sh. haghani

Insufficient nursing qualifications are among the factors contributing to clinical errors in care units. Additionally, frequent false alarms diminish nurses' trust in alarm systems and delay response times, potentially leading to alarm fatigue over time. This study aimed to investigate the association between alarm fatigue and clinical competence among neonatal intensive care unit (NICU) nurses.

This descriptive correlational study included 140 NICU nurses from Kermanshah, Iran, during 2023-2024, selected using a census sampling method. Data collection tools comprised a demographic questionnaire, the "Nurse Competence Scale," and the "Alarm Fatigue Questionnaire." Statistical analysis was conducted using SPSS version 16, employing both descriptive and inferential methods, with a significance level set at p<0.05.

The mean alarm fatigue score was 21.61±7.45, indicating a level above average. Most participants (75%) demonstrated very good clinical qualifications. The average clinical competence score was 174.76±26.74, also rated at a very good level. A significant relationship was observed between alarm fatigue and clinical competence in the teaching-coaching subscale (p=0.019). However, no significant association was found overall.

As alarm fatigue increases, clinical competence specifically within the teaching-coaching subscale declines. However, no significant correlation is observed between overall clinical competence (excluding the teaching-coaching subscale) and alarm fatigue, nor between alarm fatigue and the individual subscales of clinical competence.

The aim of the current research is to predict corona anxiety based on self-reported illness in vaccinated people at the vaccination center. The method of the current research is quantitative and has been implemented in a descriptive-correlational way, and it is practical in terms of the purpose of this research. The study population of this research is all the people who visited the vaccination center of the Holy Prophet (PBUH) Complex of West Tehran Azad University in the fall of 1400. Among these people, 400 vaccinated people who received the second dose were selected as a sample based on the amount calculated by Gpower software in a simple random manner. Self-diagnosis and Corona anxiety tests were taken from the subject. The data were analyzed using the statistical method of multivariate analysis of covariance. The results show that corona anxiety is predicted based on self-diagnosis. There is a positive and significant effect of the path coefficient of self-care on corona anxiety (p<0.001, β=0.290).

Paying attention to positive and negative emotions is very important and is one of the predictors of happiness and satisfaction in life. When judging the happiness and satisfaction of their lives, some people pay attention to the level of their negative and positive emotions, which indicates that their positive emotions prevail over negative ones. Nursing students experience a range of positive and negative emotions during their studies, and in the meantime, negative emotions and feelings can become more troublesome and hinder their learning. Studies show that emotions students experience in different learning environments can act as facilitators for their academic success, academic adjustment, and psychological well-being. Also, the results of studies show a significant positive relationship between students' positive emotion and their academic achievement. Students who receive compassion-based education have more hope, self-esteem, and overall mental health than their peers. The present study aimed to evaluate the effects of self-compassion training on the positive and negative emotions of nursing students.

This was a quasi-experimental study with pre-test and post-test design, which was conducted on 50 undergraduate nursing students studying at Iran University of Medical Sciences in the second semester of 2020. Inclusion criteria were being a bachelor student, not using psychiatric drugs, no stressful events such as divorce, death of loved ones, etc. in the past four months and a history of attending similar training classes. Exclusion criteria were not answering the exercises for at least 2 sessions. The students were selected through convenience sampling method and took the pretest. Then, students underwent training for eight 60-minute sessions (during one month and for two sessions each week). Some tasks were considered for the students in the interval of two sessions that were held during a week, and the students sent the answers of these exercises individually to the researcher. The students took the posttest one month after the last session. The instruments used were demographic profile and the reliable and valid Positive Affect and Negative Affect Scale (PANAS). Data analysis was performed using SPSS 16 through descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (paired t-test). In order to comply with ethical considerations, after obtaining permission from the ethics committee of Iran University of Medical Sciences, along with obtaining written consent from the samples, they were told that the information contained in the tools would remain confidential and there would be no obligation to participate in the research.The results of paired t-test showed that the positive emotions of the nursing students in the posttest with a mean score of 37.2 ± 9.5 was significantly higher than the pretest with a mean score of 21.24 ± 2.36, which indicates the superiority of the numerical indicators of positive emotion (P=0.001; t=23.388). Also, the results of paired t-test on negative emotions showed that the posttest score (12.2 ± 44.5) was significantly lower than the pretest score (20.34 ± 1.72), which indicates the superiority of the numerical indicators of negative emotion of nursing students (P<0.001; t=19.89). The results indicated that in the posttest, the scores of positive emotions increased significantly in all the time dimensions, while the scores of negative emotions decreased significantly.

The results of present study show that self-compassion-based education was effective on reducing negative emotions of nursing students, and therefore, affirm the research hypothesis that self-compassion-based education can increase the positive emotion scores and decrease negative emotion scores in the posttest. Based on the results of the research, self-compassion education can be employed as a high capability method for increasing positive emotions and reducing negative emotions of nursing students. The results of this study are useful for counseling centers of medical universities to better manage counseling for students. In the field of nursing students' education, the self-compassion training content presented in this study can be provided to nursing professors to acquaint their students with this content and these students can use this content as much as possible in their care plans for clients as self-compassion is a concept that applies to both healthy and sick groups in society. It is suggested that similar studies be performed on nursing students in other medical universities of the country and also on other fields of medical sciences to compare their results.

An efficient family cannot be defined as one that is free of mental stress, conflicts, and problems, but rather, it is defined based on the extent to which the family is capable of fulfilling its duties and functions. Poorly functioning families have difficulty dealing with emotional issues. In these families, communication is neglected or unqualified, the range of emotional reactions is limited, and the quantity and quality of these reactions is abnormal depending on the context and environment. These issues highlight the need to provide psychological training to the families of patients with chronic mental disorders. The variety and intensity of caring roles may lead to mental disorders in family members. If these individuals receive no intervention, their mental health will decline, thereby rendering them as ‘hidden patients’. Family interventions could reduce the recurrence and frequent hospitalization of patients with mental disorders. Therefore, the involvement of the families of patients with chronic mental disorders is paramount. The families who live with these patients are exposed to the challenges associated with their illness and are often responsible for their care and wellbeing. Life skills training is an effective psychological intervention that helps families promote adaptive and positive behaviors to manage the challenges of daily life. Life skills training for the families of patients with chronic mental disorders could also reduce the stigma associated with the disease, improve familial relations, and decrease the burden or stress of the caregivers. The present study aimed to evaluate the effect of life skills training on the performance of the families of patients with chronic mental disorders.

This single-group quasi-experimental study was conducted with a pretest-posttest design on 37 family members of patients with chronic mental disorders admitted to Iran Psychiatric Center in 2020. The sample size was calculated to be 32 considering the error rate of 0.05 and test power of 0.80, which was almost equal to 37 participants with 10% attrition. The participants were selected via convenience sampling from the family members of the patients. After obtaining the required permit to conduct the research, the researcher began the sampling process. Due to the simultaneity of the intervention with the Covid-19 pandemic, it was not possible to hold meetings in person, and the intervention was performed virtually. For this purpose, the researcher referred to the research environment, and after coordination with the educational supervisor, obtained the contact number recorded in the patientschr('39') files, and the families were contacted. While explaining the objectives of the research, the researcher convinced the families to participate in the study. To have access to all the subjects, the researcher formed a group in WhatsApp, which was called Life Skills, where all the subjects had direct access to the researcher. After completing the informed consent form and to perform the pretest, demographic forms were distributed among the families to measure the variables of age, gender, marital status, education level, relationship with the client, economic status, type of mental disorder, and family performance tools. One month after the pretest and at the end of the training course, the posttest was conducted electronically via WhatsApp by the researcher. The research samples were taught online in six 60-minute sessions for three weeks using recorded audio, PowerPoint, PDF files, and clips, which could be uploaded to WhatsApp. Initially, the demographic form and McMaster family assessment questionnaire were completed, and the life skills training was provided afterwards. The posttest was performed one month after the intervention. Data analysis was performed in SPSS version 16 using descriptive and analytical statistics. The study protocol was approved by the Ethics Committee of Iran University of Medical Sciences, and written informed consent was obtained from the participants electronically. Participation was voluntary, and the subjects were assured of the confidentiality and anonymity of the data. 

 The majority of the participants were aged less than 30 years (51.4%), female (75.7%), and married (56.8%). In addition, most of the subjects had academic education (73%) and a moderate economic status (75.7%), and the client-parent relationship was most frequent (40.5%). According to the posttest results, the mean scores of overall family performance (P<0.001) and its dimensions, including problem-solving (P<0.001), communication (P<0.001), roles (P<0.001), emotional response (P<0.001), emotional mixing (P=0.045), and behavior control (P=0.006) significantly decreased compared to the pretest, indicating the positive effect of the training intervention on family performance and its dimensions. Based on the calculated effect size, the maximum effect of the intervention was on the problem-solving dimension (0.93), and the minimum effect size was observed in the emotional response dimension (0.34).

 According to the results, life skills training for the families of patients with chronic mental disorders had a significant impact on all the aspects of family performance and could be used as an effective method in psychiatric centers to improve the performance of these families. Furthermore, it is suggested that psychiatric ward nurses become familiar with the educational content of life skills and family performance to implement these interventions for patientschr('39') families if necessary. Our findings could also help nursing managers and head nurses of psychiatric wards for the better management of care provision to patients with chronic mental disorders and supporting the families of these patients after discharge. The life skills educational content provided to our participants could also be provided to clinical professors, so that students would become familiar with these outlines and incorporate the content into their care plans. Since the implementation of an intervention based on life skills training improved family performance of clients with chronic mental disorders, it is suggested that a similar intervention be evaluated to improve variables affecting life skills areas such as communication skills, problem solving skills, and Behavior control.

Autism spectrum disorder is a complex neurodevelopmental disorder whose clinical manifestations include impaired social communication, behaviors, interests, and limited and repetitive activities. Poor eye communication, lack of emotion or social interaction, impaired use of non-verbal behaviors, and lack of age-appropriate communication are the main manifestations of this disorder. This disorder is one of the main causes of disability in children under 5 years old. The exact cause of this disorder has not yet been determined, and it can often be diagnosed by comparing autistic childrenchr('39')s speech and performance with those of their peers. In comparison to parents of typically functioning children or parents of children with other developmental disabilities (i.e. Down’s syndrome or cerebral palsy), parents or caregivers of children with an autism spectrum disorder experience more parenting stress which makes its management imperative. Parenting stress in this group of women results in depression, anxiety, divorce, reduced family cohesion and physical health, more incidence of behavioral problems in the children, and problems related to parenting. Thus, it is imperative to identify effective methods that target improvement in caregiverschr('39') mental health. The problems that mothers face in raising their children from an early age put a lot of pressure on parenting skills, and if the parentschr('39') understanding of the demands of their role is greater than the resources and methods available for coping with them, so that they will be unable to restore balance in the usual ways, it will lead to stress in parents. In the case of parents of children with autism, maternal stress is reported more than the paternal stress, and more than mothers of children with other developmental disorders and mothers of normal children. Therefore, given that the caregivers of (75%) of children with autism are their mothers, it is not unbelievable that mothers of this group of children struggle with a lot of stress. Mothers of children with autism are their primary caregivers, leading to depression, anxiety, quitting job, and suicide. Thus, effective interventions to improve the mental health of caregivers of children with autism seem necessary and the need to improve their mental health is felt. However, the results of studies that have been done so far indicate that this emotional revelation intervention through writing has been inconsistent or even ineffective on the mental health of mothers of children with autism. This study aimed to evaluate the efficacy of written emotional disclosure in parenting stress of mothers with autistic children.

In this study, conducted in 2019, a quasi-experimental design including pre-test, post-test, and control group was used. First, a sample size of 70 mothers with autistic children were selected and tested from the autistic schools in Tehran. In pre-test, the Parenting Stress Index-short form (PSI-SF) was administered individually to experimental group (n = 35) and control group (n=35). Then, written emotional disclosure, at least 15 minutes, twice a week over an 8-week period was conducted in experimental group whereas the control group received no intervention. Three mothers in the experimental group withdrew from the study due to personal reasons. Therefore, the study continued with 67 mothers. After the intervention, the parenting stress was measured again in both groups. In the intervention group, the mothers first wrote about their deepest feelings and negative experiences of caring for an autistic child. Topics for mothers to write about included their feelings when they found out their children were diagnosed with autism; writing down the most difficult situations they had experienced in communicating with their autistic children; the most important issues that had made them upset in their daily lives about their children; and what do they do when their children do not cooperate with them?
Ethical considerations of the research, including informed consent to participate in the research and obtaining consent from the participants, observing the principle of confidentiality and avoiding bias in announcing the results of the study, have been observed. Data were analyzed using descriptive statistics (mean and standard deviation) and inferential statistics (independent t-test and paired t-test) in SPSS 16.

