محمدعلی چراغی

Aesthetic leadership is a leadership style closely intertwined with ethical leadership. This style is values-based and focused on promoting ethical behaviors, with a strong ethical goal centered onvalues of justice and fairness. This study aimed to explore ethical aesthetics from the perspective of nursing managers at Tehran University of Medical Sciences.

This descriptive qualitative study used a customary content analysis with the approach of Graneheim and Lundman. The study population included the leadershipand management team of hospitals affiliated with Tehran University of Medical Sciences. Data collection was done through semi-structured, face-to-face interviews. The sampling method was purposive snowball sampling and participants were selected until data saturation was reached. A total of 28 interviews were conducted with matrons, supervisors and head nurses.EthicalConsiderations:The study was approved by the ethics committee.Ethical considerations such as obtaining informed consent, voluntary participation, explaining the research objectivesand ensuring confidentiality were adhered to.

After analysis, three main categories and sub-categories were identified. The main categories included aesthetic ethical thinking (self-discipline, absence the sense of superiority, respect in work, empathy and understanding of others, altruism, having a clear conscience, attention to human dignity, adherence to professional ethics principles), aesthetic ethical behavior (efforts to uphold employee rights, ethical judgments, ethical disciplinary methods, appreciation and recognition of staff efforts, adherence to justice, patience, forgiveness, altruism in behavior) and aesthetic ethical speech (respectful communication, courage in speech, fairness in speech, preservation of human dignity in speech, honesty and truthfulness in speech, respecting individuals' privacy in speech).

The aesthetics of ethics is an internalized ethical inclination that leads to actions (speech and behavior) grounded in human aesthetic values, goodness, benefitand truth. This research can strengthen the theoretical foundation of aesthetic leadership and complement the model of aesthetic nursing leadershipwithin the healthcare system. It also contributes to the objectification and clarification of the concept of beauty and the sublime beauty of ethics in organizational life and nursing leadership and management in the Iranian healthcare system.

The consideration of the aesthetic dimension in leadership has the potential to transform organizations. Therefore, it is imperative that nursing leaders and managers acquire a concrete and systematic understanding of nursing aesthetics. Qualitative research should be employed to objectify this aspect of nursing across all its domains, including management, leadership, clinical practice, education, and research. This study aimed to elucidate the role of aesthetics in the perceptions of nursing leaders at Tehran University of Medical Sciences.

This qualitative study utilized conventional content analysis, adopting the Graneheim and Lundman approach in 2023. The study population consisted of leadership and management teams from hospitals affiliated with Tehran University of Medical Sciences. Data was collected through semi-structured, in-depth, face-to-face individual interviews. Purposive and snowball sampling techniques were employed to select participants until data saturation was reached. A total of 28 interviews were conducted with Directors of Nursing, supervisors, and head nurses.

A total of 525 codes were extracted from the 28 interviews. Subsequent analysis revealed three primary categories and their subcategories. The core themes identified in the final analysis were spirituality aesthetic thought, ethical aesthetic thought, and intellectuality aesthetic thought. These findings suggest that spirituality, ethics, and intellectuality are fundamental aspects of aesthetics  thought of aesthetic leaders.

This research has strengthened the findings of  the previous studies, contributing to the theoretical foundation and development of the literature on aesthetic leadership. Methodologically, it complements the model of aesthetic nursing leadership within healthcare systems. Consequently, this study can facilitate the objectification and elucidation of the concepts of beauty and sublime within healthcare organizations and nursing leadership in the Iranian healthcare system.

Compared to other hospital departments, emergency department (ED) nurses experience higher levels of occupational fatigue. However, despite the importance of fatigue in EDs, limited studies have investigated the issue. Therefore, the present study aimed to identify factors affecting ED nurses’ fatigue with a systemic approach and provide a comprehensive model of fatigue.

The present study was the first phase of a mixed-methods study with an exploratory sequential design that was conducted qualitatively. Data was collected using a semi-structured interview technique among ED nurses in TUMS hospitals in Tehran. The data was analyzed with a systematic approach and qualitative content analysis method. To check the credibility and trustworthiness of the study results, Goba and Lincoln criteria, including transferability, peer review, and member check, were used.

