نشریه پرستاری ایران
پیاپی 133 (دی 1400)

Irritable bowel syndrome is one of the most common gastrointestinal disorders that significantly affects the quality of life of patients. One of the salient features of this disease is that most of the patients are young adults who, in addition to gastrointestinal symptoms, are involved with various physical symptoms and suffer from extensive extra intestinal symptoms. The chronic nature of the disease is such that it disrupts a person's lifestyle and causes degrees of psychiatric disorder by interfering with underlying health. Several studies have shown a high prevalence of concomitant mental disorders among people with irritable bowel syndrome. It is worth mentioning that this disease has been introduced as a stress-related disorder and psychological factors play a very important role in its control and prognosis. The results of studies show that the more severe the symptoms of IBS, the greater the contribution of psychological variables in these conditions, and in moderate to severe cases of the disease, especially in patients with psychosocial problems, it is better in addition to drug treatment, psychotherapy should also be used. Written emotional expression is a non-pharmacological intervention that has been studied in several studies on its effect on physical and mental health and the prognosis of chronic diseases. The results of some studies suggest that there is a link between emotional repression and emotional inhibition with IBS. Psychological inhibition, which means the inability to express thoughts, feelings, and behaviors related to an experience, occurs when people think they cannot easily talk about their experience with others. Patients with irritable bowel syndrome are more likely than healthy people to hide their negative emotions. Embarrassment about the symptoms of the disease may lead to secrecy and reluctance to discuss the emotional problems associated with the disorder. Accordingly, encouraging patients to express emotions and change behaviors associated with emotional suppression can be valuable in IBS treatments. Doing so may improve the quality of life of sufferers, as suppressing emotions brings more psychological burden and, by increasing anxiety, exacerbates symptoms and worsens the disease. Expressing emotions in the form of writing, in addition to the effect it has on improving a person's emotional state, can be easily taught and practiced, and it is done spontaneously, without face-to-face and continuous referrals, and with less interference from the intervener. Considering the benefits of written expression and considering the importance of the role of psychological variables in aggravating the symptoms of this syndrome and the educational-supportive role of nurses, this study aimed to determine the effect of written emotional expression on severity of gastrointestinal symptoms in patients with Irritable bowel syndrome.

This clinical trial study was conducted in 2019, on 71 patients with Irritable bowel syndrome who were referred to the gastrointestinal clinics of Firoozgar and Hazrat Rasoul Akram hospitals in Tehran. Patients were selected using a continuous sampling method. Participants were randomly (permuted block randomization) assigned to two groups: the control group (n=35) and the intervention group (n=36). The sampling process started in November 2019 and continued for 8 months until the completion of the sample size until May 2020. Inclusion criteria include: IBS according to the doctor's diagnosis, at least 3 months have passed since the diagnosis, having symptoms based on the severity of symptoms of irritable bowel syndrome (SI-IBS) in the mild, moderate or severe range, having Literacy, having sufficient physical and mental ability to write, age 18 to 65 years, no acute mental disorders based on physician diagnosis and record, no use of anti-anxiety drugs during the last 3 months according to patient reports and no infection At the same time, participants had other functional or structural gastrointestinal disorders based on patient reports. Exclusion criteria also include: diagnosis of any disease during the study by the treating physician who has symptoms similar to the symptoms of irritable bowel syndrome, the patient does not have the necessary cooperation or unwillingness to continue cooperation, the patient does not attend pre-test or post-test evaluations , Not writing in the booklet more than 2 times or 4 sessions in total and hospitalization of the patient due to exacerbation of gastrointestinal symptoms during the study. After obtaining permission from the ethics committee, the researcher referred to the research environments, selected people with IBS who met the inclusion criteria, and after explaining the objectives of the research to these people and if they wish to participate in the research, the informed consent form Completed by them. A questionnaire on demographic characteristics and symptom severity index (IBS-SI) were answered by participants in both groups. The Symptom Severity Index Questionnaire was designed in 1977 by Francis et al. The Persian version of this questionnaire was translated into Persian in the study of Afshar et al by the standard method of linguistic validation. The internal correlation coefficient of this scale is 0.86 and Cronbach's alpha is 0.69. In the intervention group, in addition to routine care, a white booklet with a special format was given to each participant to express their emotions in writing. A weekly written expression of the patient's feelings for a period of 15 to 30 minutes, based on the topics in the booklet, was done at home for one month. During the intervention, the process of writing patients was followed by a researcher by phone at the end of each week. At the end of the intervention, by phone call and at the invitation of the researcher, the research samples were referred to medical centers again and after the presence of test subjects in the clinic training class, patients' notes were collected by the researcher. After the researcher viewed the booklet in terms of the patient's written expression each week, the booklet was returned to them. Also, all subjects in the experimental group answered the symptom severity index questionnaire again and in the same session. The control group received only routine care by clinic staff after the pre-test. In this group, telephone follow-ups were performed every week, in which the researcher answered the questions of the sample people regarding their health status and the training they received from health care providers. In this group, after one month, the subjects returned to the medical centers on the dates agreed by the researcher and completed the IBS-SI tool. Finally, in order to observe the ethical points, a written guide to the written emotional expression was provided to this group. Questionnaire data were extracted and analyzed using SPSS software version 16 and descriptive statistical methods, independent t-test and analysis of variance with repeated measures.

