فهرست مطالب mohammad alicheraghi

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.

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.

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.

The present study aimed to assess the correlation of spiritual well-being with parental stress and coping strategies in mothers with preterm neonates hospitalized in neonatal intensive care units (NICUs).

This prospective cross-sectional study assessed Spiritual Well-Being (SWB), parental stress, and coping strategies in mothers (n=200) of preterm infants admitted to NICUs. Mothers were further divided based on socio-demographic characteristics, such as mother’s age, gestational age, average scores at school, mothers’ literacy level, the birth rank, cesarean or vaginal delivery, number of children, job, and duration of hospital stay.

The results pointed out that 46.6% and 53.4%of mothers had moderate and high levels of SWB, respectively. Moreover, the religion domain (53.30±7.33) had a higher score, in comparison with the existence domain (46.03±7.15). The planful problem-solving was the most frequently used (46.02±11.46) strategy. Religion domain had a significant positive and negative correlation with planful problem-solving strategy (r=0.439**; P≤0/000) and emotional-driven coping strategy (r=-0.420**; P≤0/000), respectively. There was a significant negative correlation (r=-0.322**; P≤.0/000) between the existence domain and the emotional-driven coping strategy.

Regarding the close interrelationship between mothers and NICU nursing staff, it is clear that nurses can help mothers to cope with stress more quickly and efficiently using accurate assessment and appropriate intervention in terms of their spiritual and religious beliefs.

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 turbulent and stressful work environment of prehospital emergencies, the conflict among emergency medical technicians (EMT) and other health‑care providers is inevitable. This study aims to examine the concept of workplace interpersonal conflict (WIC) in prehospital emergencies.

The eight‐step Walker and Avant’s concept analysis approach was adopted to define the concept. Iranmedex, SID, Magiran, ISC, PubMed, Scopus, Embase, and Web of Science searched with keywords such as WIC and hospital emergencies. After an extensive review of online national and international databases, one dictionary, nine books, and 25 articles in English and Persian were retrieved for the purposes of the study.

The antecedents, attributes, and consequences of the concept identified. EMT must learn how to eliminate their destructive effects while enhancing constructive effects.

Conflict is an inevitable part of life, and EMT must learn how to reduce their destructive effects while increasing constructive results

Spiritual health (SH) has received great attention from nurses and other health‑care providers in recent years. The existing instruments for SH measurement measure either some aspects of SH or SH‑related concepts, and there is no specific SH measurement instrument, particularly for Muslim adults in Iran.

This study aimed at the development and psychometric evaluation of the Spiritual Health Questionnaire (SHQ).

This exploratory sequential mixed methods study was conducted in a qualitative and a quantitative phase in 2014–2016. In the qualitative phase, a concept analysis was conducted using the hybrid model and its results were used to develop the primary SHQ. In the quantitative phase, the face, content, and construct validity and reliability of SHQ were assessed. Exploratory factor analysis and concurrent validity assessment were performed for construct validity assessment. Test–retest stability and internal consistency were also assessed for reliability assessment.

The qualitative phase of the study showed that the concept of SH had six main components. In the quantitative phase, the number of primary SHQ items was reduced from 88 to 59 after face and content validity assessments. In construct validity assessment, 12 more items were excluded and the remaining 47 items were loaded on six factors which explained 45.2% of the total variance. The Cronbach’s alpha values of the questionnaire and its six dimensions were 0.778 and 0.752–0.788, respectively. Convergent validity assessment showed that the mean scores of SHQ and the Spiritual Well‑Being Index had a significant correlation with each other (r = 0.35; P = 0.032).

The 47‑item SHQ is a specific instrument for SH assessment with acceptable validity and reliability.

Heart transplantation is a standard treatment for end-stage cardiac disease. In addition to inducing physical changes and improving the quality of life, it causes unique mental and psychological changes in transplant recipients. Therefore, this study sought to explain and interpret the experience of heart transplant recipients in Iran.

Using a qualitative content analysis approach, this study was performed on 13 heart transplant recipients in Tehran. The data were collected through observation and semi-structured interviews. The participants were selected using purposive sampling, and the interviews continued until data saturation. After obtaining informed consent, interviews were recorded, transcribed, and analyzed using conventional and concurrent content analysis.