Extensive factors were identified in the four levels of nurses’ work system, including individual factors, work unit, organization, and extra-hospital factors that could facilitate or prevent nurse fatigue. Specifically, the categories that were mentioned the most by the nurses were aggression and conflict with visitors, ED workload, understaffing, crowding and noise, obligatory overtime, acknowledgement, visitor’s expectations, reporting (paperwork), and clients’ distrust of nurses. Finally, based on the qualitative results, a conceptual model of factors affecting occupational fatigue of ED nurses in Tehran was presented.

Traditionally, fatigue management programs in hospitals only consider issues related to work shifts and sleep hygiene. However, the results of the present study revealed other fatiguing factors in the work system of ED nurses. These findings can help health system decision makers and HFE experts in designing effective fatigue risk management systems in Iranian hospitals, especially in emergency departments.

Context:

 The intention to quit is a step before the actual leaving the job. The complex conditions of treating covid 19 patients, nurses physical pressures and mental tensions during the covid-19 pandemic, encourage them to quit their jobs. The present study was conducted to determine the factors related to the willingness of nurses to quit during the covid-19 pandemic in the hospitals of Isfahan city.

416 nurses working in the hospitals of Isfahan participated in this cross-sectional descriptive-analytical research in the form of quota sampling and systematic random stratification. The data collection tool was a researcher-made questionnaire with high validity and reliability (0.95) that measured the intention to quit of nurses during the covid-19 pandemic in 4 dimensions of individual, occupational, organizational and transorganizational factors. SPSS version 25 software was used for data analysis.

Findings :

The average score of nurses' willingness to leave during the corona pandemic in Isfahan hospitals was 2.98 out of 5. The average of Transorganizational factors (3.30) was higher than the average of organizational factors (3.05) in driving the intention to leave of nurses. A relation was seen between demographic information such as; received compensation, secondary job and total income and intention to quit.

During the covid-19 pandemic, several factors lead to the quit in the group of nurses. Since the willingness to leave the job in public hospitals is higher than in private hospitals, managers of these organizations should pay more attention to evaluating factors, determining their impact and making effective decisions.

The outbreak of the Covid-19 pandemic caused fundamental changes in the field of human resources, especially among the employees of the healthcare system. Nurses working in medical centers and hospitals face many challenges during the provision of medical services, which affect the quantity and quality of their services. Challenges that hinder the realization of joining professional nursing. Examining all challenges from the perspective of nursing metaparadigm will lead to the formation of a deep and broad view of the variety of problems and their effects on nursing.

A narrative review was used to write this letter to the editor.

Being aware of the challenges in society and applying effective solutions leads to creating a systematic vision and active performance. Challenges achieved in 3 levels; Macro, mezo and micro are placed in 4 dimensions of person, environment, quality of health and nursing.

Paying attention to the variety of challenges and their effects from the philosophical point of view and metaparadigm of nursing will broaden the vision of the leaders and managers of this profession. Improving the professional competence of nurses depends on having the right environment and professional requirements. The goal of health for all, which is one of the goals of sustainable development, will be realized with the realization of professional nursing in the society.

With the use of nursing theories in patient care, It was hoped that standards of care can be improved for patients, reduced the cost of nursing care and quality of life of patients co Reduced costs of nursing care and quality of life of patients correction.

Using Neuman theory as a solution in Iranian nursing care challenges.

In order to find studies and resources related to Neuman Theory and Iranian nursing care,  we used three-step techniques. digital databases in the National Library of Medicine of Iran (Elsevier, Nursing consult, Proquest, Scopus, ...) and Google scholar and Persian databases including Irandoc, Iran Medex, Magiran, SID and Medlib was used. Search articles from 1980 to 2016 in English and Persian papers from 1380 to 1395. Then, based on analysis of various studies on the use of Betty Neuman's theory challenges were identified. in early search 803 artcle was found. 231 article was related to the theory Newman, education and nursing care and at the end of the second stage only 23 articles reviewed. 12 cases (52%) articles related to nursing education, 8 (34% ) in relation to nursing care and other articles associated with the gap between theory and practice.

The results of the studies showed that the use of the Neuman Theory in the Iranian nursing system is very poor. More nurses in hospitals, provided nursing care to patients in the secondary level of prevention And their activities in other areas and other prevention levels in community settings and Holistic care, is very limited and it is inconsistent with the philosophy of holistic nursing care.

Neuman's theory focuses on a community vision is to provide nursing services.Due to the importance of the country's nurses' knowledge and skills in health promotion community, empower the nurses in this field is a special place of access to the education system in need of objective review Nursing and health care system in order to use the services of nursing theory nurses to provide care to care to the individual and society are ready.