The results of independent t-test showed that there was no statistically significant difference between parenting stress of mothers (P = 0.881) and its subscales (P <0.05) before the intervention, but after the intervention this difference was significant (P <0.001), so that in the experimental group, the scores of parenting distress were significantly lower than the control group but the scores of parenting stress of mothers and other subscales were significantly higher. The results of paired t-test showed that parenting stress of mothers and its subscales in the control group were not significantly different before the treatment and after the treatment (P <0.05), but the scores of parenting distress after the intervention decreased significantly in the experimental group and parenting stress scores and its other subscales increased significantly (P <0.001). The results of independent t-test showed that the reduction of parenting stress scores of mothers and its subscales was less in the intervention group than the control group (P <0.001).
In addition, the independent and paired t-test analysis showed that written emotional disclosure was effective in reducing parenting distress sub-scale in experimental group (29.06 + 6.01) (p< 0/001). Also٫ the intervention could not improve the scores of parenting stress among experimental group (128.78 + 12.29) (p< 0.001).  

Written emotional disclosure, as a useful therapeutic intervention could be effective in improving parenting distress sub-scale٫ but ineffective in improving parenting stress. The findings of this study could also reinforce the hypothesis that expressing positive emotions about chronic stress may lead to more adaptive functions. This study suffers from some limitations. It was conducted on limited number of mothers with autism children, the same gender, and therefore, its generalizability is reduced. The results of this study show that the intervention of written emotional disclosure has been effective in increasing parenting stress of mothers with autistic children. Therefore, it is recommended to perform this method under the supervision of a consultant to control its negative effects. It is also suggested that future research, in addition to examining the variables affecting the effectiveness of this intervention, standardize the intervention pattern in writing positive, negative, and neutral emotions and use more follow-up sessions to enable more comparison.

Rheumatoid arthritis is an autoimmune disease with a chronic and progressive nature. It starts with periods of inflammation in the synovium, and causes it to be thicken resulting in edema in the synovial tissue. It affects 1% of people worldwide, but its prevalence varies among different regions, different races, and different groups of people. Like other chronic diseases, this disease not only has no definitive cure, but also leads to a severe decline in the performance of the affected people and a decrease in independence in performing their daily activities. Studies show that structured educational approaches about self-care can improve the performance and health of patients with chronic diseases such as rheumatoid arthritis. Accordingly, individuals must learn the knowledge and skills needed to make decisions, solve their problems, and communicate with others. Self-care education in these patients helps them to reach a level of health where they not only feel satisfaction with their personal life, but also can contribute effectively and significantly to the community as a citizen. Therefore, encouraging patients to adopt appropriate self-care behaviors is an important factor in the management of rheumatoid arthritis. People with high levels of self-care have more access to health care, experience shorter periods of hospitalization, and subsequently less complications caused by hospitalization in these centers. Without education and patientschr('39') participation in the self-care process, health care programs will be more expensive and the patient’s quality of life will be reduced. Thus, self-care education along with other treatment and rehabilitation processes seems necessary in patients with rheumatoid arthritis. Despite the importance of self-care, studies suggest that patients with rheumatoid arthritis have little knowledge and information about their disease and self-care methods, and lack of knowledge leads to frequent recurrence of the disease and an increase in the frequency of their hospitalizations. Likewise, there is a gap in the studies about education of affected people and few studies have investigated this issue. Therefore, the researcher decided to conduct a study to evaluate the effectiveness of self-care education on the functional status of people with rheumatoid arthritis.

This is an evaluation and single group study conducted on 40 patients with rheumatoid arthritis, and evaluated the effect of self-care education on functional status of patients with rheumatoid arthritis. The sampling process continued from October 2019 to February 2020 among patients hospitalized in the rheumatology wards of Imam Reza and Ghaem educational-research center and treatment centers in Mashhad. Before the intervention, the samples were asked to complete demographic and functional status questionnaire. They also completed the form of informed consent and the researcher ensured that their information would remain confidential. Five 25-minute self- care educational sessions were held for samples individually and at their bedside every other day. The researcher was responsible for holding educational sessions and presenting educational contents. Two weeks after the last educational session, functional status questionnaire was performed again to record the patientschr('39') function scores in different areas after the intervention. After the data collection process, data were analyzed using statistical tests in SPSS 16. Frequency and percentage were used for qualitative variables and numerical indices including minimum, maximum, mean, and standard deviation were used for quantitative variables. Paired t-test was used for inferential statistics for comparison before and after the intervention.

This study included 40 patients with rheumatoid arthritis hospitalized in rheumatology wards of Imam Reza and Ghaem hospitals. The Findings showed that the mean age of the samples was 45.72 ± 9.77 years, most samples (%70) were female, married (%87.5), housewives (%57.5), had a diploma and lower degrees (90%), and 55% reported an underlying disease. Most of them (%62.5) had rheumatoid arthritis for five years and less. Table 1 shows these findings. The results of t-test revealed that the score of activities of daily living (P<0.001), basic activities of daily living (P<0.0001), psychological function (P=0.001), job function (P<0.001), and social activities (P=0.002) increased significantly after the intervention.  However, the increase in the dimension of the quality of social interaction was not significant (P=0.77). In terms of tool cut point, the findings showed that the mean score of activities of daily living was at warning zone before the intervention for all samples, but after the intervention, (15.0%) showed good performance. In activities of daily living, before intervention all samples were at the warning zone but after the intervention, (12.5%) ​had a good performance. In terms of psychological function, before the intervention, 80% of the samples were at warning zone, but after the intervention, (25%) showed good performance and (75%) were at the warning zone. In job function dimension, all patients were at warning zone before the intervention, but after the intervention, (10%) had good performance. In social function dimension, 95% of the subjects were at the warning zone. After the intervention, (75%) were at warning zone and (25%) showed good function. In quality of social interactions dimension, before the intervention, (85.0%) were at the warning zone and after the intervention, (72.5%) of the subjects were at the warning zone and (27.5%) showed good performance.

The results of the present study indicated that a self-care education approach plays an effective positive role in the treatment and rehabilitation of people with rheumatoid arthritis and these programs can be used as a part of the healing process of these patients along with other treatment and rehabilitation processes. In addition, the research hypothesis concerning the positive effect of self-care education on the functional status of people with Rheumatoid Arthritis was confirmed using the research data. There was no statistically significant increase in the quality of social interactions, which may require more time, and it is suggested that future studies devote more time to examining changes. Also, using more specialized educational contents for quality of social interaction can improve and enhance the results of educational process in this area of functional status of rheumatoid arthritis patients.

Childbearing is one of the most important components of population science and is more important than other demographic phenomena such as death and migration. Therefore, population policies in most countries are mainly focused on reducing or increasing fertility. Nowadays, we are facing a decrease in the tendency to have children in Iran, so that the total fertility rate (TFR) has decreased to 6.5 since mid-1978 and reached replacement level fertility in 1999 and is expected to decrease to 1.13% during 2020 - 2024. According to the Low Population Growth Scenario released by the United Nations in 2010, if Iran continues replacement level fertility and has no plan to balance it, its population will reach 31 million in the next 80 years, and 47 percent will be the elderly over 60 years. These statistics and reports have caused serious concerns for the authorities, and the Supreme Leader of Iran has mentioned this issue several times and called for serious planning and legislation to get out of this situation. This has made population growth policies one of the priorities of the government. Meanwhile, according to previous researches, Markazi province is ranked as the third city in terms of the low desire of women to have children. This study aimed to determine the factors related to childbearing willingness in 18-45 -year old women referring to Arak health centers in 2019.

This cross-sectional study was performed on 255 women aged 18-45 years, in 2019. The women were unwilling to have children. Data were collected from these women referring to 10 health centers in Arak who were selected through cluster sampling. Sampling was performed in January 2019. The data were collected through a questionnaire and included demographic information and variables related to childbearing willingness taken from Piltan et al.chr('39') questionnaire (2015) which included 78 items on religious beliefs (21 items), economic status (15 items), social participation (14 items), marital satisfaction (6 items), childbearing problems (7 items), gender socialization (5 items), fashionism (6 items), and fatalism (4 items), scored on a 5-point Likert scale ranging from strongly agree (1) to strongly disagree (5). In order to assess the validity of the questionnaire, researchers extracted all the factors related to childbearing unwillingness from different researches and included them in the personal characteristics part of the questionnaire and a few faculty members assessed its reliability. Also, to evaluate the validity of the variables related to childbearing unwillingness, factor analysis methods and KMO test were used and all major components with a factor load of higher than 0.5 were confirmed, indicating a minimum acceptable correlation between factors and the items. In order to investigate the factors related to childbearing unwillingness in women referring to Arak health centers in 2019, independent t-test and chi-square were used and also to investigate the normal distribution of data, skewness, and kurtosis were used.

According to the results, 9% of women unwilling to have children obtained low scores in terms of social participation, and 90.9% obtained medium and high scores. In addition, 9.8% of women unwilling to have children had low economic status, and 90.2% had medium and high levels. 3.9% of women unwilling to have children were at the low level in terms of marital satisfaction and 96% were at the medium and high levels. 2% of women unwilling to have children were at a low level in terms of childbearing problems and 98 were at the moderate and high levels. 38.8% of women unwilling to have children obtained low scores for gender socialization, and 61.2% obtained medium and high scores. 48.2% of these women obtained low scores for fatalism and 51.7% were obtained median and high scores. In addition, 32% of the women had low scores in terms of fashionism, and 68% had medium and high scores. Also, the results of the study revealed that only 0.4% of the women participating in the study had low religious beliefs and 11.4% had average to high religious beliefs, and 88.2% were at the high level. Given that the upper and lower limits for the variables of social participation, economic status, marital satisfaction, childbearing problems are positive, so at 95% confidence interval, a direct relationship can be concluded between the variables of social participation, economic status, marital satisfaction, childbearing problems with childbearing unwillingness in women referring to Arak health centers at 95% confidence interval. Also, considering that the upper and lower limits for the variables of gender socialization and fatalism are negative, and the lower limit is negative for fashionism, so at 95% confidence interval, no significant relationship can be concluded between the variables of gender socialization, destiny and fashionism with unwillingness to have children. The results showed that only 0.4% of participants had low religious beliefs, 11.4% had average religious beliefs, and 88.2% reported high religious beliefs.

The decline in population growth in Iran is one of the most important problems and based on the results, women who do not want to have children have higher scores in terms of social participation, economic status, and marital satisfaction, so, it is necessary to teach them the importance of having children in health centers. On the other hand, in the present study, higher education level and social participation of women have been suggested as important factors related to womenchr('39')s unwillingness to have children. On the other hand, fertility problems were reported in most women who did not want to have children. Accordingly, proper management of active forces in society, including women, can prevent a sharp decline in fertility. This can be done by paying attention to family-oriented policies. In fact, providing low-cost care services for the children of mothers with higher social participation and making some laws in this area help women to combine maternal and social roles. As a result, women can engage in extracurricular activities such as education, employment, and social activities while caring for their children, and on the other hand, the tendency to have children may increase by reducing the problems of childbearing. One of the limitations of the present study was that self-report of marital satisfaction and economic status may have affected the accuracy of the results, which was beyond the control of the researcher.

Ensuring patient safety is the first vital step in improving the quality of healthcare services. Patient safety is defined as an event that prevents unwanted injuries to a patient due to functional and unintentional actions. Safety standards are a set of requirements that are critical to implementing patient safety programs at hospitals. These standards provide an operational framework to help the hospitals fully match with the dimensions of patient safety in order to provide quality and patient-centered services. Therefore, 100% compliance with the required standards of patient safety-friendly hospital should be the priority of every hospital. The COVID-19 pandemic is one of the emerging infectious diseases that has affected the whole world in recent months. As its outbreak is an unexpected event or sequence of events of enormous scale and overwhelming speed, it has led to a high degree of uncertainty and has posed a variety of challenges to healthcare systems. Therefore, the realization of this important issue is felt more than ever in the structures and processes of each hospital of the healthcare system, in order to successfully control and efficiently manage this disease and preserve national assets. Therefore, this study aimed to determine the compliance of Imam Khomeini Hospital of Tehran with the patient safety-friendly hospital standards with respect to COVID-19 pandemic in 2020.

