نشریه پرستاری ایران
پیاپی 128 (اسفند 1399)

One of the primary goals of health service provision is to prevent patient harm and maintain patient safety. Patient safety is defined as minimizing the risk of unnecessary injuries compared to other treatments or lack of treatment. Safe nursing care has four dimensions of nursing skills, providing physical safety, providing mental safety, and nurseschr('39') cooperation with other members. The provision of safe care depends on the quality and efficiency of nursing services. The efficiency of nurses depends on the measures taken to preserve the body and mind of nurses and the improvement of the quality of their work life. Quality of work life emphasizes personal consequences and professional improvement to meet onechr('39')s needs in the four dimensions of personal life, work framework, work context, and global dimension of work. Safe care and quality of work life are important issues, and their dimensions have been assessed and identified separately in some studies, while they could be fully recognized and promoted through more approaches. The present study aimed to assess the correlation of safe nursing care and the quality of work life of nurses in the public hospitals of Rasht, Iran in 2020.

This cross-sectional, descriptive-correlational study was conducted to assess the correlation between safe nursing care and quality of work life in eight public hospitals in Rasht. The participants included 250 nurses who were selected via stratified sampling based on the ratio of the total number of the nurses in the public hospitals of Rasht and each hospital department accessibly. Data were collected using a demographic questionnaire, Brookschr('39') quality of work life (QWL) for nurses (2005), and Rashvand safe nursing care questionnaire (2017). Brookschr('39') QWL questionnaire has four dimensions regarding the quality of work life of nurses with 42 items, including personal life (seven items), work framework (10 items), work field (20 items), global work dimension (five items). Each items was assigned a score within the range of 1-6 (Strongly Disagree=1, Strongly Agree=6) within the score range of 42-252. The reliability coefficient of this questionnaire has been confirmed at the Cronbachchr('39')s alpha of 0.91. Rashvand safe nursing care questionnaire had 33 items in the four dimensions of nursing skills (16 items), mental safety (four items), physical safety (seven items), team work (five items), and one general question. The demographic and QWL questionnaires were completed by the nurses, and the safe nursing care questionnaire was completed by the nursing supervisor. Sampling was performed during September 22-October 20, 2020, and each questionnaire was completed within 20-30 minutes. The inclusion criterion was employment in a public hospital in Rasht, and the exclusion criteria were incomplete questionnaires and not returning the questionnaires. After the sampling process, 250 questionnaires were collected. Data analysis was performed in SPSS version 16 using descriptive statistics (absolute and relative frequency, mean, and standard deviation) and inferential statistics (independent t-test, analysis of variance, and Pearsonchr('39')s correlation-coefficient), and the significance level was considered <0.05.

The quality of work life of the majority of the nurses (78.8%) was moderate. The highest and lowest mean scores were obtained in the work field dimension (58.37 ± 15.74) and the global work dimension (41.92 ± 18), respectively. In the majority of the studied nurses (94.4%), the level of safe nursing care was favorable and higher, while their cooperation level with the other healthcare team members was lower comparatively. Safe nursing care had no significant correlation with the quality of work life and none of its dimensions. In addition, none of the demographic variables were significantly correlated with the quality of work life of the studied nurses. However, safe nursing care had significant correlations with gender, marital status, employment status, age, and work experience (P>0.001).

Despite the moderate quality of work life, safe nursing care was considered favorable. However, no significant correlations were observed between safe nursing care, the quality of working life, and its dimensions. This finding could be due to the prevailing professional rules and beliefs in the nursing profession, which maintains safe care despite the limitations in the factors associated with the quality of work life. Although safe nursing care was favorable, the constantly increasing need for promoting the quality of care and the competition of care service organizations to attract more clients, safe nursing care must be enhanced continuously. According to the findings, the dimension of clinical skills was rather poor in terms of safe nursing care, which requires skills retraining and further monitoring in this regard. Since the global quality of work life mainly concerns nurses, chief executives must pay special attention to the salaries and wages of these individuals, as well as their job security and presenting a correct image of nursing to the society.