The two groups were homogeneous in terms of demographic characteristics. Before performing the written expression, the mean score of symptom severity in the experimental group was 262.36 with a standard deviation of 104.74 and the mean in the control group was 263.48 with a standard deviation of 11.874. The results of independent t-test showed that before the intervention, the experimental and control groups were not statistically significant in terms of symptom severity and were homogeneous (p = 0.966). One month after the written expression, the mean score of symptom severity in the experimental group was 218.75 with a standard deviation of 116.11 and the mean in the control group was 239.51 with a standard deviation of 107.67. After the intervention, there was no statistically significant difference in the severity of symptoms in the control group (p = 0.134). The severity of gastrointestinal symptoms in the experimental group decreased significantly compared to before the intervention (p = 0.016). However, there was no statistically significant difference between the mean scores of gastrointestinal symptoms in the experimental and control groups 1 month after the intervention (p = 0.438).

Execution of written emotional expression in this study, although did not cause a statistically significant difference in the score of gastrointestinal symptoms in patients with irritable bowel syndrome, but was associated with a decrease in the severity of gastrointestinal symptoms in patients in the experimental group, so that significant improvement in gastrointestinal symptoms. Patients with severe symptoms and mild to moderate symptoms were observed. This non-pharmacological intervention can be considered as a practical and easy method along with pharmacological treatments for patients with irritable bowel syndrome.

One of the health-related problems in the workplace is job-related stress. Nursing is one of the professions in which nurses experience a lot of stress. Job stress is a physical and emotional response that occurs when job demands conflict with one's ability, resources, or needs. High workload and long working hours, dissatisfaction with wages and benefits, communication with patients and their relatives, communication with doctors and other nurses, working on holidays are some of the things that lead to stress in nurses. Long-term work stress has a negative effect on nurses' physical and mental health and reduces their psychological well-being. According to Ryff studies, psychological well-being is one of the most important components of health. Psychological well-being can be defined as a positive psychological function that includes self-acceptance, a sense of autonomy, purpose in life, environmental mastery, personal growth, and positive relations with others. Cognitive flexibility is the ability to adapt cognitive and behavioral strategies in response to environmental changes. As a result, it allows people to react more adaptably to stressors or life events, resulting in psychological well-being. Therefore, the aim of this study was to investigate the relationship between job stress and psychological well-being with the mediating role of cognitive flexibility.

