hamidreza khankeh

Treatment adherence (AT) can enhance hemodialysis patients' quality of life and life expectancy. Nurses in the healthcare system can benefit from understanding this concept, its attributes, antecedents, and consequences. This study aims to clarify the concept of AT in hemodialysis patients.

A three-phase concept analysis was conducted utilizing a hybrid model. In the theoretical phase (first phase), a literature review was conducted using PubMed, Web of Science, ProQuest, EBSCO, Scopus, Google Scholar, SID, and Magiran search engines. In the fieldwork phase (second phase), semi-structured interviews were conducted with eight patients and nurses. The final analysis (third phase) combined the results from the previous phases.

The characteristics of treatment adherence include being process-oriented, actively participating in therapy, being patient-centered, accepting responsibility for treatment, and being committed to the treatment process. To understand this concept, antecedents related to the patient, society, and the health care system must be considered. As a result of the emergence of this concept, patients' quality of life has been improved, and healthcare costs have been reduced.

This study provides insight into the characteristics of adherence to treatment and the factors that influence its proper implementation. This program will assist healthcare providers in better understanding this concept and improving their clinical practices for hemodialysis patients.

The occurrence of disasters in the world leaves consequences and health, as well as economic and social problems for people and governments, and requires careful management and planning. Policies for preventing and reducing risks caused by natural disasters and unexpected events were formulated and announced in the country in 2014. Nearly two decades have passed since the promulgation of these policies, and the management of accidents and incidents in the country is facing deficits. This study was conducted to investigate and identify the challenges of implementing crisis management policies and providing suggestions for improvement.

This study was conducted as qualitative research using targeted semi-structured interviews with 32 managers of various organizations and institutions, which continued until the saturation stage. Granheim and Lundman's conventional content analysis method was used for data analysis, and MAXQDA software was used for data management. To ensure the accuracy and reliability of the data, Lincoln and Guba criteria were used.

36 sub-challenges were identified in the country's crisis management. Which were divided into 5 categories of main challenges (gap in policymaking, weakness in the implementation of policies, limitation of financial resources, failure in coordination and information management, inefficient attitude at the level of decision maker and decision maker). The lack of a coherent, comprehensive and future-oriented system of policies, the absence of a comprehensive roadmap and planning to advance policies, the lack of transparency in the powers and responsibilities of organizations, the lack of budget priority allocation for crisis programs, the weakness in playing the role of coordination of the crisis management organization and the weakness in The monitoring and evaluation system of organizations was one of the most important sub-challenges.

The implementation of disaster management programs in the country at the levels of policy, planning and implementation is associated with challenges and problems in organizations. Paying attention to the principles of policy-making in reviewing policies, and reforming the structure, laws and national guidelines and processes in the programs of the country's crisis management organization can lead to the improvement of the country's preparedness and proper management when disasters occur.

 Throughout history, humanity has faced numerous biological threats that have resulted in catastrophic epidemics. The challenges (Fear, uncertainties, failure of care, etc) posed by epidemics necessitate the implementation of a variety of strategies to contain them. This study was conducted to identify strategies to ensure effective and safe patient care during biological events.

 This study is phase of a larger research project that used the Delphi method in its third stage. The objective was to address the need for effective and safe care in intensive care units (ICUs) during biological events like the COVID-19 pandemic. The Delphi questionnaire was constructed using insights from the first two phases of the study: the qualitative component and the integrative review phase. The Delphi method was implemented over three rounds, with experts selected through purposive sampling. The Kendall coefficient measured the degree of consensus among the experts’ opinions.

 The strategies identified for the provision of effective and safe patient care during biological events were categorized into 10 main categories, which were further divided into related subcategories.

 Identifying and implementing strategies to improve care in intensive care units can improve patient care during crises, such as new disease outbreaks. By identifying these strategies, biological events similar to the COVID-19 pandemic can be managed more effectively. Further research is warranted to explore strategies to improve patient care in other healthcare sectors.

