mahnaz khatiban

Nursing model is used to improve the adaptation of patients. Patients' participation in support groups can play an important role in improving their adaptation by getting to know similar patients. The purpose of this study was to determine the effect of using support groups based on the nursing model on social adaptation of patients with implantable defibrillators.

Methods and Materials: 

In this randomized clinical trial, 60 patients referred to the heart clinics of Farshchian Hospitals in Hamedan and Kausar hospital in Shiraz were selected as convenience sampling. Patients were randomly assigned to intervention and control groups by blocking gender and ejection fraction. Patients in the intervention group participated in support groups based on Roy's nursing model, and then their condition was followed up twice a month through phone calls. Patients in the control group received only routine care. The social adaptation of the patients was assessed using Bell's adjustment inventory before and 3 months after the intervention. Data analysis was done by SPSS software using chi squared, t student and t paired tests.

The findings showed that mean age of the patients was 60.48 ± 4.38 years. The majority of patients (56.7%, n=34) were men, and 35% (n=21) had at least one shock per month. The most common cause of implantation of an implantable defibrillator in patients was heart failure (n=54, 80%). The patients in the two groups did not differ significantly from each other in terms of demographic characteristics. Patients in the test group had a significant difference in the social adaptation before and after the intervention. (p>0.001).

This study showed that patients' participation in support groups based on Roy's nursing model along with telephone follow-up of patients can be used as an effective strategy in improving the social adaptation of patients with implantable defibrillators.

 Pressure ulcer is one of the common problems in hospitals, especially in long-stay inpatient departments and intensive care units. This study was conducted with the aim of investigating the effect of planned nursing care on the occurrence and severity of pressure ulcers in patients admitted to the intensive care units.

 In this interventional study, 80 patients were gradually placed in two control and experimental groups. The participants of the experimental group received the care plan based, while the participants of the control group received only the daily and routine care plan. The rate of pressure ulcer development was evaluated based on the scale of the International Pressure Ulcer Society. The data were analyzed using chi-square test and Fisher’s exact test in SPSS version 16 software.

 The relative and absolute frequency distribution of the research units according to the presence or absence of pressure ulcers after the intervention showed that pressure ulcers in the experimental group decreased significantly (P≤0.05). Also, the difference in the severity of pressure ulcers in the two groups indicated that the intervention reduced the degree, severity, and depth of pressure ulcers.

 Carrying out planned care in patients who have a high risk of pressure ulcers will reduce the possibility of pressure ulcers, especially with high severity and degree. Therefore, applying the principles of pressure ulcer prevention by the care team is emphasized and recommended for patients who are not able to do this themselves.

Burn pain during therapeutic procedures causes anxiety in patients. Spiritual health and resilience are factors affecting anxiety. The present study aimed to determine the relationship between spiritual health with resilience and wound pain anxiety in burn patients.

In this cross-sectional study, 213 patients were selected by random sampling method. Demographic information, Polotzin and Ellison's spiritual health questionnaire, Connor-Davidson Resilience Scale, and Burns Specific Pain Anxiety Scale were used to collect data. T-tests and one-way analysis of variance were used to analyze the collected data. Data analysis was performed using SPSS software (version 21).

The findings showed that most patients were male (62.91%) with an average age of 38.21 ± 12.72. The average scores of spiritual health, wound pain anxiety, and resilience were 73.63 ± 21.20, 52.83 ± 16.18, and 58.24 ± 13.51, respectively. Although a significant relationship was found between spiritual health and resilience and between resilience and wound pain anxiety, no significant relationship was seen between spiritual health and wound pain anxiety.

Burn patients suffer a lot of pain during procedures such as dressings. Considering the relationship between spiritual health, burn pain anxiety and resilience, educational workshops are suggested to increase spiritual health, resilience and better tolerance during hospitalization.

