mostafa roshanzadeh

Identifying the learning process of surgical technologist students in the operating room environment can effectively reveal the factors and strategies they use to learn and enhance the quality of their education. This study aimed to elucidate the clinical learning process of surgical technologist students.

This qualitative study employed a grounded theory approach at Shahrekord University of Medical Sciences in 2022. Data were gathered through six in-depth individual interviews and three focus groups. Purposeful and theoretical sampling persisted until theoretical saturation was achieved. Data analysis was conducted using MAXQDA10 software.

Thirteen subcategories and four main categories were found. The core variable was self-protection. Students fear making mistakes in the uncertain learning environment and employ flexible strategies, utilizing relationship-oriented approaches to achieve success while avoiding performance that could hinder learning, thereby preventing issues that would protect themselves.

It is essential to enhance students' learning by employing strategies that boost their self-confidence and avoid adhering to the current approach solely for the satisfaction of the training team, thereby preventing numerous negative consequences. Clinical managers are also encouraged to foster an educational atmosphere in the operating room and to cultivate a positive attitude among employees to support student education in these settings. Establishing constructive communication between the clinical environment and the educational system and emphasizing the significance of student education can improve the educational atmosphere in clinical settings.

The conditions of the coronavirus epidemic have had an undeniable impact on the career process of employees and especially academic staff members and have affected their teaching and activities. Telework is a form of changing the procedure in doing work that has potential and serious effects on the performance of the organization, so the present study was conducted to explain the experiences of faculty members during telework due to the coronavirus.

This qualitative study was conducted in one of the universities of medical sciences in 2022 using the contractual content analysis method. Overall, 15 faculty members who had telework experience during the Covid-19 era were selected in a purposive method and data were collected using semi-structured in-depth individual and group interviews. Interviews continued until data saturation and when no new themes or categories were obtained. Analysis was done using Gernheim and Lundman approach.

Interviews with the participants were conducted during 4 months. Overall, 15 interviews were conducted face-to-face. The average duration of the interview was 30 minutes. The findings included one theme (Continuous and effective activity), and five categories (professor's professional commitment, institutionalized conscientiousness, usefulness in telework, continuous monitoring and supervision, conditions and atmosphere of the work environment).

The increase in the organizational commitment of academic staff members and their conscientiousness is formed due to the feeling of job satisfaction and usefulness in remote work, as well as the atmosphere governing the organization, and as a result of these issues, it improves the activities of the members.

Nursing students are exposed to various educational, family, and social stresses and various factors can affect their mental health. Therefore, in order to pay attention to different dimensions of health and investigate the effects of spirituality on health, the present study was conducted to determine the effect of fasting on the mental health of nursing students of Borujen Faculty of Medical Sciences.

The present semi-experimental study with a pre-test-post-test design was conducted in 2022 at Shahrekord University of Medical Sciences. Ninety nursing students of Borujen Faculty of Medical Sciences were selected by available methods and assigned to two intervention and control groups by a simple random method. The intervention in this study included at least 23 days of fasting during Ramadan. The data before and after the intervention were collected by the demographic information questionnaire and the 21-question depression, anxiety, and stress standard tool (DASS). The validity and reliability of this questionnaire were conducted for the first time in Iran by Sahebi et al. in 2005. SPSS  was used for analysis. Descriptive statistical tests including frequency percentage, mean and standard deviation, and inferential statistical tests including t-test, paired t-test, analysis of variance, and chi-square were used.

There was no significant difference in the total mental health score between intervention (32.32±11.62) and control (29.87±14.09) groups before the intervention (P=0.08). There was a significant difference in this score between intervention (20.6±5.71) and control (29.49±8.9) groups after the intervention (P=0.04). The total mental health score in the control group before (29.87±14.09) and after (29.49±8.9) the intervention had no significant difference (P=0.15); while in the intervention group before (32.32±11.62) and after (20.6±5.71) the intervention had a significant difference (P=0.001). Mental health dimensions before and after intervention, indicated that anxiety (P=0.04) and stress (P=0.003) decreased significantly after the intervention in the intervention group. However, there was no significant difference in the depression dimension (P=0.06).

