amir vahedian

In the new age, there is a need to have committed and professional nurses for reasons such as advancing technology, increasing public awareness, and public demand for quality care.

Examining and Identifying affecting factors on the formation of nurses' professional identities.
Materials: The paper was a systemic review study that was conducted in the year 2020 by searching English databases Scopus, Pubmed, Web of Science, Proquest, EMBASE, Google Scholar from 1980 to 2019 and Persian databases, Iran Medex, Magiran and SID 1991 to 2019 using the keywords of professional identity, professionalism, identity in nursing, and its English equivalents.

Of the 27298 preliminary papers, 17 papers entered in the final analysis. The result of the finalized studies showed that the most critical factors about the formation of professional nursing identity were: Poor team, Participatory and communicative activities, the role of professors and clinical instructors, educational approach, individual characteristic (age, gender, self-confidence, job satisfaction, etc.), ambiguity in the role and role of culture and media.

in order to educate nursing students, professors and educators with a positive professional identity must be used to promote and shape students identities; moreover, in order to clarify and remove the ambiguity of the role of the profession, it is necessary to properly introduce the nursing in the community people and try to change the culture of the society towards the identity of the nursing profession.

Identifying factors that can help to ensure and promote the spiritual well-being of the students may draw an outlook for educational system to train and nurture nurses who are optimistic, meaningful and purposeful in their upcoming career. The study purpose was designing the spiritual health relationship model with the educational and well-being components of the master nursing students in critical care.

A mixed research conducted in two phases of narrative review and three-step Delphi approach in the second-half of 1394 and the first-half of 1395. Through purposeful and snowball sampling 35 experts in spiritual health were selected and participated in the five stages of panel. To design the initial version of the study model, all available articles in “Iranian Journal of Medical Education” were reviewed. Quantitative and qualitative categorization, prioritizing and categorizing the variables into two groups of educational and well-being components were done in three stages of Delphi study.

The findings of this study showed that students' spiritual well-being is in a two-ways and mutual-relation between student's academic components including academic satisfaction, academic self-efficacy and academic-motivation and well-being components including psychological well-being, thoughtful practice and cultural intelligence.

Monitoring and enhancing the academic and well-being components of master students of critical care and their related variables, either in the form of initial screening or during the course of study, should be considered by educational system in order to maintain and enhance the spiritual well-being of students, which is one of the most important prerequisites for providing holistic care.

Multiple sclerosis (MS) is an inflammatory disease, makes damage in central nervous system. Evidence showed Progressive Muscle Relaxation (PMR) technique is one of the non-pharmacological methods used to treat MS. The purpose of the study was to determining the effect of PMR on the MS's outcomes in published papers in the field.
  This systematic and meta-analysis study were conducted from the beginning to April 2018. English and Persian databases were searched until the February 2018. Studies that implement PMR in MS patients and had available data for analysis were included and irrelevant and duplicated studies were excluded.  To quality appraisal of articles, four scales JADAD, CONSORT, Newcastle-Ottawa and Cochran's risk of bias were used. Data analysis was carried out through the random-effects model, and heterogeneity was investigated by I2 index by using the STATA and SPSS software version 11.
  From 773-studies, 12-articles were selected that conducted between years 2008 to 2016. Studies have mentioned a positive and significant effect of PMR on reducing stress [-5.34(-8.18.-2.50) I2=75.7%], pain [-2.27(-4.17.-0.37) I2=96%], fatigue [-1.13 (-1.71.-0.55) I2=93%], depression [-3.76(-10.98.-3.46) I2=87.4%] and improving sleep quality [-5.34(-8.18.-2.50) I2=75.7%]. Spearman's correlation coefficient between scores of JADAD, CONSORT and Newcastle-Ottawa were significant.
  PMR can be recommended as a nursing intervention, a suitable, inexpensive, and effective technique to reduce the outcomes of MS patients.