The present study was a cross-sectional correlational study. The statistical population included all nurses working in hospitals in Isfahan in 2019. Using cluster sampling method, four hospitals in Isfahan (Kashani, Chamran, Khorshid and Hojjatieh) were randomly selected and then 4 wards were randomly selected from each hospital and 150 questionnaires were distributed among the nurses of those wards. In order to observe ethical considerations, the research samples voluntarily entered the research and signed a written consent. They were also assured that the information in their questionnaire would remain confidential. In addition, this study has a research ethics code. The research tool consisted of three questionnaires. 1- HSE Job Stress Questionnaire with 35 questions designed to measure work-related stress by the UK Safety and Health Executive. Higher scores indicate high levels of stress. In Iran, the reliability of the questionnaire using Cronbach's alpha was 0.78. 2- Short Form of Ryff Psychological Wellbeing Questionnaire which included 18 questions. Higher score indicates better psychological well-being. In Iran, Cronbach's alpha for the whole scale was 0.71. 3- Cognitive flexibility questionnaire is a short 20-item self-report tool. This questionnaire is used to assess a person's progress in creating flexible thinking. In Iran, the total test-retest reliability coefficient has been reported to be 0.71. To analyze the data, SPSS software version 16 and to test the mediating role cognitive flexibility in the relationship between of job stress and psychological well-being, the proposed steps of Baron and Kenny were used by hierarchical regression method.

Demographic variables showed that 111 (74%) of the nurses were women and 39 (26%) were men. 46 (30.7%) were single and 104 (69.3%) were married. The highest frequency of nurses' education was 119 that related to bachelor degree (79.3%).The mean (standard deviation) of study variables including job stress was 89.94 (±16.97), cognitive flexibility was 102.41 (±14.69) and psychological well-being was 78.28 (±9.44). The results of Pearson correlation showed that job stress has a negative relationship with two variables of cognitive flexibility and psychological well-being and cognitive flexibility has a positive relationship with psychological well-being. The results of regression analysis showed that in the first stage, job stress with beta (β = -0.42) is a significant predictor of psychological well-being. In the second stage, the variables of job stress and cognitive flexibility predicted psychological well-being with beta (β = -0.21 and β = 0.54), respectively. Due to the fact that the beta of job stress decreased in the second stage compared to the first stage, the partial mediating role of cognitive flexibility in the relationship between job stress and psychological well-being was confirmed.

Most people can cope with stress for a short time, but chronic stress causes changes in physiological and psychological status, the consequences of which can decrease psychological well-being. It seems that some factors play a mediating role in the relationship between job stress and psychological well-being, including cognitive flexibility, which was examined and confirmed in this study. More flexible persons can consider difficult situations and life events as manageable situations and think of alternative solutions. In such situations, a person's capacity to cope, adapt and get rid of stress and difficulties in life increases. The nursing profession is one that requires the observation of various factors and information, each of which may require a different response. For example, in addition to paying attention to the patient's emotional, behavioral, and physiological states, they should response to the diagnostic and therapeutic information obtained for each patient. Their work environment can be accompanied by sudden changes that require vigilance and the ability to shift attention from one job to another. Thus, cognitive flexibility, which includes the ability to change cognitive sets to adapt to changing environmental stimuli, helps nurses respond to the ever-changing work environment. It should be noted that part of the negative relationship between job stress and psychological well-being is affected by reduced cognitive flexibility. Therefore, when it is not possible to eliminate the source of stress, strengthening cognitive flexibility can reduce the negative effects of stress. In this regard, it is suggested that sessions be held with the aim of training cognitive flexibility to nurses and its effectiveness on increasing psychological well-being is examined.

Every Iranian nurse during clinical service with at least one of the conflicts, including: job dissatisfaction, poor economic and social status, lack of medical staff, long-term commitment to work in care organizations and ethical environment Faced with inappropriate care or moral climate. Determines the ethical atmosphere of an organization; To what extent ethical standards are observed in that organization and also how much decisions are made according to ethical standards. The ethical atmosphere of an organization can be examined through the level of employees' perception of the organizational climate, how employees make decisions when faced with ethical problems and the degree of employee participation in solving ethical problems. So it can be said in what ethical atmosphere nurses are working; It affects their attitudes toward moral issues and their moral decisions. The ethical climate leads the nurse to strengthen her moral reasoning by sharing in the decision-making and responsibility for the consequences of the action she has taken. Also, the moral atmosphere creates opportunities for collective participation in problem solving, which leads to higher levels of moral reasoning. Although it is important to have an ethical approach to issues and the ability to make decisions based on ethical reasoning, responding correctly to situations and overcoming fear requires moral courage as well as the encouragement and support of the organization's managers. ; There was no study in the field of measuring the relationship between moral atmosphere and moral courage and moral reasoning in Iran, so the present study was conducted to investigate the moral atmosphere prevailing at work and its relationship with nurses' moral reasoning and courage.