This descriptive-analytical cross-sectional study was conducted from September- December 2020 in Imam Khomeini Hospital Complex of Tehran during COVID-19 pandemic. 266 nurses with inclusion criteria were selected via stratified random sampling. For this purpose, the required list of 1,200 nurses was received from the nursing office of the complex. 866 nurses from 50 different wards were selected from the list based on the inclusion criteria. Then, the nurses who were in the same wards were placed in one stratum, so that the existing 50 wards including emergency department, operating room, ICU, CCU, NICU, dialysis, internal ward, surgical ward, infectious disease wards, oncology, pediatric ward, VIP and diagnostic wards were finally placed in 13 strata. Therefore, 292 samples were selected based on the quota of nurses from 13 existing strata via simple random sampling to provide a specified sample size of 266 nurses with an additional 10% to manage their attrition. Online sampling was performed by sending the link of the questionnaires through the virtual network of the study. The questionnaires included nurseschr('39') demographic information and patient safety-friendly hospital standards (Parvizi et al), including 27 items and five dimensions. The minimum score was 27 and the maximum score was 135. A higher score from the point of view of the research unit meant that the hospital was more in line with the standards of a patient safety-friendly hospital. Item 21 was scored in reverse. Scores 108-135 showed high compliance, scores 80-107 indicated moderate compliance, and scores 27-79 indicated the poor compliance of the hospital with the standards of patient safety friendly hospital. The internal consistency of the instrument was determined to be 0.934 using Cronbachchr('39')s alpha. After introducing the researcher and explaining the research objectives to the research units, data were collected. Data were analyzed using descriptive statistics including absolute and relative frequency distribution, mean and standard deviation in SPSS software version 16.

The mean and standard deviation of the age of nurses was 38.6 ± 7.94 years and most of them (90.2%) were female. The mean and standard deviation of the total length of service as a nurse and the length of service in the current ward was 13.87 ± 7.41 and 6.87 ± 5.80 years, respectively. ICU nurses had the highest frequency, 25.6%, compared to other hospital wards, and also rotating shifts with 42.4% had the highest frequency. The level of compliance with the standards of patient safety friendly hospitals was 97.35 ± 16.59 from the perspective of most nurses (61.7%) (80-107), and 3.58 ± 0.62 based on a Likert scale, which indicates moderate compliance. Continuing education dimension with the average compliance equal to 3.87 ± 0.69 had the highest mean and governance and leadership with the average compliance equal to 3.41 ± 0.71 had the lowest mean scores. Mean scores of dimensions of a safe environment, participation, and interaction with patients and the community, safe clinical services were 3.45 ± 0.67, 3.44 ± 0.85, and 3.71 ± 0.7, respectively.

Based on the findings of the present study, the level of compliance with the standards of a patient safety-friendly hospital was moderate in the Imam Khomeini Hospital complex during the coronavirus pandemic. The highest and lowest levels of compliance were related to the dimension of continuing education and the dimension of governance and leadership included in the standards of patient safety-friendly hospital. To improve the current situation, purposeful and evidence-based management of organizational resources, attention to "barriers to achievement" dimensions of patient safety, institutionalizing patient safety culture and promoting safety, attention and focus on patient safety indicators, continuous and effective training of educational staff needs are needed to improve the safety of beneficiaries, especially during the COVID-19 pandemic. Relying on the results of the present study, managers can take appropriate corrective measures to achieve 100% compliance with patient safety-friendly hospital standards and national accreditation standards, and achieve patient safety goals and provide quality and patient-centered services in the healthcare system. The results of the present study can provide a basis for examining the patient safety status and monitoring it in future researches. It is recommended that future researchers, in order to ensure patient safety and monitor the quality of healthcare and patient-centered services, analyze non-compliance in mandatory, basic, and advanced standards of patient safety-friendly hospitals using PSFHI checklist of the World Health Organization through the process of observation, interview, and review of documents in the Imam Khomeini Hospital complex.

Nursing, the core and front line of the health system, is considered as one of the most challenging jobs due to problems such as lack of human resources, increasing demand in the clinical environment, constant changes in work schedule, client expectations, legal problems, and client mortality. Paying attention to influential factors including client health is important in creating a positive working environment and increasing the mental health of nurses. One of the issues raised recently is psychological capital, with four dimensions of self-efficacy, optimism, hope, and resilience. Psychological capital has a positive effect on work attitude and behavior and is positively related to constructive performance. In addition, psychological capital leads to better psychological health, better adaptation to stressful conditions, and increases nurseschr('39') ability to cope with the problems. Given that nurses are always exposed to physical, mental, and emotional challenges, hospital managers should provide mechanisms to reduce potential workplace risks. Recognition of preventive factors (e.g., psychological capital) is the first step towards the growth and development of effective policies in this area. Therefore, this study was conducted to determine the psychological capital of nurses working in academic medical centers of Iran University of Medical Sciences.

This descriptive study was conducted to examine the psychological capital of nurses working in academic medical centers of Iran University of Medical Sciences in 2019. The study population was all nurses working in academic medical centers affiliated to Iran University of Medical Sciences in 2019 and the sample included 305 nurses with inclusion criteria (at least 1 year of clinical experience and not facing severe crises or death of loved ones during the last 6 months) from emergency departments, pediatric ward, ICU, CCU, internal ward, psychiatric ward, Operating room, obstetrics ward, surgical ward, dialysis unit, burn unit, oncology, and etc. Sampling was performed using proportional allocation procedure and samples were selected from academic medical centers of Iran University of Medical Sciences. The Psychological Capital Questionnaire devised by Luthans was used to collect the data. The questionnaire Includes 24 items in 4 subscales of hope, self-efficacy, resilience, and optimism, and is scored based on 6-point Likert scale  ranging from 1 (strongly disagree) to 6 (strongly agree). Its score ranges from 24 to 144, with a higher score indicating a higher level of psychological capital. The Demographics Survey included information such as age, gender, marital status, employment status, education, work experience, income, employment in one or more hospitals, experience in the current ward, work experience in current hospital, job position, shift work. Sampling and collecting questionnaires took about 5 months (from October 2019 to March 2020) as the nurses were too busy. Data analysis was performed using SPSS software version 16. Descriptive statistics and inferential statistics were used to analyze the data. In the descriptive statistics part, frequency distribution tables were used to analyze the qualitative variables of the research and numerical indices of minimum, maximum, mean, and standard deviation were used to analyze the quantitative variables of the research. In inferential statistics part, Pearson correlation coefficient, independent t-test, ANOVA, and multiple linear regression model were used.

The mean age of the subjects was 34.75 with a standard deviation of 7.71 years. 86.9% of the nurses were female and 86.6% had an undergraduate degree. Most nurses were married (55.4%). The economic status of 78.7% of the nurses was average and 89.8% of them did not report any specific chronic disease. 49.8% of the nurses were employed. The morning shift accounted for 63.3% of the work shift. The majority of participants were nurses (85.2%). Most of the participating nurses were working in intensive care units (38%). The average work experience of all participants was 10.44 ± 6.96. Their average work experience in the current wards was 4.82 ± 4.41 and also the average work experience in the current hospital was 8.26 ± 6.20. The results revealed that the mean of psychological capital was 104.63 ± 15.25, and given the score range of 24-144 in the Psychological Capital Questionnaire and the mean score, it can be concluded that nurses had a high level of psychological capital.  Among the components of psychological capital, the highest mean score was related to self-efficacy of 28.29 ± 4.70 and the lowest mean score was related to resilience of 24.62 ± 4.37. Also, psychological capital had a statistically significant relationship with job position (P <0.001) and chronic disease (P = 0.050). Tukeychr('39')s multiple comparison showed that the mean score obtained for psychological capital of nurses was significantly lower than the one obtained for head nurses (P = 0.002) and supervisors (P = 0.029). It was also observed that the average score of psychological capital in nurses with chronic diseases was significantly lower than others. It should be noted that other personal and occupational variables had no statistically significant relationship with psychological capital.

According to the mean scores obtained from this study, it can be said that nurses have an almost high level of psychological capital and the highest mean score among the dimensions of psychological capital was related to self-efficacy. Regarding the correlation of research variables with demographic characteristics, the results showed that the psychological capital of nurses was less than that of head nurses and supervisors, which increases the importance of addressing psychological capital in nurses.  It is possible to provide the basis for improving their personal, professional, and caring performance by focusing on psychological capital in nurses and adopting proper planning for necessary training in this field. Considering that the resilience component of the psychological capital variable obtained the lowest average, paying attention to this component in nurses is of great importance. We can also point out the importance of these variables and their impacts on personal, occupational, and organizational areas, including personal and psychological effects and care outcomes such as improving the quality of care and organizational outcomes, which increases the importance of paying attention to it.

The emergency department is one of the most important departments of the hospital, the performance of which can have a great impact on the activities of other hospital departments. In the emergency room, emergency services are provided to patients at all hours of the day and night, and there is a large number of patients in this ward, which shows the importance of good performance and effective communication between nurses to maintain patient safety and quality of patient care. Nursing is one of the professions that effective communication is one of its pillars and having communication skills is a professional necessity that is necessary for all nurses especially nurses who work in the emergency wards and it is a prerequisite for nursing competency. Nurses’ competent performances in the emergency wards are also affected by their self-efficacies. Thus, in this study, nurses’ competencies and communication self-efficacies were examined.

This cross-sectional study with descriptive design was carried out on the emergency wards of hospitals affiliated to Iran University of Medical Sciences in 2020. In this study, 234 nurses were recruited through census method and they filled questionnaires. Data collection was conducted by using communicative competence scale and self-efficacy questionnaire. Data was analysed via SPSS Software Version 18 by utilizing independent t-test, one way analysis of variance, Pearson correlation coefficient and linear regression.

234 nurses working in emergency departments participated in this study. The response rate of the participants was 100%. According to the results, the mean score of nurses’ communication competency was 141.03 ± 15.09 which was higher than the meidan of the scale (108). The highest average communication competencies related to "let others know that you understand them", "listen to what people say" and "support others" are 0.70, respectively. ± 4.15, 4.15 57 0.57 and 4.15. 0.68. The lowest mean was for the phrase "you do not pay attention to meeting and talking with strangers" (2.32 ± 1.28). The mean score of emergency nurses’ communication self-efficacy was 86.24±22.00 that was slightly higher than the median of the questionnaire (66). What is the highest average communication self-efficacy related to "Have appropriate nonverbal behaviors (such as eye contact, facial expressions, gestures, and gestures) during conversation?" Was. Lowest average for "Make a pre-prepared plan to talk to the patient?" Was. Based upon the regression model, 11% of communication competency among emergency nurses were explained by working hours per week (P=0.001), hospital type (P<0.001) and educational level (P=0.023) and working hours per week with the standard coefficient -0.249 had the most effect on nurses’ communication competencies. Also only 12 percent of nurses’ communication self-efficacy had been explained influenced by working hours per week (P<0.001).

Although the levels of communication competencies and communication self-efficacies of the emergency wards nurses in this study are approximately high, Due to the activity and role of emergency nurses in the front line of the organization, higher levels of communication competency and self-efficacy are expected. Effective communication by health workers, especially nurses, is essential in improving the quality of care and maintaining patient safety. Due to their role, nurses should have extensive communication with patients and other health workers, so communication competence is an important principle in providing nursing care. Owing to the structure of the emergency department and the clients of this department, it is useful and necessary to find the cause and determine the appropriate solutions to bring the communication competency and self-efficacy of emergency nurses to the highest possible level and thus improve quality and safe care. According to the results of the present study, communication competence decreases with increasing working hours. This can be due to fatigue and high work pressure after spending long hours in a stressful emergency environment. The presence of patients in need of immediate and acute care has increased fatigue, which leads to low efficiency of nursing services and endangers the safety of patients. It is necessary to plan for the use of experienced nurses as well as higher and specialized education in the emergency department. However, this does not diminish the importance of increasing the workforce in the emergency departments and reducing the workload of nurses in order to improve the quality of services and improve patient safety. Communication self-efficacy of nurses working in the emergency department was relatively high. The highest communication self-efficacy of the studied nurses was related to having appropriate non-verbal behaviors during the conversation and the lowest communication self-efficacy of the nurses was related to pre-planning for talking to the patient. Self-efficacy is considered as an important indicator of a personchr('39')s confidence in performance, including job performance. A strong sense of self-efficacy increases nurseschr('39') confidence in their performance and knowledge. Nurses who are confident in their abilities in all areas, including effective communication, define their goals and commit to maintaining them.

