فهرست مطالب فاطمه بهرام نژاد

Professional autonomy and commitment are factors influencing the retention process in the nursing profession, job satisfaction and quality of care in Critical Care Units (CCUs). The level of education of nurses plays an important role in their ability to develop autonomy and commitment. This study was conducted with the aim of investigating the relationship between autonomy and professional commitment with the level of education.

The present study is a cross-sectional study was conducted in the year 2021 in the CCUs of hospitals affiliated to Qom University of Medical Sciences. The study population consisted of 160 nurses working in CCUs who were selected by available method. Research tools included demographic questionnaire, autonomy and professional commitment questionnaire. In order to determine the relationship between the variables, Pearson correlation, analysis of variance and independent t tests were used.

According to the findings, the average score of professional commitment in the CCUs in general (12.82 ± 91.14) and the average score of professional autonomy in nurses (74.10 ± 15.35) was reported, which shows the commitment and high professional autonomy of the nurses working in these units. Among the different dimensions of professional commitment, the highest score was related to engagement with the nursing profession with an average of 3.63 ± 0.78 and the lowest score was related to understanding of nursing with an average of 3.02 ± 0.56. Professional autonomy in the performance-based autonomy dimension had the highest mean (25.26 ± 6.31) and value-based autonomy dimension had the lowest mean (23.87 ± 6.15). Professional autonomy had a significant relationship with the level of education (P = 0.020).

The findings showed that there is a significant relationship between commitment and professional autonomy. Therefore, familiarizing nurses with the factors affecting professional autonomy, including increasing and updating knowledge, can be effective in increasing professional autonomy. Considering the autonomy in the performance of nurses in CCUs, it can increase the quality of care by increasing professional commitment. Also, the findings showed that considering the limited level of education, it cannot be concluded that nurses with a bachelor's degree show higher autonomy and professional commitment.

Recognizing the pivotal role of lifestyle in preventing diabetes among prediabetic individuals, this study aimed to assess the impact of a cognitive behavioral program on their lifestyle.

This quasi-experimental study took place between July 2020 and April 2022 in specialized diabetes clinics affiliated with the Institute of Endocrine and Metabolism Sciences at Tehran University of Medical Sciences. Forty-two prediabetic individuals participated in the research through simple random sampling. After random allocation to both groups, data were collected using the International Physical Activity Questionnaire, Adolescence Food Habit Checklist, and Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ).

The findings revealed a statistically significant difference in the dietary habits of adults in the intervention group before and after the intervention (p<.001, p=.480). Additionally, there was a statistically significant difference in tobacco dependence between the intervention and control groups before and after the intervention (p=.084, p=.241). The average dietary behavior score for the intervention group was 19.23 (SD=1.86) compared to 15.95 (SD=2.26) for the control group. The cognitive behavioral program significantly increased dietary behaviors in the intervention group (F=27.87, P<.001).

This study underscores the effectiveness of educational interventions utilizing cognitive behavioral programs in addressing the physical, behavioral, cognitive, and social aspects of smoking cessation and dietary habits among prediabetic individuals. Such models hold promise for inclusion in educational programs aimed at diabetes prevention.

Delirium is a multifactorial phenomenon that can be influenced by demographic factors. The present study was conducted with the aim of determining the relationship between demographic and clinical components with the occurrence of delirium in patients hospitalized in the intensive care unit of hospitals affiliated to Kurdistan University of Medical Sciences.

The present study was conducted between June 2021 and August 2022 in Kurdistan province and on the number of 118 patients hospitalized in the intensive care unit who were selected by available sampling method. The evaluation of delirium between the hours of 4 and 8 in the afternoon was checked by the researcher. The patients were divided into two groups and both groups were evaluated for delirium with the CAM (ICU) tool. The data were analyzed with the help of STATA version 12 software. A significance level of P<0.05 was considered statistically significant.

Most of the patients participating in the study did not have delirium (56.78%). A significant relationship was observed between marital status, education level and the reason for hospitalization with delirium (p<0.05). Also, body temperature, blood pressure and heart rate had a statistically significant relationship with the occurrence of delirium (p<0.001).