This descriptive-analytical study and census sampling was performed on 87 nurses in Meybod and Ardakan in 1398. Olson Hospital Ethical Climate Survey (HECS), Nursing Ethical Dilemmas Test and Ethics Courage Questionnaire designed by Bagozz and Sekerka were used to collect data. 18 were analyzed and appropriate tests including descriptive and analytical (Pearson, independent t test, ANOVA) were used.

The age range of participants was 24 to 50 years. The results showed that no significant relationship was found between moral atmosphere and moral reasoning and courage (P≥0.05). The mean score of ethics (3.22 67 0.67), moral reasoning (45.00 91 6.91), moral courage (45.55 6 6.04) was obtained. There was a significant relationship between gender and perception of moral atmosphere (P = 0.03). None of the individual characteristics of nurses had a significant relationship with the studied variables (P≥0.05).

According to the results of this study, nurses' perception of the ethical atmosphere has no significant relationship with ethical reasoning and moral courage of nurses. Having a positive moral atmosphere in the treatment environment and the nursing profession is necessary and inevitable and leads to the promotion of moral values ​​such as moral courage and moral reasoning in the clinical environment. Although having a moral attitude towards issues and also overcoming fear in moral decisions and having moral courage have a great impact on creating a positive moral atmosphere, but the ability to make decisions based on moral reasoning is also very important.The present study showed that nurses' understanding of the moral climate is favorable. Research has concluded that the climate of the organization has a great impact on the emergence and spread of ethical behaviors. Managers of organizations should be a role model and supporter for employees and support them in the field of ethics and professionalism so that they can without fear and worry and with courageous decision in the nurse in the clinical environment according to the ethical values of work. Do your homework; The nurse, the patient, and the clinical environment themselves benefit from that ethical practice. The present study showed that nurses' understanding of the moral climate is favorable. Research has concluded that the climate of the organization has a great impact on the emergence and spread of ethical behaviors. Managers of organizations should be a role model and supporter for employees and support them in the field of ethics and professionalism so that they can without fear and worry and with courageous decision in the nurse in the clinical environment according to the ethical values of work. Do your homework; The nurse, the patient, and the clinical environment themselves benefit from that ethical practice n the present study, nurses' moral courage was reported to be above average. Altman acknowledges that a lack of moral courage is common in the present age, and that we must ultimately increase moral courage in nurses by increasing their courage and adherence to ethical principles. There is a significant relationship between demographic characteristics and moral reasoning and moral courage. not found . In general, increasing work experience is expected to increase the ability of nurses to face ethical challenges and thus their moral reasoning and courage, but there may be factors such as organizational interests, differences in management and the hospitality of the hospital. and has taken the necessary ground to upgrade these capabilities from them. One of the limitations of this study is the low sample size, which can affect the results. It also affects the generalizability of the results. Another limitation of the present study is the sampling method available.