The analysis of the data revealed two stages experienced by heart transplant recipients. The transition stage was categorized into two concepts of "emotional turmoil" and "feeling of duality". The emotional turmoil was subcategorized into feeling guilty, alienation with the new heart, and gratitude. Besides, the "feeling of duality" was subdivided into personality change and lifestyle changes. The stabilization stage was conceptualized into “self-acceptance” which was subcategorized into three concepts of the acceptance of the new heart, feeling of unity with the donor, and normalization.

Adaptation to the new heart is a multistage process in heart transplant recipients. Based on the insights from this study, it can be concluded that healthcare professionals need to improve their knowledge of post-transplant changes, recipients’ feelings, and their adaptation strategies. They are also advised to address the physical needs and mental concerns of transplant recipients.

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.

Working adolescents need to cope with extreme situations they face, and it is important to identify what factors influence their resilience to better support their health and well-being.  The purpose of this study was to explore resilience in working adolescents.

The directed content analysis approach based on the ecological-transactional resilience model was employed across five domains of resilience (Self, Family, Peers, School, and Community).  Semi-structured interviews with a purposive sample of working adolescents were conducted. Inclusion criteria were being 12-18 years of age, Persian speaker, and direct experience of being forced to work for at least one year. Hsieh & Shannon (2005) instruction was used for data analysis.

17 participants were interviewed, 59% were male, 88% immigrants and 41% had started working by age 6. Adolescents reported experience of significant adversity. A dichotomic range of resilience-related factors was identified within five domains, embedded with distinct themes. There was evidence of self-care, patience, empathy, and emotional insight within extremely difficult life circumstances. Peers and schools were identified as supporting resilience. Very few Family or Community resilience factors were identified; instead, adolescents reported hurt, alienation, and voicelessness within the family; and fear and insecurity in the community.

Working adolescents in this study revealed some dichotomic strengths and vulnerabilities. Individual, peer, and school factors were more evident than family and community factors in fostering resilience among working adolescents.

Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses’ ethical performance. This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study’s conclusions. In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase’ results were categorized into three themes: “perception of conscience”, “commands of conscience”, and “obedience to conscience. The final definition was reached by merging the theoretical and field stages. This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.

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.

Death is always considered as one of the major concerns of humankind. In spite of the diverse believes about the concept of death which are heavily influenced by the culture and traditions of societies, there are also commonalities regarding it.

The aim of this study was to analyze the concept of human death by Walker and Avant concept analysis method. Setting and Design: This is a concept analysis and library study.

To clarify the concept of death, the internet search of the Persian and English words death, dying ،dying patient, concept analysis and Walker and Avant was done in SAGE, PubMed, Medline, Google scholar, science direct, and Scopus databases and the related articles and book about death were reviewed. In the present study, it was attempted to extract the commonalities of death and clarify this concept further. To clarify the concept of death, the Walker and Avant model was used. Statistical Analysis Used: No statistical methods were used in this study.

The findings reveal that death is a metaphysical phenomenon with features such as a part of life from the beginning of creation; an ambiguous and sometimes horrific truth; too far; too close; certain and inevitable truth; universal for all beings; a necessity for excellence; divine blessing for man; passage to another world and irreversible.

It seems that this concept requires more and more research, and deeper knowledge and appreciation regarding it can lead to more positive and logical attitudes toward it.

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.

Spiritual health has attracted wide attention in health-related and nursing sciences. However, most research on this complex and ambiguous concept has been conducted from the Judeo-Christian philosophical worldview, and the Muslim community that comprises a large population of the world, and particularly the Iranian population, has not been investigated.

The present study aimed to explore the experiences of Iranian Muslim adults regarding spiritual health.

This qualitative content analysis was conducted among 14 participants. Semi-structured interviews were used for data collection, and Granheim and Lundman (2004) method was used for qualitative content analysis. The results were categorized into six major themes.