Hyperglycemia can increase anxiety, depression, and stress in patients with type 1 diabetes, and as a result, poor control of the disease and a decrease in the patient's quality of life. The present study aimed to present the nursing process of an adolescent with hyperglycemia based on King's goal achievement model.

In the present case study, the research sample was a teenage client with frequent hyperglycemia who had visited the hospital several times and was hospitalized. For this purpose, sample selection was performed by available sampling from the research community (i.e., teenagers hospitalized in Hamedan Children's Department with hyperglycemia diagnosis). Data collection was performed through the client's file, interview, and observation of the client, family, doctor, and nurse. The nursing process, according to King's goal achievement model, started after the patient accepted the researcher's request on the last day of hospitalization. The stages of the nursing process(i.e., examination, diagnosis of nursing, determination of common goals and prioritization, transaction based on client's preferences, and evaluation of the degree of achievement of goals by the client by comparing before and after in the range of -2 to +2) were performed in the form of qualitative analysis.

The result pointed out that diabetic adolescents did not have a proper understanding of the factors affecting the stability of blood sugar levels in the normal range. Nonetheless, they found the necessary preparation to interact with the nurse by implementing the nursing process and understanding the conditions affecting hyperglycemia. The findings led to 4 nursing diagnoses and 12 care goals. In the evaluation, it was found that after the implementation of the nursing process, the adolescent client was able to experience the stability of the blood sugar level within the normal range.

The nursing process, according to King's model, was able to stabilize the blood sugar level in the normal range in the patient under study. Therefore, it is possible to suggest the nursing process according to King's model in adolescents with type 1 diabetes in order to maintain the blood sugar level in the normal range.

Workshop training is one of the most effective learning methods. This study aims to compare the effect of virtual and face-to-face workshop training on students’ learning and satisfaction.

A three-group intervention study with before and after measurements was conducted with the participation of 106 nursing students. A convenient method of assigning replacement blocks was used. The groups included three groups, a virtual workshop, a face-to-face workshop, and a control. The data collection tool included a demographic form, and researcher-made awareness, performance, and satisfaction questionnaire. The content validity of the tool was confirmed by experts in the fields of nursing, health in disasters and emergencies, and medical education. The reliability of the tool using test re-test and Cronbach’s α was 0.858. Awareness and performance were evaluated before and after the study. Satisfaction was checked at the end of the study. Data were analyzed using analysis of variance with SPSS software, version 23.

Most of the students were female (55.66%), with a Mean±SD of age 22.75±2.05 for all groups, single (93.4%), seventh semester (62.30%), without experience of participating in the training workshop (67.9%), and reading the book related to triage with mass casualty incident (MCI) (81.13%). Before the intervention, the groups had no significant difference in terms of awareness (P=0.169) and performance (P=0.296), while after the intervention, the difference was significant (P˂0.001). After the intervention, the most awareness and performance were related to the face-to-face workshop. A significant difference was observed between the groups in terms of satisfaction (P˂0.001). In the face-to-face workshop, 43.42% were very satisfied and 36.36% were satisfied, while very satisfied students did not exist in the virtual workshop and only 22.44% of students were satisfied. Satisfaction in the control group was moderate and poor.

Since the face-to-face workshop increased students’ awareness, performance, and satisfaction, it is suggested to use face-to-face educational workshops to improve the scientific level of nursing students before graduation.

Moral distress is a harmful factor in nursing and nursing care. Ethical courage helps nurses to perform nursing care. The present study aimed to determine the relationship between moral distress and moral courage of nurses working in selected hospitals of Hamadan University of Medical Sciences during the Covid-19 pandemic.

This cross-sectional study was conducted with the participation of 204 nurses working in selected educational hospitals by random sampling method. Data were collected by the self-report method using a demographic checklist, as well as Corelli Moral Distress and Sekerka Moral Courage questionnaires. The data were analyzed in SPSS software (version 21) using independent t-test, ANOVA, and regression analysis. A P≤0.050 was considered statistically significant.