The incidence and prevalence of delirium in the intensive care unit (ICU) are extremely high. Generally, the incidence and prevalence of delirium in the hospitalized patients in ICU are 29-31% (1, 2) and 11-25% (3, 4), respectively. Each additional day with delirium increases a patient’s risk of dying by 10%. The incidence of delirium among mechanically ventilated patients compared to non-intubated patients is reported 45 to 87% more (5-8).  
Due to the high prevalence of delirium in hospitalized patients in the ICU, the many effects of delirium on the short and long term outcomes of patients, and the imposition of high costs on the health system; several studies have assessed the impacts of delirium to outcomes of patients and healthcare systems (8,9). Recently, a study looking at costs over 1 year following an episode of delirium, estimated that delirium is responsible for between $60,000 and $64,000 of additional health-care costs per patient with delirium per year; at national level, total direct 1-year health-care costs attributable to delirium might range from $38 billion to up to $152 billion nationally (9). The cost associated with delirium in mechanically ventilated patients in the United States of America is around 4–16 billion dollars per year (10) which is impacts of the delirium on the health system.
The short-term implications of delirium for hospitalized patients in ICU include prolonged hospital stay, functional decline during hospitalization, increased risk of developing a hospital-acquired complication, and increased admission to long-term care (11, 12).
Chronic cognitive impairment and different physical and psychological functional disability are among the long-term impacts for hospitalized patients in ICU (13).
In overall, it can be concluded that there are differences between the complications of Delirium incidence, both short and long term, in admitted patients to the ICU by sex, socioeconomic status, race, ethnicity, and even the degree to which one practices an organized religion (religiosity) (14).  
According to the definition, religiosity and spirituality are broadly defined as feelings, thoughts, experiences and behaviors that arise from searching for the “sacred,” with former implying group or social practices and doctrines, and the latter referring to personal experiences and beliefs (15, 16).   
It’s been reported that approximately 90% of Iranians (USA 84%) report religious affiliation, and 96% of Iranians (USA 82%) report religion as at least somewhat or very important in their lives (17, 18).
Several systematic reviews of the literature support a relationship between religiosity promoting improved health behaviors (19, 20) and lower all-cause mortality (21, 22).
Emerging evidence suggests that religiosity and spirituality are correlated with improved mental and physical health outcomes, including decreased rates of depression (23), anxiety, post-traumatic stress disorder, suicide, and coronary heart disease (24).
Despite the recognition of the impacts of the delirium occurrence and its high cost on the health system from one side, and the relationship between religiosity and the delirium event, which significantly improves the consequences of it, from other side (19-22), to the best knowledge of the researchers, Still, the study does not investigate the effect of religiosity and spirituality on the severity of delirium to determine whether different levels of religiosity and spirituality cause different levels of delirium in admitted patients to the ICU or the effects of medications, the environment of the ICU and so on …. without affecting the different levels of religiosity, there are different degrees of delirium? which brings up a chicken-or-the-egg conundrum.

  The current study evaluated Iran’s ranking in health policy research compared with the world and with countries of West Asia and North Africa based on the Scopus database. The present review considered 2 criteria for ranking: (1) the number of indexed papers, and (2) citations to the papers in Scopus. Changes in Iran’s scientific ranking based on both indicators from 2002 to 2016 were compared with those of other countries. In general, Iran’s ranking in the world had a relatively mild growth based on both indicators. Iran achieved its most desirable rankings in the based on number of papers in the year 2014 with the ranking of 19 and in the year 2011 with the ranking of 25 based on the number of citations. Iran ranked much higher based on the number of papers in West Asia and North Africa, going from 5th place in 2002 and 10th place in 2003 to first place in the region in 2014. Based on number of citations, Iran ranked second in the region in the year 2016. In recent years, the status of research in the field of health policy in Iran has advanced. Efforts to index all Iranian health policy journals in the Scopus database and to increase scientific collaborations and financing can improve the position of Iran’s scientific ranking in terms of number of articles and citations in the field of health policy.