The six major themes extracted for spiritual health included harmonious reciprocal connectedness, moderation, spiritual striving, transcendence, purpose seeking and wisdom thinking, and faith. These characteristics were reciprocally interconnected and intertwined. It should be noted that some of the extracted attributes were quite new.

Considering the cultural and philosophical foundations of different communities, assessment of spiritual health in different societies would reveal novel and innovative aspects of this concept. Paying attention to these aspects is essential in the health promotion.

Because of the chronic nature of Heart Failure (HF), low Quality of Life (QoL) and poor self-care are prevalent among patients with HF. Thus, the aim of this study was to evaluate the effect of illness perception correction- based educational program on QoL,and self- care in patients with HF. In this randomized controlled trial, 78 eligible patients were included in the study from Rajaei Heart Center (Tehran, Iran) and randomly assigned into intervention and control group with 1:1 allocation ratio. The intervention was a combination of illness perception correction- based education program (30- minute sessions over 3 consecutive days) and 10-minute phone calls made once a week in the course of 8 weeks. The control group received usual care. The primary outcome was quality of life and secondary outcomes were self- care and illness- perception which were measured at baseline and at the end of the study. SPSS version 13 was used for the analysis. Out of 76 eligible patients, 70 patients with HF finished the study. Although the mean of quality of life, self-care, and illness perception were not different at baseline, QoL (45.2 (8.3) VS 66.8 (15.4); P<0.001), self-care (18.5 (4.5) VS 37.1 (7.2); P<0.001), and illness- perception (183.6 (8.4) VS 151.2 (24.5); P<0.001) improved following the program in the intervention group in comparison to the control group. According to the study findings, this program can be applied by nurses for patients with HF as a discharge plan in order to improve their QoL, self-care, and their illness perception.

  Gynecological surgeries associated with loss of feminine organs evoke more personal, interpersonal and psychological distress that may diminish women’s quality of life. Women need and seek support to cope with various distresses which may change over the course of diagnosis to treatment. This study aimed to explore Iranian women’s needs to cope with hysterectomy and oophorectomy. This qualitative study was conducted in Kerman and Tehran, Iran from 2015 to 2017. Thirty interviews were conducted with 28 eligible participants including 24 main participants including one gynecologist, one midwife and one nursing faculty member, one gynecologist and one midwife and 2 husbands. They were recruited through purposeful sampling. Data were collected through semi-structured and in-depth interviews and analyzed with Graneheim and Lundman’s method of conventional content analysis. The trial version of the MAX QDA 10 Software was used to manage the coding process. “Tender care” emerged as the main theme. It was comprised of three categories: “to be well-informed, “to be treated with compassion in healthcare setting”, and “to be welcomed in the society”. Women after hysterectomy/oophorectomy were preoccupied with many physical and emotional concerns. They need a whole package of care which consists of proper information to know what to do, a well-prepared/trained healthcare setting to meet their needs, and visibility in the society as a whole person. A multidisciplinary approach must be activated to meet their coping requirements and it is necessary to address these needs in each level of healthcare services.  

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.

Abstract Ethical management with minimum moral distress is one of the main duties of nurse managers. There is no doubt that a better understanding of the experiences of nurse managers in morally challenging situations could have an effective role in improving health care systems. The present study aimed to investigate the lived experiences of clinical nurse managers regarding moral distress. This hermeneutic phenomenological qualitative research involved the use of semi-structured interviews with nurse managers. The interviews were transcribed and analyzed by the Diekelman, Allen and Tanner approach. For this purpose, a total of 14 Iranian nurse managers with at least five years of experience in nursing management in hospitals were purposefully selected. The findings related to nurse managers’ experiences of moral distress contained two main themes (psycho-emotional trauma and professional desperation syndrome) and four sub-themes (shame, emotional dissociation, helplessness, impaired professional identity). The findings of the study indicated that in order to understand the phenomenon of moral distress among nurse managers, it is essential to investigate the moral distress experienced by them. We also found that although they experience moral distress in their daily decisions repeatedly, they are not fully aware of this phenomenon According to the results, for clinical nurse managers, moral distress is an ambiguous situation like suspension along with uncertainty, fear and so on. They believed that experiencing this kind of conscious mistake is the reason for the occurrence of professional desperation syndrome and psycho-emotional trauma.