According to the results, it should be said that regular and periodic examination of the health level, and the promotion of educational and training programs on the subject of fasting to improve mental health, should be considered.

Ethical principle trainingcan lead to changes in nurses’ behavioral patterns, including anger control. Given the high workload of nurses, more emphasis should be put on virtual and remote approaches to ethical training. Therefore, the present study was conducted with the aim of determining the effect of virtual training of professional ethics on anger control among operating room nurses working in the teaching hospital of Shahrekord University of Medical Sciences.

The present study was a Quasi-experimental study with single-group before-after design conducted in 2019 on 35 operating room personnel who were selected by convenience sampling. Demographic information and standard anger control questionnaires were used to collect data. Data analysis was performed using SPSS version 16, with descriptive statistics such as percentage, mean, and frequency, and inferential tests including Independent TTest, ANOVA and Pearson correlation test at a significance level less than 0.05.

Ethical Considerations: 

Written informed consent was obtained from the participants. They were also assured of data confidentiality and their right to withdraw during the research.

Based on the results the mean age of the participants was 30.77±8.17 years. Results showed a significant difference between the mean score of anger control after the intervention (49.54±7.97) and before the intervention stage (104.43±21.37, p <0.001). No significant relationship was reported between anger control and the variables of age (P=0.62), service history (P=0.92) and number of working hours (P=0.74). Also, the mean of anger control was not significantly different according to gender (P=0.12).

The research findings showed that virtual training on professional ethics can enhance anger control. It is recommended that managers and authorities provide virtual courses on professional ethics so that operating room staff can improve interpersonal relations and anger control by increasing their awareness of professional ethics principles.

In the current health system conditions, the strategies adopted by nursing managers in their ethical decision-making can lead to different results for patients, nurses, and health systems. Therefore, the present study aimed to explain ethical decision-making strategies implemented by nursing managers. The present study was conducted using qualitative content analysis in 2022 at Shahrekord University of Medical Sciences. A total of 18 nursing managers were selected through purposive sampling and were interviewed using in-depth unstructured individual interviews. Data were analyzed using the method proposed by Graneheim and Lundman. The results revealed one main category (human-centeredness) and three subcategories (customer-centeredness, valuing employees’ dignity, and the conflict between respecting the rights of patients and employees and adhering to organizational policies). Nursing managers attempted to make their ethical decisions based on the principle of humanism by using customer-centeredness strategies, valuing employees’ dignity, and prioritizing the rights of individuals and employees over organizational rules. The results of the present study showed nursing managers make decisions in line with respecting the rights of patients and employees. However, sometimes these decisions conflict with the interests of organizations. In this regard, the existing obstacles that create the conditions for such conflicts should be identified. Increasing organizational commitment in managers can also be effective in decisions that benefit different groups of customers, personnel, and health organizations.

The coronavirus epidemic has caused a lot of confusion and tension in the health, economic, and political systems of the world, and its impact on society has led the governments' policy to support the production of drugs and related vaccines, Therefore, this research was conducted to investigate the findings of vaccination of people infected with covid-19 hospitalized in Vasei Sabzevar Hospital in 2022.
This cross-sectional descriptive study was conducted in the year 2022 at Sabzevar city. 3686 people were included in the study by available sampling method. Information was extracted from Sib system using a demographics questionnaire and checklist and analyzed with SPSS 26 software.
The results showed that %64.7 people had not been vaccinated. The number of hospitalized unvaccinated people was about 1.8 times the number of vaccinated people. There was no significant difference between the number of hospitalized men and women according to the vaccination status (P=.38), although there was a significant difference in the age of people (P=.001). The frequency of diabetes was higher in the vaccinated population. There was no significant difference between the number of hospitalized men and women in terms of the number of doses received (p=0.23). Also, the mortality rate in non-vaccinated people was significantly higher and this difference was significant (P=0.017).
Vaccination reduces mortality and hospitalization rates, so encouraging this and proper planning to prepare vaccines in similar critical situations is recommended.