The dramatic increase in life expectancy in the twentieth century has been one of the greatest health achievements in the world, which has led to an increasing trend in the overall age of the population compared to the past. With increasing life expectancy and declining fertility rates, it can be said that in most countries, including Iran, the slope of population growth for people over 60 is higher than other age groups, and this causes the world's population to age.According to the Iranian National Statistics Portal (2016), the life expectancy of Iranian men has increased from 45 to 69 and then 74 years in 1960, 2000 and 2015, respectively, and for women from 44 to 71 and then 76 years. Accordingly, the ratio of the elderly to the total population has been increasing in recent decades, and it is estimated that the percentage of elderly people in Iranian society will be 6.6-6.6% in 2025, 19% in 2030, and 21.7% to 30.8% in 2050.In this regard, due to the higher life expectancy of women than men, older women are more exposed to potential health threats, such as increased incidence of chronic diseases, loneliness and isolation, and lack of social support. The aim of this study was to compare the general health and happiness of elderly women with and without a spouse referring to health centers in Bandar Abbas, one of the deprived areas in southern Iran, in 2018.

This descriptive-analytical study was performed on 390 women over 60 years of age (260 with spouses and 130 widows) referred to 8 selected health centers in Bandar Abbas, Iran, in 2018, using quota cluster sampling method. Data collection tools included a demographic information questionnaire, the Goldberg and Hiller General Health Questionnaire, and the Oxford Happiness Questionnaire. The collected data were processed using SPSS software version 21. Descriptive statistics (frequency, percentage, mean and standard deviation) and analytical statistics (chi-square, and independent t-test, analysis of covariance) were used to analyze the data and a significant level of P <0.05 was considered.

In this study, out of 260 elderly women with a spouse, 218 (83.8%), and out of 130 elderly women without a spouse, 83 (63.8%) were under 70 years old. Most women without a spouse (67.6%), and with a spouse (65%), have 5 to 9 children, and more than half of them in both groups (58.4% of the group with a spouse and 51.9% of the group without spouse) had 5 to 9 married children. About half of women in the two groups (48.5% in the group with a spouse and 50% in the group without a spouse) had primary education, most (94.2% in the group with a spouse, and 95.4% in the group without a spouse) were housewives. In terms of economic status, most of the two groups (61.5% of each group) were at a moderate level, and often (48.1% of the group with a spouse, and 50.8% of the group without a spouse) were financially dependent. The two groups were homogeneous in terms of demographic variables except age and number of years of living with a spouse (P <0.001). The results showed that although older women with a spouse had a higher level of general health and happiness than the other group, the results of analysis of covariance showed that this difference was not statistically significant.

According to the results of this study, the average general health score in both groups was lower than the cut-off points for the whole test (23), which means that in terms of general health, most women in both groups have a good level of health. However, the mean health score in this study is higher than the mean health score of the elderly in Yazdani study in Tehran (Yazdani, 2010), and Nejati study in Qom (Nejati, 2005). This shows that the elderly in Tehran and Qom have higher general health. Perhaps the reason for this can be attributed to the deprivation of Bandar Abbas city and the lower quality of health services provided to the elderly in deprived areas compared to the center.Also, although the average general health score, and each of its areas, is lower in the group of women with a spouse, and it seems that women with husbands have higher general health, but the results of analysis of covariance showed that this difference is statistically Not significant (P = 0.38).Perhaps one of the reasons for the insignificance of this difference can be attributed to the factor of social support provided by children, which according to Okabayashi et al, can have a greater impact on the mental health of older women than other sources of support, including spouses, friends and acquaintances.Also, in relation to the physical dimension of elderly women's health, according to the results of the Bennet study, the decrease in the level of physical health in older women is more a function of burnout and aging, than widowhood and lack of spouse support. This could be a justification for the lack of significance of this relationship in our study.The results of this study also showed that the mean score of happiness is higher in women with a spouse, but this difference is not statistically significant (P = 0.17). According to Hughes and Waite, regarding the role of marriage and its relationship with feelings of health and happiness, although some changes in physical and mental health can be explained by marital status, marriage seems to be only part of this relationship. Also, Ryan, and Ryan and Willits, believe that it is the quality of family relationships that can contribute to the psychological well-being of the elderly, not just the presence of a spouse and the number of children.

 Although some changes in physical and mental health can be explained by marital status, other factors besides just having a spouse may also affect the sense of well-being, health, and happiness of these older women, and identifying them requires further research.

