questionnaires

Determining both general and organ-specific Mizaj is a crucial step in the diagnosis and treatment within Persian medicine (PM). Developing a standardized instrument for assessing the Mizaj of body organs, particularly the heart, is a research priority in PM.

The present study aims to extract major and minor indices of heart Mizaj based on PM literature and expert opinions as an initial step towards standard development.

This qualitative study was designed using a hybrid model that includes both theoretical and experimental phases. Initially, heart Mizaj indices were extracted from ten written PM sources and categorized. Additionally, 23 PM experts were interviewed, and ten participated in expert panel sessions. Each expert scored the importance of each index on a scale of 0 - 3, and the practical method for determining each index was discussed. Final decisions on indices were based on average scores (< 1: Index removed, 1 - 2: Minor criterion; ≥ 2: Major criterion).

From the 30 primary heart Mizaj indices identified on the hotness axis, 15 were classified as major and 10 as minor. The wetness/dryness axis comprised 14 indices, with six categorized as major and five as minor. Across both axes, indices pertaining to mental and emotional states emerged as some of the most significant and frequently noted.

The indices extracted in this preliminary study highlight their importance and provide methods for the practical diagnosis of heart Mizaj criteria. These findings can facilitate the development of a standardized tool for diagnosing heart Mizaj.

Considering the lack of quantitative measurement tools to monitor recovery in the patients with schizophrenia spectrum or major mood disorders in Iranian patients, this study was designed to determine the validity and reliability for the Persian translation of self-report questionnaire Recovery Assessment Scale: domains and stages (RAS-DS). 

The Persian version of RAS-DS was prepared via an independent translation process. Sampling was done from in- and outpatients referred to Iran Psychiatric Hospital. Patients completed demographic information datasheet, WHO quality of life - Brief Form (WHOQoL-BREF), Depression, Anxiety, Stress Scale (DASS-21), and translated RAS-DS questionnaires, in addition to Brief Psychiatric Rating Scale (BPRS). Twenty patients completed the RAS-DS and WHOQoL-BREF for the follow-up evaluation in two to four weeks.

142 patients (81 men and 61 women) participated in this study with an average age of 35.4 (± 9.2) years. The intensity of depression, anxiety, and stress (DASS-21) exhibited a significant negative correlation with all domains of RAS-DS, while the various domains of quality of life (WHOQoL-BREF) exhibited a positive and significant correlation. All domains of RAS-DS had positive significant correlations with each other, and with the total score of questionnaire. Cronbach's alpha coefficient was calculated as 0.960 for the whole questionnaire and 0.835, 0.944, 0.881, and 0.815 for its four domains, respectively.

Persian translation of RAS-DS questionnaire has good reliability and validity, as well as acceptable internal consistency, and could therefore be used to conduct research in the field of recovery for Iranian patients with schizophrenia spectrum and major mood disorders.

Considering the importance of skeletal anchorage in orthodontic treatment, this study aimed to assess the frequency and pattern of skeletal anchorage usage by Iranian orthodontists.

In this cross-sectional study, 301 Iranian orthodontists filled out a questionnaire consisting of 10 questions, 5 about miniscrews and 5 about miniplate usage. It also asked for the demographic information of the participants. The relationship between the participants' demographic information and their responses to the questions was also analyzed. Statistical analysis was conducted by the Chi-square test, one-way ANOVA, t-test, and Mann-Whitney test (alpha=0.05). 

There were 46.7% males and 53.3% females with a mean age of 38.9 years and a mean work experience of 8.95 years. Of all, 89.7% of the participants used miniscrews and 16.3% of them used miniscrews and miniplates. Generally, participants not using skeletal anchorage were significantly older (P=0.002) and had a significantly longer work experience (P=0.000). Also, there was no significant association between gender and skeletal anchorage usage (P=0.204). From the perspective of the orthodontists, the main indication of anchorage devices was to provide optimal anchorage.

The results showed that a high percentage of Iranian orthodontists used different types of skeletal anchorage devices. They preferred to use miniscrews more frequently than miniplates, mostly due to difficulties associated with their surgical insertion. Also, it was observed that older orthodontists used skeletal anchorage less frequently than younger orthodontists.