Emergency medical technicians (EMTs) should have good socioeconomic status and health status so that people in need can benefit from their services. The present study aims to measure the biopsychosocial health of EMTs in Tehran, Iran.

This is a descriptive cross-sectional study. The study population consists of the EMTs from six regions of Tehran, Iran. Of these, 563 EMTs were included in the study. Stueck et al.’s health cube battery (HCB) tool, which has six domains of individual resources, external resources, workload, stress consequences, biocentric performance, and socioeconomic status, was used to collect data online. The physiological reactions (blood pressure, pulse rate, and oxygen saturation) were assessed based on three levels of socioeconomic status (low, moderate, and high). The data analysis was performed in Excel and SPSS software, version 22.

The mean age of participants was 31.88±43.6 years, and their mean work experience ranged from 1 to 30 years (mean=14.7±73.5 years). The mean score for biocentric performance was higher than that of other domains. The mean levels of physiological reactions were within the normal range. Overall, 50% (n=281) had moderate socioeconomic status. There was no significant difference in terms of physiological conditions among the three socioeconomic groups.

The EMTs with better socioeconomic status have better performance and physiological status. There is a need for more attention to the socioeconomic status of EMTs in Tehran, which has a direct impact on their performance and an indirect effect on their physiological health.

Social trust in relief organizations is one of the prerequisites for community preparedness for disasters. This study aims to explore the challenges of social trust in disaster management in Iran with a focus on the COVID-19 pandemic, and provide recommendations for building social trust.

This is a qualitative study using a conventional content analysis method. Participants were 27 lay people and managers of emergency and relief organizations in Tehran who were selected purposefully with maximum diversity. We used in-depth semi-structured interviews to explore their experiences and perceptions. Data analysis was performed using MAXQDA software, version 2018 and Graneheim and Lundman’s content analysis method. 

In this study, two main themes emerged, “challenges to building social trust” and “recommendations for building social trust.” The challenges had four categories: Managerial issues, misunderstanding of the situation, lack of transparency, and lack of coordination. The recommendations had three categories: Management improvement, efficient risk communication, and experience-based interventions. 

Social trust during disasters in Iran can be improved by transparency in the performance and tasks of relief organizations, timely and accurate provision of information (risk communication), and emphasis on social participation and solving managerial issues.

The growing production of plastic and its integration into consumption patterns have raised significant concerns regarding its environmental and health impacts. The presence of microplastics in various environmental contexts and the excessive exposure of individuals pose serious health risks that must be addressed at multiple levels—from national policy-making to individual and family behaviors. Understanding public perception of microplastics is crucial for effective risk management and mitigation. This study aimed to clarify the understanding of microplastic risks to the health of Iranian citizens.

This study employed a conventional qualitative content analysis approach. Data were collected through purposive sampling via in-depth semi-structured interviews with 29 ordinary citizens and disaster and environmental health professionals. Data collection continued until concept saturation was achieved.

Continuous data analysis revealed four main categories and 23 subcategories: (1) Poor management practices and lack of coordination in public administration, (2) Nature of the phenomenon and health and environmental factors, (3) Weakness in education on risk communication, and (4) Improvement strategies.

Iranian citizens’ understanding of the harmful effects of microplastics is linked to effective management of this issue, the nature of environmental impacts, the complexity of health effects, and educational challenges. To mitigate the adverse conditions associated with microplastics, it is essential to enhance public awareness of their dangers, promote alternative consumption patterns, and coordinate efforts across all sectors. Effective environmental management is vital for safeguarding human interests and the rights of future generations, reducing financial and environmental damages, and fostering community participation.

Childhood cancer is significant due to its high prevalence and its impact on the entire family, resulting in various psychological, social, economic, and communication challenges for the families.

The aim of this study was to explore the barriers and facilitators to pediatric oncology social work practices in Iran.