Economic evaluation is an invaluable and important tool in healthcare decision- and policy-making. The volume-based paradigm has been a prominent tool to evaluate healthcare economy for consecutive decades. In this approach, the main focus is on volume of treated patients alongside to reduce healthcare costs. Despite this view and during recent years, there was a dramatic rising in healthcare costs without attaining excellence in quality and health outcomes. This status is escalating to the point at which governmental budgets, service providers, and patients are unwilling or unable to afford its related costs (1). There is a similar situation in high-income countries that spend several times more money on health than middle-income and low-income countries (2).
The experts believed that one of the most important and underlying causes of this situation is ineffective healthcare service models that resulted in fragmentation, lack of coordination, reduced quality of care, and finally increased health costs (3). It is assumed that the health service delivery models can seriously affect health costs. Accordingly, health economics does not only refer to health costs but also it includes quality improvement, access to, and equity of health services (4).
For the first time in 2006, “value-based care” was developed to evaluate healthcare economy (5). This paradigm which is also considered a kind of healthcare delivery model, is based on patient outcomes payment as an alternative for the fee-for-service model of payment. Based on this approach, healthcare providers such as physicians and nurses will be rewarded when their services improve the health of patients, reduce the complications, and help to make a healthier life for patients (6); while the population transition to old age and an increase in noncommunicable diseases which require behavioural approches for modifying risk factors in addition to acute care only, are also fueling the mandate for change. Therefore, 30% of healthcare payments in the US by the end of 2016 and 50% of payments by the end of 2018 were tied to the value-based care approach. Based on that, new institutions such as Accountability Care Organizations (ACOs), Advanced Primary Care and Integrated Care models were launched (7). The focus of these institutions is on effective care pathways which, along with the reduction in health care costs, lead to prevention and primary care (7). The principals of new payment model are greater teamwork and integration, more effective coordination of health providers across settings, greater attention to population-based healthcare, and providing information system to improve care for patients (7).
A report in 2011 entitled “The future of nursing: leading change, advancing health” asserted that despite the financial concerns, nursing service can on the one hand address the increasing demand for safer and high-quality healthcare and on the other hand, create equitable and affordable access to health services for societies (8).
The report believed that nursing practice covers a broad continium from health promotion, to disease prevention, to coordination of care, to cure-when possible-and to palliative care-when cure is not possible. Therefore, nurses have a direct and indirect effect on patient care. They can provide assessments and care in hospitals, nursing homes, clinics, schools, ambulatory settings, and workplaces and accordingly they can contribute to the provision of accessible, equitable, and high quality care in healthcare system.
From value-based model perspective, quality, access, and value are key indicators that are specific and sensitive to health service effects on health economics (1). Evidence reveals that nursing services can suprisingly affect these three indicators. However, there are few studies showing that the development of nursing services results in lower costs, along with increased service quality. Of course the evidence in favor of such a conclusion is growing. The current evidence on these indicators are as follows:Nursing and health service quality
Although causation is difficult to prove, an emerging body of literature has revealed that the quality of care depends, in a large degree, on nurses. The association between nursing care and quality of hospital care such as patient outcomes, including lenghts of stay, mortality, pressure ulcer, deep vein thrombosis, and hospital-acquired infections has been published in several studies (9-11). Studies have shown the role of nurses in improving the quality and efficacy of hospital (12,13). However, the extent to which nursing care has an impact on health and life or death issues is still ambiguous (8) Also, the patient-centered nursing care has recently been disscussed as a cause of patient satisfaction which is an indicator of the delivered service quality in all over the world (14,15).
Nursing and access to health services
Evidence suggests that access to quality care can greatly be expanded by developing the use of nurses in primary, chronic, and transitional care from hospital to home. For example, If nurses are involved in special roles such as care coordinators or primary healthcare providers, that increase the level of access to services, the hospitalization and rehospitalization rates of patients will be reduced. A 52% reduction in emergency department (ED) visits with a cost per admission of at least $800 has been mentioned as a result of nursing postoperative visits and telephone follow-ups (16). In the coordination of transitional care from hospital, nursing visits during a three-month transition period in patients with heart failure showed the average savings of $4,845 per patient with a significant increase in survival and fewer readmissions (17). Also, performed activities such as self medication management and referral care coordination by nurses in community-based or ambulatory care settings can save $686 per patient in a 12-month period (18).
Nursing and value of health services
The value in healthcare is expressed as the physical health and sense of well-being achieved relative to the cost. There is little evidence at the macro level indicating that the development of nursing services results in cost savings to society while promoting outcomes and ensuring quality (19). For example, managing nursing work hours is dramatically associated with 1.5 million fewer hospital days, nearly 60,000 fewer inpatient complications, and 0.5 percent reduction in costs (20).
Overall, it seems that we need to conduct precise studies at macro-level to assess the net economic effects resulting from nursing care delivery models in order to seriously integrate them into health policy. Also, undrestanding the impact of nursing care on the health system requires the data to enable nurses have more effects on healthcare transformation