Breast cancer is the most common cancer among women worldwide. Diet is recognized as an important factor in the prevention of cancer. No research has evaluated the association between the Planetary Health Diet Index (PHDI) and breast cancer risk in the Iranian population. Therefore, the association between PHDI and breast cancer odds in Iranian women was examined in this study. The present case-control study (n=134 cases, n=267 controls) was conducted in two hospitals in Tehran, Iran. Women aged 30 or older diagnosed with breast cancer through biopsy were included. In the current study, the participants’ food consumption was assessed using a food frequency questionnaire, a reliable and valid tool.  A lower odds of breast cancer was observed in the last tertile of the PHDI compared to the first tertile in both crude and adjusted models [adjusted model: Odds Ratio (OR)=0.54; 95% Confidence Interval (CI): 0.31-0.95]. In the subgroup analysis, based on the menopausal status, in the fully adjusted model, lower odds of breast cancer were found in the last tertiles of PHDI compared to the first tertile in the post-menopausal group (OR=0.38; 95% CI: 0.17-0.84). The findings suggest an inverse association between higher PHDI scores and breast cancer risk. An inverse association between PHDI and breast cancer risk was also evident, particularly among post-menopausal women.

Cultural capital can interestingly mediate what a person prefers to eat and, thus, may be effective in dietary choice. The objectives of this study were to compare the distribution of cultural capital components within the different educational levels and also compare food consumption patterns across the different educational levels; and examine cultural capital’s role in the educational inequalities in food consumption among healthy women. 

The data was obtained in the form of a cross-sectional design with face-to-face interviews with 527 women who had visited shopping centers and parks in Tabriz from September to November 2021, using convenient sampling. Food recall as well as cultural capital questionnaire were completed for the participants, and anthropometric indices were measured. The level of education of the participants was considered as an indicator of socio-economic status. 

Family institutionalized cultural capital, objectivized cultural capital, and most of the incorporated cultural capital’s indicators were significantly differed by educational inequalities. Daily frequency scores of unhealthy food consumption in the participants with primary education was higher than other educational groups (p<0.001). The high-educated individuals’ intakes healthier foods were compared to unhealthy foods, and participants with low total cultural capital score were in adherence of a low overall healthy food consumption (PR: 1.49, 95%CI: 1.23-1.68). 

Education levels are significantly associated with cultural capital, and participants with high levels of cultural capital choose healthier foods more often than participants with low cultural capital.

This study compared the opinion of dental clinicians and patients regarding dental appearance and the need for cosmetic dental procedures. This information can serve as a basis for efficient treatment planning.

This cross-sectional study was conducted on 200 dental patients, 5 general dentists, and 5 restorative dentists. A standardized questionnaire with 17 questions was used to collect information regarding the opinion of patients about the appearance of their anterior teeth and the need for cosmetic dental procedures. Tooth shade, overjet, and overbite were also recorded, and three photographs were obtained from their teeth and assessed by dental clinicians. Data were analyzed by the Spearman, independent t, Mann-Whitney, and Bonferroni tests and ANOVA (alpha=0.05). 

Of 100 male and 100 female patients participating in this study, 73% were satisfied with the appearance of their teeth, which was higher than the satisfaction rate reported by general dentists (65%) and restorative dentists (48%). The difference in opinion was not significant between the patients and general dentists (p=0.325). The satisfaction level of the restorative dentists was significantly lower than the patients (p<0.001) and general dentists (p<0.001). The patients were mostly dissatisfied with the color of their teeth (60%), and 88.5% were interested in cosmetic procedures (mostly bleaching). The opinion of the three groups was not significantly different regarding the need for cosmetic procedures (p=0.414). 

Restorative dentists had a significantly lower satisfaction with dental appearance of the patients, compared with general dentists and patients themselves. However, the opinion of the three groups was not significantly different regarding the need for cosmetic procedures.

Global health agencies advocate that no mother should die while giving life, more so from preventable causes. However, there are persistently high maternal mortalities in various regions with a current global maternal mortality ratio of 211/100,000 live births. This study sought to investigate the causes and determinants of maternal mortality.

A four‑year retrospective, cross‑sectional study was conducted in three tertiary hospitals within Migori county in Kenya. Data were extracted from 101 maternal mortality records from January 1, 2016 to December 31, 2019.

Leading complications were hemorrhage 34.70%, eclampsia 20.80%, and sepsis 15.80%. Mothers who were unmonitored using partograph, had reactive HIV status, were in the postpartum period, were referred from periphery facilities, and low socioeconomic levels were most vulnerable.