The outbreak of the Covid-19 pandemic has caused many nurses to leave their service. The purpose of this research is to design, validate and reliability of the questionnaire of factors related to intention turnover of nurses during the covid-19 pandemic.

 In this research, the conceptual model of occupational stress, quality of life and willingness to leave the job was first used, and then, in order to design the questionnaire items, the studies published in several databases. Content and face validity were quantitatively calculated and in the last step, Cronbach's alpha coefficient were used to calculate the reliability of the questionnaire.

Content validity index and content validity ratio in all four dimensions  factors were also obtained in the range of 0.8 to 1. The face validity of the questions was between 4.5-1.2. In checking the reliability of Cronbach's alpha coefficient, a score higher than 0.7 was obtained for each dimension of the questionnaire.

The above-mentioned questionnaire has good validity and reliability..

Identification of competencies is necessary base for a succession plan and efficient human resource management. Studies show that this important issue has been neglected by using the competency model at the middle-level nurse managers.
Since, the methods based on fuzzy logic provide the possibility of mathematical formulation of ambiguous concepts, such as competence. The aim of this study was to design a competency model for middle-level nurse managers using FDM in the second half of 1399.

This study was conducted according to health system management studies. The population included all managers of nursing services (matrons) of hospitals affiliated to Tehran University of Medical Sciences. Census sampling used and research samples included 14 nursing service managers (as experts). After reviewing literatures, an initial conceptual model was designed. In the following, two next steps were conducted as a survey form was used to receive the opinions of experts confirming the model leveling. In the second step, the indicators were screened using the FDM.

All participants were female and 9 people had a master degree. The experts' agreement with the model leveling was 90%, which indicated that it was approved. In FDM, the indicators with crisp values higher than 0/7 were confirmed by experts. The design model consisted of 3 dimensions technical, relational, perceptual, 6 components, 14 indicators and 28 sub-indicators.

This study showed that the criteria for selecting middle-level nurse managers include various dimensions of competence including technical, relational and perceptual. Senior managers can use the results of this research to achieve an appropriate planning for succession plan.

Patient-centered care (PCC) is a valuable and logical concept in the nursing discipline. The aim of this study was to development and psychometrically evaluate a patient-centered care questionnaire in CICUs (PCC-CICUs).

This methodological study was performed in two phases. The first phase is the qualitative stage by grounded theory study in which, a literature review was carried out for tool development. The second phase includes a psychometric evaluation of the PCC-CICUs. The tool’s content validity was performed by skilled nurses in the field of patient-centered care. The reliability of the tool was assessed by Cronbach's alpha and its stability was measured by internal consistency and reliability. Exploratory factor analysis was used to determine the construct validity.

The PCC-CICUs was evaluated for validity and reliability. Exploratory factor analysis was used to assess the construct validity. The analysis led to the development of a tool with 28 items in four dimensions of patient and family empowerment, understanding the patient, skill and expertise, and respecting the patient and family, which accounted for 35.380% of the variance. Cronbach's alpha of the tool was 0.68. The test-retest method supported the stability of the instrument.

Patient-centered care questionnaire in cardiac intensive care units is a standard and accepted questionnaire to assess the amount of patient-centered care from the patients' point of view. Health care professionals can use the PCC-CICUs to assess their own and peers’ practice to detect potential areas for improvement in nursing care and help nurse managers with planning appropriate quality improvement programs.

Progressive visual impairment is one of the problems that threatening the health of patients and has the negative effects on their abilities. This study aimed to explore the health concerns of patients with Retinitis Pigmentosa (RP).

 A qualitative inductive approach was used. Eleven patients with RP, participated in this study in Iran. Patients were selected through purposeful sampling. Data collection was done through two methods of in-depth semi-structured individual interviews and field notes. Data analysis was performed using approach of conventional content analysis.

 The categories of "perceived health threat" and "perceived support needs", were extracted. The category of perceived health threat included sub-subcategories of "gradual decline in physical function", "sustained fluctuations in mental health", and "weakening of social capability". "need for socio-economic support", "need for educational support", "need for psychological support", and "need for a personal assistant" were extracted as sub-subcategories of perceived support needs.

 RP Patients faced with the problem of abilities impairment in various physical, mental, and social dimensions and need for support in society. So, to improve the health of these patients, members of the health group are suggested to develop a context-based wholistic care program through multidisciplinary cooperation.