Empowerment is a dynamic, positive, interactive and social process, leading to the improvement of quality of life (QOL) in patients with chronic disease. The purpose of this systematic review and meta-analysis was to determine the effect of family-centered empowerment model (FCEM) on QOL in adults with chronic diseases. Methods & Materials: By searching FCEM in Persian databases including SID, MagIran, IranMedex, IranDoc, and googlescholar, Scopus, Pubmed, Web-of-science, Proquest, and Sciencedirect, all relevant studies were extracted. The methodological quality of the papers was examined using Cochrane-risk-of-bias. Data analysis was carried out through the random effects model and heterogeneity by I2 index. The data were analyzed using the STATA software version 11.0. Of the 647 initial studies, only 8 studies examined the effect of FCEM on the QOL in adult patients using SF-36. The pooled standardized mean difference of the 8-dimensions of QOL included: social-functioning (1.781), Physical role limitation (1.416), bodily pain (0.987), general health (1.352), social functioning (1.010), general health (1.122), emotional role limitation (0.656), and vitality (1.361). The implementation of FCEM had a significant effect on the 8-dimensions of QOL based on the SF-36 questionnaire. The implementation of FCEM is recommended in order to improve the QOL of adult patients with chronic disease.

Angiography is the gold standard test for the diagnosis of coronary artery disease; however, more than 82% of patients have stress and anxiety before they undergo angiography, which significantly effects the diagnostic results. One of the common complications of the angiography method through the radial artery is the occurrence of arterial spasm that is seen more in patients with severe anxiety. The current researchers believe that using Benson relaxation is effective in reducing the patient’s anxiety.
This study was designed to evaluate the Benson relaxation method in patients undergoing radial angiography.
This study was a clinical trial, which was performed on 60 candidate patients undergoing coronary angiography by radial method at Baqiyatallah Hospital during year 2017 (N = 60). The samples were randomly allocated to two groups, intervention and control. The information gathering tools were demographic questionnaire, the Beck Anxiety Inventory (BAI), and hemodynamic variables checklist. Data analysis was done with the SPPSS V16 software using Kolmogorov - Smirnov test, Mann - Whitney test, and paired - t test.
The results showed a significant difference between the anxiety of the patients before and after the intervention in each group (P Benson’s relaxation method can be effective in reducing anxiety in angiography candidate patients. Accordingly, it may also be effective in reducing the occurrence of radial artery spasm.

Endotracheal suctioning is a necessary procedure practiced by nurses in intensive care units to remove lung secretions. This procedure leads to higher oxygenation levels and reduced breathing difficulties. It also prevents atelectasis, pulmonary infections, and the accumulation of secretions..
The present study aims to compare the effectiveness of open and closed endotracheal suction tube systems on pain and agitation in patients under mechanical ventilation..
A randomized controlled clinical trial was conducted in the general intensive care units of Khatam-ol-Anbia hospital and Sina hospital, Tehran, Iran, in 2015. In total, 60 patients who were qualified to be included in the study were randomly assigned to either the intervention group or the control group. When necessary, suction was carried out for each patient using the standard technique. The patients’ level of pain and agitation was measured in both groups at five stages (before, during, immediately after, 5 minutes after, and 15 minutes after the intervention) using the behavioral pain scale and the Richmond agitation sedation scale..
Significant statistical differences in the pain and agitation at different times within each of the two groups were observed for both open and closed suction (P > 0.001). However, these changes at different times between the two groups was not significant (P Although statistical differences were observed in the levels of pain and agitation in the two groups, the type of suction system did not have any effect on the level of pain and agitation of patients under mechanical ventilation. The researchers recommend that other studies with larger sample sizes should be carried out..