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.

Diabetes is a chronic, lifelong disease that could occur at any age. The incidence of type II diabetes increases with age. According to the International Diabetes Federation (IDF), the prevalence of type II diabetes is higher among the elderly compared to other age groups. Type II diabetes is associated with various complications and may lead to several physical and mental problems in the elderly. Loneliness is one of the psychological complications in the elderly with chronic diseases such as diabetes. Loneliness is a unique psychological structure, which is characterized by feeling unhappy due to the lack or reduction of the expected interpersonal relationships. Loneliness is an important indicator of psychological health, with a two-way relationship with diabetes as it is also an important factor in the treatment of these patients. Loneliness in the elderly could lead to chronic diseases such as cardiac disorders, hypertension, stroke, obesity, diabetes, lung diseases, and even death. Identifying the psychological issues associated with diabetes is prioritized in health care. The present study aimed to assess loneliness and the contributing factors in the elderly with type II diabetes in order to determine the significant factors that may be associated with loneliness. Examining the state of loneliness as a psychological component in the elderly with diabetes could lay the groundwork for nursing interventions and improving healthcare resources for these patients.

This descriptive, cross-sectional study was conducted on 257 elderlies diagnosed with insulin-dependent type II diabetes referring to the comprehensive health centers of the elderly affiliated to Iran University of Medical Sciences during October-December, 2019. The participants were selected via continuous sampling. The inclusion criteria were consent to participate, age of 60 years or more, no cognitive impairment (minimum score of 7 out of 10 in cognitive impairment test), ability to communicate, no known mental illnesses (based on the medical records statement of the patient), and definitive diagnosis of insulin-dependent diabetes (based on medical record). Data were collected using a demographic questionnaire consisting of data on age, gender, marital status, occupation status, education level, insurance status, type of insurance, housing state, having a companion/support in life, the most important needs in life, and living with others. In addition, we used the abbreviated mental test (AMT), which is a short cognitive test for the cognitive assessment of the elderly. AMT consists of 10 items, with scores ≤7 indicating the presence of a cognitive disorder (maximum score: 10). Another tool was the University of California at Los Angeles (UCLA) questionnaire, which was developed by Russell et al. in 1980 and has 20 four-response items, 10 negative statements, and 10 positive statements. This scale is used to measure the degree of loneliness. In the present study, the revised version of the loneliness questionnaire was used, and the content validity was confirmed by two faculty members. In addition, the reliability was confirmed at the Cronbachchr('39')s alpha of 0.9. Data analysis was performed in SPSS version 16 using descriptive statistics, including absolute frequency distribution and frequency percentage for qualitative variables and mean and standard deviation for quantitative variables, to describe the characteristics of the samples. Independent t-test and analysis of variance (ANOVA) were also applied for statistical analysis.

In total, 55.3% of the elderlies were aged 60-69 years. The sample population included 55.3% women and 44.7% men. Approximately 65.4% the participants lived with their spouse, and 96.9% had insurance. Regarding the correlation between loneliness and demographic characteristics in the patients, it was observed that age (P<0.001), marital status (P<0.001), occupation status (P<0.001), living with another elderly (P<0.001), maximum support (P<0.001), the most important needs in life (P<0.001) and insurance status (P=0.032) were significantly correlated with loneliness. In addition, paired comparison by Tukeychr('39')s test indicated that the feeling of loneliness was more significant in the elderly aged more than 80 years compared to those aged 60-69 years. Loneliness was significantly less in the married patients compared to the divorced, widowed, and single elderlies, while it was also significantly less in the widowed elderlies compared to the singles (P=0.003). Overall, 82.1% of the elderly patients reported slight loneliness, whereas 17.9% reported significant feelings of loneliness.

