medical facilities during the Gaza war. In this scoping review, we gathered data from primary and secondary sources, such as newspapers, peer-reviewed journals, open-source platforms, social networks, and Non-Governmental Organization (NGO) websites from October 27, 2023 to May 21, 2024. Additionally, we collected data from some organizations, such as Physicians for Human Rights (PHR), the World Health Organization (WHO), Palestine Ministry of Health, World Bank, and United Nations Children’s Fund (UNICEF).According to different reports, between 400 to 800 incidents of violence against the healthcare services were documented in Gaza from the start of the war on October 27, 2023 until May 21, 2024. These incidents include obstruction of access to medical facilities, attack on ambulances, damage to hospital buildings, and targeting of medical staff and healthcare volunteers. Although the WHO issued warnings to stop the violence against medical staff and health facilities, these efforts were unsuccessful.The results revealed that unprecedented tragedies are occurring in Gaza, where medical facilities and staff are being targeted and killed. However, the response of international organizations appears to be passive and not appropriate to the extent of the war crimes. Moving forward, the international community should consider developing more effective solutions to address criminal behavior within the healthcare sector.

Caring for COVID-19 patients was a new and challenging experience for nurses. Knowing the effect of psychological, emotional, and spiritual care on physiological responses, nurses provided holistic care.

This qualitative study was conducted with the conventional content analysis approach in one of the referral hospitals for COVID-19 in Iran. Data were collected using in-depth, semi-structured individual interviews. Data was analyzed using the Lundman and Granheim qualitative content analysis and the Lincoln and Goba criteria.

In all 17 nurses were interviewed. The mean age (SD) of participants was 34.41 ± 7.49 years. The findings indicated a "butterfly-like care" with four main categories [caring with all one's heart, resilience, self-sacrifice, and conscious presence in danger).

During the COVID-19 pandemic, nurses, being aware of all the health and social consequences and overcoming fear and doubt, volunteered to take care of patients and save lives, and despite understanding the risk of being infected, they lovingly surrounded the patients. Considering the central role of nurses in the treatment team, special attention should be given to the maintenance and strengthening of nurses in the planning of the development of healthcare systems in the face of the upcoming epidemics.

As explained in the first part, the acquisition of firsthand experiences is an essential element of qualitative research for uncovering and enriching study findings. However, individuals with cognitive disorders are often excluded due to various challenges. In these cases, researchers may rely on caregivers or close associates to understand their feelings and views. This approach not only reduces these individuals to mere objects but also presents ethical dilemmas, thereby impacting the depth and richness of study findings (1). Given that the methods of data collection significantly impacts the results of studies (2), it is imperative for qualitative researchers to strive towards directly gathering information from the individuals themselves. Understanding the experiences of people with cognitive impairments is crucial for providing evidence-based services. However, these patients often encounter challenges such as speech difficulties (3), ‘pseudo-reminiscences’ (4-6), mood fluctuations and behavioral problems (7), and other issues. Therefore, researchers should take into consideration certain factors when conducting interviews with these individuals as in-depth interviews aim to gain a deeper understanding of participants' life experiences (8,9). These interviews require specialized skills across various stages, encompassing the development of interview guides, participant recruitment, obtaining consent, conducting effective interviews, data analysis and interpretation, and proficient communication and dissemination of research findings. This section delves into the key aspects of each of these phases. During interviews, it is important to prioritize the well-being of both the researcher and the participant while reflecting on and ensuring the depth and richness of the interview content (6).

Recognizing the pivotal role of lifestyle in preventing diabetes among prediabetic individuals, this study aimed to assess the impact of a cognitive behavioral program on their lifestyle.

This quasi-experimental study took place between July 2020 and April 2022 in specialized diabetes clinics affiliated with the Institute of Endocrine and Metabolism Sciences at Tehran University of Medical Sciences. Forty-two prediabetic individuals participated in the research through simple random sampling. After random allocation to both groups, data were collected using the International Physical Activity Questionnaire, Adolescence Food Habit Checklist, and Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ).