Because the core of delirium management protocols is based on prevention and diagnosis, evaluation and compilation of the accurate history of patients in the form of demographic components can play a significant role in the prevention and management of delirium.

Applying knowledge transfer and study findings in health care systems can help to save millions of lives. Also, this process plays a role in preventing financial losses in the health field. Considering the process of knowledge translation in the final defended thesis, this study was conducted with the aim of analyzing the knowledge translation of master's theses in nursing and midwifery, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences.

This study was a descriptive study using census method that was conducted on the collection of Nursing and midwifery master's theses documented in the Faculty of Nursing and Midwifery, Tehran University of Medical Sciences from 2001 to March 2019. According to the researcher-made form, the topics of theses were analyzed with the aim of analyzing the knowledge translation. In the next step and in a qualitative approach, the content of the educational messages for the contacts of theses was examined.

In the field of nursing, the topics of care and nursing profession, target communities of patients and nurses, and cross-sectional descriptive and clinical trial method were the most frequent in the studies in nursing. In the field of midwifery, the topics of midwifery care and patient education, target communities of patients and midwives, and clinical trial and quasi-experimental methods were the most frequent in the studies. In the qualitative approach, the studies were categorized into four main themes: clinical dimension, educational dimension, research dimension and management dimension.

The results showed that the attention that the results of a study can be used in which departments and for which groups is considered in nursing and midwifery theses. However, there is still a long way to reach the standards of knowledge translation and application of the results by the stakeholders. It is recommended to hold training workshops on knowledge translation and consider encouraging the research team to take steps towards knowledge translation in this field.

According to a global report, 47 million people are currently living with dementia, and due to the aging population, its prevalence is expected to triple by 2050. In the future, Iran is expected to experience a significant increase in the elderly population. Currently, in Iran, the prevalence of dementia among individuals over 60 years old is 7.9%. Therefore, this group represents a significant population that warrants further research (1). The best understanding and explanation of human experiences come from first-hand sources, specifically from people who have experienced those phenomena. Therefore, reliable research sources place great emphasis on including the voices of these individuals (2). Qualitative research out for its collaborative, inclusive, and flexible structure, enabling the exploration of complex issues, including mixed or ambiguous attitudes (2). It can reveal the profound experiences and core values of people with cognitive impairment that may not emerge in quantitative studies. Additionally, qualitative research excels in vividly portraying these experiences and values (3). Throughout history, people with cognitive impairments have been marginalized from engagement in health and social research, resulting in their voices being inadequately represented in such studies. (2, 4). Instead, their perspectives have been channeled through their legal representatives or guardians, a practice that often entails constraints. These limitations include the inability to accurately predict the patient's decision-making process, the amount and manner of information provided, and the weight of decision-making responsibility placed on them (5). Furthermore, excluding these individuals from the research process can dehumanize them and perpetuate negative stereotypes about people with cognitive disorders. This also contributes to power imbalances (2). Therefore, it is crucial to develop strategies that ensure the safe participation of these individuals in research endeavors. Through these efforts, we can improve our understanding of policy and measures aimed at promoting health and well-being (6).

Many employees present at work when they are sick, and it is high among medical professionals. The effect of presentism was confirmed on the well-being of nurses, professional burnout and dissatisfaction. The excessive demand to nurses highlights the need to ensure a resilient workforce. Resilience is considered as a personal capacity that enables nurses to adapt to the demands of the workplace. This study was aimed to investigate critical care nurses presentism and its relationship with their resilience

 This was a descriptive in which 300 critical care nurses was selected randomly and responded to the research questions, including resilience and presentism questionnaires in addition to demographic variables. Data were collected online and the SPSS software was used for analysis.

 The findings showed that half of the nurses were in their fourth decade of life; 87% were women and the majority have a bachelor's degree. The majority believed that the scheduling was not done according to their request. Almost half of had an average level of presentism; and the resilience of the majority was also above average. After removing the effect of confounding variables, there was a relationship between presentism and resilience in the regression model (p<0.001). According to the coefficient of determination, the regression model could predict %91 of variance.