According to the results, feelings of loneliness were associated with the demographic and clinical characteristics of the elderly with insulin-dependent type II diabetes. Unlike most studies, the score of loneliness was relatively low in the current research, and the discrepancy may be due to the presence of trained elderly nurses in the ward and the demographic and clinical characteristics of the participants. Given the growing number of the elderly patients with type II diabetes, proper strategies should be adopted to improve physiological and psychological health of these individuals. Patients with type II diabetes (especially insulin-dependent diabetes) are more likely to feel lonely, and increased loneliness may reduce their desire and motivation for treatment. Therefore, we believe that nurses, physicians, and other healthcare providers should pay attention to the effects of loneliness on these patients during treatment and clinical care. In addition, preventive measures should be taken, and the importance of the issue should be explained to patients and their caregivers. It is recommended that interventional studies be performed to reduce the feeling of loneliness in the elderly with chronic diseases (e.g., diabetes). Furthermore, opportunities should be provided for the public awareness of the importance of loneliness as a mental health alert that may affect chronic illnesses (e.g., diabetes) and even mortality.

Health workers are the most fundamental elements of the health system whose mission is to improve the health of the rural community. Assessing and measuring the level of health is one of the important health issues. Health is a broad concept with multiple dimensions including physical, mental, and social health. Social health is a concept that has become increasingly important in scientific, policy, and executive circles. Social health emphasizes aspects of health related to a personchr('39')s relationship with other people or the communities in which he lives. One of the factors affecting social health is quality of life. Quality of life is a multidimensional concept affected by many important factors such as physical and mental conditions. Assessing the quality of life is important in order to determine physical, mental, and social performance. These dimensions can be discussed independently, but there is a correlation between them. Certainly, the development of health promotion programs in the community, regardless of the social and cultural context of the community in question leads to inefficient solutions. Despite the importance of health workerschr('39') work, their high volume of work, and pathological consequences, few studies are conducted on the qualitative and social fields of health workers. As a result, it is necessary to pay attention to their physical, mental, and social health and quality of life. Achieving goals in the field of health requires preventing death, reducing disability, improving the quality of life, and efficient workforce. Since health workers are at the forefront of health care centers, it is necessary to have good social health and quality of life to provide services to villagers. Therefore, this study was conducted to determine the social health and quality of life in health workers in Qorveh and Dehgolan in 2019.

This study was conducted to evaluate the social health and quality of life of health workers in Qorveh and Dehgolan cities affiliated to Kurdistan University of Medical Sciences. This was a descriptive cross-sectional study and included 198 health workers working in health centers in Qorveh and Dehgolan cities. Among them, 87 were working in 42 health centers of Dehgolan and 111 in 58 health centers of Qorveh. Samples were selected by census sampling method. After obtaining approval from the Research Ethics Committee and receiving a letter of introduction from Iran University of Medical Sciences and submitting it to Kurdistan University of Medical Sciences, the researcher obtained permission to participate in the research. In order to observe ethical considerations, the researcher first explained the objectives and method of the study to the officials of Qorveh and Dehgolan health centers, and in collaboration with them attended the workshops where the researcher attended as a lecturer and after obtaining informed consent, the researched distributed demographic information form, Social Health Questionnaire, and SF-36 Quality of Life Questionnaire among health workers to complete in 10 days and deliver to Qorveh health workers, and then to Dehgolan Welfare Training Center, and subsequently to Dehgolan Health Center. The researcher thanked the health workers and collected the information of the health workers who were absent during the workshops hold in the health centers. After collecting information which lasted for 3 months, the data were analyzed using SPSS software version 16.