This qualitative study used a content analysis method and involved 19 pediatric oncology social workers. We used a purposeful sampling method until data saturation was reached. Data were collected through semi-structured interviews and field observations and then analyzed.

This study demonstrated that the factors influencing social workers' practice include personal characteristics and interpersonal communication at the micro level, while barriers mainly consist of cultural, social, economic, organizational, and structural dimensions at the macro level.

In order to better support children with cancer and their families, policymakers and health system managers need to give special attention to the status of social workers. Strengthening support systems and addressing the challenges they face can be effective in protecting the professional practices of these caregivers.

This systematic scoping review aimed to investigate and delineate the dimensions of the Community First Responder (CFR) model implemented in emergency medical services (EMS) across different countries. The primary focus was on identifying key components and characteristics associated with CFR programs.

This study conducted an extensive search across multiple databases (PubMed, Scopus, and Web of Science) and grey literature sources (Google Scholar, official sites) until Mar 2023 using keywords related to community first responders. Initially, 14,135 articles were found. After removing duplicates and similar titles, 37 articles were reviewed. The analysis covered training, motivation, public awareness, emotional support for responders, coordination with ambulance staff, program development, and the impact on patient outcomes.

This review revealed key dimensions and components common to CFR models worldwide. Notable findings included insights into the significance of training, the motivating factors for individuals joining CFR groups, public awareness regarding the role of CFRs, the importance of emotional support for CFRs, effective coordination with ambulance staff, development requirements of CFR programs, and the consequential effects of plan implementation on patient outcomes.

This systematic scoping review offers valuable insights into CFR models worldwide, enhancing understanding of their effectiveness, challenges, and capabilities. Its recommendations can influence policy, guide future research, and strengthen CFRs' contributions to emergency medical services.

 With the beginning of the pandemic caused by the COVID-19 virus, the concept of social distancing received a lot of attention and was used in many public health announcements. However, this concept is vague and inexpressive and in the scientific literature, there is no consensus about what is called social distancing. Considering the multi-dimensional view and the ambiguity in different dimensions of social distancing, the need for further development and efforts to achieve a deep perception of this concept is felt. Therefore, this study was conducted with the aim of analyzing the concept of social distancing and determining its dimensions and characteristics.

 The analysis of the concept of social distancing, based on Walker and Avant's approach, was done in eight steps: Choosing a concept; determining the purpose of analysis; identifying the uses of the concept; defining attributes, antecedents and consequences; identifying model, borderline and contrary cases and finally, empirical referents. The articles within the time span of 2019-22 were searched in electronic databases PubMed, ProQuest, CINAHL, Irandoc, SID and Google Scholar search engine, using the keywords social distancing and social distance.

Ethical Considerations:

 In the current research, the ethical aspects of the review study have been observed, including the originality of the texts, honesty and trustworthiness.

 The result of the search was 480 articles, which were screened according to the research criteria and finally, 23 articles that had repeatedly been used to define or describe the antecedents, characteristics and consequences of the desired concept were analyzed. After analyzing the studies, the concept of social distancing was found to have certain qualities: Preventing the transmission of infectious diseases, recommending staying at home and being quarantined, being culture-oriented and the passage of time.

 In this study, a definition of social distancing was obtained, which is also supported by the literature. According to this definition, social distancing is a health protection and preventive measure, which prevents or reduces the transmission of contagious diseases through recommending keeping physical distance from others, staying at home and being quarantined during the outbreak of infectious diseases. Future studies can use this definition in designing preventive interventions related to the adverse consequences of this concept. Furthermore, this definition can be the basis for better teaching this phenomenon to students. Since concepts such as social distancing are always associated with issues like changing social relations and ethical challenges, the need for more reflection on the application of this concept is felt, due to the lack of respect for individuals’ independence.