 According to the results of the present study, managers are advised to take steps to improve the quality of care by planning to reduce presentism while increasing the resilience of nurses.

Nursing grand rounds are one of the potential factors for providing up-to-date evidence to nurses and nursing students and their use at the patient's bedside. Identifying the visible and hidden angles of this experience can help to improve this approach.  Based on this, this study was exploring the experience of undergraduate nursing students from Grand Round.

This study is part of a qualitative study with an exploratory sequential interventional combined approach that was conducted with the help of conventional content analysis. For this purpose, 25 undergraduate nursing students of the 7th semester, who had internship experience in intensive care units in the Grand Round method, were purposefully included in the study. Then, with the help of semi-structured, in-depth, and face-to-face interviews with an average of 40 to 60 minutes, the experiences of these participants were extracted and after recording and implementation, they were analyzed with the help of Granheim and Lundman's approach.

The mean± SD age of these students was 21.3 ± 10.8 years. From a total of 25 interviews conducted with the participants, 423 primary codes were extracted. After merging the codes that had similar content and meaning, three main categories of internship purposefulness, withdrawal from island education and perceived challenges appeared with 9 subcategories.

Since the participants in the study claimed that with the help of this approach, education at the bedside is targeted and in fact, they are faced with a new approach in education, it is necessary to take steps to identify this approach and try to solve the challenge of this approach.

The early mobility of a patient hospitalized in the intensive care unit (ICU) is a very complicated issue and requires coordination between the departments and between all ICU staff, including physicians, nurses, and physiotherapists. Early mobilization program is safe and feasible and has positive results for the patient, medical staff, families, and health system. The present study aims to determine the barriers to early mobility of patients admitted to the ICUs of hospitals in Kohgiluyeh and Boyer-Ahmad Province, Iran.

This is a descriptive cross-sectional study conducted in 2020-2022. The study population consists of the ICU staff of hospitals in Kohgiluyeh and Boyer-Ahmad Province, including physicians, nurses, and physiotherapists. Sampling was done by a census method. The data were collected using a demographic form and a researcher-made questionnaire of early mobility barriers of ICU patients and analyzed in SPSS software, version 18 using descriptive and inferential statistics.

In the present study, 174 nurses, physicians, and physiotherapists answered the questionnaire, where 57.8% were female and 59.8% were single. Among the barriers to early mobility, the patient-related barriers had the lowest mean (0.411±0.108) and cultural barriers had the highest mean (0.478±0.146).

It is necessary to investigate the barriers to early mobility of patients admitted to the ICU of study hospitals, especially the cultural barriers. In this regard, there is a need to design a clinical protocol to manage and reduce these barriers.

The aim of this study was to design, implement and evaluate a comprehensive spiritual care package in self-care and the meaning of life for hemodialysis patients. A mixed-sequential-exploratory study was performed in 2020-2021 in the population of hemodialysis patients referred to hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. First, in-depth, semi-structured interviews were performed with 18 patients undergoing hemodialysis with purposive sampling, and then based on these interviews, the patients' needs were extracted. In the quantitative phase, 60 patients with inclusion criteria were included in the study. Intervention The intervention was performed every week for 8 weeks. The findings of the qualitative section included the two main categories of mortality with the subcategories of death anxiety, pessimism about life, spiritual pain, and feelings of abandonment. The second subclass of resilience with the subclasses of the joiner ring with the divine essence was a reflection on creation, purpose-making, and the harmony of the soul. In the quantitative ward, self-care performance with an average of 120.86 (19.00) and meaning of life with an average of 40.06 (10.45) after intervention in hemodialysis patients had increased. The results of this study showed that although there are negative thoughts and anxiety of death and annihilation in hemodialysis patients, but spirituality and spiritual beliefs can be an effective aid in accepting the disease and a good support for promoting physical, mental and social health in Hemodialysis patients..

Various factors play a significant role in shaping the professional identity of nursing students, and among these factors, the impact of the hidden curriculum holds utmost importance. However, this process remains still unknown.  The aim of the study is to explore the role of hidden curriculum in the formation of professional identity among undergraduate nursing students.