The findings revealed a statistically significant difference in the dietary habits of adults in the intervention group before and after the intervention (p<.001, p=.480). Additionally, there was a statistically significant difference in tobacco dependence between the intervention and control groups before and after the intervention (p=.084, p=.241). The average dietary behavior score for the intervention group was 19.23 (SD=1.86) compared to 15.95 (SD=2.26) for the control group. The cognitive behavioral program significantly increased dietary behaviors in the intervention group (F=27.87, P<.001).

This study underscores the effectiveness of educational interventions utilizing cognitive behavioral programs in addressing the physical, behavioral, cognitive, and social aspects of smoking cessation and dietary habits among prediabetic individuals. Such models hold promise for inclusion in educational programs aimed at diabetes prevention.

Delirium is a multifactorial phenomenon that can be influenced by demographic factors. The present study was conducted with the aim of determining the relationship between demographic and clinical components with the occurrence of delirium in patients hospitalized in the intensive care unit of hospitals affiliated to Kurdistan University of Medical Sciences.

The present study was conducted between June 2021 and August 2022 in Kurdistan province and on the number of 118 patients hospitalized in the intensive care unit who were selected by available sampling method. The evaluation of delirium between the hours of 4 and 8 in the afternoon was checked by the researcher. The patients were divided into two groups and both groups were evaluated for delirium with the CAM (ICU) tool. The data were analyzed with the help of STATA version 12 software. A significance level of P<0.05 was considered statistically significant.

Most of the patients participating in the study did not have delirium (56.78%). A significant relationship was observed between marital status, education level and the reason for hospitalization with delirium (p<0.05). Also, body temperature, blood pressure and heart rate had a statistically significant relationship with the occurrence of delirium (p<0.001).

Because the core of delirium management protocols is based on prevention and diagnosis, evaluation and compilation of the accurate history of patients in the form of demographic components can play a significant role in the prevention and management of delirium.

According to a global report, 47 million people are currently living with dementia, and due to the aging population, its prevalence is expected to triple by 2050. In the future, Iran is expected to experience a significant increase in the elderly population. Currently, in Iran, the prevalence of dementia among individuals over 60 years old is 7.9%. Therefore, this group represents a significant population that warrants further research (1). The best understanding and explanation of human experiences come from first-hand sources, specifically from people who have experienced those phenomena. Therefore, reliable research sources place great emphasis on including the voices of these individuals (2). Qualitative research out for its collaborative, inclusive, and flexible structure, enabling the exploration of complex issues, including mixed or ambiguous attitudes (2). It can reveal the profound experiences and core values of people with cognitive impairment that may not emerge in quantitative studies. Additionally, qualitative research excels in vividly portraying these experiences and values (3). Throughout history, people with cognitive impairments have been marginalized from engagement in health and social research, resulting in their voices being inadequately represented in such studies. (2, 4). Instead, their perspectives have been channeled through their legal representatives or guardians, a practice that often entails constraints. These limitations include the inability to accurately predict the patient's decision-making process, the amount and manner of information provided, and the weight of decision-making responsibility placed on them (5). Furthermore, excluding these individuals from the research process can dehumanize them and perpetuate negative stereotypes about people with cognitive disorders. This also contributes to power imbalances (2). Therefore, it is crucial to develop strategies that ensure the safe participation of these individuals in research endeavors. Through these efforts, we can improve our understanding of policy and measures aimed at promoting health and well-being (6).

Applying knowledge transfer and study findings in health care systems can help to save millions of lives. Also, this process plays a role in preventing financial losses in the health field. Considering the process of knowledge translation in the final defended thesis, this study was conducted with the aim of analyzing the knowledge translation of master's theses in nursing and midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences.

This study was a descriptive study using census method that was conducted on the collection of Nursing and midwifery master's theses documented in the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences from 2001 to March 2019. According to the researcher-made form, the topics of theses were analyzed with the aim of analyzing the knowledge translation. In the next step and in a qualitative approach, the content of the educational messages for the contacts of theses was examined.