In the time of emerging infectious diseases, quarantine is one of the necessary preventive measures to maintain public health. This study aimed at reviewing the determinants of quarantine compliance in epidemics in synchrony with the coronavirus disease 2019 (COVID-19).

A systematic scoping review of studies (2000-2020) on quarantine determinants was done in both Persian and English. PubMed, Embase ProQuest, Science Direct, Google Scholar, MagIran, SID, Iran Doc, and Element were searched using the following keywords: quarantine, social distancing, home quarantine, infectious epidemic, compliance, acceptance, adherence, and non-compliance in both Persian and English.

A total of 13,755 articles were found of which 10 eligible studies were included in this review. The main factors inhibiting adherence to the COVID-19 quarantine were financial problems following job loss, lack of adequate education and awareness, low levels of education, psychological pressures, difficulty of the quarantine period, lack of trust, and low supervision. Factors influencing adherence to quarantine included awareness, creating voluntary conditions, clear communication, offering assurance about jobs, moral commitments, high levels of education, and living in urban areas. Economic incentives and effective informative and training campaigns could increase public compliance with quarantine.

There is paucity of information about compliance with quarantine during COVID-19 pandemic, therefore, further studies on this issue are needed in Iran and other countries.

In the past, the war was mainly a "hard war" using military means, but now its form has changed to a more "soft war" type, which is basically diplomacy-based. Health professions have also recently entered this field, and nurses are using diplomacy because of their occupational nature, their various roles including advocacy. Given the proximity of the concept of advocacy to the nature of diplomacy and negotiation, we aimed to investigate the role of advocacy of nursing managers in nursing diplomacy.

This is a qualitative study with a conventional content analysis approach. Data were collected using in-depth unstructured interviews with 14 nurse managers at different levels through purposeful sampling.

After analyzing the data, three main categories of system advocacy (including subcategories: systematic thinking and holistic view, organizational affiliation), advocate for people (including subcategories: demonstrating the role of the nurse in service to people, the use of people-centered literature) and the use of advocacy in negotiation (including 3 subcategories: unifying positions with an emphasis on interests, finding common ground, focusing on the other sidechr('39')s concerns).

The findings of this study indicates that nursing managers are involved in diplomacy and relying on the advocacy role that is less paid attention in the clinic. They use it to achieve their organizational goals.

neglect as a global health issue threatens adolescents and their families' health. more resilient and compatible the adolescents, more successful to bunch bake the adversities. spirituality plays a true role in promoting adolescents' resilience. few studies investigated the neglected adolescents lived experiences. the aim of the current study is to explore the neglected adolescents considering the spirituality.

a total of 18 in-depth face to face interviews were conducted in this phenomenological study. Van manner analysis instruction was used to data analysis

"Creating a hopeful horizon (passive confrontation with the unknown future, drawing a vision, positive acceptance of circumstances, self-confidence, unyieldingness, positive meaning of self)", "Searching for the meaning of experience (learning from failure, searching for the meaning of events, The relationship between cause and effect of events ("and tolerance in the shadow of spirituality (patience, tolerance, trust in God, hope in God)" has been the result of analysis in this study.

neglected adolescents experience resilience under the shadow of spirituality.

Poor quality of sleep is a common problem among patients in the coronary care unit. The use of earplugs, as an uncomplicated non-pharmacological method, can improve quality of sleep in patients. This study aimed to investigate the effect of using earplugs on the quality of sleep in patients hospitalized in coronary care unit.

This study was a randomized clinical trial conducted in the coronary care unit of the hospitals affiliated to Tehran University of Medical Sciences. 72 acute coronary syndrome patients having the inclusion criteria participated in this study and written consents were obtained. Through simple random sampling, the participants were assigned to two groups of intervention and control. In the intervention group, earplugs were used for the first three nights after hospitalization for 45 minutes in the beginning of sleep. The quality of sleep was measured upon hospitalization and three days later using the Pittsburgh Sleep Quality Index. The data were analyzed by SPSS 16 using descriptive and inferential statistics (Chi-square, Fisher's exact test, independent samples t- test).

The mean ± standard deviation of quality of sleep for the intervention group using earplugs decreased from 8.11±3.00 (before the intervention) to 6.00±2.30 (after the intervention). It increased from 6.33±3.08 to 8.80±2.45 for the control group. The results of independent samples t- test showed a statistically significant difference between the intervention and control groups in terms of average change in the sleep quality score before and after the intervention (p=0.001).