Methods & Materials: 

This is a qualitative research using the grounded theory approach. The participants in this study included 35 undergraduate nursing students from Tehran University of Medical Sciences during the 2020-2021 academic year who participated in semi-structured interviews. The interviews lasting between 30 and 60 minutes were conducted with each participant. Subsequently, the interviews were transcribed and analyzed following the framework proposed by Strauss and Corbin in 2008.

After analyzing the data, three main categories and 12 subcategories have emerged. The theory developed in this research was formed through the core category of “identity instability within the nursing profession”. The main categories that emerged were “ambiguity and lack of motivation in professionalization”. The study identified "the governance of a discriminatory culture" as the underlying process, while “the promotion of demotivation resulting from inefficient patterns” served as the basis of this study.

Based on the study's findings, the process of developing a professional identity can be metaphorically likened to a river. In this analogy, discrimination serves as the clouds hovering over this river, casting a shadow on the identity development process. While inefficient patterns can be likened to lightning bolts that further complicate the process. Furthermore, the rocky bed of the river, symbolizing the lack of motivation among learners towards professionalism, makes it even more challenging to build a strong professional identity.

The present study reviews published studies on the effects of antipsychotic use in the treatment of delirium in the elderly in order to determine the effect of antipsychotic drugs on the prevention and treatment of delirium in the elderly admitted to the intensive care unit and the possible side effects of these drugs in this group of patients.

The present review article was conducted in the year1399-1400 by searching relevant keywords in English and Persian in national and international databases. 70 studies were included in the study in the first phase. After deleting duplicate and unrelated studies, 48 studies remained, and finally 19 studies were excluded due to problems such as the lack of eligible criteria for this study, and the remaining 29 studies in this article were reviewed.

Haloperidol, dexmedetomidine, risperidone, olanzapine, quetiapine, promazine, and clozapine are some of the common antipsychotic drugs used to treat delirium in the elderly. Although in some cases the use of these drugs can reduce the symptoms of delirium, but it can also cause side effects that include increased cerebrovascular complications, increased blood pressure and heart rate, dizziness, myocardial infarction, increased QT interval, tachycardia sinus, T-wave reversal, increased ST-segment elevation, ventricular atrial block, metabolic problems, sodium deficiency, hyperglycemia, pneumonia, and deep vein thrombosis.

According to the evidence obtained from the articles, the use of antipsychotics in the prevention and treatment of delirium in the elderly is not recommended, and in some cases it seems that the risk of using antipsychotics in the treatment of delirium in the elderly outweighs the benefits of using it. Therefore, due to the lack of sufficient evidence for the beneficial role of these drugs in the prevention and treatment of delirium in the elderly, it is recommended to pay more attention to preventive measures against delirium in this group of patients.

Addressing the issue of health literacy in patients undergoing hemodialysis by following the treatment regimen and using health services can be an effective tool in improving the care services system to planners and health officials. Therefore, this study was conducted to determine the relationship between health literacy, adherence to treatment regimen and the use of health services utilization in hemodialysis patients referred to hemodialysis centers of Chaharmahal and Bakhtiari province, 2019.

This descriptive correlational study was conducted in 2019 on hemodialysis patients referred to hemodialysis centers in Chaharmahal and Bakhtiari province. A total of 162 patients undergoing hemodialysis were selected to take part in the study by convenience sampling method based on inclusion criteria. The data collection tools included demographic information questionnaire, Iranian urban population health literacy questionnaire (HELIA), treatment adherence questionnaire in hemodialysis patients (ESRD-AQ) and a researcher-made questionnaire on health services utilization. The validity and reliability of the questionnaires were reviewed and confirmed. Study data were analyzed by SPSS software version 23 using descriptive and inferential statistics.