In the field of nursing, the topics of care and nursing profession, target communities of patients and nurses, and cross-sectional descriptive and clinical trial method were the most frequent in the studies in nursing. In the field of midwifery, the topics of midwifery care and patient education, target communities of patients and midwives, and clinical trial and quasi-experimental methods were the most frequent in the studies. In the qualitative approach, the studies were categorized into four main themes: clinical dimension, educational dimension, research dimension and management dimension.

The results showed that the attention that the results of a study can be used in which departments and for which groups is considered in nursing and midwifery theses. However, there is still a long way to reach the standards of knowledge translation and application of the results by the stakeholders. It is recommended to hold training workshops on knowledge translation and consider encouraging the research team to take steps towards knowledge translation in this field.

Although patients› self-report is the gold standard for pain, many patients admitted to the intensive care units are unable to communicate and express their pain. Accordingly, the nurse must have special abilities to diagnose and manage pain in such conditions. This study assesses nurses’ knowledge, attitude, and performance regarding pain management of non-verbal critically ill adult patients in intensive care units.

This cross-sectional descriptive study was conducted from February to May 2020 among nurses working in four national referral hospitals in Dar es Salaam, Tanzania. The study sample included 202 intensive care unit nurses who were recruited by the census. The data was collected using pre-validated questionnaires, including the knowledge and attitudes survey regarding pain tools, and a performance tool by Eunkyoung. The data were analyzed using the chi-square test, one sample t-test, and Spearman correlation coefficient in the SPSS software, version 20. The significance level was set at P<0.05.

The mean knowledge and attitude score was 13.26±2.75, indicating inadequate knowledge and negative attitude. The mean performance score was 2.08±0.16, indicating low performance. No significant relationship was detected between nurses’ knowledge and attitude and their performance according to the t-test (t=2.84, P=0.09) and the Spearman correlation coefficient (r=0.12, P=0.102). Meanwhile, no significant relationships were found between the nurses’ knowledge, attitude, and performance and their demographic characteristics.

Planning to increase knowledge and improve the attitude and performance of ICU nurses for better pain management of non-verbal patients is necessary. It is recommended to evaluate the pain of these patients based on the observation of behavioral indicators of pain and choose the appropriate tool for pain assessment.

Nursing grand rounds are one of the potential factors for providing up-to-date evidence to nurses and nursing students and their use at the patient's bedside. Identifying the visible and hidden angles of this experience can help to improve this approach.  Based on this, this study was exploring the experience of undergraduate nursing students from Grand Round.

This study is part of a qualitative study with an exploratory sequential interventional combined approach that was conducted with the help of conventional content analysis. For this purpose, 25 undergraduate nursing students of the 7th semester, who had internship experience in intensive care units in the Grand Round method, were purposefully included in the study. Then, with the help of semi-structured, in-depth, and face-to-face interviews with an average of 40 to 60 minutes, the experiences of these participants were extracted and after recording and implementation, they were analyzed with the help of Granheim and Lundman's approach.

The mean± SD age of these students was 21.3 ± 10.8 years. From a total of 25 interviews conducted with the participants, 423 primary codes were extracted. After merging the codes that had similar content and meaning, three main categories of internship purposefulness, withdrawal from island education and perceived challenges appeared with 9 subcategories.

Since the participants in the study claimed that with the help of this approach, education at the bedside is targeted and in fact, they are faced with a new approach in education, it is necessary to take steps to identify this approach and try to solve the challenge of this approach.

Many employees present at work when they are sick, and it is high among medical professionals. The effect of presentism was confirmed on the well-being of nurses, professional burnout and dissatisfaction. The excessive demand to nurses highlights the need to ensure a resilient workforce. Resilience is considered as a personal capacity that enables nurses to adapt to the demands of the workplace. This study was aimed to investigate critical care nurses presentism and its relationship with their resilience

 This was a descriptive in which 300 critical care nurses was selected randomly and responded to the research questions, including resilience and presentism questionnaires in addition to demographic variables. Data were collected online and the SPSS software was used for analysis.