Epidemiological changes over time have made chronic diseases increasingly important. Hypertension is also known as a chronic disease. The high prevalence of hypertension worldwide has made the disease a major health problem in communities. Spiritual health has been proposed as one of the health indicators and also as one of the predictors of self-care in chronic diseases. The aim of this study was to determine the relationship between spiritual health and adherence to treatment regimen in patients with hypertension.

In this descriptive correlational study, 121 patients with hypertension were selected by continuous sampling method from cardiac clinics affiliated to Iran University of Medical Sciences. Data were collected through demographic information form and validated spiritual health questionnaires Ellison, Paloutzian (1982) and Hil-Bone (2000) diet adherence. For data analysis, SPSS software version 16 and statistical tests of Spearman, independent t-test, Chi-square and analysis of variance were used.

The results of this study show that there is a negative and significant relationship between spiritual health and adherence to treatment regimen in patients with hypertension (p = 0.001 and r = -0.05).

As spiritual health increases, adherence to the treatment regimen in patients with hypertension decreases. Having spiritual health for this group of patient’s leads to less adherence to the treatment regimen.

Cardiopulmonary resuscitation is one of the most important medical emergencies and the effect of trained and skilled people on the outcome of resuscitation has been proven to be positive. The results of studies indicate poor performance and insufficient knowledge of operating room technicians in the field of cardiopulmonary resuscitation. Despite the importance of cardiopulmonary resuscitation training, very little attention is still paid to teaching patient life skills with attractive and appropriate methods, so the current need is not only to slightly increase cardiopulmonary resuscitation training, but more importantly, to increase the quality of training. One way is self-assessment. In the medical profession, the ability of employees to identify their strengths and weaknesses is very important, and proper self-assessment can be effective in developing a person's abilities. Learners also use the rethinking process to gain insight into their own performance and identify strengths and abilities, as well as areas that may need further development. The aim of this study was to investigate the effect of visual self-assessment training on the level of knowledge, self-esteem and performance of operating room personnel in field of advanced cardiopulmonary resuscitation.

This Semi-experimental pre-test post-test single group study was performed with participation of 32 operating room technicians. Sampling was continued in an accessible method according to the inclusion criteria reach the specified sample size. The intervention was in the form of a cardiopulmonary resuscitation workshop and takes a video from resuscitation operation on the model by each of the participants and then replaying the video for self-assessment. The two-day workshop includes theoretical and practical training including recognizing life-threatening dysrhythmias, recognizing and using the cardiac shock device, airway management (airway opening maneuvers and artificial respiration by airway and ambo bag), and cardiopulmonary resuscitation training. According to the latest guideline of cardiopulmonary resuscitation 2017, it was in the form of a lecture and slide show and all the resuscitation steps were performed in the form of simulations on a mannequin for cardiopulmonary resuscitation. At the end of the workshop on the second day, each participant was given 3 minutes to perform a short-term scenario about cardiopulmonary resuscitation. From all participant’s performances were recorded a video and after the resuscitation, each person film was shown for himself on the TV in the resuscitation room. Then, knowledge, self-esteem questionnaire and self-assessment performance checklist were given to each participant to complete immediately after the intervention. At the same time, during the resuscitation by the participants, a performance observation checklist was completed for them by the researcher. At 8 weeks after the intervention, the participants repeated the above steps again by receiving another short scenario and performing 3 minutes of cardiac resuscitation on the mannequin and showing the resuscitation video and completing the knowledge, self-esteem and self-assessment questionnaire. At this time, the performance observation checklist was completed again by the researcher. So the data were collected using a researcher-made questionnaire and Rosenberg self-esteem questionnaire in 3 times (before, immediately and 8 weeks after the intervention) and self-assessment performance questionnaire and observational performance checklist in two times (immediately and 8 weeks after Intervention) were collected. This article was extracted from a research project approved by Isfahan University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the nurses. Data were analyzed by SPSS.v16 software and repeated measures analysis, Greenhouse-Geisser and Bonferroni post hoc test and paired t-test were used. 