According to the findings, the mean score of health literacy of the samples was 112.89 ± 26.04 and the majority of them (30.86%) were inadequately literate. In terms of adherence to the treatment regimen, the majority of samples (66.67%) adhered to the treatment moderately. Regarding the use of health services utilization during the past year, the majority of samples (68.52%) had not been going for emergency visits, and most of them (54.32%) had not been hospitalized. Among patients who needed to be hospitalized in the past year, the people who had been hospitalized once before were at majority (26.54%). Also, in terms of the number of days being in hospital, the majority of samples (70.99%) had been hospitalized for less than 5 days. Data analysis by Spearman correlation coefficient showed a significant relationship between health literacy and treatment adherence (P = 0.000). However, no significant relationship was found between health literacy and use of health services utilization and also between adherence to treatment and using health services utilization.

Nurses 'knowledge and awareness about patients' health literacy and its promotion can lead to more effective education in these patients and consequently the rate of following more treatment and using health services in these patients is reduced and the ground for Reduce treatment costs and hospitalization rates, which are largely the responsibility of the government.

The majority of nursing students believed that their knowledge in the field of pharmacology is far from the desired level, which can be due to the large volume of intensive one-semester content and ineffective teaching of the pharmacology course. Accordingly, this study has determined and compared education with the mobile application and puzzle classroom on memorization of pharmacology course for undergraduate nursing students.

This quasi-experimental study was performed between 2020-2021. Seventy, 4th and 5th semester nursing students were divided into two groups using a table of random numbers. One group was taught through the mobile application and the other group was taught through the puzzle classroom. Before and one month after the intervention, students were tested in clinical reasoning. Data were analyzed using software version 16 and independent t-test, paired t-test and descriptive statistics.

The findings of this study showed that there was no statistically significant difference between the memorization score of the pharmacology course of the puzzle classroom with education through mobile application compared to before and after the intervention and also in comparison between the two groups.

Based on the findings of this study, both puzzle classroom and teaching through mobile application can be used to enhance learning pharmacology among undergraduate students.

The professional identity of nursing students was defined as the primary trend in becoming a profession. The present study aimed to explore the factors affecting students' professional identity as nurses.

This Study is a qualitative content analysis from May 2019 to October 2020. The participants were contributed through purposefully sampling. Data were collected through in-depth semi-structured interviews. The duration of each interview was between 30 and 60 minutes. Interviews continued until data saturation. Data analysis was performed simultaneously with Graneheim and Lundman approach.

123 open codes with five subcategories and two categories were extracted. In the present study, "belongingness" was explained as the central theme. Two categories, "positive role model in the education process" and "The perception of the society towards the nursing profession," were explored.

The present results showed that the identification of nursing students is influenced by belonging influenced by the nursing community and the general community. In addition, the community’s appreciation of the nursing profession and the approval and respect for the nursing profession among the community members have been considered crucial factors for nursing students to become good nurses. Due to the importance of growing a belonging and better understanding of professional identity by nursing students in the educational period, the development of teachers’ abilities as a model and creating a platform for recognizing the professional identity of nursing among community and medical science students is recommended.

 Moral distress is one of the important issues in the field of medical ethics that can have different effects on nurses, patients and health systems. One of the important effects of this phenomenon is professional stress in nurses. The aim of this study was to determine the relationship between moral distress and occupational stress of nurses in Tehran University of Medical Sciences in the care of Covid 19 patients.

 This descriptive-analytical study was performed on a sample size of 265 nurses working in the ward 19 in the hospitals of Tehran University of Medical Sciences in 2021. Sampling was done by stratified and simple random method. Data were collected using a demographic questionnaire, Corelli Moral Distress, and Wolfgang Occupational Stress. Then they were analyzed by SPSS software version 16 using descriptive (percentage, frequency, mean, standard deviation) and inferential (Pearson correlation coefficient) statistical tests.

Ethical Considerations: 

In this study, criteria concerned with moral principles as confidentiality,  personal satisfaction and freedom of participants in cooperation or non –cooperation during the study  process have been observed.

 The results showed that moral distress with a mean standard deviation of 99.52±  26.32 was at a low to moderate level. Also, the mean and standard deviation of occupational stress was 80.32±10.40. There was a statistically significant relationship between moral distress and nurses' professional stress (p <0.001).
 