 The findings showed that half of the nurses were in their fourth decade of life; 87% were women and the majority have a bachelor's degree. The majority believed that the scheduling was not done according to their request. Almost half of had an average level of presentism; and the resilience of the majority was also above average. After removing the effect of confounding variables, there was a relationship between presentism and resilience in the regression model (p<0.001). According to the coefficient of determination, the regression model could predict %91 of variance.

 According to the results of the present study, managers are advised to take steps to improve the quality of care by planning to reduce presentism while increasing the resilience of nurses.

The early mobility of a patient hospitalized in the intensive care unit (ICU) is a very complicated issue and requires coordination between the departments and between all ICU staff, including physicians, nurses, and physiotherapists. Early mobilization program is safe and feasible and has positive results for the patient, medical staff, families, and health system. The present study aims to determine the barriers to early mobility of patients admitted to the ICUs of hospitals in Kohgiluyeh and Boyer-Ahmad Province, Iran.

This is a descriptive cross-sectional study conducted in 2020-2022. The study population consists of the ICU staff of hospitals in Kohgiluyeh and Boyer-Ahmad Province, including physicians, nurses, and physiotherapists. Sampling was done by a census method. The data were collected using a demographic form and a researcher-made questionnaire of early mobility barriers of ICU patients and analyzed in SPSS software, version 18 using descriptive and inferential statistics.

In the present study, 174 nurses, physicians, and physiotherapists answered the questionnaire, where 57.8% were female and 59.8% were single. Among the barriers to early mobility, the patient-related barriers had the lowest mean (0.411±0.108) and cultural barriers had the highest mean (0.478±0.146).

It is necessary to investigate the barriers to early mobility of patients admitted to the ICU of study hospitals, especially the cultural barriers. In this regard, there is a need to design a clinical protocol to manage and reduce these barriers.

The aim of this study was to design, implement and evaluate a comprehensive spiritual care package in self-care and the meaning of life for hemodialysis patients. A mixed-sequential-exploratory study was performed in 2020-2021 in the population of hemodialysis patients referred to hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. First, in-depth, semi-structured interviews were performed with 18 patients undergoing hemodialysis with purposive sampling, and then based on these interviews, the patients' needs were extracted. In the quantitative phase, 60 patients with inclusion criteria were included in the study. Intervention The intervention was performed every week for 8 weeks. The findings of the qualitative section included the two main categories of mortality with the subcategories of death anxiety, pessimism about life, spiritual pain, and feelings of abandonment. The second subclass of resilience with the subclasses of the joiner ring with the divine essence was a reflection on creation, purpose-making, and the harmony of the soul. In the quantitative ward, self-care performance with an average of 120.86 (19.00) and meaning of life with an average of 40.06 (10.45) after intervention in hemodialysis patients had increased. The results of this study showed that although there are negative thoughts and anxiety of death and annihilation in hemodialysis patients, but spirituality and spiritual beliefs can be an effective aid in accepting the disease and a good support for promoting physical, mental and social health in Hemodialysis patients..

Various factors play a significant role in shaping the professional identity of nursing students, and among these factors, the impact of the hidden curriculum holds utmost importance. However, this process remains still unknown.  The aim of the study is to explore the role of hidden curriculum in the formation of professional identity among undergraduate nursing students.

Methods & Materials: 

This is a qualitative research using the grounded theory approach. The participants in this study included 35 undergraduate nursing students from Tehran University of Medical Sciences during the 2020-2021 academic year who participated in semi-structured interviews. The interviews lasting between 30 and 60 minutes were conducted with each participant. Subsequently, the interviews were transcribed and analyzed following the framework proposed by Strauss and Corbin in 2008.

After analyzing the data, three main categories and 12 subcategories have emerged. The theory developed in this research was formed through the core category of “identity instability within the nursing profession”. The main categories that emerged were “ambiguity and lack of motivation in professionalization”. The study identified "the governance of a discriminatory culture" as the underlying process, while “the promotion of demotivation resulting from inefficient patterns” served as the basis of this study.