The results demonstrated that the majority of nurses were male (55.40%) with a mean age of 41.96±9.53 years, working in the emergency department (43.20%), with 5-10 years of work experience (51.38%), and contract employment (57.45%). Moral distress was significantly correlated with gender, place of service, and work experience; moreover, moral courage and age were significantly associated (P≤0.050). Nevertheless, no significant relationship was detected between moral distress and the type of employment. Moral courage was not correlated with the type of employment, work experience, gender, and place of service (P≥0.050). There was a significant negative relationship between moral distress and moral courage (R=-0.863, P≤0.050). The results of the adjusted regression model illustrated that with each unit increase in the moral distress score, the moral courage score decreases by 0.33. This relationship was statistically significant (β=-.033, P<0.001). The mean scores of moral distress and moral courage were 57.61±3.32 and 36.92±2.46, respectively.

Since there is a significant negative relationship between moral distress and moral courage, it is recommended to hold moral motivation workshops to reduce moral distress and increase moral courage for nurses.

Leukemia and its treatment is a long process and requires adherence to self-care behaviors. Orem's self-care deficit nursing model provides a framework for the nursing process in this direction, therefore this study aims to apply The nursing process based on Orem's self-care deficit model was performed on a patient with acute myeloid leukemia.

In this case report, the nursing process of a client suffering from acute myeloid leukemia, referred to Beheshti Hospital in Hamadan city in 1401, based on the Orem's self-care deficit model, was presented. Data collection was done by using Orem evaluation form and by examination, interview, and observation methods. Based on the general self-care needs, development, and deviation from the patient's health, nursing diagnoses were determined, then planning and setting goals were done and the type of nursing system used was determined. Finally, nursing actions were performed based on promoting self-care, and the achievement of the patient's goals and progress was evaluated as a factor of self-care.

Based on the recognition of the patient's self-care needs, ten nursing diagnoses were determined, and finally, the implementation of the nursing process based on the Orem model led to an increase in the quality of nursing services along with an increase in the patient's self-care performance regarding the problems caused by his illness, so that improving the patient's self-care ability in relation to pain control, reducing Risk of infection, control of bleeding and improvement of sleep, reduction of fear and dependence, an increase of motivation and self-confidence and sense of independence was observed in the patient.

Orem's self-care deficit model greatly helped to identify and comprehensively understand the patient's needs and facilitated the achievement of care goals by involving the patient in self-care.

To investigate the relationship between outcomes and demographic-clinical variables in in-hospital cardiac arrest (IHCA).

The Medline database was searched along with Google Scholar, Scopus, Web of Science, and Persian language database without time limitation until January 6th, 2020. The inclusion criteria included papers published in journals or presented in English and Persian congress that reported the IHCA outcomes based on the Utstein criterion. All the descriptive, cross-sectional, and cohort studies on CPR were covered based on inclusion and exclusion criteria. Primary checks covered titles and abstracts followed by a full-text check of the remaining papers from the first screening stage. Data analysis was done using comprehensive metaanalysis (CMA) software version 2.0. The finding’s heterogeneity was checked using Q and Cochran tests with heterogeneity >50% and the random-effects model was used to estimate survival and favorable neurological outcome (FNO) in the analysis. To detect the publication bias of studies, the subgroup test, meta-regression test,sensitivity analysis test, funnel plot, and Eagger’s regression test were used.

Survival to discharge was 19.1% (95% CI=16.8-21.7) and FNO in the survived to discharge cases was 68.1% (95% CI=55.8-78.3). Survival to discharge and FNO were notably higher in men, CPR duration <15min, and shockable dysrhythmias.

IHCA outcomes are poor in developing countries. The outcomes of IHCA in terms of gender were inconsistent with the result reported by other meta-analyses.

Nursing profession and field, as a scientific field, needs a scientific basis of which nursing models were and still are. One of the prominent models in nursing is Orem's self-care model. Therefore, this study was conducted with the aim of applying the nursing process based on the Orem self-care model in patients with tibia fractures.