A total of 32 operating room technicians were included in the study, one participant was excluded due to obstetric delivery, one due to transfer from a medical center and 2 due to not participating in the evaluation 8 weeks after the intervention. Finally, data analysis was performed on 28 operating room personnel participating in the study.  Demographic data of participants showed 89.29% were female, 67.86% had a bachelor's degree in operating room and the mean age of participants was 39.37 years. The comparison of the mean score of operating room technicians knowledge in 3 times was significant (P<0.001). The pairwise comparison of knowledge index was significant at the time (before-immediately after (P<0.002) and before -8 weeks after the intervention (P<0.05)). The comparison of the mean score of operating room technicians self-esteem in 3 times was significant (P<0.001). Also, the comparison of the mean performance self-assessment score and the comparison of the mean performance score observed immediately after and 8 weeks later were significant (P<0.001). According to the results obtained by comparing the knowledge index in pairs at three different times with Bonferroni test, the difference between the means of the times before and immediately after the intervention and the times immediately after and 8 weeks after the intervention was significant (P <0.0001) and there is no significant difference between the time before and 8 weeks after the intervention (P = 0.321). Also, according to the results obtained by comparing the self-esteem index in three different times, the difference between the means of the times before and immediately after the intervention (P = 0.002) and the time before and 8 weeks after the intervention was significantly different (P = 0.05). While there was no significant difference between the times immediately after and 8 weeks after the intervention (P = 1,000). So visual self-assessment has elevated the self-esteem of operating room technicians in cardiopulmonary resuscitation and it kept high until 8 weeks later. While knowledge was high immediately after the intervention and decreased significantly 8 weeks after the intervention. There was also a significant improvement in functional cardiopulmonary resuscitation.

Visual self-assessment method is effective in increasing the knowledge, self-esteem and performance of operating room technicians in the field of cardiopulmonary resuscitation. Especially since their self-esteem and performance will be indelible. The presentation of this method by clinical instructors and diversity in educational affairs are the advantages of using the visual self-assessment training method in clinical education and it can be useful if its outputs such as quality of patient care will be evaluated. It is suggested that such a study be conducted in other research settings and along with investigating of factors affecting the self-esteem and performance of staff and even their self-efficacy and self-confidence to perform care, especially in urgent and stressful care.

One of the consequences of brain injury is coma. On the other hand, complications that threaten comatose patients in ICU wards are a risk factor for sensory deprivation.

The aim of this study was to compare sensory stimuli with familiar sound and patient auditory preferences on the level of consciousness of patients in coma admitted to intensive care units.

The present study is a Interventional study of three groups before and after  that was performed on 45 patients admitted to the intensive care unit of selected hospitals in Ahvaz in 1399. Patients with inclusion criteria were randomly divided into two intervention groups and a control group. The minute was broadcast on the patientchr('39')s bedside for 3 days from the beginning of admission and twice a day (6 times in total) at 10 am and 3 pm on the patientchr('39')s bed. Routine care was performed for the control group and routine sounds were given. Awareness level was collected 15 minutes before and 15 minutes after the intervention in all three groups. The instrument for assessing patientschr('39') level of consciousness was GCS and FOUR scale. Descriptive and inferential statistical methods were used to analyze the data.

The mean level of consciousness of the auditory preferences and familiar voice group after the intervention was significantly higher than the control group (P <0.05) but there was no significant difference between the two groups of auditory preferences and familiar voice (P> 0.05).

Considering that the effect of familiar sound and hearing preferences has been more than unfamiliar sound, it is recommended to provide a program of auditory stimulation with familiar voice and hearing preferences for some patients in ICU wards

The elderly population in the world as well as in Iran has a growing trend, which can indicate a significant increase in chronic diseases, especially renal failure in the elderly and its associated complications, including sleep disorders, which cause trouble in daily activities and quality. Life goes down in these patients. Therefore, have been decided to conduct a study using exercise and its effect on sleep quality in elderly patients undergoing hemodialysis.