The nature and consequences of COVID-19 have engendered various challenges for vulnerable groups, particularly the elderly. This study aims to scrutinize the mental health disorders experienced by the elderly during the COVID-19 pandemic, along with associated contributing factors.
This systematic review conducted in 2023 adhered to the guidelines of York University. Articles were identified using a combination of keywords, including mental health, the elderly, COVID epidemic, mental problems, psychological effects, psychological distress, and with no time constraints.
A total of 5 articles were published in Iran, while 26 articles were sourced from international journals. Among these, 21 articles employed quantitative methods, 4 were qualitative, and 4 constituted systematic reviews. The results were categorized based on the study's objectives into three groups: symptoms of mental distress in the elderly during the COVID-19 epidemic, factors contributing to increased psychological distress in the elderly and factors associated with decreased psychological distress in the elderly.
Given that the elderly are susceptible to numerous risk factors such as loneliness, physical ailments, and home quarantine, it is imperative to not only assess their physical well-being but also screen for mental health. Prioritizing elements such as home entertainment and virtual communication, alongside emphasizing faith, self-care and maintaining a normal lifestyle, can play a pivotal role in mitigating the adverse effects of COVID-19 on the mental health of the elderly.

The conditions of the COVID-19 disease epidemic have had an undeniable role in the education of students, especially health students, including nurses, and it can potentially affect the clinical competence of these students as a workforce in the future. Therefore, the current study will be conducted to explain the medical students' experiences of the challenges they have experienced in their clinical education during this period.

The present qualitative study was conducted using the contractual content analysis method in 2023 in Saveh Medical Sciences Faculty. 17 students were selected purposefully and, the data were collected using in-depth semi-structured interviews and analyzed using Granheim and Lundman's approach.

Interviews with participants were conducted individually with 17 students during 3 months. The average duration of the interview was 30 minutes. The findings included one category (lost learning) and five subcategories (fear preventing learning, limitations of the educational system, confusion in interactions and communication, limited clinical learning, and discouragement towards educational conditions).

Considering that it is impossible to teach in the hospital environment without encountering infectious diseases, it is necessary to prevent harm to the learning of students of various fields by formulating rules and guidelines. Also, the use of educational methods such as movies and animations, as well as other methods of virtual education, can help to improve the level of students' learning in cases where they can't be present at the patient's bedside.

Clinical environment is a significant component in relation to students' learning. Exposure to the challenges of the clinical learning environment has some consequences for students and can affect their learning. Identifying these consequences will moderate the challenges, and therefore, improve the quality of learning in such environments. The present study aimed to explain the consequences of exposure to clinical learning challenges among operating room students.

This study was conducted based on the qualitative content analysis approach at Shahrekord University of Medical Sciences, Shahrekord, Iran, in 2022. A total of 14 surgical technology students were selected by a purposeful sampling method. The required data were collected using in-depth, semi-structured face-to-face interviews. The data were analyzed using Graneheim and Lundman's approach.

The results of the study revealed two categories (i.e., learning distress and using harmful clinical shortcuts) and four subcategories (i.e., feeling of helplessness in learning, anxiety, incomplete care, and wrong modeling). Under the conditions and challenges in the learning environment, students felt helpless toward learning, experienced anxiety, and suffered from learning distress. It was also found that in the clinical learning atmosphere, when faced with the existing challenges, the students would be likely to facilitate the care process and attempt to do unprincipled care by imitating the wrong personnel examples.

Faced with the learning challenges of the clinical environment, the operating room students suffered from learning stress and resorted to harmful clinical shortcuts. Examining students' anxiety and their disappointment and helplessness toward the conditions and challenges of clinical education, identifying clinical wrong patterns in the care process, as well as modifying the care process provided by the personnel as wrong role models of students can have an effective impact in reducing the existing consequences.