In this case study, the nursing process of a patient with tibia fracture admitted to Ba'ath Hospital in Hamedan city in 2019 was presented. In the stage of nursing research and recognition, data collection was done based on the "Orem self-care model survey form". Nursing diagnoses were compiled and care goals were determined and nursing measures were taken to achieve the goals. Data analysis was presented using a table.

The findings showed that cases of self-care deficiencies and patient self-care needs decreased after nursing measures based on the Orem self-care model. The findings led to 7 nursing diagnoses and 42 care goals.

Using Orem's self-care model as a framework for diagnosis, choosing the appropriate action and evaluating the results was very useful. It is suggested that nursing theories be applied in all departments and on different patients.

Burn is one of the most debilitating type of trauma. Preparing the patient to find the optimal way to deal with the disease as well as maintaining independence and happiness in life is an essential part of the treatment process for burn patients. The aim of this study was to apply the Callista Roy's adaptation model in the care of burn patients.

This study was a case study that was conducted with the participation of a burn patient hospitalized in the burn ward of Besat Hospital in Hamedan city in 2022. Data were collected using observation, interview and patient documentation and were analyzed in four dimensions, based on the steps of the nursing process in Roy's adaptation model.

The results of the study showed that the patient had compatible and incompatible behaviors in physiological dimensions, adaptation of self-perception, role playing, independence and dependence. However, after nursing care based on Roy's adaptation model, some of these incompatible behaviors decreased. Also, based on the information obtained from the Hospital Anxiety and Depression Scale (HADS), the application of the Roy's adaptation model reduced the patient's anxiety and depression in three stages. So that the overall score of the anxiety and depression questionnaire in the second and third time compared to the first time of completing the questionnaire decreased by 67% and 68%, respectively.

According to the results of the present study, the implementation of the nursing care program based on the Roy adaptation model can be effective on physical and psychological adaptation and reduction of incompatible behaviors in patients with burn injuries.

Self-evaluation and peer as formative evaluation have an effect in increase students' learning. To introduce a more effective method, this study was done to Purpose comparison of two formative evaluation methods on satisfaction and learning of clinical skills in nursing students.

In this interventional study to crossover design, all one semester of bachelor nursing students of hamadan nursing and midwifery school entered the study to perform two suction and dressing procedures. Standard checklists were used to evaluate each procedure. Using the checklists, Simultaneous with the instructor evaluation, all 49 students by lottery were don one procedure by self- evaluation and the next procedure to a peer evaluation. Two weeks later, each student was reassessed by the instructor during the procedure. The final score was considered as the learning criterion. Students' satisfaction with evaluation methods was assessed using a researcher-made questionnaire. Data were analyzed by SPSS-16 with a significance level of 0.05.

In the suction procedure, there was no difference between the final scores of the students in the two evaluation methods. In the dressing process, peer evaluation improves students' learning than the self-evaluation method (p<0.01). Peer evaluation led to higher satisfaction of students in the communication dimension and anxiety reduction (p <0.05).

Considering students 'satisfaction of peer evaluation and its positive impact on students' learning of clinical skills, it is recommended to use this method in teaching students to the educational authorities.

 Chemotherapy-induced nausea (CIN) is one of the most common and uncomfortable symptoms in cancer patients, and different factors can be associated with it.

 This study aimed to determine different factors associated with CIN in cancer patients.

 A total of 144 cancer patients were selected by convenience sampling. The patients at acute phase of chemotherapy were assigned to case group (n = 58) if they had nausea or to control group (n = 86) if they did not have nausea. The patients' data were collected using a researcher-made questionnaire including items on potential factors for CIN through interviews with the patients and according to their medical records. Logistic regression models were used to conduct data analysis, and the correlations in question were expressed as odds ratio (OR) at 95% confidence interval (CI).