The findings of the present study showed that most of the health workers participating in this study were women, their average age was 37 years, the majority were married, and officially employed, and had a diploma degree. Most of them assessed their economic situation as moderate, owned a house, and had no underlying diseases. The total score of social health was 69.28 ± 7.6 which indicates the average social health in health workers. The highest and lowest mean scores obtained among the dimensions of social health were social cohesion with an average of 4.09 ± 20.67 and social acceptance with an average of 2.96 ± 0.64, respectively. The total score of quality of life of health workers was 63.30 ± 20.87, which indicates their average quality of life. Quality of life was the highest in the dimension of physical function with an average of 73.35 ± 29.74, and was the lowest in the dimension of general health with an average of 57.82 ± 21.74. Also, the physical health dimension with an average of 63.85 ± 24.58 was higher than the mental health dimension with an average of 62.75 ± 21.29. The only variable that had a statistically significant relationship with the social health of health workers was housing status (p = 0.005). Tukeychr('39')s multiple comparison showed that the average score of social health obtained for health workers with a private home was significantly higher than those with a rental house (p = 0.005), and the difference was not significant in other cases. But all demographic variables of health workers had a statistically significant relationship with quality of life. The results showed that the quality of life in male health workers compared to the females (p = 0.012), health workers with diploma degree compared to health workers with secondary education (p <0.001), single health workers compared to married ones (p <0.001), and health workers who had no history of disease was higher (p <0.001). Age was another variable that had a statistically significant relationship with quality of life (p <0.001). Quality of life in health workers with formal employment was significantly lower than corporate health workers (p <0.001) and also contracted ones (p = 0.007), and this difference was not significant at other levels. Quality of life in health workers with more than 20 years of experience was significantly lower than health workers with 10 - 19 years of experience (p <0.001) and also less than 10 years of experience (p <0.001). The quality of life in health workers with poor economic status was significantly lower than those with average economic status (p = 0.04) and this difference was not significant at other levels. Housing status was another variable that had a statistically significant relationship with quality of life (p = 0.009). Also, the mean score of quality of life obtained for health workers with a private home was significantly higher than those with a rental house (p = 0.018) and in other cases this difference was not significant.

The present study showed that the social health of health workers was average and higher than the mean score of 60. The highest and lowest scores obtained in the dimensions of social health were social cohesion and social acceptance, respectively. Also, the quality of life of health workers was moderate. Health workers obtained the highest score in the physical function dimension and the lowest score in the general health dimension. The mean score in the physical dimension was higher than the mental health dimension. The study on the effect of demographic variables showed that the only variable with a statistically significant relationship with social health was housing status and the difference was not significant for the other cases. All demographic variables of health workers had a statistically significant relationship with quality of life. Variables of quality of life and social health are dynamic concepts that change over time. Examining and measuring this concept depicts the status of human development in society, so continuous monitoring of quality of life and social health is essential. The health system will have the desired efficiency when the problems and needs of its employees are taken into account in its design and management. The results of this study highlight the importance of implementing health education and health promotion interventions in the field of social health and quality of life among employees.

Nursing is a holistic practice, and patient care is an essential component of this practice. The main task of nurses is to interact with patients, which leads nursing to an integral part of health care. Nurses play a key role in determining the quality of hospital services. The concept of quality nursing care refers to the patientchr('39')s access to physical, communicative, psychological, and social needs, which affect patient satisfaction and wellbeing, as well as the better performance of healthcare organizations. Excessive work shifts, personal conflicts, facing death, lack of psychological support, conflict with physicians, and ambiguity regarding authority are among the influential factors in the quality of nursing care. Nurses communicate with the patient in a fully personal environment, which may not always bring about positive outcomes. The long-term exposure of nurses to workplace stressors could adversely affect their mental and physical health and lead to burnout, which deteriorates the quality of patient care. The most comprehensive definition of burnout has been proposed by Maslach and Jackson, who consider this syndrome to consist of three dimensions, including emotional exhaustion, depersonalization, and personal accomplishment. The most prominent symptom of this syndrome is emotional exhaustion when the individual feels pressured, and their emotional resources are depleted. Compared to other occupations, nurses are prone to severe burnout due to direct patient care. The main consequences of burnout include chronic fatigue, insomnia, negative attitudes toward self and clients, absence from the workplace, and job dissatisfaction. The negative consequences of burnout affect patient satisfaction as they reduce the quality of nursing care. Considering the sensitivity of the nursing profession and the debilitative effects of burnout on the efficiency and mental health of nurses, the present study aimed to investigate the correlation between the quality of nursing care and burnout of nurses in the teaching hospitals affiliated to Mazandaran University of Medical Sciences, Iran.