Operating room students have experienced anxiety for various reasons that affect their educational process such as stitching. Due to the effective role of simulation in improving the education of students, this study was conducted with the aim of the effect of animal skin suturing simulation on the skill level and anxiety level of operating room students.

In this study, 30 people (75%) of the samples were aged 18-25 and 10 people (25%) of them were 26-35. 10 people (25%) were men and 30 people (75%) were women. Also, in terms of marriage, 7 people (17.5%) were married and 33 people (82.5%) were single. The present quasi-experimental study was performed with a two-group plan before and after with 40 operating room students of Shahrekord University of Medical Sciences (Shahrekord, Broujen) in 2020. The samples were randomly assigned to two test and control groups using the method based on the purpose of selection. Data were collected before and after the intervention by Spielberger Anxiety Tool and Suturing Skills Questionnaire and analyzed by SPSS software and descriptive and analytical statistical tests (Chi-square test, t-test, paired t-test).

The t-test test showed that the mean of obvious anxiety in the intervention group (36.35±10.22) and the control group (41.15±7.92) after the intervention was not significant (P=0.346). Also, the mean hidden anxiety in the intervention group (36.65±10.47) and the control group (38.65±6.13) had no significant difference (P=0.089). The t-test test showed that there was a significant difference in sewing skills after the intervention in the two intervention groups (28.2±58.22) and the control group (23.42±3.12) (P=0.04).

The texture of suture mannequins is very different from human skin in terms of consistency, and it does not convey the same feeling of sutures on natural skin to students. On the other hand, it is easier to enter and exit and move the needle and thread in the sheepskin, and this provides the students with the possibility of stitching more easily. Therefore, it is suggested to buy and prepare sheep skin for training students and teach them stitches on it.

Communication skills are considered as the most important feature required for health care workers and provide the basis for the development of professional ethics. Since working in the operating room requires team effort and establishing communication between team members, the importance of communication skills in operating room nurses is more visible. Therefore, in the present study was performed, with the aim of determining the effect of virtual training on the principles of professional ethics on communication skills of operating room staff of Ayatollah Kashani and Hajar hospitals of Shahrekord University of Medical Sciences.

A quasi-experimental study with a single-group plan before and after in 2020 was performed on 35 operating room staff of Kashani and Hajar teaching hospitals in Shahrekord who were selected by random sampling. Demographic information questionnaire and Queen Dam communication skills questionnaire were used to collect the data. Data analysis was performed by SPSS software using independent t test, Analysis of variance, paired t-test and ANOVA statistics.

Paired t-test showed that the mean of communication skills after the intervention was significantly different from before (P<0.001). The mean of communication skills before the intervention was 65.85±24.52 and after the intervention was 139.77±5.70. No significant relationship was reported between communication skills and age, service history and number of working hours (P>.0.05). Also, there was no significant difference in the average of communication skills according to the variables of gender, marital status, field of study and degree (P>0.05).

The present study showed that professional ethics training was able to improve the communication skills of employees. Therefore, it seems necessary to compile virtual professional ethics training for health care providers and other groups providing health services who do not have enough time to participate in face-to-face classes. According to the results obtained, managers of health systems are recommended to use strategies such as holding workshops on the principles of professional ethics to develop communication skills in their employees.

The use of massage as a safe method to control and manage complications after major surgery is recommended.

This study aimed to determine the effect of this method on arterial blood oxygen saturation and temperature changes in patients after abdominal and thoracic surgery.

This quasi-experimental study was conducted on 60 patients undergoing surgery in Shahrekord city in 2019. They were enrolled in the study by convenience sampling and assigned to the intervention and control groups by the blocking method. In the intervention group, a hand and foot massage was performed at 5-minute intervals for 4 sessions on each patient’s limb 3 times a day. The control group received routine care. Data were collected by a demographic questionnaire, pulse-oximetry, and thermometer. They were analyzed using SPSS version 16 and descriptive and inferential statistical tests (t-test, paired t-test, and analysis of variance (ANOVA)).