Improvement in healthcare systems to enable optimal care to mothers diagnosed with leading complications and socioeconomically empowering women in Migori county is urgently needed.

In Indonesia, several hospitals have designed various forms of discharge planning in line with the guidelines provided by the Indonesian Endocrinology Association. These initiatives were implemented to enhance the quality of healthcare service. Despite the efforts made by the government, the rate of non‑compliance (9%) and readmission (20%) has continued to increase. This indicates that there is a need to reevaluate the existing discharge planning module. Therefore, this study aims to validate the contents of the diabetes mellitus discharge planning module, which was incorporated into the summary of diabetes self‑care activity. The effectiveness of the intervention in improving the compliance of patients with self‑care activity was also evaluated.

This study used a mixed methodological approach, which combined an evaluation method and an experimental quantitative design. The content validity of the module used was carried out using professional judgment, involving competent experts in the bahteramas hospital in southeast Sulawesi, Indonesia. The sample population consisted of sixty‑five randomly selected respondents, who participated in the validation of the summary of Diabetes Self‑Care Activities (SDSCA) questionnaire, which had three phases, namely pre‑test, during, fieldwork, and post‑test.

The content validity of the module was tested using Aiken’s v, and the results ranged from 0.82 to 0.88 for each session, indicating that it was valid. Furthermore, the internal consistency (Cronbach’s alpha) obtained in this study was acceptable, with values ranging from 0.60 to 0.92. 

The results showed that the diabetes mellitus discharge planning module could be used to improve self‑care among patients.

Numerous national and international nursing research studies have used the 13-item Chronic Illness Therapy Functional Assessment-Fatigue (FACIT-F) scale to measure the level of self-reported fatigue among the elderly population. Nonetheless, a culturally adapted Arabic version of the scale of the same quality was required to boost its use in Arabic-speaking nations. This study cross-culturally validated the Arabic version of the FACIT-F scale and tested its validity and reliability in an Arabic-speaking population.

We conducted the study among an elderly Jordanian population using a methodological cross-sectional approach. Using a cluster random selection technique, we randomly selected 250 older adults from a larger pool. We evaluated the scale’s validity, internal consistency, and acceptability. We analyzed the construct validity using both confirmatory and exploratory factor analysis.

The Arabic version of FACIT-F was proven to be acceptable for the one-factor model in the elderly Jordanian population. Cronbach’s alpha coefficient for the Arabic FACIT-F was 0.95, which indicated good reliability. Evidence suggested that construct validity for the FACIT-F was generally quite acceptable.

With regard to evaluating fatigue in an older Jordanian population, the Arabic translations of the FACIT-F have been shown to be reliable and valid.

Stress is a major factor affecting the mental health and academic performance of medical academicians, which necessitates the use of valid and reliable tools to measure it within their specific cultural and educational contexts. Given the unique circumstances of Iranian medical academicians, it is essential to adapt and validate the Korean Medical Academicians Stress Questionnaire (KMSSQ) to ensure it accurately captures the stressors they experience.

This study aimed to adapt and validate the KMSSQ for use among Iranian medical academicians, ensuring its cultural relevance and accuracy in reflecting the unique stressors they face.

This study, focused on psychometric evaluation, included 900 medical academicians selected using stratified sampling from universities in Tehran. Participants completed both the KMSSQ and the occupational stress inventory (OSI). Face validity, content validity, concurrent validity, structural validity, internal consistency, and test-retest reliability were evaluated using SPSS (version 21) and LISREL (version 8.8). The cut-off point of the questionnaire was determined using the ROC curve.

The KMSSQ demonstrated high face, content, and concurrent validity (r = 0.91). Exploratory factor analysis (EFA) identified six factors that explained 60.41% of the variance. Confirmatory factor analysis (CFA) supported a six-dimensional construct. The questionnaire exhibited high internal consistency (Cronbach’s alpha = 0.93) and test-retest reliability (r = 0.91). The cut-off point was set at 120, with a sensitivity of 100% and specificity of 85.23%.

The KMSSQ is a valid and reliable tool for assessing stress among Iranian medical academicians. It can be used for educational planning and psychological interventions, offering a culturally adapted measure that addresses the unique challenges faced by this group.