Health is a holistic concept, incorporates physical, social, cultural, emotional, spiritual, political, mental, mystical, intrinsic, communicative and cognitive dimensions. From aforesaid dimensions, spiritual health is the least understood and most challenged concept. The aim of the study was to explain the concept of spiritual health.
In this multi methods research, narrative review method was utilized with three-step-searching in scientific information database (SID) up to the November 2015 about religion, spirituality, spiritual health, religious beliefs and the effect of spiritual health on the body and soul health. Also, to demonstrate conceptual model of spiritual health, Rodgers's Evolutionary concept analysis method was used.
Ethical Considerations: Moral rules such as honesty and integrity were taken into consideration in the analysis and report of searched literature.
From 3136 articles resulting from the primary search in the step one, 16 articles were scrutinized, totally, three themes including spiritual health concept and its dimensions, spiritual health relationship with others health dimensions and health concept model were extracted.
Although, the results of the study provide preliminary definition of spiritual health concept and its dimensions; spiritual health and its sub-categorizations, are ambiguous concepts with unclear domains so that, there is a necessity for more analyzing and investigation to indiscriminate and discern it. Exact definition and identification of spiritual health with ascertained effects and extensive beliefs of people to it; can effectively be conducted as an appropriate strategy for more influences of treatments and even non-drug treatments.

The Intensive Care Unit (ICU) is a paramount essential part of each hospital, which the most critically ill patients are treated and taken care by the highest experienced physicians and nurse's with the most advanced equipment in an appropriate and adequate space (1, 2). Those with different scopes of practice work more or less independently, in ways that might not best serve the needs of patients and their families (3). In such situations, lake of harmony, coordination, and consensus among the clinicians is the major source of human error, which is the eighth leading cause of deaths in the ICU (4). The applying shared decision making models (SDMMs), is one of the savior's approaches to harmonize and optimize the coordination and communication among the clinicians and can prevent the dreaded and catastrophic human errors. Shared decision making models have traditionally been understood to be the sharing of responsibility and control over medical decisions between patients, families, nurses, and physicians (5) and from many years ago, the models were introduced in the developed countries (6, 7).However, with many advantages and very minor disadvantages of SDMMs, the models remain in its infancy and significantly lag behind the progress made by developed countries in order to demonstrate the need for innovation. Furthermore, it should be stated why the models didnt get run in the developing countries and also, what the barriers and bridges of the commencing era of the SDMMs in the countries are.

Ventilator-associated pneumonia (VAP) increases the cost of intensive care unit (ICU) treatment and the chance of mortality. Due to the increasing use of proton pump inhibitors (PPI) and H2 receptor inhibitors for stress ulcer prophylaxis, the purpose of the study was to investigate the differences of VAP in two groups of patients receiving PPI or H2 blocker. In the retrospective cross sectional study, from September 2011 to September 2012, 43 patients who had positive pulmonary cultures (PC) were studied. These patients had a clinical pulmonary infection score (CPIS) ≥6 for more than 48 hours after receiving stress related mucosal diseases prophylaxis (SRMD). Patients whose SRMD prophylaxis was changed within 72 hours before obtaining the PC samples were excluded. Patients were divided into two groups. One group received pantoprazole (20 cases) and the other group received ranitidine (23 cases). Between the groups, age, sex, APACHE II score, predicted mortality, type of used SRMD prophylaxis drug, duration of prophylaxis prior to PC sampling, interval time between ICU admission and VAP manifestation, the type of bacterial causes of VAP, gastrointestinal bleeding, ICU length of stay and actual mortality were compared. The APACHE II score and predicted mortality were higher in the pantoprazole group (P=0.173, 0.167). We found that 30% of the ranitidine group suffered from upper GI bleeding. In the pantoprazole group, 21.74% suffered from upper GI bleeding (P<0.001). Patients receiving ranitidine had a higher mortality rate and a worse prognosis (P< 0.001). Although there were more critically ill patients with a higher predicted mortality in the pantoprazole group, the ranitidine recipients turned out to have a higher mortality rate.