This qualitative study aimed to identify the key issues within Emergency Medical Services (EMS) in large urban regions. This study used qualitative content analysis as its research methodology. The study was conducted in 2023 and involved 21 Iranian EMS stakeholders, selected through purposive sampling with maximum diversity to ensure a broad range of expertise. Data were collected through semi-structured, in-depth interviews, which were conducted until data saturation was reached. The analysis followed the method proposed by Landman and Graneheim, which involved systematic coding and categorization to identify key themes and patterns related to EMS challenges. The study included 17 men and 4 women. The data analysis identified eight subcategories, which were then divided into three main categories based on their similarities. These main categories addressed challenges in EMS delivery, emerging issues in EMS demand, and resource constraints. This study highlighted the challenges that Iran’s EMS encountered in megacities due to rapid urbanization and an elderly population. Key issues included operational inefficiencies, increasing demand, and limited resources. Addressing these challenges is crucial for enhancing the effectiveness and sustainability of EMS. Further research is required to develop strategies for overcoming these obstacles and strengthening EMS in large urban regions.

Congress 60 is an NGO that offers services to drug abusers, but its underlying theory has not been explored inprevious studies. The purpose of this study is to examine the changes in the physical dimensions of the people treated in Congress60.

Grounded theory methodology was used to arrive at the underlying theory of Congress 60. The data were collected from2021 to 2023 through interviews with 21 individuals, participant observation, and a review of available texts from Congress 60.Data were analyzed in MAXQDA 2020 following the constant comparison method recommended by Corbin and Strauss in 2014.

The core concept included “Addiction-related transformations in body structures”. Addiction-related transformations inbody structures include addictive body structures (addiction and chronic substitution, and nervous system and external substances)and healthy body structure (opium tincture medicine, opium tincture dosage measurement, and taper-up-off of opium tincture inover time or Dezhakam Step Time).

The theory of “Addiction-related transformations in body structures” derived from this study explains the processof entering and leaving addiction from the perspective of Congress 60. A person using drugs enters Congress 60 with addictedbody structures. In Congress 60, using the right dose of opium tincture medicine and the Dezhakam Step Time (DST) method, theperson’s body structures return to normal. The findings of this study offer a novel perspective on addiction, suggesting potentialavenues for further research through the exploration of various hypotheses.

Autonomy in hemodialysis patients leads to more appropriate self-management of patients' problems. One of the ways to increase self-care ability is the short and simple 5A model, which helps patients in self-care, and as much as possible, disease management is left to the patients themselves. The purpose of the present study was to investigate the effect of implementing the 5A self-management program on the self-care ability of hemodialysis patients admitted to Hazrat Rasool Akram (PBUH) hospital in Kalaleh city.

This semi-experimental study was conducted on patients referred to hemodialysis in Hazrat Rasool Akram (PBUH) hospital in Kalaleh City. 60 patients were selected into intervention and control groups. After completing the demographic and self-care questionnaire (SCA), routine measures were performed in the control group, and the 5A nursing model was implemented for three months in the intervention group, and the self-care program was implemented in person or through phone calls and text messages. Finally, data analysis was done in SPSS software version 23 (the significance level in this study was considered less than 0.5)

The results of the demographic characteristics showed that there is no significant difference between the two groups in terms of age, gender, education, marriage, and dialysis time after the intervention, while after the intervention, the self-care ability score in the intervention group was 126.76 ± 13.88 and compared to the control group, a significant difference was observed between the two groups: 138.96 ± 0.18 (P<0.05).

The implementation of the self-management program based on the 5A nursing model increased the care capacity of hemodialysis patients. Therefore, drawing the current situation in the field of increasing self-care capacity using the 5A method can help nurses, lecturers educational planners, and nursing managers to have access to a suitable model for providing care and education according to the conditions of patients and their needs.

Following the emergence of population aging phenomenon in the world, “successful aging” as a quality concept has recently attracted the attention of many researchers and policy makers; yet it seems that there is no single and clear definition of it presented in the literature. This study aims to analyze the concept of successful aging.