Based on the study's findings, the process of developing a professional identity can be metaphorically likened to a river. In this analogy, discrimination serves as the clouds hovering over this river, casting a shadow on the identity development process. While inefficient patterns can be likened to lightning bolts that further complicate the process. Furthermore, the rocky bed of the river, symbolizing the lack of motivation among learners towards professionalism, makes it even more challenging to build a strong professional identity.

The present study was conducted with the aim of reviewing the role of serum albumin in heart failure.

Heart failure is a complex clinical syndrome that affects a large population worldwide yearly, and its mortality is even higher than that of many cancers. Although the identification of traditional risk factors has helped in primary prevention, the death rate due to this disease is still increasing. Identifying potential and modifiable risk factors that are not known yet seems necessary in this situation. Serum albumin has been known for many years as a strong prognostic biomarker in many pathological conditions. In recent years, studies have been conducted regarding the role of serum albumin in the prediction, prognosis and treatment of heart failure symptoms.

This narrative study was conducted in 2023. For this purpose, the data bases, PubMed, Scopus, Web of Sciences, SID, MagIran were searched out with the keywords albumin, heart failure, diastolic failure, systolic failure, and a total of 30 articles were included in the study.

Hypoalbuminemia is a common finding in patients with heart failure, and among its main causes in heart failure are malnutrition, inflammation, lack of intestinal function, lack of kidney function, and liver disease. According to clinical and experimental evidence, hypoalbuminemia is related to fluid retention and exacerbation of pulmonary edema in these patients. Also, hypoalbuminemia can independently predict the onset of a new heart failure and can be measured as a prognostic factor of heart failure outcomes. However, there is still no evidence that directly shows the benefit of albumin injection in patients with heart failure.

Serum albumin can be measured as a modifiable risk factor and a prognostic factor in heart failure, but it is necessary to limit its use to cases where its effectiveness has been confirmed.

This study was conducted with the aim of providing care solutions to manage the hemodynamic status of potential donors with brain death.

Currently, organ transplantation is the treatment of choice for complete organ failure. The results of studies have shown that a significant percentage of potential donors with brain death organs are not usable for transplantation due to hemodynamic instability. Therefore, hemodynamic management in this category of donors plays an essential role in the donation process. Despite the studies, there are no strong evidences and recommendations about the management of hemodynamic stability of these patients. Therefore, in this review, evidence-based solutions have been tried to maintain the hemodynamic stability of these donors.

In this review study, with library search and search in databases PubMed, Scopus, Web of Science, SID, and MagIran with the keywords organ donor management, brain death, hemodynamic care, organ donor, deceased donor, hemodynamic management, donation after neurological death, and cardiovascular management published in the period from 2009 to 2024. In addition, the Google Scholar search engine was also explored. A total of 20 articles were included in the literature review.

Maintaining proper organ perfusion and identifying clinical conditions that can be effectively treated are among the most important goals of hemodynamic management of these donors, and hemodynamic monitoring, serum therapy, use of cardiac drugs, and hormone therapy are among the most important. There are also studies that recommend serial echocardiography to identify reversible clinical conditions.

The high demand for organ transplantation, and despite the high number of brain deaths and sometimes consent for transplantation, only a small percentage of these people's organs are successfully transplanted. In order to preserve the transplanted organs, it is recommended to take proper and basic care of the patients with brain death. It is necessary for nurses, especially nurses in the intensive care unit, to be very careful in caring for patients with potential brain death.

Interventional studies are necessary to gain new knowledge in medical sciences; they can also be associated with several risks and impose high costs on patients and healthy people, and ethical considerations must be considered, as well. Understanding the ethical challenges and issues of interventional studies is essential. Using placebo, ethical consent, and clinical trials in specific groups are some of these challenges. This systematic review study was conducted to determine ethical considerations in interventional studies with an emphasis on the four ethical principles, including autonomy, non-maleficence principle, beneficence, and justice. Researchers in interventional studies should pay attention to ethics and take the necessary steps in line with these four biological principles.