This cross-sectional, descriptive-correlational study was conducted on 125 nurses working in the teaching hospitals affiliated to Mazandaran University of Medical Sciences in Sari, Iran during June-August 2020. The sample size included 125 nurses who were selected via random sampling from four teaching hospitals in Sari. The inclusion criteria of the study were willingness to participate, having at least a bachelorchr('39')s degree in nursing, and at least two years of work experience in the nursing profession. The exclusion criterion was incomplete questionnaires. After selecting the participants and obtaining their written informed consent, the objectives of the research were explained to the subjects, they were assured of confidentiality terms regarding their personal information and instructed on completing the questionnaires. Data were collected using a demographic questionnaire (age, gender, marital status, education level, type of employment, shift work, work experience, level of interest in nursing), Maslach burnout inventory, and quality of patient care scale. Sampling was performed after the approval of the study protocol and receiving the ethics license from the Ethics Committee of Mazandaran University of Medical Sciences. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution tables, mean, and standard deviation) and analytical statistics (Mann-Whitney test, t-test, Spearmanchr('39')s correlation-coefficient, Kruskal-Wallis test). In all the statistical analyses, the P-value of <0.05 was considered significant. 

In total, we enrolled 125 nurses with the mean age of 35.02 ± 6.82 years selected from four teaching hospitals affiliated to Mazandaran University of Medical Sciences (Zare Hospital: 18.4%, Imam Khomeini Hospital: 28%, Fateme Zahra: 26.4%, Buali Sina Hospital: 27.2%). Approximately 78% of the participants were female. The majority of the nurses (36%) were formally employed and had rotating work shifts (88%). In addition, most of the nurses had a BSc degree (90.4%). In this study, the mean quality of nursing care was estimated at 200.15 ± 26.01. The mean scores of nursing care quality in the psychosocial, relational, and physical dimensions were 84.29 ± 10.40, 40.23 ± 6.09, and 75.62 ± 15.32, respectively. The mean scores of burnout frequency in the dimensions of emotional exhaustion, personal accomplishment, and depersonalization were 21.44 ± 9.89, 17.18 ± 7.92, and 7.84 ± 7.35, respectively. The mean scores of the same dimensions in terms of the intensity of burnout were estimated at 25.19 ± 10.93, 31.26 ± 8.35, and 8.79 ± 7.78, respectively. The quality of nursing care with the subscales of burnout frequency, including emotional exhaustion (r=-0.369; P<0.001) and depersonalization (r=-0.471; P<0.001), had reverse and significant correlations. In addition, the quality of nursing care was directly correlated with personal accomplishment (r=0.226; P=0.011), which was very weak. The quality of nursing care with the subscales of the intensity of burnout, including emotional exhaustion (r=-0.362; P<0.001), personal accomplishment (r=0.289; P=0.001), and depersonalization (r=-0.501; P<0.001), also had significant correlations, which were very weak as well. In other words, reduced frequency or intensity of burnout was associated with the higher quality of nursing care. Our findings indicated a strong and direct correlation between the frequency and intensity of burnout (r=0.952; P<0.001). However, none of the demographic variables had significant effects on the quality of care and burnout of the nurses.

Undoubtedly, the provision of quality care to hospitalized patients will increase their satisfaction with hospitals. Given that nurses have the most interaction and contact with patients compared to other healthcare providers, they play a key role in achieving this goal. Our findings indicated a reverse correlation between burnout and the quality of nursing care. Therefore, special attention must be paid to this issue by healthcare authorities. It is hoped that by performing appropriate psychological interventions to manage the stressors of the work environment and decrease the burnout of nurses, a step will be taken toward increasing the quality of nursing care. One of the limitations of the present study was that the sample population only included the nurses working in teaching hospitals, and the nurses working in other hospitals (e.g., private hospitals) were not taken into account. Therefore, it is suggested that further investigations in this regard address this limitation.

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.