The present study is an experimental study that was conducted to investigate the effect of exercise on sleep quality in the elderly with Sheldon venous catheter undergoing hemodialysis referred to Ghiasi Charity Center in Tehran in 2020. This center covers 200 patients, of which 40 are active elderly patients over 60 years of age, 30 of whom met the inclusion criteria, which were randomly selected by lottery method (writing their names on paper) into two groups, the intervention and control groups (15 people in each group) were assigned. Initially, the cognitive health of the elderly was assessed using a short cognitive test tool, all of them had cognitive health. In the experimental group, one of sample was hospitalized and two were transferred to another dialysis center, thus, they were removed from the samples. Research tools included demographic information form, Abbreviated Mental Test and Sleep Quality questionnaire. The Abbreviated Mental Test(AMT) tool, developed by Hodkinson in 1972 to screen for cognitive disorders such as dementia and delirium in the elderly, to identify the elderly with dementia and remove them from the study. The tool includes 10 short and simple questions to measure orientation, focus and attention, short-term and long-term memory of the elderly, each item of which has 1 point and the sum of the resulting scores is 10. The cut-off point for distinguishing cognitive status is 7 out of 10, which normalizes status from abnormal. Foroughan et al. (2014) in Iran have translated this tool into Persian. The validation and internal reliability of the Persian version of this tool with Cronbachchr('39')s alpha coefficient of 0.76 has been acceptable. The Pittsburg Sleep Quality Index (PSQI) was developed by Buysse et al in 1989 and has 9 items, of which 5 questions contain 10 sub-items, so the whole questionnaire has 18 items. These questions are in seven components : Subjective sleep quality, Sleep latency, Sleep duration, sleep efficiency, Sleep disturbance, Use of sleep medication, Daytime dysfunction. The score of each question is between 0 to 3 scores of the questionnaire from 0 to 21. The higher the score, the lower the quality of sleep. Dr. Buysse et al. Obtained the internal consistency of the questionnaire using Cronbachchr('39')s alpha of 0.83. Farahi Moghadam et al. (2012) have also confirmed the validity and reliability of this questionnaire in Iran; Cronbachchr('39')s alpha coefficient of this questionnaire was 0.78 to 0.82. All instruments were completed by asking the elderly at two times, before the start of the study and in the eighth week of the study. In order to intervention in the experimental group, the elderly performed a sports activity protocol designed by a sports physiologist with the help of a researcher and under the supervision of the centerchr('39')s physiotherapist for 8 weeks and 3 times a week during dialysis. Exercises were performed due to the age of the samples in bed and during dialysis. In the first week, because the exercises were light and it was not possible to warm up and cool down in the real sense, the time to start the first exercise activity was 30 minutes in the first week. Then, 35 minutes in the second week, 40 minutes in the third week, 45 minutes in the fourth week, week. The fifth and sixth week were considered 50 minutes. One-half of the exercise time was devoted to aerobic exercise with a minibike (small bike) with arms and legs, and the rest of the time was equally devoted to other resistance exercise. In the first session, the method of conducting research, the rules of participating in the sessions, the impact of exercises on the body and how to do exercises were presented. At the beginning of each exercise session in the intervention group, vital signs were assessed and with the permission of the physician, the patient participated in exercise. Exercise started 30 minutes after the start of dialysis and stabilization of the patient. In the control group, except for routine interventions, no intervention is performed, but they were assured that if the research results are effective in the experimental group, exercise sessions will be held for them.

By comparing the quality of sleep between the first and eighth week of research in the experimental group, it was found that after exercise, sleep quality improved significantly (p <0.0001) but in control group the sleep quality between the first and eighth week of the study was significant reduced (P = 0.001). Comparison of the mean of sleep quality between the experimental and control groups before the study was statistically significant (P = 0.035). The control group had better sleep quality but the mean of sleep quality between the two groups in the eighth week of the study was significant (p <0.0001) and sleep quality was better in the experimental group than the control group.

The results of this study, in addition to being effective in increasing nursing knowledge, can also be used as a safe and low-cost method to improve sleep quality in the elderly undergoing hemodialysis