Addressing the issue of health literacy in patients undergoing hemodialysis by following the treatment regimen and using health services can be an effective tool in improving the care services system to planners and health officials. Therefore, this study was conducted to determine the relationship between health literacy, adherence to treatment regimen and the use of health services utilization in hemodialysis patients referred to hemodialysis centers of Chaharmahal and Bakhtiari province, 2019.

This descriptive correlational study was conducted in 2019 on hemodialysis patients referred to hemodialysis centers in Chaharmahal and Bakhtiari province. A total of 162 patients undergoing hemodialysis were selected to take part in the study by convenience sampling method based on inclusion criteria. The data collection tools included demographic information questionnaire, Iranian urban population health literacy questionnaire (HELIA), treatment adherence questionnaire in hemodialysis patients (ESRD-AQ) and a researcher-made questionnaire on health services utilization. The validity and reliability of the questionnaires were reviewed and confirmed. Study data were analyzed by SPSS software version 23 using descriptive and inferential statistics.

According to the findings, the mean score of health literacy of the samples was 112.89 ± 26.04 and the majority of them (30.86%) were inadequately literate. In terms of adherence to the treatment regimen, the majority of samples (66.67%) adhered to the treatment moderately. Regarding the use of health services utilization during the past year, the majority of samples (68.52%) had not been going for emergency visits, and most of them (54.32%) had not been hospitalized. Among patients who needed to be hospitalized in the past year, the people who had been hospitalized once before were at majority (26.54%). Also, in terms of the number of days being in hospital, the majority of samples (70.99%) had been hospitalized for less than 5 days. Data analysis by Spearman correlation coefficient showed a significant relationship between health literacy and treatment adherence (P = 0.000). However, no significant relationship was found between health literacy and use of health services utilization and also between adherence to treatment and using health services utilization.

Nurses 'knowledge and awareness about patients' health literacy and its promotion can lead to more effective education in these patients and consequently the rate of following more treatment and using health services in these patients is reduced and the ground for Reduce treatment costs and hospitalization rates, which are largely the responsibility of the government.

The majority of nursing students believed that their knowledge in the field of pharmacology is far from the desired level, which can be due to the large volume of intensive one-semester content and ineffective teaching of the pharmacology course. Accordingly, this study has determined and compared education with the mobile application and puzzle classroom on memorization of pharmacology course for undergraduate nursing students.

This quasi-experimental study was performed between 2020-2021. Seventy, 4th and 5th semester nursing students were divided into two groups using a table of random numbers. One group was taught through the mobile application and the other group was taught through the puzzle classroom. Before and one month after the intervention, students were tested in clinical reasoning. Data were analyzed using software version 16 and independent t-test, paired t-test and descriptive statistics.

The findings of this study showed that there was no statistically significant difference between the memorization score of the pharmacology course of the puzzle classroom with education through mobile application compared to before and after the intervention and also in comparison between the two groups.

Based on the findings of this study, both puzzle classroom and teaching through mobile application can be used to enhance learning pharmacology among undergraduate students.

The professional identity of nursing students was defined as the primary trend in becoming a profession. The present study aimed to explore the factors affecting students' professional identity as nurses.

This Study is a qualitative content analysis from May 2019 to October 2020. The participants were contributed through purposefully sampling. Data were collected through in-depth semi-structured interviews. The duration of each interview was between 30 and 60 minutes. Interviews continued until data saturation. Data analysis was performed simultaneously with Graneheim and Lundman approach.

123 open codes with five subcategories and two categories were extracted. In the present study, "belongingness" was explained as the central theme. Two categories, "positive role model in the education process" and "The perception of the society towards the nursing profession," were explored.

The present results showed that the identification of nursing students is influenced by belonging influenced by the nursing community and the general community. In addition, the community’s appreciation of the nursing profession and the approval and respect for the nursing profession among the community members have been considered crucial factors for nursing students to become good nurses. Due to the importance of growing a belonging and better understanding of professional identity by nursing students in the educational period, the development of teachers’ abilities as a model and creating a platform for recognizing the professional identity of nursing among community and medical science students is recommended.