Job burnout is a very serious problem for the nursing staff and can decrease the quality of care they provide. Nurses are at risk of job burnout due to the difficult working conditions and high expectations due to their caring role. Better speaking, nurses work in stressful and challenging environments that threaten their mental health and are predisposed to burnout. For example, nurses experience physical aggression from patients in the workplace, which can play a role in the occurrence of burnout. High levels of burnout jeopardize work motivation in nursing staff and increase their negligence in the workplace. The higher burnout level of nurses is associated with their lower empathy with their colleagues, patients, and families. In contrast, nurses with low levels of burnout are less likely to leave their jobs and have higher levels of organizational trust. Nurses working in intensive care units experience various stresses and are more at risk of burnout than other nurses. For this reason, researchers suggest that interventions such as resilience training need to be performed for this group of nurses. Resilience improves the quality of work of nurses and promotes their job satisfaction. Conversely, nurses without resilience have fewer professional competencies. Accordingly, nursing researchers suggest implementing resilience training programs to improve nurses' mental health. The researcher, as a psychiatrist nurse in the intensive care unit, observed that nurses become psychologically incapacitated when they suffer from burnout. Therefore, this idea came to the researcher's mind that the problem may be due to nurses' unfamiliarity with the concept of resilience. Given the foregoing, the importance of the concept of burnout in the nursing profession. Given that one of the roles of psychiatric nurses is their educational role, the researcher decided to conduct a study to determine the effect of resilience training on burnout of nurses working in intensive care units.

This quasi-experimental study was conducted in 2019, and 96 nurses from intensive care units of teaching hospitals affiliated to Iran University of Medical Sciences were selected via convenience sampling and divided into experimental and control groups via nonrandom allocation. Each group consisted of 48 nurses. The resilience training program was conducted for the experimental group in a two-day workshop, 4 hours each day, but the control group received no treatment. The content of the program was presented through a lecture using slides followed by questions and answers, group discussions with the participants, and the expression of their experiences. Also, a working group was set up for nurses to cite skill-related examples, practice each skill, and role play. Four weeks after the intervention, the post-test was administered in 2 groups. Data were collected using demographic form and Maslach and Jackson Burnout Inventory. Also, data were analyzed using descriptive (mean and standard deviation) and inferential statistics (Chi-square, independent t-test, paired t-test, ANCOVA, and Fisher's exact test). In order to comply with ethical considerations, a code of ethics was obtained from the Research Ethics Committee of Iran University of Medical Sciences. In addition, nurses were told that their information would be kept confidential and that there would be no obligation to participate in the study.

The results of independent t-test showed no statistically significant difference between the two groups in terms of severity and frequency of burnout scales before the treatment (P>0.05). The results of ANCOVA revealed a statistically significant increase in the mean scores of individual failure in the experimental group compared to the control group after the treatment and the mean scores of the severity and frequency of emotional burnout and depersonalization were significantly lower in the experimental group compared to the control group (P<0.001). The results of paired t-test revealed that there was an improvement in the severity and frequency of individual failure scores in the posttest compared to the pretest and the mean scores of severity and frequency of emotional burnout and depersonalization decreased significantly (P<0.001). Analyzing the results of the control group showed no significant difference in the severity and frequency of all burnout scales in the post-test compared to the pretest (P>0.05), while there was a significant difference in the frequency of burnout scales between the pretest and posttest (P<0.01).

Based on the results of the present study, it can be acknowledged that nurses' burnout, as a variable that is rooted in organizational psychology, is strongly influenced and improved by the implementation of resilience-based psychological intervention. According to the results, resilience training is effective in improving emotional exhaustion, depersonalization, and personal accomplishment of nurses. Thus, such an intervention can increase nurses’ resilience and reduce their burnout and ultimately improve the quality of their function. According to the findings of this study, the resilience training program reduces the burnout of nurses and, given that nursing is one of the professions that makes people prone to burnout, it is suggested that nursing managers pay more attention to resilience training programs with high applicability, in order to reduce the burnout of nursing staff in general and nurses working in intensive care units in particular. Also, given that the nurses participating in the present study could not receive the necessary training on resilience during continuous sessions due to their busy schedule, it is recommended that a similar study be conducted using a virtual network-based approach for nurses.

The nutrition of every individual is closely correlated with their physical and mental health. Adequate consumption of nutrients maintains health and increases efficiency, while improper nutrition leads to physical and mental complications. Foodborne illnesses constitute a very large group of diseases in the world and are considered to be a major health concern in different countries. Improper nutrition is an inherent element of an unhealthy lifestyle, as well as an important cause of this issue. Improper nutrition leads to the further progression of chronic diseases, such as type II diabetes, cardiovascular diseases, and cancers, which cost billions of dollars in medical care and reduce annual production. Malnutrition and obesity are among the major causes and contributing factors to mortality. Studies of the dietary patterns of Iranians have indicated significant deficiencies in the daily food consumption of various social groups. Furthermore, a national health survey has shown that Iranians consume more saturated fatty acids and energy than the recommended amount. Changing health behaviors is the greatest hope for reducing the burden of disease and mortality worldwide. The importance of womenchr('39')s nutritional health as part of the society and mothers and their impact on maintaining the health of other family members make them a suitable target group to improve nutritional behavior. Women constitute about half of the worldchr('39')s population, and their health guarantees community health and is of particular importance. With the implementation of the comprehensive program of health ambassadors in the urban and rural health centers in Iran, women were considered as the main educators of the family. The majority of health ambassadors are women, who are often selected from among the covered families by various healthcare units. Female health ambassadors are the housewives or employed women who help improve community health by receiving education and passing it on to other family members and the population under their care. Studies have indicated that using the patterns and theories of behavior change could increase the likelihood of the higher impact of health education programs by considering the individual and environmental characteristics that influence behaviors. Researchers have used multiple models for behavioral change, with the training primarily based on an educational model, so that the initiation and continuity of the training would be more effective. The health belief model is an effective model to provide education on various aspects of health, including nutritional behaviors. It is a waiting value model that emphasizes decision balance. The present study aimed to evaluate the effect of nutrition education based on the health belief model on the nutrition knowledge and performance of female health ambassadors.

This study was conducted as an evaluation research with effect analysis and a pretest-posttest design on the female health ambassadors of the health centers of Saqez, Iran in 2019. In total, 48 subjects were selected via simple random sampling using a random numbers table. Sampling started on November 5, 2019 and ended on December 12, 2019. A written training program in the field of nutrition based on the health belief model was implemented in three sessions (120 minutes each). Data were collected using the structured questionnaire of the Iranian Ministry of Health and Medical Education, which was designed in 2011 in collaboration with Tehran University of Medical Sciences (NUTRI-KAP). The questionnaire was completed by the participants before the training intervention and one month after the training in three sections containing questions on demographic characteristics (age, education level, marital status, occupation status, number of family members, and history of working as a health ambassador), nutrition knowledge, and nutrition performance regarding the basic principles of nutrition, food groups, nutrient sources, and nutritional needs at different stages of life. The reliability of the tool was measured using the retest method. For this purpose, the tool was completed by 18 individuals with the same characteristics as the research community (not among the research samples) and re-completed by the same individuals two weeks later. Based on these data, the reliability of the tool was calculated using the Kuder-Richardson formulas. The reliability for knowledge was estimated at 83% and 97% for performance, which indicated the acceptable reliability coefficient. The validity of the educational content was also examined by three faculty members of the School of Nursing and Midwifery, and corrections were made based on their opinions. In terms of ethical considerations, the required permit was obtained from the Ethics Committee of Iran University of Medical Sciences, and the necessary coordination was also made with Kurdistan University of Medical Sciences. The research process was explained to the participants, and they were morally informed that participating in the research was voluntary. In addition, the female health ambassadors were assured of the confidentiality of their personal information. After completing the training sessions and data collection, data analysis was performed in SPSS version 16 using descriptive and inferential statistics. With regard to the descriptive statistics, frequency distribution tables were used for the qualitative variables, and the numerical indices of minimum, maximum, mean, and standard deviation were used for the quantitative variables. As for the inferential statistics, paired t-test was used, and the P-value of less than 0.05 was considered significant in all the statistical analyses.

Before the intervention, the mean score of the nutrition knowledge and performance of the participants was 18.39 ± 4.38 and 8.81 ± 1.87, respectively, which reached 24.70 ± 4.41 and 12.27 ± 2.67, respectively after the intervention. A significant difference was observed before and after the intervention in terms of knowledge (effect size: 1.43; P<0.001) and performance (effect size: 1.52; P<0.001). Moreover, the normality of the research variables was confirmed based on skewness and kurtosis.  

According to the results, the nutrition knowledge and performance of the female health ambassadors improved after the educational intervention based on the pattern of the health belief model, and the effects would persist even after the training. Given the efficiency, cost-effectiveness, and efficacy of this model, it could be used as a framework for nutrition educational programs alongside other educational methods in every healthcare center. It is also recommended that educational programs based on this model be developed and implemented for female health ambassadors on a larger scale, and model- and theory-based educational interventions are also suggested for this group, particularly training based on the health belief pattern.

Trauma is an important public health concern in the world. With the advancement of science and technology and the industrialization of societies in the past century, trauma and its complications have become an important issue. Trauma is the most common cause of death and disability in people aged 1-44 years. Furthermore, trauma is the leading cause of reduced life expectancy and years of life lost worldwide. The most important measure to be taken in the event of a crisis is to maintain the survival of the casualty, prevent permanent complications before basic treatment, return the casualty to pre-injury living conditions as soon as possible, and provide emergency assistance quickly and intelligently. Since traumatic injuries may deteriorate without intervention and time resolution, posttraumatic survival rate largely depends on time. The chances of survival after trauma in the case of severely injured patients increase with their timely transfer to treatment centers. Pre-hospital emergency medical services (EMS) are an integral part of the healthcare delivery system and play a key role in the provision of pre-hospital services and patient transfer to medical centers. The purpose of such medical services is to provide appropriate treatment at the right place and time by using available resources. The correct operation of different parts of this system results in the rapid and timely dispatch of ambulances to the patientchr('39')s bedside and the prevention of death and disabilities. Qazvin province has a strategic location in terms of transportation and industry. Qazvin is the communication route of more than 13 provinces in Iran and a bridge between the capital and the northern and western regions, as well as Caucasus and European countries. Figures related to the traffic accidents in Qazvin province show that this province has a large share of road accidents due to the small geographical area in the country. The present study aimed to determine the influential factors in the survival of trauma victims until discharge from selected hospitals in Qazvin province during 2014-2018.

This retrospective correlational study was conducted on 835 trauma patients using the data of Qazvin Emergency Center during 2014-2018. All the cases of the air transport of injured patients were included in the study due to the small number of cases. Among the cases of transferring trauma patients via the ground route, the subjects were selected via stratified random sampling with an equal volume for each year of the study period. Data were collected using an information registration form consisting of data on personal characteristics, trauma characteristics, pre-hospital and hospital emergency procedures, patientchr('39')s clinical condition upon arrival at the patientchr('39')s bedside, transfer mode, consciousness level at different times, and vital signs at different times. Data collection tools were the emergency center information questionnaire and the hospital records of trauma victims. Data analysis was performed in SPSS 16 using Chi-square, t-test, and regression analysis at the significance level of P<0.05.