Nowadays, Non-communicable diseases are widespread due to modernization of societies, technology development, population density in urban areas, and changes in life style. Variety of cardiovascular diseases are the most common causes of death and important factors of failure in most countries including Iran.This study was conducted to determine the effect of progressive muscle relaxation on the lifestyle of patients with myocardial infarction. In this randomized double-blind clinical trial, after sampling, 66 patients were randomly selected and assigned to either the control or test group. An orientation session was held to explain the research goals and intervention. The test group did the progressive muscle relaxation techniques, two 20-30 minute sessions daily for two months (120 sessions). Data collection tools were demographic information questionnaire, lifestyle questionnaire, and self report check list. Independent t- test and mann-whitney U showed there are no significant differences in four aspects of life before the intervention, but these differences were significant after the intervention(P<0.05). ANOVA with repeated measures in three different times (before, 1 and 2 months after intervention) showed significant difference between the two groups (P<0.05). Applying progressive muscle relaxation technique on various aspects of life of patients suffering myocardial infarction would modify, adjust and improve their lifestyles.

Chronic obstructive pulmonary disease (COPD) is one of the few major causes of death whose prevalence is continuing to rise in the world. Pulmonary rehabilitation (PR), as a component of the treatment protocol, should be considered for all patients with chronic respiratory disease who have persistent symptoms. The purpose of the study was to investigate PR in patients with COPD, following six questions including comprehensive definition, nature's mechanism, commencing indication, advantages and disadvantages, comprehensive dimensions, and the cornerstone dimension of PR. The University of York Center for Reviewers and Dissemination Guidance approach was used for searching seven databases (Science Direct, Ovid, Cochrane, Ebsco Host, Scopus, Pub Med, and SID) with nineteen keywords and different combinations of aforesaid nineteen keywords from the year 1985 to the January 2015. Thirty full texts met the inclusion criteria and were analyzed for responding to the six research questions. The results showed that PR consists of exercise training, education, nutritional intervention, support in self-management behaviors, and psychosocial support. The extensive review of the literature indicated exercise training is the cornerstone of PR, but the study also corroborated that psychological aspect of the patients with COPD is the most important and the first dimension in PR. Furthermore, before the commencing any education, the patients with COPD in any stages, must have an effective and useful psychological support for ameliorating and improving the applicability of the PR.

To explore patient education problems in clinical and educational settings. A review and an explanatory sequential mixed methods design were used. In the quantitative phase, an extensive review of the literature was performed for improving the validation of the questionnaire and after that, 2300 nursing students by convenience sampling were recruited. Data were collected by a self-report bridges and barriers of patient education questionnaire. In the qualitative phase, 25 nursing students were recruited using purposeful sampling. Data were gathered using semistructured interviews and two focus groups. In the quantitative phase, two items were recognized as first priorities (Need assessment of each patient in each ward and protocol creation based on; and Good communication between the nurse and patient). In the qualitative phase, onemain theme (Club of patient education problems) with two sub-themes (Educational and experimental problems; and communicational and managerial problems) emerged. It is essential for the managers in all levels of nursing to try to equalize and integrate the educational and clinical opportunities in two more important and inseparable environments of college and hospital. Practice Implications: It is possible that for the better education and implementation of the patient education courses for nursing students, particularly Iranian nursing students, the authorities of colleges and hospitals be able to use from the results of this research.