The mean arterial blood oxygen saturation in the groups after the intervention did not show a significant difference compared to before (P = 0.95), but its mean was significantly higher in the intervention group after the intervention than before (P < 0.001). The mean temperature in the 2 groups after the intervention did not show a significant difference compared to before (P = 0.38), but the changes in the mean were significant in the massage group after the intervention compared to before (P = 0.019).

The hand and foot massage can be used by nurses along with the required medical care to improve arterial blood oxygen saturation and reduce body temperature. Further research in this area is suggested.

Fatigue is the most common and annoying complaint in patients undergoing chemotherapy Therefore, it seems necessary to implement low-risk and low-cost methods such as art therapy to control fatigue in children with cancer. The present study was conducted with the aim of investigating the effect of painting art therapy on the fatigue of children with cancer undergoing chemotherapy.

This clinical trial study was carried out on 65 children with cancer who were admitted to a teaching hospital in Isfahan for chemotherapy. The samples were randomly assigned to two groups: intervention group (n = 32) and the control group (n =33). Children in the intervention group did free drawing for 6 sessions. The data before and after the intervention were collected by using the multidimensional scale of children fatigue.  The data were analyzed by SPSS version 16 software using descriptive and inferential statistical tests.

There was no significant difference in fatigue score between the intervention group 73.41) ±8.81) and the control group 68.11 ±)10.51) at baseline (P=0.53). The t-test showed that the mean fatigue in children was significantly decreased in the intervention group 62.21 (±12.23) as compared to the control group 70.02 )±10.61) (P<0.001). The paired t-test also showed that the mean fatigue score in children in the intervention group 62.21 )12.23) compared to baseline 73.41 ±)8.81) significantly decreased (P<0.001).

The findings of the study showed that painting can have a significant effect on reducing the fatigue of children with cancer undergoing chemotherapy.

Moral distress is an important challenge among critical care nurses. psychological empowerment can pave the ground for proper moral performance and prevention of moral distress among nurses. This study aimed to predicting moral distress through the dimensions of psychological empowerment in nurses.

This descriptive cross-sectional and analytical study carried out in 2018. For this purpose, 190 nurses were selected by convenience sampling from the critical care units in Southern Khorasan Province, Iran. Data were collected using Corli's Moral Distress Questionnaire and Spreitzer's Psychological Empowerment Questionnaire. Data were analyzed in IBM SPSS ver. 16 using descriptive and inferential statistics.

Finding showed that moral distress intensity was (4.8±0.51) and negatively correlated whit psychological empowerment (P=0.03, r=-0.5). Moral distress frequency was (5.2± 0.56). The psychological empowerment was (4.1± 0.44). The results of the multiple regression indicated that 2 % variation of moral distress intensity explained by psychological empowerment (ADJ.R2:0.238). Among these dimensions, three dimensions meaning, competence and self-determination significantly predict the intensity of moral distress (R2=0.25, P< 0.05). Moral distress correlated with age, working experience, and type of the ward (P<0.05).

Nurses with a greater psychological empowerment showed less intensified symptoms of distress where they were able to perform morally proper action.

Clinical learning is an important part of the health field, where the student interacts with the environment and applies the learned concepts in practice. Clinical environments such as operating rooms are challenging for students due to their special complexity and can have a negative impact on their learning process. In order to identify students ‘learning challenges in the operating room environment, the present study was conducted to explain students’ experiences in the field of clinical learning challenges.

The present qualitative study was performed by contract content analysis method in 2022 in Shahrekord University of Medical Sciences. Fourteen surgical technology students were purposefully selected and data were collected using in-depth semi-structured individual and group interviews and analyzed using the Granheim and Landman approaches.

The participants were interviewed over a period of 5 months. 9 face-to-face interviews were conducted with 14 participants. There were 6 individual interviews and 3 group interviews. The average duration of the interview was 30 minutes. The interviews continued until data saturation and when no new themes or categories were obtained from the interviews. The findings included a theme of “unfavorable learning environment” and three categories of “confusion in learning educational content, improper professional behavior of staff and insufficient self-confidence”. The main challenge that students faced in the field of clinical learning was the unfavorable learning environment. Conditions such as confusion in learning educational content, improper professional behavior of staff and insufficient self-confidence experienced by the students in the operating room, cause the students to find the learning atmosphere in the operating room unfavorable.