 Out of 835 trauma victims, 608 cases (72.8%) were male, and 227 cases (27.2%) were female. In terms of age distribution, the mean age of the injured subjects was 39±16.03 years (range: 18-98 years). The trauma pattern was pervasive in 106 patients (12.7%) and blunt in 729 patients (87.3%). Among the subjects, 59 cases (7.1%) died of trauma, of which 14 cases (23.7%) had penetrating trauma and 45 cases (76.3%) had blunt trauma. The mean body mass index of the trauma patients in the hospital was 25.88±4.44 kg/m2. Underlying disease (P=0.03) and smoking habits (P=0.028) were significantly correlated with survival. The most common site of trauma was the limbs in 790 patients (94.6%). The type of trauma was blunt in 729 patients (87.3%) and 106 patients (12.7%), and the most common cause of trauma in 602 cases (72.1%) was vehicle accidents, while the least common causes were work-related accidents, explosion/lightning, and electric shocks (n=30; 3.6%). In addition, the mean severity of head, face, abdomen, upper limb, lower limb, and superficial anatomy injuries of the subjects was estimated at 22.66 ± 13.64, and the mean severity of head, face, abdomen, limbs, pelvis, and chest injuries of the subjects was 21.62 ± 14.23. The mean total duration of emergency services was one hour and 21 minutes (standard deviation: 33 minutes), and the mean duration of release operations was 25 minutes (standard deviation: 11 minutes). To investigate the influential factors in survival, a logistic regression model was used along with the inter-method reliability, and the variables affecting survival were analyzed by the regression model. According to the findings, the injury severity score (ISS; P=0.001) was significant in the regression model. In other words, a one-unit increased in the ISS reduced the chance of survival in the injured by 0.86. Furthermore, the chance of survival in the injured who had normal pupil and heart conditions was three and four times higher, respectively.

 Proper and timely methods of diagnosis and treatment of trauma (especially the prevention of these injuries) are paramount. Due to the high prevalence of traffic accidents as the main cause of such injuries, cultural and social structures should be corrected in the field of driving and transportation improvement. Diagnosis of the severity of the injuries plays a key role in effective patient care and leads to reduced mortality and morbidity due to major trauma. Given the large number of road accidents, efforts must be made to develop the necessary care and protocols to prevent death following trauma in proportion to the severity of the patientchr('39')s injury. This requires the cooperation of various institutions, including the police, roads, and urban development.

Nursing, by its nature is ranked as one of the most stressful jobs. Emergency nurses are exposed to more stress. A lot of studies have shown that nurses who work in critical care environments; such as emergency departments experience high levels of occupational stress during working time. Job stress may result in anxiety, restlessness, hate of working, absenteeism, and even a lot of illnesses. Interventions to manage nurses’ stress are required in order to improve patient care. Positive self-talk is a psychological skill. In this technique, the person commands the mind to direct its own thoughts and behaviors and to prepare all sources in order to achieve success. This study was carried out to evaluate the impact of positive self-talk on the job stress of nurses working in emergency wards.

In this evaluation study, 62 nurses working in emergency wards of three teaching hospitals affiliated to Iran University of Medical Sciences, including Hazrat Rasool-e- Akram (PBUH), Firoozgar, and Shohada-ye Hafte Tir hospitals participated in this study and were divided into two groups; control group and intervention group. Data collection was started in September and finished at the end of December 2019. At first, the list of nurses working in the emergency department was prepared by referring to the nursing offices of each center, and then, considering the inclusion criteria (at least one year of experience in the emergency department), the list was reviewed again. Then, based on the final list of samples from each center, 11 were randomly assigned to the control group and 11 to the intervention group using lottery. Finally, 33 were placed in the intervention group and 33 in the control group. Towards the end of the study, 32 were in the control group and 30 in the intervention group due to attrition. After identifying the groups, the researcher first introduced himself / herself to the samples of the control group of all 3 centers, and after explaining the objectives of the study and ensuring the confidentiality of information and obtaining informed written consent, asked them to fill the demographics questionnaire form and Expanded Nursing Stress Scale (ENSS) (French et al, 2000). No intervention was provided to the control group. 3 weeks after the pretest, ENSS (posttest) was completed again by the control group. In the next stage, the nurses of the intervention group were selected and after completing the data collection tools, the experimental group participated in a positive self-talk workshop at the School of Midwifery Nursing for two weeks (one session per week) from 8 am to 2 pm. The workshop was administered through lecturing about positive self-talk with presenting scenarios and group discussion as well as role play. One week after the workshop, the data collection tools were completed again by the intervention group. Data analysis was performed using independent t-test and chi-square in SPSS software version 16. The Expanded Nursing Stress Scale (ENSS) (French et al., 2000) was used in this study. This is a self-administered instrument. The ENSS is an expanded and updated version of the classic Nursing Stress Scale (NSS), which contains 57 items in 9 subscales related to physical, psychological, and social working environments. 9 subscales include: death and dying, conflict with physicians, inadequate emotional preparation, problems with peers, problems with supervisors, work load, uncertainty concerning treatment, patients and their families, and discrimination. The 57 items were arranged in a 5 point Likert  scale including ‘does not apply’ (0) , “never stressful” (1), “occasionally stressful” (2), “Frequently stressful” (3), “extremely stressful” (4). The total and subscale mean score was derived from this instrument which ranged from 0-4. The score range was 0-228. The higher scores indicated that the situation was highly stressful.

Findings showed no statistically significant difference between the two groups in terms of demographic characteristics. The results of paired t-test indicated a statistically significant difference between stress and its 5 dimensions in the intervention group before and after the intervention, so that the total stress before the intervention was (119.5 ± 36.02) which decreased to (95.86 ± 40.08) after the intervention (P = 0.001). The results also showed that the mean stress score in the intervention group after the intervention (95.86 ± 40.08) was significantly lower than the control group (129.06 ±40.52), indicating that with positive self-talk training, the stress of the intervention group is reduced  significantly (P = 0.002). Also, the results of independent t-test showed a statistically significant difference between the two groups in terms of subscales of job stress, which indicates the effect of positive self-talk on reducing job stress.

It is important to know that stress might be to some extent productive, whereas higher stress in staff costs a lot in terms of individual well- being and quality of health care services. Therefore, it must be managed effectively. Positive self-talk reduced nurseschr('39') job stress in emergency departments. Given the significant decrease in the nurses’ stress using positive self-talk strategies, this approach can be suggested to nurses in critical care units in order to reduce their stress and increase their efficiency. It is suggested that managers and nursing officials hold cognitive-behavioral stress management workshops, including positive self-talk for nurses working in different wards, and help them to improve the quality of nursing services. Researchers suggest that future studies investigate the comparative effect of positive self-talk with other psychological intervention on problem-solving and decision making skills in nurses working in emergency departments.

Infancy is the most important time for the formation of emotions and emotional development, and mother-infant attachment is of special importance during this period. Domestic violence seems to be one of the factors relating to the mother- infant attachment. In fact, domestic violence is an attack on the mother-child relationship and the child care system. Violent fathers directly and indirectly weaken the emotional bond between mother and child. Those women who are the victims of domestic violence often live in fear and anxiety to protect their childrenchr('39')s mental health and safety, and this fear may be inadvertently transmitted to children, forming undesirable attachment patterns; as some children perceive their mothers as a source of fear and anxiety, and eventually the child will suffer from unresolved trauma by perceiving a threat to its mother. Consequently, unresolved fear and trauma results in disorganized attachment. However, most studies have examined attachment at different stages of life from pregnancy to infancy, childhood, and adulthood, and the emotional relationship in infancy is neglected. Therefore, considering the role of mother-infant behavior and attachment and the effects of fatherchr('39')s violence on the health of mother and child, the present study was conducted to determine the relationship between domestic violence and mother-infant attachment.

This was a cross-sectional study conducted on 320 mothers referring to the comprehensive health centers affiliated to Iran University of Medical Sciences in Tehran in 2019. Multistage sampling method was employed to select the subjects. First, the comprehensive health centers were divided into two groups (west and northwest). The comprehensive health centers located in the west covered four districts (9-18-21-22) and Northwest centers covered three districts (2-5-6). Then, two centers were selected from each district by simple random sampling method and 320 mothers, referring to the health centers, meeting inclusion criteria were selected continuously. Sampling lasted approximately 3.5 months (from November 29, 2019 to February 15, 2019). The inclusion criteria were the Iranian nationality, mothers aged 18 to 45 years, monogamy status, minimum literacy, having a seemingly healthy infant aged one month to one year, infant birth weight more than 2500 grams and wanted pregnancy, no history of severe stress during the last year (death of a first-degree relative, serious illness of mother or father, decision to separate, severe family conflicts), no drug addicted parents, no history of severe psychological disorders in the last year (history of referring to the doctor, medication, or hospitalization), no mother- child separation for more than 24 hours in the early hours following delivery, and no history of parental infertility. Demographic and Fertility Questionnaires, the Maternal Attachment Inventory (MAI), and revised Conflict Tactics Scales (CTS2) were used to collect data. The MAI was used to measure mother- infant attachment. The questionnaire has 26 items and each item has four options rated on the 4- point Likert scale, including almost always (4), usually (3), sometimes (2), and never (1). The scores of the questionnaire range from 26-104. The revised Conflict Tactics Scales used to measure domestic violence had 36 items including the areas of negotiation (6 items), physical violence (12 items), psychological violence (8 items), sexual violence (4 items), and injury (6 items). Each item has eight options rated on a 7- point scale. The scores of the different scales are not added up in this questionnaire, and finally the samples receive zero for the absence of violence and one for the existence of violence, thus the overall prevalence of domestic violence and the relative prevalence of each type of domestic violence or subscales are shown in frequency and percentage. Descriptive statistics were used to describe the data and Chi-square, independent t-test, and analysis of variance were calcualted in the SPSS software version 16 to examine the relationship between the variables. Significance level was considered at P <0.05.

The results showed that the mean of mother- infant attachment was 97.78 ± 7.56. Overall domestic violence in the mothers participated in the study was 42.2%. Among the studied mothers, 53.8% experienced violence in domains of negotiation, 24.7% physical violence, 75.6% psychological violence, 12.5% ​sexual violence, and 31.6% injury. Thus, the areas of psychological violence and negotiation had the highest frequency and the areas of sexual violence and physical violence had the lowest frequency among the dimensions of domestic violence. Based on the overall results of the two groups; abused and non-abused women (P = 0.010), there was a statistically significant difference between the groups in terms of mother- infant attachment in all areas of negotiation (P = 0.014), physical violence (P = 0.043), psychological violence (P = 0.014), and injury (P = 0.010), except sexual violence (P =0/356). None of the demographic variables of mothers was significantly related to mother- infant attachment (P> 0.05) and also domestic violence (P> 0.05).

The findings of the study showed that overal domestic violence was significantly related to mother-infant attachment and mother-infant attachment was lower in mothers experiencing violence. Domestic violence was significantly related to mother-infant attachment in all areas except sexual violence. Therefore, the present study showed that domestic violence against mothers during infancy can undermine the mother-infant attachment. Since the formation of attachment during infancy is a good starting point for improving the role of fathers in building social and emotional relationships with their children and, consequently, the growth and health of emotional relationships and family memberschr('39') attachment, it is necessary that officials and care systems pay more attention to motherschr('39') mental health and family status by identifying, counseling, and adopting timely preventive and supportive strategies through active participation of fathers in physical and emotional wellbeing of their infants to improve mental health of family members and mother-infant attachment by reducing domestic violence. Midwives and healthcare providers can use special tools and perform psychological screening for early and timely referral during postpartum care to reduce all types of domestic violence and harms to families experiencing violence. Also, timely detection of parent-child attachment disorder and the factors affecting it and eliminating it through educational and counseling interventions and parental support in this area can help to prevent the loss of economic and human capital. Also, in terms of the quality of parental attachment, this research can provide the basis for interventional research or subsequent studies to identify other factors affecting attachment. This study suggests that more studies investigate the relationship between the violence of other people, other than the husband, and the mother- infant attachment. It is also recommended to study the relationship between motherchr('39')s violence against the father and the mother-infant attachment. It is suggested to conduct a study that can examine the effect of parentschr('39') violence against each other on the mother- infant attachment. More studies are also needed to be performed on a larger sample size in order to generalize the results. Moreover, this study suggests that an extensive research project be conducted to investigate the relationship between other factors related to mother-infant attachment such as marital satisfaction, social support, and parental personality traits.