The study was conducted with Walker and Avant’s 8-step approach. For this purpose, articles meeting the inclusion criteria were selected through searching the SID, Magiran, Noormags, ISI, Pubmed, Scopus and Proquest databases and using the keywords of aging, successful aging and related concepts during the years 2000-2022. Then they were analyzed using Graneheim and Lundman's content analysis method to extract the successful aging concept's applications, characteristics, antecedents and consequences.

The content analysis of 83 selected articles revealed the characteristics of successful aging in the following seven categories: 1) "manageable process", 2) "multi-dimensional and comprehensive", 3) "socio-cultural context-bounded", 4) "enjoyment of physical, psychological and social health", 5) "non-dependence on others", 6) "happiness", and 7) "continuity and active participation in different fields of life".

A comprehensive definition of successful aging was presented using the identified characteristics, antecedents and consequences, which can help to better understand this concept, recognize its various dimensions, and ultimately, plan for its realization.

Infectious outbreaks due to disrupted social and environmental conditions after climate change-induced events complicate disasters. This research aimed to determine the contentions of bioclimatic variables and extreme events on the prevalence of the most common Climate-Sensitive Infectious Disease (CSID); Malaria in Iran.

The present narrative systematic review study was conducted on the bioclimatic variable impact on the prevalence of malaria, as a common CSID. The search was conducted in 3 sections: global climate change-related studies, disaster related, and studies that were conducted in Iran. The literature search was focused on papers published in English and Persian from Mar 2000 to Dec 2021, using electronic databases; Scopus, Web of Science, PubMed, Google Scholar, SID, Magiran, and IranDoc.

Overall, 41 studies met the inclusion criteria. The various types of climatic variables including; Temperature, rainfall, relative humidity, and hydrological events including; flood, drought, and cyclones has been reported as a predictor of malaria. The results of studies, inappropriately and often were inconsistent in both Iran and other parts of the world.

Identifying malaria outbreak risks is essential to assess vulnerability, and a starting point to identify where the health system is required to reduce the vulnerability and exposure of the population. The finding of most related studies is not congruent to achieve reliable information, more extensive studies in all climates and regions of the country, by climatic models and high accuracy risk map, using the long period of bioclimatic variables and malaria trend is recommended.

The Arbaeen march ritual stands as one of the largest congregations, attended by tens of millions every year. Given the large number of participants in this ritual, it is essential to minimize the health repercussions for pilgrims and ensure their prompt access to medical care. The present study was conducted to analyze the healthcare services during the 2019 Arbaeen march.

Employing a qualitative approach, this study utilized various data collection methods, including in-depth and semi-structured interviews, field observations, and document review. The target population comprised healthcare decision-makers, managers, and providers of the 2019 Arbaeen march. The interview and data collection guide were developed in accordance with the World Health Organization (WHO) guidelines. Data collection continued until data saturation. Directed content analysis was employed to analyze the data. 

Data saturation was achieved after conducting 30 personal interviews. Out of the challenges and significant factors found in healthcare deliveries during the Imam Hussein (AS) Arbaeen march, 9 main themes and categories were identified: Trauma system, disease surveillance system, health issues, health education and promotion, healthcare coordination and collaboration command in the health system, information and communication management, response planning, support and resource management, and safety and security.

This study identified the major healthcare issues in the AS Arbaeen march, serving as an evidence-based guide for policymakers and planners of this famous religious ritual. The results of this study are applicable to similar public gatherings and marches.

Measuring socioeconomic status (SES) as an independent variable is challenging, especially in epidemiological and social studies. This issue is more critical in large-scale studies on the national level. The present study aimed to extensively evaluate the validity and reliability of the Iranian SES questionnaire.  