It is recommended that nurses employ earplugs as a non-pharmacological intervention for improving the quality of sleep of patients in the cardiac care unit.

Self-concept or self-perception is a person’s own imagination and idea about himself/herself. Self-concept has a competent effect on one’s psychological and educational conditions, and can lead to either the individual’s growth and excellence or multiple harms. Self-concept in child laborers is an important factor in harm prevention and the provision of their required services. This analysis aims to clarify the self-concept in street child laborers compared with its classic definitions.
This concept analysis study was done using Walker & Avant approach. After an extensive review of the relevant articles, all papers with quantitative and qualitative research design were assessed, and based on that, the definition, uses, attributes, antecedents, consequences, and empirical referents of self-concept were extracted.
Street child laborers have to work because of their living conditions, and this fact has led to positive and negative changes in their self-concept. Specific traits of self-concept in child laborers are "being aware of own potential as a sense of responsibility towards family, and financial independence", "interacting with others and forming support groups while competing with each other", "the influence of various variables on internal and external dimensions of self-concept", "being flexible and influenced by education", "acceptance and compatibility with the existing status" and "lack of understanding of the ways to deal with the harm".
The self-concept in street child laborers should be deeply studied and compared to its classic definition to prevent physical, psychological and social harms by providing the required support and needs-based training.

Paying attention to spiritual needs of patients as an important aspect of care is not only essential for improving health consequences, but also to respect the dignity of patients. Spiritual care is the major core of the quality of life of patients and their families, which becomes possible through identifying the care needs of clients. Research has shown that the needs of a child and their family from the time of diagnosis of cancer change until the treatment stage and other stages of the disease. The patient child’s parents feel insecure and do not know how they should take care of their patient child. This study has been conducted with the aim of comparatively investigating the spiritual care needs of mothers of children suffering from cancer at early stages of diagnosis as well as terminal stages of the disease.
This descriptive-analytical study was conducted on 400 mothers of less than 14-year-old children suffering from cancer at early stages of diagnosis and terminal stages of the disease, hospitalized in blood and oncology wards for children of hospital throughout Tehran in 1394-95. All mothers whose children were hospitalized in the mentioned wards due to cancer and had the inclusion criteria were included in the study through available sampling. The inclusion criteria for the mother to enter the study were: having a child below 14 years of age, hospitalization of the child in the ward for at least two days, having early criteria for diagnosis and terminal stage of the disease (according to the documents available in the patient’s file, diagnosis made by the specialist, guidelines of the ward head-nurses, or the information of the child’s patent), as well as literacy (both reading and writing). The data collection instrument included patient spiritual needs assessment scale, which was translated into Persian and validated. This questionnaire included 18 questions about demographic information of the mother and her child (including 9 questions about the information associated with age, gender, disease, time of diagnosis, place of residence, treatments tried, having a relative with cancer, the number of hospitalization of the child during one month, and 9 questions about the information associated with age, marital status, education, housing situation, level of monthly income, support of social institutions, supportive resources in the family, and correspondent of the child’s disease. Spirit questionnaire includes 70 questions with a Likert scale and two open-ended questions. The first section includes 43 five-option items in relation with reflection of the spiritual care needs of the mother (“never” score 1, “rarely” score 2, “sometimes” score 3, “most of the time” score 4, and “always” score 5). The second section includes 27 four-option items with a Likert scale and questions the affairs that mothers may want the child’s nurse to do those cares for them. The options include: “absolutely disagree” score 1, “disagree” score 2, “agree” score 3, “absolutely agree” score 4). The lowest score of the first section implies more need of mothers to receiving spiritual care, and the lowest score of the second section suggests refusal by the mother to receive spiritual care by a nurse. This scale has no cut-off point, but considering the instrument’s median, the subjects were categorized into three groups of extreme, medium, and low, in terms of spiritual care. The data was analyzed by SPSS 18. The responses given to the open-ended questions of the questionnaire (10 persons from the early diagnostic stage and 20 from the terminal stage) were analyzed and classified in a directed way. Eventually, through a quantitative method, the frequency of the obtained themes was calculated.
Ethical considerations: After receiving confirmation from the ethics committee of Tehran University of medical sciences with the code of (9211196001_137223), the researcher visited the environment of the research and after receiving permission from the hospital officials and explanation about the study objectives, the written informed consent of mothers was received to participate in the study.
Findings: Most children in both groups had an age of between 5 and 14 years old, with 46.1 and 57.7% being in an early diagnostic and terminal stage groups, respectively. In both groups, around half of the children were male and the other half were female. Most of the children in both groups lived in Tehran. The majority of children in the terminal stage group (52.4%) had been hospitalized three times or more per month, while most children in the early diagnosed group (74%) had been hospitalized twice or less per month. A total of 97% of the children in both groups had a second-degree relative with cancer. Further, over 80% of children in both groups had undergone chemotherapy. In both groups, most mothers had an age of between 25 and 35 years old, were married, housewife, and an educational level of diploma. In most families, the main reporter of the family was the father, the average monthly income of the household was less than 250 Dollars and they had rented houses. A total of 59.1% of the families in the early diagnosed group and 44% of the families in the terminal stage group had been supported by social institutions.
The average of spiritual care needs in the terminal stage group was significantly higher than the diagnostic group (p The spiritual care needs in the mothers of the terminal stage group and willingness of the mothers in both groups across different stages of the disease are contemplative. Considering the progressive increase in the rate of cancer in children and spirituality as an inseparable part of the life of patients and their families, measurement of the spiritual care needs of mothers with children suffering from cancer is essential in care planning. Meeting the spiritual care needs should be taken into account in health policymaking through developing trust and companionship of the family, establishing a favorable relationship, providing a silent and peaceful place for mother’s praying, encouraging mothers to talk about their spiritual concerns, and holding praying ceremonies. Accordingly, it is suggested that spiritual care be incorporated in the comprehensive care protocol of these patients and their families.