Failed pregnancy is a destructive and common experience associated with physical, psychological, and cognitive complications, including a negative self-image, doubts about onechr('39')s fertility, considering the body to be inefficient, and feeling of failure in playing the feminine role and fulfilling the feminine identity adequately, which are manifested through reduced sexual activity and unwillingness to become pregnant again. In addition, the lack of sexual drive causes communicational tensions between parents. Therefore, a failed pregnancy affects the approach and attitude toward parenting, and since attitude is the foremost factor in the development of reproductive behavior, changing attitudes toward childbearing decreases fertility. Repeated pregnancy positively influences the stress caused by a failed pregnancy despite a sense of doubt and hesitation in the parents. After fetal loss, the majority of women need consultations and follow-ups regarding the causes of the incident, estimated risk of future pregnancy, and prevention of recurrence, while they may not be presented with the opportunity and receive no training, and the lack of awareness leads to concerns about the recurrence of the incident, unwillingness for another pregnancy, and even the attempt to conceive inappropriately. Therefore, the provision of an educational, care, and support program for these women with an emphasis on their experience of a failed pregnancy is paramount. Knowledge-based empowerment interventions promote the knowledge of fertility, self-efficacy, self-esteem, and self-control, thereby improving social communication, reducing negative emotions, and creating the right attitude to life experiences; in relation to failed pregnancies, such interventions have not been performed in Iran. The present study aimed to evaluate the impact of empowerment on women with a history of failed pregnancies.

This clinical trial was conducted on 80 women with a history of failed pregnancies who were admitted to Shahid Akbarabadi Hospital in Tehran, Iran within the past 3-6 weeks for the termination of pregnancy during January-May 2020. The inclusion criteria were the age of 18-40 years, basic literacy, no medical prohibition for pregnancy, no children, absence of mental disorders, no pregnancy after a failed pregnancy, history of failed pregnancies up to the maximum of two cases, no history of infertility, and intentional failed pregnancy. The exclusion criteria were stressful events during the study, absence in more than one training session, and pregnancy during the study. The names of eligible subjects were extracted from the hospital medical records unit continuously until the completion of the sample size. The women were invited to participate via phone. After obtaining written informed consent from all the subjects, they were assigned to two groups of intervention and control with four random blocks, and each sample was assigned a specific code. In the intervention group, empowerment training was performed based on the steps of threat perception, problem-solving, training participation, and evaluation in four training sessions and group discussions for four consecutive weeks at Akbarabadi Medical Training Center. Before and six weeks after the intervention, data were collected using Soderbergchr('39')s attitudes toward fertility and childbearing scale, which was completed by both groups. Data analysis was performed in SPSS version 16 using independent and paired t-test, analysis of covariance (ANCOVA), Chi-square, and Fisherchr('39')s exact test, and the P-value of less than 0.05 was considered significant.   

The intervention and control groups had no significant differences in terms of the mean age of the women and their spouses, womenchr('39')s age upon marriage, duration of marriage, womenchr('39')s age in the first pregnancy, fetal age, education level, occupation status of the spouses, cause of the failed pregnancy, gender of the expired fetus, method of pregnancy termination, and current method of contraception (P>0.05). Before the intervention, no significant differences were observed in the mean scores of attitude toward the fertility and childbearing of the women and all the subscales, with the exception of fertility required for the fulfillment of prerequisites (P=0.032) between the intervention and control groups (P>0.05). Six weeks after the intervention, the results of independent t-test and ANCOVA indicated significant differences in the mean scores of attitude toward fertility, female fertility, and all the subscales between the study groups (P<0.001), and the scores of the intervention group were significantly higher compared to the control group. In addition, the results of paired t-test showed significant differences in the mean scores of attitude toward fertility, childbearing, and all the subscales in the intervention group after the intervention as the scores were higher compared to before the intervention (P<0.001), while the difference was not considered significant in the control group (P>0.05). The results of independent t-test also indicated that the increase in the scores of attitude toward pregnancy, childbearing, and all the subscales was more significant in the intervention group compared to the control group six weeks after the intervention than before the intervention (P<0.001).   

The present study aimed to assess the effects of empowerment on the attitudes toward fertility and childbearing in the women with a history of failed pregnancies. According to the results, the mean total score and mean scores of the subscales of attitudes toward fertility and childbearing were significantly higher in the intervention group after the empowerment training compared to the control group, indicating that the implementation of an empowerment program with the aim of increasing knowledge, motivation, self-esteem, and self-efficacy results in self-control, preventive behaviors, and improved attitudes, which in turn positively influence the promotion of health and quality of life. Although pregnancy could be a pleasurable experience for the mother and family, the awareness of loss and feelings of shock, sadness, anger, and rejection cause tremendous ambiguity and concerns about the consequences of future pregnancies, while also causing negative attitudes toward fertility and childbearing, which may lead to immediate attempts for repeated pregnancy without considering the challenges of a terminated pregnancy and recurrence of failed pregnancy or the unreasonable delay of the next pregnancy regardless of the time limit of female fertility. Therefore, psychological support and training along with physical care by knowledgeable experts could be effective by empowering these vulnerable women through providing correct information to eliminate misconceptions, which in turn enhances healthy fertility by improving the attitudes toward fertility and childbearing. Since midwives have more interaction with these women as one of the most effective healthcare team members, they could use our findings to take effective steps toward improving this crisis and finding proper solutions.

The work environment of healthcare providers and hospitals is constantly exposed to tremendous work pressure, complexity, and chaos. Due to the changes in various fields of treatment and care, these work environments are constantly changing as well. Meanwhile, bullying is considered to be a serious phenomenon in these organizations, which has also been reported worldwide as an important issue in the nursing profession. Workplace bullying could variably affect nursing. In healthcare organizations, workplace bullying could increase absenteeism, job loss, and job dissatisfaction among the employees. Furthermore, this phenomenon may reduce the quality of nursing care in hospitals and medical centers. These issues are particularly highlighted in the nursing profession since as the largest group of healthcare providers in these organizations and the leading managers of hospitals, nurses play a pivotal role in patient care. Improving the quality of nursing care is the most important factor to accelerate the recovery and return of patients to the community; therefore, the quality assessment of nursing care is essential. In Iran, most of the studies on bullying have been performed on students and teachers in schools, and few studies have been focused on nurses. Given the lack of accurate statistics on the rate of workplace bullying among Iranian nurses and the fact that the quality of nursing care is an important issue that could be affected by the bullying phenomenon, the present study aimed to evaluate the level of workplace bullying among Iranian nurses and its association with the quality of nursing care.

This cross-sectional, descriptive-correlational study was conducted on 200 emergency department and intensive care unit (ICU) nurses at Imam Khomeini Hospital Complex affiliated to Tehran University of Medical Sciences, Iran in 2019. The sample size included 200 nurses who were selected via simple random sampling. The inclusion criteria were employment as a nurse in the emergency department or ICU of Imam Khomeini Hospital Complex, willingness to participate in the study, and minimum work experience of six months as a nurse in the department. The exclusion criterion was incomplete questionnaires. Data were collected using a demographic questionnaire (age, gender, marital status, admission to the nursing major based on interest/knowledge, education level, clinical ward, service history, type of employment, shift work, duration of employment in the current department, having a managerial position, interest in the workplace, and coercion in the current department), negative acts questionnaire-revised, and SERVQUAL questionnaire. Sampling was performed after the approval of the study protocol and receiving the ethics license from the Joint Organizational Ethics Committee of the School of Nursing and Midwifery and the School of Rehabilitation of Tehran University of Medical Sciences. Eligible nurses were selected after explaining the research objectives and procedures and being assured of the confidentiality of their information with oral consent. The questionnaires were completed anonymously and in a self-report manner. Data analysis was performed in SPSS version 16 using descriptive statistics to describe the samples (frequency distribution tables, mean, and standard deviation). In addition, research objectives were used to describe the samples. To determine the gap between the perceptions and expectations regarding the quality of nursing care, paired t-test was used, and to determine the correlation between workplace bullying and the quality of nursing care, Pearsonchr('39')s correlation-coefficient was employed at the significance level of 0.05.

About half of the nurses (51.5%) were female, with the mean age of 32.58 ± 6.38 years. The mean work experience of the subjects was 9.74 ± 5.86 years in the nursing profession and 4.59 ± 3.99 years in their current ward of employment. The majority of the nurses (51%) were formally employed, had rotating work shifts (77%), and worked in the ICU (61.5%). In addition, most of the nurses had a BSc degree (84.5%). Based on the experience of daily or weekly workplace bullying, the mean workplace bullying of the nurses in the work-related bullying dimension was 10.11%, while it was 4.27% in the person-related dimension, and 5.66% in the physical dimension, with an overall mean of 6.68%. The maximum and minimum mean values belonged in the dimensions of work-related bullying and physical dimension, respectively. The results of paired t-test indicated significant differences between the dimensions of the perceptions, expectations, and gaps in the quality of nursing care in the viewpoint of the nurses and the dimensions of reliability (P<0.001), assurance (P<0.001), and total score (P<0.001). Furthermore, workplace bullying had inverse, significant correlations with the dimensions of reliability (P=0.006; r=-0.194) and assurance of nursing care quality (P=0.001; r=-0.229), so that with decreased workplace bullying, the quality of nursing care increased in these dimensions.

Although the results of this study indicated the low prevalence of bullying among nurses, nursing managers and policymakers should properly plan for the recognition, prevention, and management of this phenomenon due to the physical, psychological, and organizational effects of workplace bullying on the nurses employed in hospitals and health centers. Moreover, the organizational factors that lead to the workplace bullying of nurses should be identified. Due to the significant associations between workplace bullying and the dimensions of the reliability and quality assurance of nursing care, hospitals must fulfill their promises accurately and consistently. By recruiting nurses with adequate knowledge and skills, a sense of trust and confidence should be created in patients. This study showed that the lower rate of workplace bullying is associated with the higher quality of nursing care. Therefore, it is recommended that further investigations be focused on the effects of workplace bullying on patient care and its dimensions, as well as the quality of the provided care in hospitals and health centers.

Midwives play a key role in the delivery of care services to mothers and neonates in the health system. The provision of high-quality services by midwives has a great impact on the prevention of maternal and neonatal mortality and its consequences, as well as the empowerment of women. It has been recommended that countries expand their midwifery programs, maintain the highest global standards, and improve the environment where midwives could effectively address the needs of women and their families. To achieve these goals, it is essential to motivate midwives as high job motivation could promote their efficiency. Theorists consider several factors to be influential in job motivation, such as physiological needs, safety, social needs, respect, and self-actualization. In Herzbergchr('39')s two-factor theory, the needs and stimuli that motivate employees have been listed, as well as the approaches through which they could be addressed in an organization. Numerous studies have assessed the influential factors in the job motivation of midwives in Iran based Herzbergchr('39')s theory. Meanwhile, midwives in healthcare centers have exclusively focused on their job duties (i.e., care of women of the reproductive age, pregnant women, and neonates). It seems that some of the motivational dimensions proposed for midwives have been modified due to the changes in the job duties of healthcare midwives in the Health Sector Evolution Plan, in which all midwives have been regarded as healthcare midwives, their organizational position has changed, and they were obliged to provide non-specialized and non-midwifery services in addition to specialized midwifery services, such as care services for infectious and non-communicable diseases for all ages and genders. Since the influential factors in the job motivation of midwives have not been properly recognized after the Health Sector Evolution Plan, the present study aimed to determine the influential factors in the job motivation of midwives based on Herzbergchr('39')s theory.

This descriptive, cross-sectional study was conducted on 207 midwives employed in the health centers affiliated to Tehran University of Medical Sciences (TUMS), located in the south of Tehran, Iran during in October-December 2018. The participants were selected via stratified sampling. Since TUMS covers three health networks of the south, Islamshahr, and Shahreray, each health network was selected as a stratified rank. Based on the population of the midwives of each rank and considering an average of two midwives per each health center, 120 health centers (south=60 bases, Islamshahr=25 bases, Shahreray=35 bases) were selected using a random numbers table for sampling. Data were collected using the standard Herzberg questionnaire and two open-ended questions regarding job motivation and intention to continue the profession after the Health Sector Evolution Plan. The quantitative data were analyzed in SPSS version 16 using descriptive statistics (independent t-test, analysis of variance, and Pearsonchr('39')s correlation-coefficient). In addition, the qualitative data were analyzed by content analysis.