 Caring for Covid 19 patients increases nurses 'stress, which has a positive effect on nurses' moral distress. Therefore, it is suggested that due to the existing conditions, necessary measures should be taken to reduce stressors.

Educating students in a safe environment such as simulated centers can be effective in providing educational services and preparation for clinical work. Accordingly, the present study was conducted with the aim of designing, implementing and evaluating clinical pharmacology simulation training method for nursing students.

This study was performed in 2019-2021 in three main phases of design, implementation and evaluation of Pharmaceutical Skills Center in Clinical Skills Center of Tehran School of Nursing and Midwifery. First, the design phase was accomplished by preparing the space and the desired drugs. Due to the prevalence of Covid-19 disease, part of the implementation and evaluation phase was carried out in the virtual context. Before and after the internship, students' knowledge, skills, satisfaction and clinical reasoning were measured using relevant questionnaires and analyzed using descriptive and analytical statistics.

The mean scores of the three variables in terms of pharmacology knowledge, drug calculation skills and clinical reasoning of pharmacology of nursing students before and after the internship were examined. The results demonstrated that all three means were significantly improved compared to that of before the intervention (P <0.001 and P = 0.001). The mean of total students' satisfaction with pharmacology internship course turned out to be 30.57 (3.2), which indicated the relative satisfaction with the training course.

In general, the results of the study indicated an improvement at the level of pharmacological knowledge, clinical reasoning of pharmacology and a significant improvement in pharmacological skills. Despite the limitations of Covid 19, this training method seems to augment the performance of nursing students in pharmacology.

This study was conducted with the aim of analyzing and exploring the spiritual intelligence of nurses working in Covid- 19 units.

The present sequential explanatory mixed method was conducted in 2020-2021 in Tehran University of Medical Sciences, Tehran, Iran. In the quantitative phase, 100 nurses working in Covid -19 units with inclusion criteria were included in the study and after analyzing the score obtained from their King Spiritual Intelligence Questionnaire, individuals with low, medium, and high mean(SD) scores were purposefully entered into the qualitative phase of the study. Twenty semi-structured interviews with nurses were conducted through social media and telephone. Data were analyzed using conventional content analysis approach.

The findings of the quantitative phase showed that the mean (SD) of spiritual intelligence of nurses working in Covid-19 wards is at a moderate level(58/5)41/53. In the qualitative phase, the two main themes of missing link communication with sub-themes, "lack of communication with family" and "lack of communication with the patient" and the theme of lack of sense of meaning with the sub-themes "no purpose in life", "change of sense of belonging", "change Attitudes toward "death" and "inefficiency" appeared.

According to the findings of the study that nurses 'spiritual intelligence is moderate and due to the frequent waves of this disease, to prevent a decrease in nurses' spiritual intelligence that affects the patient's spiritual care, comprehensive planning should be done.

Epidemics and their consequences have widespread effects on health care workers. Since hospital work environments are under high workload, complexity, and chaos, and are constantly changing due to different medical and care developments. During epidemic and pandemic crises, this situation is exacerbated by an increase in the number of patients and lack of resources, resulting in an increased likelihood of physical and mental vulnerability of staff. In this regard, the Covid-19 pandemic has caused physical and psychological challenges for hospital staff more than the previous epidemic, especially since the high prevalence and mortality rate of the virus is the most important challenge in this field. The other common unprecedented consequence of these conditions can be depression, anxiety, insomnia, and burnout of staff especially among the elderly and experienced staff. These secondary consequences have negative impacts on the quality of the services provided by the staff and act as major barriers to effective health care delivery. However, despite the many barriers, some facilitators can facilitate and improve the delivery of different services. For example, protective actions, social distancing, and widespread detective strategies, and detection of patients can play an important role in controlling the disease and thus reducing the workload of health staff.  Therefore, identifying barriers and facilitators in health care delivery for patients can be helpful in the management of this pandemic and we can rely on them to provide the basis for further studies and thus better planning. Therefore, this study aimed to explore the barriers and facilitators of caring for Covid-19 patients.