 Moral distress is one of the important issues in the field of medical ethics that can have different effects on nurses, patients and health systems. One of the important effects of this phenomenon is professional stress in nurses. The aim of this study was to determine the relationship between moral distress and occupational stress of nurses in Tehran University of Medical Sciences in the care of Covid 19 patients.

 This descriptive-analytical study was performed on a sample size of 265 nurses working in the ward 19 in the hospitals of Tehran University of Medical Sciences in 2021. Sampling was done by stratified and simple random method. Data were collected using a demographic questionnaire, Corelli Moral Distress, and Wolfgang Occupational Stress. Then they were analyzed by SPSS software version 16 using descriptive (percentage, frequency, mean, standard deviation) and inferential (Pearson correlation coefficient) statistical tests.

Ethical Considerations: 

In this study, criteria concerned with moral principles as confidentiality,  personal satisfaction and freedom of participants in cooperation or non –cooperation during the study  process have been observed.

 The results showed that moral distress with a mean standard deviation of 99.52±  26.32 was at a low to moderate level. Also, the mean and standard deviation of occupational stress was 80.32±10.40. There was a statistically significant relationship between moral distress and nurses' professional stress (p <0.001).
 

 Caring for Covid 19 patients increases nurses 'stress, which has a positive effect on nurses' moral distress. Therefore, it is suggested that due to the existing conditions, necessary measures should be taken to reduce stressors.

Home healthcare guidelines emphasize the engagement of family caregivers of heart failure (HF) patients in patient care at home. Thus, this study was conducted with the aim to explore the deep experiences of home care team members regarding the needs of family caregivers of HF patients in home healthcare services in Iran.

The present qualitative study was performed with a conventional content analysis approach. Data were collected through in-depth, semi-structured interviews with 23 participants who were recruited through purposive sampling. The Data were analyzed using the Graneheim and Lundman method for conventional content analysis in MAXQDA Software.

The participants included 14 women and 9 men with the mean age of 46.21 ± 11.44 years. After analyzing the interviews, 3 main categories and 15 subcategories were extracted. The main categories were “family caregiver’s unmet needs” (with 5 subcategories), “Empowering Informal Caregivers” (with 3 subcategories), and “access to a standard home healthcare system” (with 7 subcategories).

Deep understanding of the needs of family caregivers of HF patients in home health care services increases the quality of services, the quality of life (QOL) of the family, and prevents patients’ hospital readmissions. Moreover, it will contribute to our next project of the home healthcare guideline for HF patients in the health care system of Iran. Identifying the training needs of caregivers within the home health care services has an important role in the designing of education strategies in policy making programs at the level of the Ministry of Health or planning at lower levels of the health network.

There are numerous dressings used to treat pressure ulcers (PUs), depending on their advantages to achieve optimum patient outcomes. This study aimed to compare hydrocolloid dressings and silver nanoparticles in treating PUs among patients with spinal cord injury (SCI).

This randomized clinical trial was conducted on 70 patients with SCI in Iran. Participants were randomly divided into two equal groups (n=35) receiving silver nanoparticle dressing and hydrocolloid dressing, respectively. The groups were evaluated in four assessment periods using the Bates-Jensen Wound Assessment Tool (BWAT). Data analysis was performed using SPSS software version 13, repeated measures ANOVA, non-parametric tests, and chisquare.

Chi-square test was used to investigate the difference between the scores before the intervention, the results of which were not statistically significant. In repetitive measurements, the results of the analysis of variance showed that the average assessment score in both groups decreased and both dressings were effective in the treatment process. Although PU improvement status in the group that received silver nanoparticles was better, between-group analysis of variance did not show any statistically significant difference between the two groups.

Our results indicated that silver nanoparticles and hydrocolloid dressings can be used interchangeably in the treatment of PUs.