In the responses to the internal factors in Herzbergchr('39')s job motivation questionnaire, the highest score belonged to the nature of the job (mean: 2.86±1.01), and the lowest score belonged to recognition (mean: 2.10±0.93). Among the extrinsic factors, the highest score belonged to the interactions of colleagues (mean: 3.99±0.76), while the lowest score belonged to salary and income (mean: 1.65±0.94). Furthermore, work experience prior to the Health Sector Evolution Plan (P=0.027) and work experience after the plan (P<0.001) had significant, inverse correlations with the internal factors. Work experience before the plan (P=0.016; r=-0.167) and work experience after the plan (P=0.001; r=-0.239) also had significant, inverse correlations with the internal factors, so that increased age and work experience before and after the plan led to the reduction of the mean scores of these factors. In addition, employment status had a significant association with the internal factors (P=0.004), so that the mean score of the internal factors in the corporate midwives was significantly higher than the formal and contractual midwives. Significant associations were observed between the work experience before the plan (P=0.037) and work experience after the plan (P<0.001) with the external factors. In addition, work experience before the plan (P=0.036 and P=-0.146) and work experience after the plan (P=0.036 and P=-0.146) had inverse, significant correlations with the external factors, and the increment in these variables led to reduced scores of the external factors. In addition, age had a significant correlation with the external factors (P=0.035), and the mean scores of these factors were significantly lower in the subjects aged more than 40 years compared to the mean scores of those aged less than 40 years. The majority (81.1%) of the midwives who answered the open-ended questions about changing job motivation (first open-ended question) reported that their job motivation has decreased compared to before the implementation of the evolution plan, and more than half of the midwives who answered the open-ended question about the continuation of the job as a healthcare midwife were willing to quit.

In general, the analysis of the responses to the open-ended questions indicated that low income, heavy workload, stress, and unrelated tasks to midwifery reduced job motivation and increased the tendency to quit in the healthcare midwives after the health evolution plan. Therefore, it is recommended that healthcare authorities attempt to enhance the motivation of midwives and guarantee the quality and maintenance of midwifery care by designing appropriate evaluation and motivational mechanisms, providing a payroll system based on workload (improving the external factors), defining the job position of family midwives in the health system as opposed to healthcare midwives, and the fundamental review of the job description and position of midwifery in the health system (enrichment of the midwifery profession). Furthermore, conducting research on the views and opinions of middle-range managers of the Health Sector Evolution Plan about staff motivation and the challenges in improving the quality of the healthcare services provided by midwives and healthcare providers could result in the inclusive assessment of the issues and challenges and adoption of comprehensive, practical, and effective strategies.

Heart failure (HF) is a disorder that is caused by the inability of the heart to pump blood properly due to the disorders in the structure or function of the heart. Quality of life (QOL) is lower in patients with HF compared to the general population and patients with other chronic diseases. For optimal QOL, it is necessary to change behaviors and follow treatment regimens throughout the period of self-care. The impact of any chronic and long-term condition on the patients and their ability to optimize self-care could be attributed to several factors, such as the understanding of the condition and its nature, impact of the condition on the ability of the patient to perform daily activities, beliefs and expectations, patientchr('39')s involvement in self-care, and support. Disease perception could affect the mental health of the patients and management of the disease, thereby affecting their self-care behaviors and QOL. The present study aimed to predict the self-care behaviors and QOL based on the disease perception of patients with HF.

This cross-sectional was conducted with a predictive correlational design during January 2017-May 2016 on 150 patients with HF, who were selected via continuous sampling based on the inclusion criteria of the confirmed diagnosis of HF by a physician and a minimum of six months past the disease, age of more than 18 years, and ability to communicate and literacy to complete the questionnaires. Data were collected in a self-report manner using the European HF self-care behavior scale, a brief illness perception questionnaire, and Minnesota living with heart failure questionnaires. The European HF self-care behavior scale consists of 12 items, and the responses are scored based on a five-point Likert scale (Completely=1, Not at All=5) within the score range of 12-60. The lower scores in this questionnaire show the better self-care behavior of individuals and vice versa. The brief illness perception questionnaire has eight items, which were prepared based on the modified version of the questionnaire. The items are scored within the range of 0-10, and the score obtained from the eight items is within the range of 0-80, which is the highest score indicating the patientchr('39')s understanding of the high risk of the disease. The Minnesota living with heart failure questionnaires has 21 items that are scored based on a six-point Likert scale (0-5), and the total score is within the range of 0-105, and the higher scores show the lower QOL of the patient. Data analysis was performed in SPSS version 16 using Pearsonchr('39')s correlation-coefficient, the analysis of variance (ANOVA), Chi-square, independent t-test, and regression analysis.

The mean score of the illness perception was 59.42±7.86, the mean score of self-care behaviors was 36.24±7.79 (moderate), and the mean score of QOL was 59.53±16.84 (poor). A significant, direct, and weak correlation was observed between the illness perception and self-care behaviors (P<0.001; r=0.26). In addition, self-care was the only predictor of illness perception, and illness perception and QOL had a direct, significant correlation (r=0.48; P<0.001). The results of multiple linear regression analysis showed that illness perception, adequate income, education level, number of hospitalizations, and classification of HF were the predictors of QOL. The mean score of the illness perception was 59.42±7.86, and the mean score of self-care behaviors was 36.24±7.79 (maximum: 53, minimum: 15), which indicated the moderate self-care of the patients. The minimum and maximum scores of QOL were zero and 97, respectively with the mean score of 59.53±16.84, which indicated the poor QOL of the research units. A weak, significant correlation was observed between the illness perception and self-care of the patients (r=0.26; P<0.001), so that with the increased score of illness perception, the self-care scores of the patients increased. In the results of the multiple linear regression analysis indicated that the only self-care could predict self-care (P=0.046), so that with the increased score of illness perception by one point, the self-care scores of the patients increased by 0.15 units. Therefore, when the patient is threatened to perceive their disease, their self-care becomes weaker (Table 2). In addition, the correlation between the two variables of illness perception and QOL was direct and significant (P<0.001; r=0.48). As the scores of disease perception increased, the QOL of the patients was higher, so that the more the patient perceives the threat of the disease, the poorer their QOL becomes. The results of multiple linear regression analysis indicated that per one unit of increase in the perception of the disease, the QOL score increased by 0.33, which shows the deterioration of the QOL. The QOL in those with sufficient income was lower by 0.14 compared to those with insufficient income. Furthermore, the QOL score of those with an undergraduate degree (below diploma) was lower by 0.22 compared to those with higher education. The patients without the history of hospitalization had higher QOL scores by 0.31 compared to those with 5-10 hospitalizations, indicating the better QOL. In addition, the QOL score of the patients with HF class II was lower by 0.29 units and 0.16 units in those with HF class III compared to those with HF class IV, which indicated their better QOL.

According to the results, illness perception predicts QOL and self-care behaviors. In this study, patients with HF, which is a common chronic disease, were examined. In these patients, the perception and cognition that a person is affected by other factors of his disease affects the perception of their physical needs, followed by their activities and the behaviors that influence self-care and meeting needs. However, it should be noted that in addition to illness perception, other factors play a key role in the self-care of patients with HF, which must be investigated in the future studies. The healthcare professionals (especially nurses) who are more in contact with patients could improve the patientschr('39') perceptions through education to increase their self-care and QOL. The patients with poor illness perception had more negative self-care behaviors. The healthcare professionals (especially nurses) who are more in contact with patients could improve the patientschr('39') perceptions through education to increase their self-care. The results showed that poor illness perception was associated with the lower QOL. Therefore, it is suggested that interventions such as counseling and follow-up programs be considered to improve the understanding of diseases, so that QOL could be enhanced. Research must be focused on the effectiveness of these interventions. Considering the association between illness perception and self-care behaviors in the HF patients and the predictive role of disease perception (especially for QOL), nursing managers could provide facilities for planning and implementing the necessary measures to improve the patientchr('39')s understanding of HF upon admission and referral to medical centers or the proper conditions should be provided for the implementation of counseling and follow-up sessions in the management of the patients at home.

Spiritual care is to help the individuals with challenged beliefs, values, purpose, and meaning of life, which occurs when patients are faced with severe diseases. Under such circumstances, nursing care is focused on the provision of spiritual care. Accordingly, spiritual care has been emphasized and acknowledged in the nursing profession, so that the provision such care could reduce physical pain, induce mental relief, reduce depression and anxiety, accelerate recovery, increase hope, and enhance the communication of the patient and nurse. From a deeper perspective, the provision of spiritual care by nurses to patients promotes the personal growth of the nurses. Meanwhile, attention to the spiritual care competency skills of nurses could be valuable as it seems that nurses are able to provide better care to patients by using these skills in the complex clinical setting. In fact, the competence in spiritual care is a concept involved in creating standard nursing care for patients, which encompasses a set of skills used in the nursing profession with a special status in the nursing process, as well as components such as the communication between the nurse and patient, availability to the patient, active listening, showing empathy and sympathy to value the life of the patients and give hope to the patient, facilitating spiritual skills for the patients with special beliefs, helping patients to create a calm atmosphere, and referring patients to specialists in spirituality. Although some studies have been focused on the phenomenon under study in some regions of the country, the emergence of this phenomenon in the field of nursing ethics requires these studies to highlight the need for further research regarding this concept in order to bridge the gap in the nursing knowledge in the other regions of the country, so that the obtained results could be compared. The present study aimed to evaluate the spiritual care competency of the nurses employed at the teaching hospitals affiliated to Alborz University of Medical Sciences, Iran.

This descriptive, cross-sectional study was conducted on 200 nurses employed at the teaching hospitals affiliated to Alborz University of Medical Sciences (Kamali, Shariati, Imam Hossein, Madani, and Rajaei hospitals) in 2019 during four months. The subjects were selected via convenience sampling. Data were collected using demographic questionnaires containing data on the age, gender, marital status, education level, work experience, average working hours per month, ward of employment, employment status, work shifts, and organizational position. In addition, the valid and reliable tool of spiritual care competency was used for data collection. To assess the content validity, the tool was provided to five faculty members of the School of Nursing and Midwifery of Iran University of Medical Sciences, and their corrective comments were applied to the tools. The reliability was also evaluated using the retest method. For this purpose, the instruments were provided to 15 individuals, who were identical to the research samples but not included in the sample population, at two-week intervals twice, and the Pearsonchr('39')s correlation-coefficient obtained from the two tests was calculated to be 0.86. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent t-test and analysis of variance). To comply with ethical considerations, the researcher obtained the ethics code from Iran University of Medical Sciences, followed by the letter of recommendation, and made the required arrangements with the management of the selected hospitals. In addition, informed consent was obtained from the participants for enrollment, and they were justified about the research procedures, while also ensured that participation in the study was completely voluntary. In addition, the participants were assured of the confidentiality and anonymity of the data.

The majority of the nurses were aged 20-30 years (57%), female (81%), and married (70%). In addition, the majority of the participants were nurse (96%), had a BSc (94.5%), and worked in rotational shifts (89%). The total mean score of the spiritual care competency of the nurses was 54.21±14.69; considering the median of the instrument (=81), this finding indicated that the total score of spiritual care competency of the nurses was lower than the median. Among the demographic characteristics of the nurses, spiritual care competency was significantly correlated with the organizational position (P=0.005) and nursing work experience (P=0.003), and the spiritual care competency of the nurses was significantly higher compared to the head nurses. In addition, the spiritual care competency of the nurses with the work experience of 1-5 years was higher compared to the others. 

According to the results, the spiritual care competency of the nurses did not have a favorable status. Therefore, proper opportunities should be provided to promote their knowledge in this regard. In fact, the results of this study could lay the groundwork for further investigations and interventional studies in this regard. In other words, the recognition of the spiritual care competency of nurses in general and in terms of various dimensions in particular is an important step toward its promotion, resulting in the expansion of the views of nurses toward this concept. It seems that through spiritual care competency, nurses will be able to provide more comprehensive nursing care to patients. As such, nursing managers must take the necessary measures to enhance the spiritual care competency of nurses, among the most important of which are the implementation of educational workshops based on the concepts of spirituality and spiritual care for nurses, so that they could achieve spiritual care competency more efficiently in their profession. One of the limitations of this study was the emotional state of the sample while completing the research instruments, which could not be controlled by the researcher. Furthermore, the subjects were selected via convenience sampling, and the non-probability of the sampling method may restrict the generalizability of the findings.