Drug prescribing by nurses is a historic movement for the nursing profession and an essential part of the solution that the leading countries health care system applied in order to improve access and reduce patients waiting time to receive medication. Despite the increasing attention of the world to discuss nurse prescribing, the review of the literature indicates that there is no evidence in nurse prescribing in Iran. This study aimed to assess nurse prescribing context in our country.
Material & This study was designed as a descriptive qualitative study. The purposeful sampling method carried out through semi-structured interviews with various stakeholders of health care system, including policy makers, doctors and nurses. Data analysis was conducted using conventional content analysis and the coding of interviews was performed by MAXQDA software. To achieve the accuracy and reliability of the data, the Lincoln and Guba authenticity criteria were used.
Analysis of the recorded interviews of participants in this study resulted in 38 original codes, 5 sub categories and 5 main categories. The main extracted categories were "The theoretical context of nurse prescribing " with 2 sub categories, "Organizational context of nurse prescribing" with 3 sub categories, "Educational context of nurse prescribing", "Research context " and "The socio-cultural context of nurse prescribing,".
The views and perspectives of nursing policy makers and health care system stakeholders indicated there are many challenges in organizational, educational, research and socio-cultural context of nurse prescribing that require the problem based designing in nurse prescribing field.

Due to different reasons, nurses are always faced with numerous ethical issues in daily clinical practice. One of the most controversial issues is in relation to the nurse prescribing. This study aimed to describe the reasons for prescribing by nurses in some clinical situations.
This descriptive qualitative study was carried out with the participation of 19 nurses working in one of the educational centers of Tehran University of Medical Sciences through interviews in 2014. Purposeful sampling through semi-structured interviews was used to collect data. Data analysis was performed using conventional (inductive) content analysis and coding was done by the MAXQDA (2007) software. To achieve the accuracy and reliability of the data, the Lincoln and Guba authenticity criteria were used.
Analysis of the recorded interviews of participants in this study resulted in 5 subcategories and 2 main categories. The main emerged categories were" human values" (with three subcategories entitled "the priority of human life, "human conscience" and "sacrifice and dedication") and" organizational norms"(with two subcategories namely "governance of organizational rules" and" accountability system").
Despite being aware of the lack of legal authority to prescribe drugs, the participants of this study prioritize patient's life, due to adhere to ethical principles. The health system policy-makers are expected to facilitate the development of legislation and clear regulations of nurse prescribing in order to have a contribution in humanitarian action.