 The results showed that the chance of nausea increased by 6.4, 2.4, 1.2, and 1.5 times in case of expected nausea, pain, carbohydrate intake, and smelling a specific odor, respectively. The increasing nausea-inducing effect of drugs led to increased chance of post-chemotherapy nausea (OR = 2.366).

 Having pain, expecting nausea, carbohydrate intake, smelling a certain odor, and high emetogenic potential of chemotherapy are effective in the development of CIN.
 

 Care and treatment adherence are important factors for given good liver transplantation outcomes.

 Design and validate an instrument to appraise adherence to care and treatment in liver transplantation recipients.

 A mixed-methods sequential exploratory study was conducted in two phases from 2017 to 2019, in the Liver Transplantation Clinic Tehran, Iran. In the qualitative phase, the concept of care and treatment adherence in liver transplantation recipients extracted by a conventional content analysis was performed on semi-structural interviews that were conducted on 18 liver transplantation recipients that were recruited through purposive sampling technique. Also, two physicians, one nurse coordinator of the liver transplantation team, and two family members were interviewed. The scale was developed based on operational definitions extracted from the qualitative phase. The validity was assessed by face, content, construct validity, and confirmatory factor analysis. The reliability was also evaluated by calculating test-retest intraclass correlation coefficient and Cronbach's alpha. The exploratory factor analysis was carried out with 286 filled the questionnaire.

 Four factors were extracted in factor analysis. These factors explained 45.622% of the variance. The final version of the scale consisted of 20 items. The Cronbach's alpha coefficient reported as 0.889 for the total scale and the intraclass correlation coefficient was reported as 0.912. The confirmatory factor analysis led to a fitting model. Chi-square indices were reported as CMIN/DF = 2.34, NFI = 0.94, CFI = 0.96, and RAMSEA = 0.067.

 With a four factors structure, validity and reliability of adherence to care and treatment scale are acceptable; therefore, it can be used for appraisal care and treatment adherence in liver transplant recipients.

Patients with stroke due to the complex and severe nature of the disease, need to implement a thorough and comprehensive nursing care program. The use of nursing models in the patient care process can provide a framework for nurse thinking in examining different patient conditions, better analyzing the situation and organizing thinking for the best decision for the patient. Therefore, this study was conducted with the aim of influencing the application of the nursing process based on Johnsonchr('39')s behavioral system model in patients with stroke.

In this report, the nursing process of a client with a stroke referred to the neurology clinic of Shahid Beheshti Hospital in Hamadan in 2021 was presented. Data were collected during the review phase based on the "Johnson Behavioral Model Review Form" by observation, interview, and physical examination. Nursing diagnoses were formulated as sustained and unstable behaviors and care goals were determined and discussed to increase the maintenance of sustained and decreasing behaviors or eliminate unstable behaviors. Nursing procedures were performed and evaluated to achieve the goals. Data analysis was presented using tables.

The results of the study showed that clients for unstable behaviors in the four sub-behavioral systems (dysfunction in the subsystems of aggression and protection, sexual and sexual). Unstable behaviors are reduced after the nursing procedures are designed.

The use of Johnsonchr('39')s behavioral model was very useful and helpful in modifying and correcting unstable behaviors. Therefore, it is suggested that this model be used as a framework for nursing care.

Cardiovascular disease is a major cause of death, creating huge health-related costs for health care systems. A client who understands the goals of treatment and care in line with their goals and priorities, will be more involved. King's goal attainment theory has addressed this issue. This study was performed to provide a nursing process in a client with acute coronary syndrome based on King's goal attainment Model.

In this case study, a myocardial infarction client with unsuccessful coronary angioplasty and the impossibility of open-heart surgery who was referred to the hospital twice within 10 days due to complications was evaluated. Data were collected through the client's file, observation and interview with the client, family, physician and nurse. The stages of the nursing process, namely, nursing diagnosis, common goals setting and prioritization, transaction based on client preferences, and evaluation of client achievement goals by comparing before and after in the range of 2- to 2+ were performed as a qualitative analysis.