Improving the behavior and performance of staff and physicians in accordance with the standards of professional and ethical behavior and its regular evaluation from the perspective of students and other colleagues can play an effective role in maintaining professional conditions. Also, using experienced instructors who have the role of facilitating communication and learning of students in the operating room environment will play an effective role in reducing fear and controlling inappropriate behaviors of staff towards students. Educational officials are advised to solve the existing problems in order to improve the educational atmosphere of the operating room.

Meanwhile, the role of employees' social capital as an influential factor on all aspects of the organization can affect the mental health of individuals. Therefore, the present study was conducted to determine the relationship between social capital and mental health of health care personnel in Borujen.

The present study is a predictive correlation study that was done 2020 in Shahrekord University of Medical Sciences. 389 employees of health centers of Borujen city were selected by stratified method and were examined using a three-part questionnaire of demographic characteristics, a researcher-made questionnaire of social capital and a standard questionnaire of public health. Data were analyzed using SPSS16 using descriptive statistics and analytical tests.

Social capital in the dimensions of interaction, ethics and social responsibility can predict the mental health of employees (P <0.001, R2= 0.023). There was no statistically significant relationship with mental health in the dimensions of social trust, social participation and public awareness (P <0.05). The average of the total dimensions of social capital of the staff was 75± 8.40 and the average of the total mental health of the staff was 75.54±13.42.

Due to the predictive role of social capital in the mental health of employees, managers of health organizations should be advised to constantly review the level of mental health and social capital of employees and use training and counseling sessions to increase the dimensions of social capital and Mental health of employees to take action.

 Observing the ethics of the nursing profession has an effective role in providing quality care. The present study was conducted to determine Knowledge and practice of nurses regarding the standards of professional nursing ethics.

 This descriptive cross-sectional study was performed in 2020 by 392 nurses from teaching hospitals affiliated with the Sabzevar University of Medical Sciences in Iran. Nurses were selected by the simple random sampling method and to collect data, two questionnaires were used to assess the knowledge and practice of nurses to comply with nursing ethical standards. Data were analyzed by SPSS software 16 and descriptive statistics (mean and standard deviation, frequency) and inferential tests (correlation coefficient, regression). The Significance level was considered less than 0.05.

Ethical Considerations: 

To participate in the study, informed written consent was obtained from the participants. Necessary information was given about the nurses being free to participate and leave the study.

 The average knowledge of nurses about compliance with ethical standards (17.2±4.81) and their average performance was by ethical standards (130.88±9.11). Pearson correlation coefficient indicated a positive and significant relationship between nurses' knowledge and practice of adhering to ethical standards (P<0.05, r=0.65). The nurses' knowledge (R2=0.26) significantly predicts their performance in terms of ethical standards. The non-standardized beta value showed that the share of knowledge in predicting nurses' performance is (2.54). There was no significant relationship between the average knowledge and practice of nurses and demographic characteristics (P>0.05).

 The efforts of systems to improve the awareness of their nurses can play an influential role in improving their performance in line with ethical standards in the clinical environment. Continuous training programs can play an important role in sensitizing nurses in the face of ethical issues and therefore improve their performance according to ethical standards.

 Nursing students deal with psychological stress due to exposure to the hospital atmosphere and contact with patients; hence, they are more prone to harms. It is necessary to investigate their academic and mental health problems, including addiction to Internet, and its relationship with their academic procrastination. Therefore, the present study aims to determine the role of Internet addiction in predicting the academic procrastination in nursing students.

This descriptive cross-sectional study was conducted in 2018 on 392 nursing students at Shahrekord University of Medical Sciences who were selected by quota sampling method. A demographic information form, Young's Internet Addiction Test (IAT), and Solomon and Rothblum's academic procrastination questionnaire were used to collect data. Data were analyzed in SPSS v. 16 software using descriptive statistics (mean, standard deviation, frequency, and percentage) and analytical tests (t-test, analysis of variance, regression analysis, Pearson correlation test). 