Presently, in many countries, certain groups of nurses are allowed to prescribe medicine. Despite the increasing attention of the world to nursing prescription and emphasis of the World Health Organization (WHO) on its implementation in regional countries, a review of literature indicated that there is no evidence of nursing prescription in Iran. Thus, this study aimed to assess the necessity of nursing prescription from the perspective of the Iranian nursing policymakers.
This descriptive qualitative study was performed through interviews with 14 nursing policymakers. The participants were selected through purposive sampling method. Semi-structured interviews were used to collect data. Interviews were conducted after coordination with participants and in their workplace. All interviews were recorded using a digital voice recorder. Interviews were simultaneously transcribed verbatim and analyzed using conventional content analysis through inductive approach. The coding was performed using MAXQDA software. To achieve the accuracy and reliability of the data, the Lincoln and Guba authenticity criteria were used.
Analysis of the recorded interviews resulted in the extraction of the 3 main categories of "the right to health and individual’s requirements", "the current situation of the clinical setting", and "nursing prescription outcomes".
The views and perspectives of nursing policymakers indicated that due individuals’ right to health and need for health care services, and also the positive outcomes that may result from nursing prescription, the necessity of its implementation is felt. However, there are challenges to its implementation that require the relevant authoritie's efforts to resolve them.

Perceived social support in emotional, informational ,and instrumental dimensions has an important role in minimizing the adverse effects of chronic health problems. Consequently, measuring social support is of paramount importance, particularly for evaluating supportive treatments provided to patients with heart failure (HF). The aim of this study was to evaluate the reliability and the validity of the HF patients’ perceived social support inventory.
This cross-sectional study was conducted in 2012 in Hamedan, Iran. Initially, five valid and standardized questionnaires were combined to generate a single inventory. The face and the content validity of the generated inventory were confirmed by 20 specialists in psychology and instrument development. Then, a convenience sample of 50 patients with HF was recruited and the validity and reliability of the inventory was assessed through calculating its content, face and construct validity, Cronbach’s alpha, and test-retest correlation coefficient. The data were analyzed through conducting the Kolmogrov-Smirnov and the Tukey’s tests and analysis of variance as well as calculating Cronbach’s alpha correlation coefficient. Measures of descriptive statistics such as mean and standard deviation were used for data presentation.
The Content Validity Index and KMO were 0.92 and 0.817. The test-retest correlation coefficient and the Cronbach’s alpha of the inventory were α= 0.895 and 0.87, respectively. Moreover, examining the correlation of the scores of the inventory with the scores of a standardized social support questionnaire yielded a correlation coefficient of r = 0.654, denoting an acceptable validity.
The findings of the present study indicate that the HF Patients’ Perceived Social Support Inventory has an acceptable validity and reliability. Consequently, this inventory is an appropriate disease-specific inventory for measuring perceived social support among patients with HF.

Difficulty in transferring knowledge to clinical practice or knowledge translation has been identified as one of the main barriers for utilizing research in medical sciences. It is estimated that up to 40% of patients do not receive treatment consistent with the best scientific evidence and 20% of health care are not needed or are harmful. The best approach to evidence-based care is the development and implementation of clinical guidelines (1).Variety of clinical evidence may affect patient care outcomes, and the clinical guidelines can help health professionals to provide the appropriate and effective health care. That does not mean that the guidelines can be considered a replacement for professional judgment. Clinical guidelines provide a framework for clinical judgment, patient preferences and exceptions (2, 3). The guidelines make it possible to obtain a clear understanding of the decision-making models for all stakeholders about riddles and great dilemmas of health (4). Clinical guidelines can lead to improve the quality of health, and reduce unnecessary, harmful or wasteful interventions. These guidelines may provide effective recommendations for the management of patients by healthcare providers and develop standards to evaluate the clinical practice of health professionals. Also, guidelines may have effective and useful content to educate healthcare providers and help patients and their families to make informed decisions (5).

Delirium has a high prevalence after cardiac surgery. Many studies were conducted on the etiology of delirium after the cardiac surgery, but its definitive reason has not expressed. Because the high percentage of these patients experience severe pain, this study was conducted to determine the relationship between pain and the incidence of delirium in patients undergoing cardiac surgery. This descriptive-analytical study was conducted on 40 patients undergoing cardiac surgery in one of the educational hospitals in Tehran in 2014. Patients were selected through convenience sampling. The incidence of delirium in patients was assessed twice daily on the second to fifth day after surgery through the CAM-ICU scale (Confusion Assessment Method -ICU). Also pain was assessed on the second post-operative day in two times, during the rest and during the nursing procedures through the Critical Care Pain Observation Tool (CPOT) in intensive care unit. Data were analyzed by using SPSS 16 and through the chi-square and Fisher's Exact Test, Mann-Whitney and McNemar test. Incidence of pain and delirium after the cardiac surgery was 95 and 45 percent respectively. 2.5 percent of patients experienced pain during rest and delirium together, while 20 percent of patients had suffered from delirium and pain during the nursing procedures. According to Fisher's Exact Test, this relationship was not significant, but there was significant relationship between some indicators of pain such as body movement (p=0.008) and muscle tone (p=0.02) with incidence of delirium. According to the results, there is no relationship between pain and incidence the delirium. Due to high levels of pain and delirium, it is proposed to implement the nessecary actions for reducing the incidence of these complications.