Assessing reflective performance in medical students is a crucial initial step in devising effective educational strategies for its enhancement. Current reflection scales in Iran fall short, primarily because they do not adequately address students’ willingness and inclination to engage in reflective practices. This study aimed to test psychometric properties of Reflective Performance Questionnaire (RPQ) among medical sciences students in Iran.

This cross-sectional study was conducted in Tabriz University of Medical Sciences students (n=245). The RPQ underwent translation from English to Persian through a translation and back-translation process. The psychometric properties of the RPQ were done by using face, content, and construct validity, and reliability. The construct validity was done using Exploratory Factor Analysis (EFA) on 245 students. The reliability of the RPQ was also checked with two approaches of internal consistency and stability.

The content validity indices, namely Content Validity Index (CVI) and Content Validity Ratio (CVR), were deemed satisfactory with values of 0.93 and 0.74, respectively. The EFA revealed a single factor containing 40 items explained more than 33% of the total observed variance. The reliability test revealed that the Cronbach’s alpha coefficient (equal to 0.89) and the Intra-class Correlation Coefficient (ICC) indicated satisfactory internal consistency equal to 0.89 (95%CI=0.87–0.91) for the tool.

This study confirmed that the Persian version of the “Reflective performance Scale” is a reliable and valid instrument to evaluate reflective performance in medical students within Iran. The structure of the dimensions obtained in this study was consistent with the structure of the original scale.

Environmental schools (green schools) are international programs related to environmental education, sustainable development, and environmental management. The main objective of the present study was to evaluate the impact of the environmental performance of the students in improving the green school indicators as a perspective of sustainable development.

The present study was performed on Bahabad school students (Yazd province) in 2023-2024. The environmental performance questionnaire was researcher-made, and its validity and reliability were evaluated. Cronbach’s alpha was used to calculate the reliability coefficient of the questionnaire (0.7). The Kruskal-Wallis test and the Spearman correlation test were used to examine significant differences between groups and to determine the important relationship between variables.

The results of this study showed that only 12.3% of schools were first-class schools. There was a significant relationship between the environmental performance and improvement of indicators of green schools (P < 0.05). Also, educational level played an important role (P < 0.05) in the environmental performance and green schools improving indexes, while there was no relationship as a gender variable
(P > 0.05).

The green school grade had a direct relationship with the students’ environmental performance. The first-grade green schools have the highest score in the students’ environmental performance, which means that the students of schools that were closer to the standards of green schools, have an important role in improving and protecting the environment and had higher scores in locations that were different environmental dimensions (transportation, waste separation and green shopping, saving water).

Abstract Using an effective method to enhance nurses’ knowledge of ECG interpretation is one of the most essential requirements for nursing managers. Self-directed learning approaches can help to introduce lifelong learning in learners, especially in clinical settings. This study purposed to detect the effect of the implementation of the clinical teammate nurse program on the critical care nurses’ knowledge of ECG interpretation on cardiac arrhythmia.  A pilot study was performed by a quasi-experimental design with a nonequivalent control group. The participants were 32 critical care nurses divided into two groups: the clinical teammate nurse program and control groups. The data were collected by a knowledge assessment questionnaire that measured nurses’ knowledge of ECG interpretation of cardiac arrhythmia. The nurses’ knowledge was measured three times: initial study, one month, and six months later. The mean and standard deviation of age of participants was 32.38±7.03 years. There was a significant difference between three scores of repeated measurement of nurses’ knowledge (p<0.001), as the nurses’ knowledge one month after the study was significantly higher than in the initial test six months later. Also, pairwise comparisons showed that nurses in the clinical teammate program had higher knowledge scores than the control group (p<0.001).  The clinical teammate nurse program can be used as an easy and economical way to improve nurses’ knowledge in interpreting ECG. This method can also be an excellent alternative to formal and traditional methods such as lecturing programs in continuing education programs.

Mushroom presents a potential natural alternative to Monosodium Glutamate (MSG) as food flavoring, as it imparts a similar umami taste and offering health benefits when incorporated into food products. This study aimed to determine the type of mushrooms used in seasoning products in Malaysia, investigate perceptions, and evaluate sensory acceptance in vegetable soup.