 Pearson correlation test results showed a positive and significant relationship between Internet addiction and academic procrastination (P<0.05). Regression analysis results showed that all dimensions of IAT (adjusted R2= 0.186) significantly predicted academic procrastination. The non-standardized beta value showed that the shares of low time control/management and salience/neglect of social life in predicting academic procrastination were 2.14 and 2.018, respectively. The mean scores of IAT and academic procrastination were reported 20.69±2.81 and 64.4±2.48, respectively.

Considering the roles of poor time management and neglect of social life in predicting the nursing students' academic procrastination, their importance should be emphasized to the parents and students. Screening students for academic problems and procrastination and identifying the related factors as well as increasing students' awareness and skills to manage time and improve social relations should be considered.

Changes in hemodynamic parameters can indicate the health status of individuals, and treatment measures cause changes in hemodynamic parameters, and affect the treatment process of patients. Different ways of distraction can have different effects. The aim of this study was to determine the effect of music distraction and movie-watching on hemodynamic parameters of patients undergoing extracorporeal lithotripsy.

 A quasi-experimental study with a three-group, before and after design was performed on 90 patients undergoing extracorporeal lithotripsy in the lithotripsy unit of Ayatollah Kashani hospital affiliated to Shahrekord University of Medical Sciences in 2018. Patients were selected using the convenience sampling method and randomly allocated into three groups. The intervention included visual and auditory distraction. Data was collected before and after the intervention using demographic characteristics questionnaire, calibrated mercury blood pressure monitor, and pulse oximeter. Descriptive statistical tests (mean and standard deviation, percentage, frequency) and inferential tests (paired t-test, Pearson correlation coefficient and analysis of variance) through the SPSS software version 16 were used to analyze the data.

Analysis of variance showed that the mean scores of systolic and diastolic blood pressure, pulse rate and oxygen saturation in the auditory, visual and control groups were not significantly different before the intervention (P>0.05). Also, the mean scores of these variables in auditory, visual and control groups were not significantly different after the intervention (P>0.05). Paired t-test also showed the mean scores of pulse rate (P=0.133), systolic (P=0.159) and diastolic blood pressure (P=0.413), and oxygen saturation (P=0.083) did not have significant differences after the intervention compared to before the intervention between the groups.

According to the results, music and movie-watching did not have a significant effect on hemodynamic parameters of patients undergoing lithotripsy. Due to the lack of confirmatory studies, further research is needed on lithotripsy patients.

Postoperative complications can endanger the patient's life and disrupt the recovery process if not properly managed. Local cold therapy can be a safe non-pharmacologic method to manage these side effects; however, it has not been highly considered.

This study was done to determine the effect of local cold therapy on arterial blood oxygen saturation and temperature changes in patients undergoing surgery.

This quasi-experimental study was performed at Shahrekord University of Medical Sciences in 2019 on 60 patients undergoing thoracic and abdominal surgery selected by convenience sampling, and they were randomly assigned to the intervention and control groups. The intervention (local cold therapy) was performed for 48 hours after full consciousness, three times a day for 20 minutes to the intervention group. Data were collected before and after the intervention using a demographic questionnaire, pulse oximetry device, and thermometer. The data were analyzed based on the independent samples t-test, paired-samples t-test, and chi-square and Fishers’ exact tests by SPSS version 20 software.

The mean arterial blood oxygen saturation percentage (O2Sat%) during the intervention significantly increased in both groups (P < 0.05), but the rate of increase was significantly higher in the local cold group (P < 0.05). The results of within-group research showed that the mean temperature had significant differences in the local cold therapy group (P < 0.05), but the mean body temperature did not show a significant difference between the two groups (P < 0.05).

Local cold therapy can be effectively trained and used by nurses to improve the O2Sat%. It did not affect postoperative body temperature. Further studies must be conducted to investigate the effects of local cold therapy on postoperative body temperature changes.