This qualitative study was conducted in 2020 employing Conventional content analysis Approach. In this study, semi-structured interviews were conducted with 11 physicians and 14 nurses who were working in the Covid-19 units of hospitals affiliated to Tehran University of Medical Sciences and were willing to participate in the study. In order to follow the social distancing, all interviews were conducted virtually via Skype, WhatsApp, and by phone at intervals of 45 to 60 minutes by an experienced interviewer. Some interviews were conducted visually and some orally at the request of the interviewee. Interviews were continued until the data saturation and not reaching the new code in the last three interviews. Data analysis was performed according to the proposed steps of Granheim and Landman. Finally, the interviews were transcribed, typed, and read several times to extract the original codes. The codes were then merged and classified based on the similarities, and finally the hidden concepts were extracted from the data.

A total of five themes and 14 subthemes were extracted from 340 initial codes in this study. The themes of this study were double-edged sword culture, individual factors, changes in care approach, organizational factors, and ethical challenges. In the theme of double-edged sword culture, two sub-themes of ‘collectivistic culture’ and ‘facilitator culture’ emerged. The cultural diversity of the community has created problems for the management of this disease and even the care of patients. Ignoring social distancing despite the warnings of Ministry of Health officials due to adherence to customs such as visiting and handshaking, had led to the spread of the disease and made its control difficult. Especially in the dominant Iranian culture, shaking hands is a custom and wearing gloves and masks is not a routine. On the other hand, in the culture of collectivism, they also help and cooperate with others, as they produced protective equipment and disinfectants through teamwork. Others encouraged inpatients by providing virtual communication through virtual networks which helped the treatment team and facilitated the caring process. Due to the rapid spread of the disease, the treatment team, in addition to being afraid of being a carrier, also had emotional problems due to quarantine. But having the idea that the nurses should not put stress on others, enduring psychological and physical stress as a result of the situation became more difficult. In this regard, in the theme of individual factors, three sub-themes of ‘fear’, ‘emotional emptiness’, and ‘ambassador of peace’ emerged. The nature of the disease, the use of protective equipment by the personnel, social distancing, changes in patient communication, changes in professional interactions, and feelings of powerlessness in virus management have all been challenges for the treatment team in caring for these patients. This condition has also affected nurse-nurse or physician-nurse interactions. But the pandemic made another change in the treatment team, and that was teamwork. Medical and nursing staff stated that they had not cooperated closely before for various reasons and refused to work as a team, but lack of equipment, insufficient knowledge about the disease had instinctively brought the treatment team closer to each other and all tried to do their best to eliminate the disease. Thus, ‘care metamorphosis’, ‘communication’, ‘missing links in care and treatment’, and ‘integration’ were the three sub-themes emerging in the theme of change in the approach to care. The themes of organizational factors included lack of necessary infrastructure, lack of equipment, manpower and lack of adequate space for patient care, but they were encouraged and continued to work with the support of hospital managers, the Deputy Minister of Health and the support of the Minister of Health. The four sub-themes of ‘structural problems’, ‘lack of manpower’, ‘insufficient equipment’, and ‘lack of organizational support’ were the most important obstacles for the treatment team in providing the best therapeutic performance. Another theme that emerged in this study was moral distress with two sub-themes of ‘guilt’ and ‘moral helplessness’ in which the individual raised issues such as lack of privacy, and not being at the bedside of a dying patient as his main concerns. Lack of privacy, reliance on writing the last name on the clothes and not introducing themselves to the patient at the beginning of the patient admission due to high workload and lack of time, elimination of the principle of respect for autonomy, lack of regular patient visits in the final stages of life except moral distress are discussed and classified.

According to the results, culture, individual, and organizational factors can be considered as both barriers and facilitators. But ethical challenges, as an important obstacle, can cause burnout in the medical staff. It is suggested that the authorities provide more psychological support to the treatment team, or give them a recovery period by employing new staff and reducing the workload of the treatment team. Also, getting help from a psychologist and psychiatrist, encouraging people to exercise, meditation and music can help strengthen the workforce in hospitals. Therefore, authorities should plan to increase the resilience of the medical staff in emerging and man- made phenomena such as the Covid-19 pandemic.