In order to improve service quality, there are various committees in hospitals including ethics committees, which may be among the most important and necessary establishments within the health care system. Hospital ethics committees are designed to ensure proper clinical decision-making and are responsible for monitoring the ethical provision of services in hospitals. They also aim to assist patients and health care professionals without interfering in the physician-patient relationship. This article was part of a comprehensive review study performed in 2014 and 2015 by searching database not restricted to any particular period of time. The keywords used to search the sources available in English included “hospital ethics committee”, “healthcare ethics committee”, “clinical ethics committee”, and “institutional ethics committee”. Since ethical counseling is one of the main tasks of hospital ethics committees, their existence in hospitals appears to be essential. There have been few studies on the functions of hospital ethics committees in Iran, and it seems necessary to investigate the activities of these committees in the country. Moreover, it is recommended that the Ministry of Health and Medical Education take more serious actions to establish and monitor ethics committees in hospitals throughout the country.

The hospitalization of infants in the neonatal intensive care units impact intense stress on the mother. If this stress continues, in addition to endanger the health of the mother, will have also a negative impact on the mother-infant attachment process. Spiritual well-being as a variable affecting the coping strategy and stress levels is important, as well as, identifying the coping strategies by the mothers in this situation was explored. In this cross-sectional and correlation study, data were collected during three months in 1392, from 191 mothers with their infants in the NICU of the teaching hospitals affiliated to Tehran University of Medical Sciences. Tools for data collection were Lazarus and Folkman's ways of coping questionnaire, Ellison & Palvtzyan spiritual well-being scale, Mills parental stress and a demographic questionnaire. Descriptive statistics and Pearson correlation test were used to achieve the objectives of this study. Spiritual well-being have a positive relationship with problem-focused strategy and inverse relationship with emotion-focused strategy (p<0.000). In subscales of coping strategies, seeking social support had higher and escape- avoidance had the lowest mean averages which was used by the mothers. No significant relationship was found between spiritual well-being and stress scores. In addition, between stress levels and type of coping strategies, no significant relationship was found out. According to the results of this study, it is necessary to consider stress factors associated with mothers. It is also necessary to strengthen the religious dimension of spiritual health, especially in women because of its association with problem-focused strategy.

Clinical nurses have a special opportunity to apply nursing models of evidence based approach. Using the models of evidence based nursing focuses on the importance of patients centered care models in order to provide quality care in the supportive environment for patient. This model provides a framework for nurses to take on the outcome of patient care and focus on the clinical decisions.
The aim of this study was to determine the effect of evidence based nursing practice based on IOWA model on nurse’s knowledge, attitude and practice working in endocrinology ward in 2011.
This study is Quasi experimental, with before and after design. The sampling method was census. Population was nurses who work in the endocrinology ward. At first knowledge and attitude of nurses were assessed with questionnaire and practice were assessed based on National and regional guideline of diabetic foot, with checklist. Evidence based nursing on IOWA model were taught and after three months the results of before and after intervention were compared. For data analysis the software of SPSS and descriptive and analytic statistics such, frequency, mean (SD), Kolmogorov- Smirnov and pair T test were used. P The results showed that Mean (SD) of nurse's knowledge about evidence based nursing before and after intervention was 10.73(2.72) and 14.89(0.93) respectively, the Mean (SD) of nurse's attitude about evidence based nursing before and after intervention was 63.47(9.89) and 73.89(8.11) respectively and Mean (SD) of nurse's practice based on IOWA model and clinical guideline before and after intervention was 19.10(2.94) and 26.05(2.48). The results indicated that nurses’ knowledge, attitude and performance were improved, and these differences was statistically meaningful (p In the structure of organization, based on evidence based, using IOWA model can helpnursesand nursing performance to reachindependence and give them accountability about their nursing care.