Analyzes showed that although the client did not have a clear understanding of the importance of adherence to health and treatment behaviors, he was willing to interact with the nurse in a step-by step manner. Findings led to 7 nursing diagnoses and 42 caring goals. In the evaluation, the client was able to adhere the treatment well and modify the activities of daily living.

According to the nursing process based on King's goal achievement model, the Acute Coronary Syndrome client was able to act on his prioritized goals by trying to adjust daily activities. It is suggested that the nursing process be used based on King's goal achievement model in clients with acute coronary syndrome.

 Proper use of nursing models and theories is an important step in improving patient care standards and quality of life. The growing trend of kidney failure and subsequent kidney transplantation in the country shows the importance of creating a proper structure in nursing patient care for transplant patients and recognizing the stressors that affect these patients.

 This study aimed to investigate the ability of the Betty Neuman model to provide a comprehensive model for nursing care of clients undergoing kidney transplantation.

 This clinical and clinical study was performed on the client of the kidney transplant candidate based on the application of Betty Neuman system theory. During the data collection, the interactions between the client’s five variables were examined and the stressors and resources in the internal, inter, and extra-individual domains were identified. Nursing diagnoses were created in accordance with the North American International Nursing Diagnostics Association (2018 - 2018) classification, and then nursing interventions were designed and implemented at three levels of prevention.

 The results of the study of physiological, psychological, social, evolutionary, and spiritual variables, as well as interpersonal and extra-individual stressors, were 7 potential and actual nursing diagnoses.

 Designing and applying a nursing process based on this model is a holistic and systematic attitude toward the client that requires proper, efficient, and evidence-based nursing care but increases the need for nursing human resources.

Improving ethical practice needs recognizing the relationship between moral reasoning and moral courage among nurses. We examined factors (moral reasoning, practical consideration, moral dilemmas familiarity, and demographic and work characteristics) associated with moral courage among nurses. A cross-sectional design was run at all five hospitals affiliated to Hamadan University of Medical Sciences in west of Iran. A proportionate random sampling due to the total size of the nurse population in each hospital, 224 eligible nurses were completed the study questionnaires: demographic-work characteristics, Professional Moral Courage (PMC), and Nursing Dilemma Test. The relationships were examined by multiple regression analysis. Participants reported a more than moderate level of moral reasoning and PMC (43.21±5.98 and 56.16±10.18 respectively). The multivariate model showed the nurses’ PMC is positively predisposed with moral reasoning (β=0.21, p<0.01), but negatively with practical consideration (β=-0.16, p<0.01). More moral courage was found in the nurses who were never married (p<0.001), graduated from a public university (p<0.01), working in the critical care and emergency environments, as well as night shifts (all p<0.001). Moral reasoning is a predictor of moral courage, and both should be considered in designing nursing education to improve ethical nursing practice.

Emergency medical staff who are at the forefront of health care delivery face many occupational stresses that have psychological, physical, behavioral, and organizational consequences for them, including musculoskeletal disorders. The purpose of this study was to investigate the correlation between musculoskeletal injuries and stress load tolerance among medical emergency staffs in Hamedan province.

In this descriptive-correlational study, conducted in 2019, 76 (40%) of urban and 114 (60%) of employees of road bases were selected from among emergency medical staff of Hamadan, Iran. Data were collected using Nordic Musculoskeletal Injury Questionnaire and Occupational Stress Questionnaire. Data were analyzed by SPSS 23 using descriptive statistics, t-test and Spearman correlation coefficient.