This psychometric, cross-sectional study was conducted on 3000 households, selected via random cluster sampling from various areas in East Azerbaijan province and Tehran, Iran. Moreover, 250 students from Tabriz University of Medical Sciences were selected as interviewers to collect data from 40 districts in Iran. The construct validity and internal consistency of the SES questionnaire were assessed using exploratory and confirmatory factor analyses and the Cronbach's alpha. Data analysis was performed in SPSS and AMOS.   

The complete Iranian version of the SES questionnaire consists of 5 factors. The Cronbach's alpha was calculated to be 0.79, 0.94, 0.66, 0.69, and 0.48 for the occupation, self-evaluation of economic capacity, house and furniture, wealth, and health expenditure, respectively. In addition, the confirmatory factor analysis results indicated the data's compatibility with the 5-factor model (comparative fit index = 0.96; goodness of fit index = 0.95; incremental fit index = 0.96; root mean square error of approximation = 0.05).

According to the results, the confirmed validity and reliability of the tool indicated that the Iranian version of the SES questionnaire could be utilized with the same structure on an extensive level and could be applicable for measuring the SES in a broader range of populations.

One of the important dimensions of self-care in nurses is the spiritual dimension, but the concept of spiritual self-care is not well defined. Therefore, this study analyzed this concept to provide a clear definition.

This research was conducted to analyze the concept of nurses’ spiritual self-care using Walker's and Avant's eight-step approach. SID, Magiran, ISI, Pubmed, Scopus, and Iranmedex databases were searched using the keywords: nurse's self-care, spiritual self-care, and nurse spiritual self-care between 2000 and 2022. Then, eligible articles were selected and analyzed using the content analysis method of Graneheim and Landman.

The analysis of the data revealed that internal self-crystallization and behavior based on spiritual manifestation are among the characteristics of the nurses' spiritual self-care concept. It emerged from the antecedents of facing a lot of pressure and stress, understanding the spiritual nature of the nursing profession and a spiritual work environment, and led to consequences such as nursing spiritual self-polishing, resiliency, and effective nursing care.

The results of this study provide a comprehensive definition of spiritual self-care in nurses and show that spiritual self-care in nurses is a self-centered care process that leads to more nurses' attention to strengthening the inner spiritual dimensions. It also helps to provide effective care for patients in difficult and stressful professional situations.

This study aims to evaluate the prevalence, severity, and nature of adverse events (AEs) and provide suggestions on how to prevent AEs recurrence in an inpatient rehabilitation hospital in Iran.

This retrospective descriptive-analytical study was conducted in 2021 at Rofaydeh Rehabilitation Hospital in Tehran City, Iran. AEs associated with rehabilitation services and nursing care, which were reported in the hospital’s voluntary reporting system from 2018 to 2021 were evaluated. A standard checklist codified by the Ministry of Health of Iran was used to collect the data from the medical error documentation. The data were analyzed by the SPSS software, version 21, using descriptive statistics, the chi-square, and the Fisher exact tests.

A total of 5642 patients had been hospitalized in the study setting and 517 AEs had been documented during the 4 years of the study. The most common AEs in descending order were as follows: falls 288(55.7%), pressure ulcers 57(11.02%), medication errors 50(9.67%), clinical process 49(9.47%), clinical administration (issues with admission process 10(1.93%) and wrong patient identification 5(0.96%). Among 58(11.21%) cases of hospital-acquired infections, 45(77.58%) cases were urinary tract infections. There was a significant relationship between age and fall (P=0.026), pressure ulcer (P=0.006), and hospital-acquired infection (P=0.001), and between gender and fall (P=0.01), pressure ulcer (P=003), and hospital-acquired infection (P=0.01). The severity of identified AEs was categorized into mild 431(83.36%), moderate 61(11.79%), and severe 25(4.83%). The most common causes of AEs were limited supervision of patients by healthcare providers.

This study showed that patient fall, pressure ulcer, and hospital-acquired infection were the most prevalent AEs in the rehabilitation hospital. Future efforts to improve patient safety in these settings should focus on reducing such AEs along with removing barriers to voluntary incident reporting.