Without the meaning in life and setting goals, the life will be full of pain and suffering. Hence, psychologists try to discover patient’s meaning in life and guiding it. A good questionnaire is very important to identify and measure meaning in life. Therefore, the present study focused on design and psychometric assessment of meaning in life questionnaire in patients with SCI.
A total of 258 patients with spinal cord injury in 2014-2016 were selected using the available sampling method. Waltz (2010) method was used for designing the questionnaire: 1) a copy of the questionnaire was designed based on the literature review, 2) face and content validity confirmation of the questionnaire by 10 experts, 3) exploratory factor analysis for construct validity was done, and 4) internal consistency of the questionnaire was confirmed by Cronbach’s alpha coefficient. The SPSS version 16 software was used for analyzing the data.
Estimation of CVR and CVI revealed the content validity to be 0.81 and 0.9, respectively. Finally, the questionnaire was extracted with 38 items based on 4 factors: the first factor (positive perception) with 13 items, the second factor (sense of meaning) with 9 items, the third factor (purposefulness) with 7 items, and the fourth factor (spirituality) with 9 items.
Considering the existence of a valid and reliable questionnaire, it is recommended that studies be conducted on the meaning of life in various diseases and should be designed to support these patients.

Communication skill (CS) has been regarded as one of the fundamental competencies for medical and other health care professionals. Student’s attitude toward learning CS is a key factor in designing educational interventions. The original CSAS, as positive and negative subscales, was developed in the UK; however, there is no scale to measure these attitudes in Iran. The aim of this study was to assess the psychometric characteristic of the Communication Skills Attitude Scale (CSAS), in an Iranian context and to understand if it is a valid tool to assess attitude toward learning communication skills among health care professionals.
Psychometric characteristics of the CSAS were assessed by using a cross-sectional design. In the current study, 410 medical students were selected using stratified sampling framework. The face validity of the scale was estimated through students and experts’ opinion. Content validity of CSAS was assessed qualitatively and quantitatively. Reliability was examined through two methods including Chronbach’s alpha coefficient and Intra class Correlation of Coefficient (ICC). Construct validity of CSAS was assessed using confirmatory factor analysis (CFA) and explanatory factor analysis (PCA) followed by varimax rotation. Convergent and discriminant validity of the scale was measured through Spearman correlation. Statistical analysis was performed using SPSS 19 and EQS, 6.1.
The internal consistency and reproducibility of the total CSAS score were 0.84 (Cronbach’s alpha) and 0.81, which demonstrates an acceptable reliability of the questionnaire. The item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI/ Ave) demonstrated appropriate 0.97 and 0.94, respectively. An exploratory factor analysis (EFA) on the 25 items of the CSAS revealed 4-factor structure that all together explained %55 of the variance. Results of the confirmatory factor analysis indicated an acceptable goodness-offit between the model and the observed data. [χ2/df=2.36, Comparative Fit Index (CFI)=0.95, the GFI=0.96, Root Mean Square Error of Approximation (RMSEA)=0.05].
The Persian version of CSAS is a multidimensional, valid and reliable tool for assessing attitudes towards communication skill among medical students.

Following the confirmed type 1 diabetes in children and their discharge from the hospital, the care responsibilities are transferred from nurses to mothers. These mothers are faced with many challenges to play this caring role. The aim of this study was to explore the experiences of the diabetic children’s mothers from the transfer of caring role.
In 2016, semi-structured interviews with Eleven Iranian mothers of children (aged≤14 year) with type 1 diabetes were conducted. Data were analysed using Colizzi’s phenomenological method.
The following themes emerged in this study: ‘Facing the care management challenges,’ ‘care in the shadow of concern’, and ‘hard life in the impasse of diabetes’.
Them mothers of children with type 1 diabetes, who undertake the caring role that has been transferred to them by healthcare providers, are faced with many challenges. They feel a lot of concerns and experience a hard life. Thus, understanding the experiences of these mothers by the health professionals, to improve the quality of care, is necessary.