Educating students in a safe environment such as simulated centers can be effective in providing educational services and preparation for clinical work. Accordingly, the present study was conducted with the aim of designing, implementing and evaluating clinical pharmacology simulation training method for nursing students.

This study was performed in 2019-2021 in three main phases of design, implementation and evaluation of Pharmaceutical Skills Center in Clinical Skills Center of Tehran School of Nursing and Midwifery. First, the design phase was accomplished by preparing the space and the desired drugs. Due to the prevalence of Covid-19 disease, part of the implementation and evaluation phase was carried out in the virtual context. Before and after the internship, students' knowledge, skills, satisfaction and clinical reasoning were measured using relevant questionnaires and analyzed using descriptive and analytical statistics.

The mean scores of the three variables in terms of pharmacology knowledge, drug calculation skills and clinical reasoning of pharmacology of nursing students before and after the internship were examined. The results demonstrated that all three means were significantly improved compared to that of before the intervention (P <0.001 and P = 0.001). The mean of total students' satisfaction with pharmacology internship course turned out to be 30.57 (3.2), which indicated the relative satisfaction with the training course.

In general, the results of the study indicated an improvement at the level of pharmacological knowledge, clinical reasoning of pharmacology and a significant improvement in pharmacological skills. Despite the limitations of Covid 19, this training method seems to augment the performance of nursing students in pharmacology.

This study was conducted with the aim of analyzing and exploring the spiritual intelligence of nurses working in Covid- 19 units.

The present sequential explanatory mixed method was conducted in 2020-2021 in Tehran University of Medical Sciences, Tehran, Iran. In the quantitative phase, 100 nurses working in Covid -19 units with inclusion criteria were included in the study and after analyzing the score obtained from their King Spiritual Intelligence Questionnaire, individuals with low, medium, and high mean(SD) scores were purposefully entered into the qualitative phase of the study. Twenty semi-structured interviews with nurses were conducted through social media and telephone. Data were analyzed using conventional content analysis approach.

The findings of the quantitative phase showed that the mean (SD) of spiritual intelligence of nurses working in Covid-19 wards is at a moderate level(58/5)41/53. In the qualitative phase, the two main themes of missing link communication with sub-themes, "lack of communication with family" and "lack of communication with the patient" and the theme of lack of sense of meaning with the sub-themes "no purpose in life", "change of sense of belonging", "change Attitudes toward "death" and "inefficiency" appeared.

According to the findings of the study that nurses 'spiritual intelligence is moderate and due to the frequent waves of this disease, to prevent a decrease in nurses' spiritual intelligence that affects the patient's spiritual care, comprehensive planning should be done.

Adherence to the treatment plans is one of the most effective conducts to prevent and reduce postoperative side effects. Partnership‑based education is one of the most efficient ways to shape health behaviors. The aim of the present study was to determine the effect of partnership‑based education on adherence to the treatment plans in open heart surgery.

This quasi‑experimental study was conducted in 2019–2020 on the patients undergoing open heart surgery in Tehran (Capital of Iran). Sampling was done in one educational hospital. A total of 86 patients and their caregivers participated in the study. Sampling was done nonrandomly by tossing a coin, and patients were allocated into the odd week in the intervention group and the even week in the control group (n = 43 in each group), and data were collected before and after intervention using the Treatment Adherence Questionnaire concerning dietary, physical activity, and medication aspects. The educational intervention was carried out after the pretest analysis in five 20–45 min sessions (two individual and three group educations). Data were analyzed with Chi‑square, independent t‑test, and paired t‑test using SPSS 19 at a significance level of P < 0.05.

Patients and caregivers in both groups did not have a significant difference in terms of demographic variables (P > 0. 05). In addition, there was no significant difference in the mean of dietary, physical activity, and medication plans before the intervention in both groups; however, after the intervention, the mean of the three aspects in the intervention group was significantly higher than that of control (P < 0.001).

Implementing partnership‑based education with participation of patients and caregivers is influential in improving patients’ adherence to the treatment plans and it is recommended as a clinical dynamic educational strategy.