The COVID-19 pandemic has inflicted tremendous pressure on people, including older adults. Frail older adults are more susceptible to the adverse consequences of the pandemic. Although many studies have investigated the susceptibility and poor medical outcomes of COVID-19 in frail people, a few studies have explored the psychosocial effects of the pandemic on this group of vulnerable people. This study overviews the psychosocial consequences of the pandemic and necessary public interventions for frail older adults.

An integrative review method was utilized to gather, analyze, and structure the study data. PubMed, Web of Science, and Scopus databases were searched to extract the published English papers based on a designed strategy. The keywords and used Boolean operators in their titles or abstracts were ([“COVID-19” OR “CORONA” OR “SARS-CoV-2”] AND [“frail” OR “frailty”]). A total of 50 articles (47 quantitative, 2 qualitative, and 1 mixed method) were selected for the final analysis.

Anxiety and depression were reported as the most significant psychological consequences in the related studies. The results also indicated the social relations of older frail people and their access to health services noticeably reduced during the pandemic. On the other hand, physical exercise programs, telemedicine, and reading activities were the most preventive measures to mitigate the impacts of public restrictions during the pandemic.

The results of this review can assist policymakers in reflecting appropriate psychosocial support for frail seniors during the pandemic. As most studies on the psychosocial aspects of the COVID-19 pandemic among frail older adults are quantitative and have been performed in developed countries, it is suggested to conduct further qualitative studies. These studies should explore frail older adults’ experiences and perceptions and their challenges during the pandemic, particularly in developing countries.

Nurses working in intensive care units (ICU) have experienced numerous challenges while caring for patients with COVID-19.

The aim of this study was to explore ICU nurses’ experiences of caring for patients with COVID-19.

This research presents part of a qualitative study conducted using a grounded theory approach. Participants consisted of nurses and physicians from the selected hospitals in Sabzevar, Neishabour, and Mashhad, Iran. Data collection was performed using semi-structured in-depth interviews. Participants were enrolled via purposive sampling during 2022–2023. A total of 21 participants were interviewed. The method of Corbin and Strauss (2015) was used to analyze the data. We used Guba and Lincoln’s four criteria of credibility, dependability, transferability, and confirmability to ensure data trustworthiness.

Four main categories emerged from the data that collectively reflect the experiences of Iranian ICU nurses in caring for COVID-19 patients. These categories included ward overcrowding, changing patterns, complexity of care, and feeling exhausted. All of these categories show that Iranian ICU nurses were under intense pressure during the COVID-19 pandemic.

This study showed that taking care of patients was very exhausting for nurses during the COVID-19 pandemic. Hospital authorities and nursing administrators have a responsibility to support nurses and provide them facilities to feel less stress and uncertainty, while caring for patients with COVID-19.

Negligence is the most common concept in dealing with medical errors. Regarding ambiguity and lack of information on the concept, this study was conducted to analyze the concept of negligence in nursing.

In this study, Walker &Avant approach was used to analyze the concept. After searching the databases, the relevant documents entered in the study. To collect data, Persian databases, including Magiran, Med Lib, SID, and international databases, including PubMed, ISI, Scopus, and Google Scholar, were searched. The keywords searched included negligence, nursing, malpractice, and concept in both Persian and English. Entry criteria included publishing in Persian or English between 2000 and 2017 and providing information on the concept of negligence. Finally, 44 documents that had the criteria to enter the study were analyzed based on all the analytical steps mentioned in Walker &Avant approach.

The results showed that the defining attributes of the concept of negligence in nursing included: 1- Duty of care 2- Breach of the legal duty of care 3- Unintentional conduct 4- Damage 5- Causation. For clarification, simultaneously with these stages, cases such as model, borderline, and contrary cases were offered.