One of the most important events in life is accepting the role of parents who have a lot of stress in front of the responsibilities and expectations of this role. Parental stress is caused by a perceived mismatch between parental responsibilities and personal resources such as some child characteristics such as poor response, behavioral problems, child adjustment as well as specific parental characteristics such as flexibility, anxiety characteristics and life skills deficits. Child interaction. High levels of parental stress disrupt parent-child interactions and impair parental parenting skills, so that even low levels of parental stress and parental inefficiency are linearly related, making parents, especially mothers, more to blame and provoked. Accept. And leads to behavioral problems and emotional development disorders in their children. Because childhood is affected by the emotional state and stress of parents. Therefore, this stress must be overcome properly. Numerous studies have shown that teaching life skills to parents as one of the most effective and efficient methods among therapeutic approaches, has a positive and significant effect on reducing the stress dimensions of parents, parents and children and the most appropriate way to create skills and change skills workshop skills. itchr('39')s life. According to the above, the purpose of this study was to determining the effect of life skills training on parental stress in Health liaisons women with children under 7 years in Abhar city.

This is a quasi-experimental study with a control-experimental group that investigated the effect of life skills on the stress of parents of health liaisons (health volunteers) with children under 7 years in Abhar in 1398. For this purpose, 60 health liaisons with children under 7 years old were selected from health liaisons who collaborated with two health centers in Abhar city using available sampling method. While introducing research and objectives, liaisons who had inclusion criteria were selected. And completed the consent form. Then, the personal information form included the age of the liaison and their spouse and children, the number of children, the occupation and income of the fathers and the level of education of the parents (liaison and their spouse) and the duration of their cooperation with the relevant centers. The SF-PSI, which has 36 valid questions on a 5-point Likert scale with a score of 1-5, has three sets of 12 questions from three subscales of parental distress, dysfunctional parent-child interactions, and problematic child characteristics. If the total score is above 90, it indicates high parental stress, completed by both groups, and the experimental group in two groups of 15 for 5 sessions under the group life skills training program, including self-knowledge and self-esteem skills and confidence. Self, effective communication skills, emotion and anger control skills, stress management skills and problem solving skills, approved by university psychiatric professors, in the form of questions and answers, lectures, role-playing and practical exercises at home, For three weeks, two sessions of 105 minutes per week. Was presented and the control group did not receive a program and at the end, both groups completed the post-test five weeks after the start of the intervention and the training package was delivered to both groups. This study is extracted from a research project approved by Iran University of Medical Sciences and has been observed during the ethical policy stages of the university. The obtained data were first analyzed by descriptive and inferential analysis and then the hypotheses were analyzed using the statistical methods of independent t-test, analysis of covariance and Mann-Whitney test at a significant level (P≤0.01). Data were analyzed statistically using SPSS software version 21 and tests.

There was no significant difference between the two groups in terms of age, education, spouse, income, number of children, age and sex of children and duration of cooperation. The mean score of parental stress in the pre-test in the control group was 1/13±3/109 and in the experimental group was 39/16±3/114 and the mean score of parental stress in the post-test (five weeks after the intervention) in the control group was 52/14±6/97
and  in the experimental group was 17/8±83/89 in the experimental group was 17.89 after training. The group was different. It was statistically significant (P <0.001). The results showed that life skills training reduced parental stress in the experimental group in the pre-test and post-test stages. In the pre-test and post-test stages, the parent anxiety subscale in the experimental group increased from 36/1±7/40 to 24/8±3/28 and the parent interaction subscale and the child decreased from 09/5±7/33 to 88/93±3/27 and also in a difficult child 37/7±5/40 to 65/1±3/33. The mean score of parental stress and the dimension of parental distress after training in the experimental group was significantly lower than the control group, which indicates less stress in this group than the control group (P <0.001).

The results showed that the life skills training program in health caregivers reduced the mean of parental stress and stress subscales. Therefore, informing about the necessity of teaching life skills to parents in order to create a culture among the general public and especially officials for richer planning, teaching life skills to parents by holding workshops should be considered by managers and health officials.

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.