A three months cross-sectional investigation was conducted in Malaysia from August to October 2023. Phase one: a market survey on online platforms and physical stores using a self-developed market survey form (n=22); Phase two: a consumer survey using an adapted survey form (n=166); Phase three: sensory evaluation of vegetable soup containing mushroom seasoning (n=51). Data was analysed using IBM Statistical Package for the Social Sciences (SPSS) version 26.0.

Twenty-two brands of mushroom seasoning products were found in the Malaysian market, predominantly containing shiitake mushrooms (Lentinula edodes). The majority of consumers (69.3%) were aware of mushroom seasoning products via family, peers, and electronic media. The most preferred buying platforms were supermarkets (83.7%) and grocery stores (53.0%). Key drivers for purchasing were good taste (69.3%) and replacing MSG (60.8%), while price (63.3%), have certification (61.4%), and taste (58.4%) were key priorities when choosing products. Notably, most consumers had never used mushroom seasoning (75.9%) and expressed interest in trying it (92.8%). Sensory evaluation showed a high acceptance of mushroom seasoning in vegetable soup (mean score≥5.0), with no significant difference (p>0.05) compared to MSG. Furthermore, various ethnicities demonstrated the highest level of acceptance towards different samples.

Mushroom seasoning is highly acceptable to Malaysian consumers and has the potential to replace MSG as a food flavoring. More scientific evidence is needed to validate the comparative flavors and benefits of mushroom seasoning as a healthier alternative, and investigations into suitable natural food flavorings should be conducted to ensure health.

Hearing loss often coexists with various comorbidities and is commonly accompanied by tinnitus. Patients frequently report both tinnitus and hearing difficulties, posing challenges in distinguishing between the two complaints. This study aimed to assess the validity and reliability of the Persian version of the Tinnitus and Hearing Survey (THS) for distinguishing between tinnitus and hearing problems.

A psychometric study involved 100 participants aged 18–60, categorized into four groups based on hearing status and tinnitus presence. The Persian translation of a questionnaire underwent content and face validity assessments. Convergent validity for tinnitus and sound tolerance sections was evaluated using the Tinnitus Handicap Inventory (THI) and Hyperacusis Questionnaire (HQ) respectively, while pure-tone average assessed hearing section validity. Construct validity was confirmed via confirmatory factor analysis, and internal consistency and test-retest reliability were assessed using Cronbach’s alpha and Intraclass Correlation Coefficient (ICC) respectively.

The Persian version had strong face and content validity, with Cronbach’s alpha values of 0.82 for tinnitus, 0.90 for hearing, and 0.80 overall. The ICC values for the tinnitus, hearing, and sound tolerance sections were 0.8, 0.83, and 0.82. Convergent validity using the THI and HQ scores were reported 0.76 and 0.6, and the correlation value of the THS score with the PTA was 0.82. Confirmatory factor analysis confirmed a good 2-factor structure of the THS.

The Persian THS is a valid and reliable tool for separating tinnitus from hearing problems in Persian-speaking people.

The etiological factors leading to progressive supranuclear palsy (PSP) are poorly understood. This study aims to evaluate the role of various risk factors in patients with PSP. A case-control study was conducted over a period of two years from March 2016 to March 2018. The cases were recruited independently by two senior neurologists and a consensus was then reached after discussion for their inclusion. The controls were free of parkinsonian features or dementia and matched by age (±  3 years), sex, and race with the cases. The study population was then interviewed using a standard questionnaire for various possible risk factors. Variables with a significance (P ≤ 0.05) in univariate analysis were considered for bivariate analysis, multivariate analysis, and logistic-regression analysis. A total of 51 cases with an equal number of controls were included in this study. Ten separate variables that included poor educational status, well water, smoking, tapioca, bakery/fast food, tea ≥ 5 cups/day, personality, exposure to pets, exposure to cattle, and family history of stroke were found to show statistical significance after univariate analysis. Among these, tapioca consumption, fast food and bakery items consumption, type A personality, and family history of stroke were found significant after adjusting for the confounding factors. The possible etiological factors that have a relevance in the causation of PSP as borne out in our study include dietary habits such as tapioca, fast food, and bakery items consumption, family history of stroke, and type A personality trait.

An effective and reliable assessment tool is essential for evaluating the leisure activities of patients. The purpose of this study is to assess the validity and reliability of the Iranian-developed version of leisure questionnaire for people with multiple sclerosis (MS).