In this study, the concept analysis of negligence in nursing was performed, and the results would be to provide a comprehensive and reliable image regarding the use of negligence in nursing. It is recommended that nursing managers and planners and instructors at nursing schools, by providing practical training to inform nurses and nursing students with legal concepts for immunity from legal consequences.

Emergency medical services (EMS) personnel are subject to moral hazards during work, leading them to find moral distress (MD). Our literature review showed a gap in knowledge related to MD in EMS personnel. Therefore, this study investigated MD and its influential factors in pre-hospital emergency technicians.

This descriptive-analytic study was conducted in Iran in 2017. A convenience sampling method was used to select 265 technicians working in EMS from several cities in Iran. The MD thermometer was used to measure the MD in the technicians. The collected data were analyzed using SPSS software, version 20.

All the participants were male with mean age and work experience of 31.64±6.5 and 7.76±5.1 years, respectively. The mean score of MD was 4.6±1.8 (out of 10). Nearly 76% of the participants were with moderate levels of MD. A significant relationship was observed between the willingness of technicians to change or leave their job and the mean scores of MD in the participants.

EMS technicians experienced moderate levels of MD. Therefore, healthcare planners and policymakers need to pay more attention to this issue due to the complications of MD in healthcare personnel.

The Covid-19 pandemichas caused widespread worldwidehuman catastrophe over the past two years. Thus, the global management of Corona disease is of great importance due to its high prevalence and mortality rate as well as the numerous challenges caused by this illness. For this reason, it is of high importance to study the various aspects of this epidemic in order to provide practical solutions and suggestions for better management of similar biological events.

This article has been performedby reviewing international sources and guidelines and summarizing the materials presented in expert meetings.

The study addresses challenges related to reopening of school and universities, empowering people, Covid-19 monitoring process and benefit from support groups, social components of global health, intelligent quarantines and rapid screening and management defects of healthcare system during COVID-19 (Corona Disease) Pandemic Strategies related to challenges in each area are also provided.

The time interval between the possible future waves of Covid-19 provides a good opportunity for health systems at the national (our dear country, Iran) and global levels to make necessary preparations, strengthening, and reforming structure. According to the findings of this study, it is recommended that while continuously evaluating the risk of biological events, the surveillance system and early warning network must be intensified and a comprehensive plan must be compiled in order to respond to biological events. Also, by training healthcare staffs and practicing the above-mentioned program, the essential steps must be taken continuously.

Hospitals play an important role in protecting the health and survival of people during disasters. Despite the development of risk management programs worldwide in recent years, hospital preparedness in disasters is low and one reason for that is the lack of hospital standards for disaster preparedness. This study aims to develop hospital accreditation standards for hospital disaster risk management based on national and international experiences.

We used a mixed-method explanatory sequential approach. At first, a comparative study was conducted and the disaster risk management (DRM) hospital standards were extracted from 10 selected countries, namely the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, and Denmark. Standards were analyzed according to the DRM life cycle and the most comprehensive framework was chosen. For national experiences, purposeful semi-structured interviews were conducted with 22 experts in disastrous events in the country and continued until the saturation stage. In addition, Graneheim and Landman’s contractual content analysis method was used for data analysis. After combining international standards and national experiences, the proposed standards were introduced and the content validity index and content validity ratio were done by 25 experts.

Differences were observed in the quality and quantity of the selected countries’ DRM standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. A total of 27 standards from the International Standards Review and 31 standards from interviews were added (a total of 58 standards). The content validity results of the standards were within acceptable limits. After editing and determining the measurement criteria, the final standards were introduced.

This study introduces comprehensive DRM standards based on international and national documents and experiences that can be useful for policymakers and accreditation organizations in both developed and developing countries for hospital evaluation. This is also useful for hospitals as a roadmap for promoting preparedness in disasters.

Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses.

Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi‑structured interviews and were analyzed using conventional content analysis.

The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self‑efficacy.

There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses’ CR skills.</em>