Delirium is one of the most acute and prevalent cognitive disorders with complex causes among hospitalized patients and is also considered to be a common issue in the patients admitted to intensive care units (ICUs) worldwide. As the patients admitted to ICUs are exposed to numerous life-threatening physiological diseases and health challenges, their care process is extremely difficult to nurses. As such, the management of delirium as an important component of the routine care of these patients is highly demanding and challenging for ICU nurses. The high incidence and prevalence of this disorder in ICUs imposes significant costs on the healthcare system of countries and is also a strain of care for nurses, which ultimately leads to numerous adverse consequences in the affected individuals. Despite the importance of this syndrome and availability of various screening tools, the care level of these patients by nurses is rather poor. Since the nursing team is a key element in ICUs and in constant contact with patients, nurses could play a key role in the prevention of the clinical consequences and management of delirium since the preventative strategies for the occurrence and development of delirium or shortening its duration is highly effective owing to the provided care by these healthcare professionals, who provide full-time care to critically ill patients. Lack of sufficient and effective knowledge regarding delirium is an important factor associated with poor nursing care to identify this disorder. Therefore, increasing their knowledge could help with the timely identification and accurate and optimal management of the disorder, which in turn prevent the permanent complications, disabilities, and cerebral dementia, lengthy ICU admission, and reducing the associated mortality. Although education is recognized as an important factor in delirium prevention and treatment strategies, the type and methods of education and use of various approaches to the training of nurses on delirium could also be effective in this regard. Today, the advancement in educational technology has prompted the use of new methods as an alternative to traditional methods. Considering the easy access to educational contents and use of interactive feedback mechanisms, interactive e-learning has been described as an alternative approach to the teaching of large groups and offers a more flexible and cost-effective method than traditional teaching methods. The present study aimed to assess the effects of interactive e-learning on the knowledge of ICU nurses regarding delirium.

This quasi-experimental study was conducted with a pretest-posttest design and a control group on 88 ICU nurses of two teaching hospitals affiliated to Lorestan University of Medical Sciences, Iran in 2019. The subjects were selected via counting sampling. Based on the sampling method and inclusion criteria of the study, the nurses were selected. After obtaining informed consent from the research units, Shahid Rahimi Hospital was selected as the intervention group, and Shohada Ashayer Hospital was considered as the control group. In order to prevent contamination, one hospital was selected as the intervention, and another was selected as the control. The intervention involved the use of interactive e-learning contents in the form of four outputs of the Storyline software with various definitions of delirium and its characteristics, clinical symptoms, and types of delirium (16 minutes), as well as the predisposing and accelerating factors of the disease and preventive methods (20 minutes). In addition, the duration of the treatment was 23 minutes, and the diagnostic strategies and screening tools were presented for 22 minutes, along with the questions of each ward. The educational contents were uploaded on the hospital site that was considered as the intervention environment, and its link was provided to the nurses of the intervention group for two months. Immediately before and two months after enrollment, the obtained data were assessed using the delirium knowledge questionnaire (DKQ) in both groups. After data collection, data analysis was performed in SPSS version 16 using independent and paired t-test, Chi-square, Fisher's exact test, and effect size.

The knowledge scores of the ICU nurses and its dimensions were significantly higher in the intervention group compared to the control group after the interactive e-learning (P<0.001). However, no significant differences were observed in the control group in this regard after the interactive e-learning compared to before the intervention (P>0.05). In general, the effect of interactive e-learning on the knowledge of the intervention group (2.22 and 1.29) was 1.75, which showed the large effect of training on increasing the knowledge of the nurses in the intervention group compared to the control group. In addition, the changes in the total score of knowledge in the intervention group were more significant compared to the control group, so that education could increase the knowledge of the nurses. The higher effect size than 0.8 after the intervention in the total score and scores of the subscales of knowledge indicated the large impact of interactive e-learning on the increased knowledge of delirium and its subscales in the nurses.

The results of the study showed the positive effect of interactive e-learning on the knowledge of the nurses in the intervention group compared to the control group working in the ICUs of the research environments. Therefore, the use of interactive e-learning was effective in improving the knowledge of the ICU nurses, and this educational method is recommended for the training of health workers, especially nurses and nursing students. Although the changes in knowledge scores and subscale scores of delirium symptoms, signs, and consequences were positive in both groups, the increase in the scores was more significant in the intervention group compared to the control group, which could be attributed to interactive e-learning. Although the knowledge score was observed to decrease in both subscales of the risk factors and causes of delirium and disease management and prevention strategies in the control group, the changes in the knowledge scores of the intervention group increased after training in these subscales. Therefore, the decreased knowledge score in the control group may be due to the lack of interactive e-learning, while the increase in the scores of the intervention group was attributed to interactive e-learning.

Nurses work in stressful and challenging environments, which threaten their mental health. Among nurses, those in the intensive care units (ICUs) of hospitals are more likely to experience occupational, psychological, and physical stress compared to others. Due to their special working conditions (heavy workload, the need for a quick response to emergency situations, heavy responsibilities of care for critically ill patients, frequent contact with emotional situations, and being in unwanted situations to deliver bad news to the families of patients), these nurses are forced to endure more psychological pressures, which brings up the grave concern of their psychological empowerment being jeopardized. Psychological empowerment in nurses could increase organizational trust and commitment, thereby resulting in job satisfaction, productivity, participation in decision-making, provision of high-quality care, patient satisfaction, self-sufficiency, independence, self-confidence, responsibility, job control, and ultimately organizational effectiveness and occupational stress reduction. Therefore, it seems that nurses working in hospitals (especially in ICUs) need to improve their psychological empowerment. Meanwhile, resilience is one of the factors associated with the psychological empowerment of nurses. Resilience results in the better professional performance of nurses and is also a feature to help them adapt to the stresses of their work environment and improve their professional health. In the current century, nurses need to skillfully develop their resilience as it helps them to overcome their negative experiences and turn them into positive experiences. Therefore, nurses who are exposed to high stress levels could be trained to enhance their ability to overcome these pressures and gain a sense of worth. From a deeper perspective, resilience knowledge is a key to professional development in nursing. It has become increasingly important for nurses to be resilient as resilience with a preventative approach improves their mental health. Resilience training also seems to improve the psychological empowerment of nurses. The present study aimed to assess the effects of resilience training on the psychological empowerment of ICU nurses.

This quasi-experimental study was conducted in the second half of 2019 on 96 nurses working in the ICUs of the teaching hospitals affiliated to Iran University of Medical Sciences. The subjects were selected via convenience sampling. The nurses were non-randomly assigned to two groups of experimental and control (48 ​​per each). Data were collected using a demographic data form to measure age, gender, economic status, marital status, employment status, work experience, and type of shifts. In addition, the psychological empowerment scale was used for data collection with the dimensions of sense of competence, independence, effectiveness, and meaningfulness. The validity of the scale was evaluated using the content validity method, and its reliability was confirmed at the Cronbach's alpha coefficient of 0.84. Initially, pretest was performed on both groups. The resilience educational program was developed by the researcher based on concepts such as optimism, empathy, humor, problem-solving, coping with stress, self-efficacy, social adequacy, emotional management, and spirituality. The program was held for two hours per day for the experimental group during a two-day workshop. In each session, the presentation of the contents was performed in the form of a lecture with questions and answers, group discussions, and slide shows for the nurses. In addition, the nurses were provided with exercises to improve resilience, and their feedback was assessed during each session. The control group received no intervention. One month after the intervention, posttest was carried out on both groups. After the posttest on both groups, the resilience training contents were also provided electronically to the control group. This article was extracted from a research project approved by Iran University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the nurses. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (Chi-square, independent and paired t-test, Fisher's exact test, and analysis of covariance).

At the pretest stage, significant differences were observed in the scores of psychological empowerment and all its dimensions, with the exception of meaningfulness (P<0.05). At the posttest and after the control of the effects of the confounders, the scores of psychological empowerment and its dimensions were significantly higher in the experimental group compared to the control group (P<0.001). In the experimental group, the scores were significantly higher after the intervention compared to before the intervention (P<0.001), while the scores significantly decreased in the control group (P<0.001). Furthermore, the changes in the scores of psychological empowerment and its dimensions were significantly higher in the experimental group compared to the control group (P<0.001).   

According to the results, resilience training could improve the overall psychological empowerment of the ICU nurses in the four dimensions of sense of competence, independence, effectiveness, and meaningfulness. Considering that nursing is a profession that may threaten psychological empowerment, the use of resilience-based training programs that are low-cost, available, and high-performance could enhance the psychological empowerment of the nursing staff in general and ICU nurses in particular and should be considered by nursing managers.

Pain management is essential in the emergency room (ER) care plan, and nurses play a key role in this regard. The positive attitude and proper performance of the healthcare staff is critical in pain management, which is an important patients' right. The present study aimed to assess the attitude and performance of nurses regarding pain management in the patients admitted to the ER.

This cross-sectional, descriptive survey was conducted on 150 nurses employed in the ERs of the hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran in 2018. The eligibility criteria were the minimum of bachelor's degree/higher in nursing and six months of work experience in the ER. Data were collected using a demographic questionnaire and the questionnaire of performance regarding pain management. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics.

The mean age of the participants was 31.98±5.52 years, and the majority (82.9%) had no prior training on pain management. Regarding pain management in the ER, the mean scores of attitude and performance were 57.16±5.022 and 6.02±2.53, respectively. No significant differences were observed between the mean scores of attitude and performance with the demographic characteristics.

According to the results, the nurses had moderate attitudes toward pain management, and although their self-report indicated proper performance in this regard, they had inadequate knowledge regarding the use of pain management tools. Therefore, it is recommended that proper education and in-service re-training be provided for the promotion of proper pain management in the patients and increasing the quality of care, as well as proper training on the use of pain assessment measures.

Patients with bipolar disorder are faced with the phenomenon of stigma. On the other hand, self-compassion plays a key role in the improvement of their mental health. The present study aimed to determine the correlation between stigma and self-compassion in patients with bipolar disorder.

This cross-sectional, descriptive-analytical study was conducted on 200 patients with bipolar disorder hospitalized in Iran Psychiatric Center in Tehran, Iran. The patients were selected via continuous sampling. Data were collected using the questionnaire of demographic data and validated, reliable scales of stigma and self-compassion. Data analysis was performed using descriptive (mean and standard deviation) and inferential statistics (Pearson's correlation-coefficient, independent t-test, and ANOVA).

The mean scores of stigma and self-compassion were 77.03±7.06 and 77.57±4.47, respectively. Pearson's correlation-coefficient showed no significant correlation between stigma and self-compassion in the patients (P=0.301; r=-0.073). On the other hand, significant correlations were observed between the dimensions of discrimination (P=0.030; r=-0.153), disclosure (P=0.045; r=-0.142), and positive aspects of stigma with the isolation dimension of self-compassion (P=0.034; r=-0.150), which was an inverse, weak correlation as reduced isolation was associated with increased stigma in these dimensions. Moreover, significant correlations were denoted between the number of family member, age, and family history of mental disorders with stigma (P<0.05). However, no significant associations were observed between the demographic characteristics and self-compassion.

The results indicated no significant correlation between stigma and self-compassion. However, significant associations were observed between the dimensions of stigma with the isolation dimension of self-compassion, which were inversely and significantly correlated. Therefore, it could be concluded that as the patients further perceived the dimensions of discrimination, disclosure, and positive aspects of stigma, they were more inclined toward isolation. Stigma is an inherent cultural element in the community, which is so strong and complex that even high self-compassion could not diminish its effects.

Medication errors commonly occur in clinical nursing. The present study aimed to determine the causes of medication errors, their lack of report, and their frequency in intensive care units (ICUs).

This cross-sectional, descriptive study was conducted on 300 nurses engaged in the ICUs and critical care units of three teaching hospitals affiliated to Qom University of Medical Sciences in Qom, Iran in 2019. The participants were selected via census sampling. Data were collected using a demographic form and medication error questionnaire with confirmed reliability and validity. Data analysis was performed in SPSS version 21 using descriptive and inferential statistics (analysis of variance and independent t-test).

Systemic errors (mean score: 4.1±1.2) and pharmacy errors (mean score: 2.5±1.1) were the most and least important causes of medication errors, respectively. In addition, management errors (mean score: 3.8±1) and disagreement regarding the definition of medication errors (mean score: 2.6±1.1) were the most and least significant causes of the non-reporting of medication errors, respectively. On the other hand, intravenous errors (22.56%) had higher frequency compared to non-intravenous errors (21.89%). Among the demographic variables, the analysis of variance indicated significant associations between age (P=0.029) and job experience in the current ward (P=0.007) with medication errors.

According to the results, reducing the incidence of medication error by nurses requires the provision of proper conditions to minimize systemic errors in hospitals. Furthermore, nursing managers must facilitate error reporting for nurses, while meticulously monitoring the administration of drugs by nurses, especially in the case of intravenous medications.