The mean age of the participants was 34.05 (± 8.11) years and the work experience was 123.42 (±84.22) months. The majority (77%) were married, 57.3% had undergraduate degrees and 46.9% had formal employment. Employee stress burden was 503.3 (161.23%) out of 1050 points. Persons who had musculoskeletal disorder due to their job had reported more stress than others; hoever, this difference was not significant (P<0.05). People with musculoskeletal disorders in neck reported higher stress load (P<0.05) than others which was not significant. There was a significant relationship between type of employment, work experience, and type of exercise with musculoskeletal disorders (P<0.05).

There was a significant relationship only between stress and musculoskeletal damage. By modifying and eliminating stressors in emergency personnel’s routines, by holding workshops on ergonomic principles as well as stress reduction principles, it is possible to reduce the physical disorders of emergency personnel.

Medicinal nonadherence prevents the achievement of therapeutic goals in cardiovascular patients. Training is essential to increase medicinal adherence. Therefore, the present study compared the effect of two teach-back and pictorial training methods on the medication adherence in heart failure patients.

This quasi-experimental study was performed on 210 heart failure patients in Hamadan Heart Hospital in 2019. Patients were selected by convenience sampling and randomly assigned to one of three groups of Teach-back, pictorial, and control training. Training sessions were held in three sessions on three consecutive days. Data were collected using demographic and medication adherence questionnaire (MMAS-8) before, immediately and 6 weeks after training. ANOVA, ANCOVA and Repeated measures ANOVA statistical tests were used.

There was no statistically significant difference between the three groups in medicinal adherence at baseline. Immediately after training, medication adherence was significantly higher in teach-back and pictorial groups than the control group (P<0.001), but there was no difference between teach back group and the pictorial group (P=0.123). Six weeks after training, medicinal adherence was significantly higher in teach-back group compared to the control and pictorial group (P<0.001). There was no significant difference between the two methods at different levels of education (P>0.05).

Teach-back training helps maintain medicinal adherence in heart failure patients. Therefore, it is recommended that nurses use this training method to improve medicinal adherence in these patients.

Patients transferred from ICU to general ward need a higher level of nursing attention and care than other patients admitted to the ward. The aim of this study was to investigate the effect of the role of the liaison nurse on physiological indicators and the level of consciousness of patients transferred from the intensive care unit.

The present article is the result of a two-group clinical trial that was performed on 90 patients admitted to the special and general wards of Besat Hospital in Hamadan, Iran. Available sampling and patients were randomly assigned to the two groups. The control group received routine care and in the intervention group was visited twice a day by the liaison nurse for up to three days. The instrument used was a checklist of physiological indices and the GCS scale. Mean, standard deviation, variance and frequency percentage were used to describe the data by SPSS 16.

There was no significant difference between the demographic and clinical characteristics of the two groups at the beginning of the study. After the intervention of the intensive care unit nurse, the two groups were not significantly different in terms of physiological parameters and level of consciousness (P> 0.05).

In nursing services, the interface is not effective on physiological indicators and level of consciousness in patients transferred from the intensive care unit to the general ward. Further studies in this area are recommended.

Patients with multiple sclerosis need a comprehensive nursing care program because of the chronic and complex nature of the disease. Nursing models can provide a framework and goals for the nursing process to provide more effective and comprehensive clinical care. The aim of this study was to investigate the effect of applying nursing process based on Johnson Behavioral Model on improving stable behaviors client with multiple sclerosis (MS).

In this case study, the nursing process was presented by a client with multiple sclerosis who met the MS criteria in Hamadan in 2019. In the Nursing assessment and Recognition phase, data were collected based on the "Johnson Behavioral Model scale" by observation, interview and physical examination. Data sources were the client herself, her family, physician, and medical record and MS staff. Nursing diagnoses were formulated as stable and unstable behaviors. And caring goals were set and shared with the client to increase stable behaviors and reduce or eliminate unstable behaviors. Nursing measures were performed and evaluated to achieve the goals. Data analysis was presented using the table.

The results of the study showed that the client had unstable behaviors in four behavioral subsystems (inefficiency in, Aggressive- protective, Elimination, restorative and sexual subsystems). Unstable behaviors decreased after planned nursing measures.