The use or non-use of non-invasive mechanical ventilation (NIV) is one of the most important concerns of the treatment team in acute respiratory distress caused by Covid 19 disease. Therefore, this review study was conducted to determine the use or non-use of this ventilation in respiratory distress caused by the Covid 19 pandemic. This systematic study was conducted in 2021 with the entry of 14 articles. For this purpose, the articles were reviewed by the authors with the help of article quality index. In response to 4 questions posed to the authors regarding non-invasive mechanical ventilation in Covid 19 patients, it was found that although this ventilation is widely used in Covid 19 patients, in any case, there is a need for further studies and clinical guidelines in This is especially mandatory.

The present review study was conducted with the aim of exploring what nurses should know about interactions of diet containing vitamin K with warfarin. Background. Warfarin is one of the most widely used oral anticoagulants. Dietary interactions, mainly due to vitamin K, are a common concern when consuming warfarin. In the meantime, the nurse, as the first person in the care chain and the main person in charge of patient education, can play an important role in reducing these interactions, which is a challenge for patients.

The present review study was conducted through searching out library as well as databases such as PubMed, Cochrane Library, Web of Science, Scopus, Up-to-date, OVID, CINAHL, Magiran and SID using Persian keywords of warfarin, dietary interactions, vitamin k diet, patient and nurse education and their English equivalents in the period 1999 to 2021. Out of a total of 30 articles found, 8 articles were reviewed after screening the articles.

The findings of this study showed that the amount of vitamin K intake in the diet should be kept constant. This is 90 to 120 micrograms per day. Patients should be properly and continuously educated about vitamin K in various foods and supplements. In the meantime, the role of the nurse as one of the pillars of patient education is very important and fundamental.

Due to the role of the nurse in educating these patients, it is recommended that education about dietary interactions be used using authoritative sources. It is possible with methods such as preparing a clinical guide, making a video and designing an application, and including tables of vitamin K levels in foods.

Today, following the aging population, the elderly have been faced with various social issues. The social well-being and health of the elderly are important but it has been neglected that is closely related to the quality of life. The Social Comfort Scale has not been validated in the Iranian elderly. The purpose of this study was to investigate the Psychometrics properties of Social Well-being Scale in Iranian Elderly.

This is a psychometrics properties study. The participants were 550 elderly people living in Tehran who were randomly selected from health centers. The study was conducted on the Social Well-being Scale. The data were analyzed using descriptive statistics and Pearson correlation test, exploratory factor analysis, and Cronbachchr('39')s alpha via SPSS v.22 software.

Participants were 58.9% male and 41.1% female. The mean age was 66.09 ± 6.67. Alpha Cronbachchr('39')s was 0.94. Structural validity by exploratory factor analysis showed that SWS consisted of five components (social integration, social acceptance, social contribution, social actualization, and social coherence).

Social Well-being Scale has good reliability and validity in Iranian elderly. Therefore, it can be used to assess the social well-being and health of Iranian elderly.

Self-care plays an important role in the management of care for patients with chronic renal failure. In order to provide effective education, it is necessary to identify problems, concerns and challenges in this group of patients. The aim of this study was to explore the challenges of self-care in the patients undergoing hemodialysis.

This study is part of a research project on adherence to treatment regimen in hemodialysis patients referred to hospitals affiliated to Tehran University of Medical Sciences in 2019. Patients with the highest and lowest mean (SD) scores of self-care were selected by the purposeful sampling method and finally, 22 in-depth semi-structured interviews were performed with 18 interviewees. All data were recorded, transcribed and analyzed using the conventional content analysis approach proposed by Graneheim and Lundman.

Findings from the data analysis included four categories: "the mismatch between the view of patient and the view of nurse", "missing loop training", "culture: a double sword ", and "dual role of religious beliefs".

The results of the present study showed that patients undergoing hemodialysis faced many challenges in self-care. They had difficulty in understanding the meaning of self-care and its implications. There is a need to plan for educating these patients and also changing their religious and cultural beliefs.