Nurses' organizational loyalty to health systems plays an important role in expanding organizational performance. Investigating the role of factors such as citizenship behaviors and adaptive performance can be helpful in this regard. The aim of the present study was to investigate the relationship between citizenship behavior and adaptive performance with organizational loyalty in nurses.

This descriptive, cross-sectional study was conducted in 2019 on 200 nurses working in Valiasr hospital affiliated to Shahrekord University of Medical Sciences in Borujen, and were selected by the random sampling method. A demographic information form, the Lee & Allen’s citizenship behavior questionnaire, the Charbonnier-Voirin and Roussel’s adaptive performance scale, and the Kumar and Shekhar’s organizational loyalty questionnaire were used to collect the data. The data was analyzed by descriptive and inferential statistical tests using the SPSS software version 16.

The Pearson's correlation coefficient indicated a significant positive correlation between citizenship behavior and adaptive performance with organizational loyalty (P<0.05). Regression tests showed that citizenship behavior (ADJ.R2=0.199) and adaptive performance (ADJ.R2=0.131) significantly predicted organizational loyalty. All dimensions of citizenship behavior and some dimensions of adaptive performance such as creativity, learning efforts and job stress management can predict organizational loyalty in nurses. The average scores for citizenship behavior (66.85±18.26), adaptive performance (68.76±16.98) and organizational loyalty (120.67±24.09) were reported to be moderate.

Managers and planners should pay attention to factors such as creativity, stress management, and continuing education along with improving healthy working relationships and nurses’ participation, which can play an important role in expanding organizational loyalty through the development of citizenship behavior and adaptive performance.

Ethical decision-making by nursing managers is influenced by various essential factors, such as courage, without which it is impossible to act on them.

This study aimed to explore the experiences of nursing managers about courage in ethical decision-making.

The current study was conducted in Iran by a qualitative content analysis approach in 2018. Nineteen nurse managers were selected purposefully from hospitals in Tehran and Shahrekord cities. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method.

Based on data analysis, we extracted 2 categories (obligation, decisiveness) and 8 subcategories (clearness in expressing decisions, the ability of the manager to make decisions in critical and complex situations, authority/decision-making as a religious responsibility, follow the decision process, being responsible, making compensatory decisions, making preventive decisions).

The findings showed that managers who are committed to ethical decision-making have enough assertiveness to make the decisions. Educating, empowering, and sensitizing managers and enhancing their insight into ethical issues through problem-solving and role-playing techniques can play an essential role in promoting their commitment and responsibility.

Innovative climate plays an important role in the development of health care organizations and the role of organizations' ethical leadershipis undeniable. Given the ambiguity of many effective aspects of innovation in the organization and the related factors, this study explored the innovative organizational climate through the dimensions of ethical leadership in nurses.

This descriptive-correlational study was performed on 200 nurses working in the teaching hospitals in Shahrekord in Iran; they were selected through quota sampling method. Data were collected using the questionnaires of demographic information, Siegel and kaimer innovative organizational climate and Emadifar’s ethical leadership and were analyzed by means of SPSS 16.EthicalConsiderations:In order to participate in the study, informed written consent was obtained from the participants. The nurses were provided with necessary information about being free to participate and leave the study.

The mean of ethical leadership in nurses and the innovative organizational climate were obtained (134.8±6.13) and (89.85±5.02), respectively. There was a positive and significant relationship between ethical leadership in nurses and innovative organizational climate (r=0.63, p=0.04). Regression test also showed that 31% of innovative organizational climate change was predictable by the dimensions of ethical leadership in nurses (ADJ.R2=0.31). Also, among the dimensions of ethical leadership, effort to promote employees and the ability to express different opinions significantly predict the innovative organizational climate (R2=0.25).

The health system managers need to take into consideration ethical issues such as trying to promote employees and allowing them to express different opinions in order to promote innovation in the system.Continuous education and evaluation of health systems regarding the ethical issues by managers can play an important role in promoting ethical leadership and innovation in the organization.