Critically ill patients are characterized as those who survive the initial episode of critical illness but remain dependent on critical care therapies. Models of care delivery to guide care of critically ill patients are valuable resources to optimize care and promote the well-being of these patients in acute hospital settings. The purposes of this review article were 1. What are appropriate characteristics of an appropriate model for application in critical care unit (CCU)? 2. What are the effects of application nursing care models (NCMs) on the daily nursing practices? 3. What are the effects of application NCMs on the patient's outcomes? The University of York center for Reviewers and Dissemination Guidance approach was used for searching seven databases (Science direct, Ovid, Cochrane, Ebsco Host, Scopus, Pub med, and SID) with 10 key words from the 1983 to the June 2014. Lastly, 25 full texts analyzed for responding to the research questions. Additional responding to the three research questions, the core concepts of international NCMs were partnerships, evaluation the current models in CCU, better understanding of critically ill patients, and staff satisfaction from caring in CCU, however, domestic NCMs had more focused on the NCMs in CCU and in the majority ones, the staff satisfaction and selecting appropriate steps as a model were not assessed. Considering the appropriate features of domestic NCMs, it is recommended that these models carefully reviewed and adjusted to CCU's needs.

Generally, studying and taking license in doctorate of nursing should be according to the society's requirement for better applying of that doctorate degree. In this line, selecting appropriate doctorate program is one the most challenges for any nurses that fulfill the different professional need of nursing disciplinary in academic and clinical settings. The purposes of present study were comparison of the PhD and DNP programs aims and determining appropriate doctoral program from the American and Iranian professor's perspective according to the academic and clinical contexts. The design of study was a review and an internet-based cross-sectional research. Selected governmental Universities in all over the Iran and the United States (presenting DNP program) were settings of study. The participants of study were lectures with the academic position higher than instructor (Assistant professor = 32, Associate professor= 22, and Professor = 5). According to the first purpose, all of American's professors were compared and declared clearly but the majority of Iranian's professors werent differentiated between the purposes and were explained their responses in the uncertainty halo. However, curriculum compatible with the interests and goals, increase in intellectual knowledge, career advancement, primary care clinical practice, and nursing education were described as the final purposes of PhD and DNP programs. About the second purpose, new PhD curriculum was developed according to the academic and clinical contexts with two sections: theoretical (24 credits) and clinical (22 credits) courses. The evolution of such new doctoral program in nursing especially in the developing countries, due to their limitations, deficiencies, and even lacks of resources, needs a multi and interdisciplinary partnership and cooperation to ameliorate bridges and reducing barriers; because of the majority of doctoral courses have dynamic nature and for that, need to modify and reconsider continuously. Furthermore, for better managing the new and sometimes challenging situations, such partnership and cooperation are so necessary.

Health is a holistic concept that incorporates physical, social, cultural, emotional, spiritual, mental, mystical, intrinsic, communicative, and cognitive dimensions. However, spirituality is the least understood and most challenged dimension of health. The purpose of this study was to explore the concept of spirituality. In a conventional content analysis, 10 participants of the Quran and Medicine Congress were recruited. Data was collected with semi-structured interviews and narrative approach. We recognized one theme, i.e. multidimensional concept of spirituality and its aspects, and two main subthemes, namely different perceptions of people about the concept of spirituality and various aspects of spirituality. Although this study provided a definition of spirituality and its dimensions, these concepts are ambiguous and have unclear domains. Therefore, further investigations are necessary to differentiate between aspects of spirituality.

Health is a holistic concept that incorporates physical, social, cultural, emotional, spiritual, mental, mystical, intrinsic, communicative, and cognitive dimensions. However, spirituality is the least understood and most challenged dimension of health. The purpose of this study was to explore the concept of spirituality. In a conventional content analysis, 10 participants of the Quran and Medicine Congress were recruited. Data was collected with semi-structured interviews and narrative approach. We recognized one theme, i.e. multidimensional concept of spirituality and its aspects, and two main subthemes, namely different perceptions of people about the concept of spirituality and various aspects of spirituality. Although this study provided a definition of spirituality and its dimensions, these concepts are ambiguous and have unclear domains. Therefore, further investigations are necessary to differentiate between aspects of spirituality.