Johnson's behavioral model was useful in modifying and correcting the unstable behavior. So providing care based on nursing models, can increase the quality of care and client satisfaction.

The treatment process of hospitalized patients with obsessive-compulsive disorder is less studied. However, because of the complex nature of the disease, these patients require a comprehensive nursing care plan. Since nursing process based on Roy’s adaptation model is widely used to solve problems caused by chronic diseases, this study aimed to implement this model in a patient with obsessive-compulsive disorder.

This study was a case study performed on a patient with obsessive-compulsive disorder admitted in the psychiatric ward of Farshchian (Sina) Hospital in Hamadan, Iran, in 2019. Data were collected using observation, interview, and patient documentation, and they were analyzed in four dimensions based on the stages of the nursing process in Roy’s adaptation model.

Based on data from the assessment stage, manifestations of chronic maladaptive behaviors in the patient included unwanted, intrusive, repetitive thoughts and fears as the focual stimuli, family history of obsessive-compulsive disorder, parental divorce and weakness in coping mechanisms as the contexcual stimulus, beliefs of the patient's father, and psychiatric hospitalization as residual stimuli. Six types of maladaptive behaviors in four modes including inappropriate nutrition (physiological mode), reduced self-care, non-adherence to treatment, need to perform obsessive rituals, avoiding social interactions (self-concept mode), and father dependency (role function mode and interdependence mode) were identified.

Implementing a nursing process based on Roy’s adaptation model by deeply identifying maladaptive behaviors and then, promoting the use of regulate and cognitive coping mechanisms can help correct or modify maladaptive behaviors of patients with obsessive-compulsive disorder. However, achieving desirable outcomes after discharge requires long-term follow-up and support by psychiatric nurses.

Public-private partnership reduces the project fund. Besides, it focuses on utilizing private-sector capacities such as knowledge and specialized experience. The aim of this study was to match the public-private partnership models in medical education in five continents to choose a suitable model for the medical education system. Methods and Materials: This study has compared the public-private partnership models in higher education. The valid databases and websites of major universities across five continents have been searched by proper keywords of public-private partnership. The sampling of universities was done based on strategic choice, purposefulness, and access to information.

One of the good models of the partnership was to use private sector resources to train trainees in the real work environment that has benefited both public and private partners. The private sector partner had cheaper labor and the public sector partner saved money. There were furthermore, another appropriate model was consulting and knowledge transfer services for the private sector by the public sector.

It seems that using private-sector resources for clinical education as a public-private partnership in universities of medical sciences are suitable. On the other hand, the public sector lays education policy and regulation and monitors the quality and quantity of education. Correspondingly, the private sector will be responsible for providing learning space, transfer of knowledge and specialized experience.

Teaching the professional communication skills can be effective in developing the learners’ self-efficacy. In the patients' training with communication skills, the active and student-centered learning methods, such as role-playing, are emphasized. Therefore, this study was run to determine the effects of applying the role-playing method to communication education on the self-efficacy and communication skills of nursing students.   This controlled before-after quasi-experimental study was conducted in Hamadan University of Medical Sciences in 2015. Out of 15 student groups, four groups were randomly assigned to the role-playing (n=32) and four groups to the routine (n=32). Sherer's self-efficacy questionnaire was completed by students at the beginning and end of clinical education. Patient-nurse communication program training through role-playing method was implemented during the interval period. Data analysis was run using SPSS16 by statistical tests at 95% confidence level.   Students in the role-playing group were compared to the conventional group in terms of the individual characteristics (P >0.05). At the baseline, the control group had higher self-efficacy than those in the role-playing group (P<0.05). But after the intervention, analysis of covariance showed that the significant progress was only made in the role-playing students' self-efficacy compared to the control group when baseline score differences were controlled (P<0.001).   Using an active role-playing method can lead to self-efficacy of undergraduate nursing students in comparison with the traditional method.