Psychometric methods were used to assess face, content, differential, and convergent validity, as well as test-retest reliability. The study used SPSS software to enter data and assessed content validity using descriptive characteristics and the intraclass correlation coefficient (ICC) based on ratings by experts. Independent t-tests and analysis of variance (ANOVA) were used to analyse the differential validity, while the Pearson test was used to analyse the convergent validity by comparing it with the Nottingham Leisure Questionnaire (NLQ). The study calculated the reliability of the questionnaire using the paired t-test and ICC.

The subjects were 60 patients with MS. The content validity analysis showed a single measure validity coefficient of 0.158 and an average measure coefficient of 0.751, both of which were statistically significant. The results of the differential validity analysis for the entire questionnaire were also significant (t = -3.058, P = 0.003). Additionally, the convergent validity and reliability of the questionnaire were 0.92 and 0.82, respectively.

The 50-item leisure questionnaire designed for patients with MS demonstrated good validity and reliability. Therefore, it can be used as an effective research tool for exploring the leisure activities of individuals with MS.

Non-cognitive and personality variables, such as grit, have been shown to play an important role in medical science education. In order to facilitate studies in this field, it is necessary to have a reliable and valid instrument. The purpose of this study was to evaluate the factor structure and psychometric properties of the short Grit Scale (Grit-S) for Iranian dental students.

For this psychometric study, the short Grit-S was administered to a sample of dental students (n = 226) during the first semester of the academic year 2022-2023 at the School of Dentistry of Zanjan University of Medical Sciences. First, the questionnaire was translated, and then the psychometric properties of the Short Grit-S were evaluated. Descriptive statistics and Exploratory Factor Analysis (EFA) were performed using SPSS 26, while Confirmatory Factor Analysis (CFA) was conducted through AMOS 24.

The results of this study provide evidence for the validity and reliability of the Short Grit-S as a measure of grit among Iranian dental students. The internal consistency coefficient (Cronbach's alpha), split-half reliability, and test-retest were 0.80, 0.82, and 0.84, respectively. The Short Grit-S was found to be a valid and reliable instrument with good factorial validity, internal consistency, convergence, and criterion validity. The Short Grit-S was found to be useful for finding out how persistent Iranian dental students were in their efforts (Eigenvalue 3.53; variance explained 50.44) and how interested they were in learning (Eigenvalue 1.16; variance explained 16.55). The two-factor model with 7 items (item 2 was omitted) was found to be the best factor structure for the Persian version of the Short Grit-S.

In conclusion, the study found that the Persian version of the Short Grit-S with 7 items was a reliable and valid instrument for measuring grit among Iranian dental students.

The phenomenon of rationed nursing care represents a global problem that jeopardizes the provision of quality and safe care. To date, there are a limited number of studies that focus on the occurrence of this phenomenon in the private care setting.

To explore the frequency and patterns of rationed nursing care and the factors that contribute to its frequency in selected private hospitals in Slovakia.

This descriptive cross-sectional study was conducted between November 2022 and January 2023. Data collection was carried out using the Basel Extent Rationing of Nursing Care – Revised. The study sample consisted of 174 nurses working in three selected Slovak private hospitals. In data analysis, we used descriptive statistics for the evaluation of the instrument and the sample characteristics. Additionally, differences in the frequency of rationed nursing care based on selected variables were analyzed using nonparametric tests (Mann-Whitney U test; Kruskal-Wallis test). For numerical variables the Spearman correlation coefficient (r) was used. The results were tested at a significance level of p <0.05.

The frequency of rationed nursing care was 49.3%. The most frequently withheld nursing care activity was increased supervision of confused patients and the need for their restraint (69.8%; 2.26 ± 1.09). Differences in the evaluation of rationed nursing care were identified based on the type of unit and the position of the job. The occurrence of rationed nursing care was influenced by nurse experience in the current position, evaluation of quality care, overall patient safety degree, number of patients/shifts, number of admitted ad discharged patients/shifts, job satisfaction, satisfaction with the current position, and satisfaction with teamwork in our study (p <0.05).

This study serves as a catalyst for nurse managers to take proactive steps in addressing rationed nursing care, fostering a culture of safety, and promoting excellence in patient-centered care delivery within private hospital settings in Slovakia. By embracing innovation, collaboration, and a commitment to continuous improvement, we can overcome the challenges posed by rationed care and uphold the principles of quality, safety, and compassion in nursing practice.