zahra fotokian

Recognizing thirst distress and sodium intake restriction using valid and reliable tools enable evidence-based care, and improve treatment outcomes for the elderly with heart failure (HF). The present study investigated the psychometric properties of the thirst distress scale (TDS-HF) and dietary sodium restriction questionnaire for Iranian's elderly with HF (DSRQ-HF).

This crossectional study was conducted during 2021-2022. Two hundred and forty elderly people referring to the cardiology clinics and offices in the western region of Mazandaran, Iran were selected by the convenient sampling method. First, the two questionnaires were translated. Then, face, content, and construct validity were assessed. Several indices were used to evaluate, including the chi-square/degree-of-freedom ratio (CMIN/DF), parsimonious normed fit index (PNFI), comparative fit index (CFI), parsimonious comparative fit index (PCFI).

The value of content validity index of all items of the two questionnaires was higher than 0.62. The fit indices, including PCFI=0.594, PNFI=0.582, CMIN/DF=1.987, and CFI=0.979, confirmed the one-factor construct of TDS. PCFI=0.724, PNFI=0.661, CMIN/DF=1.935, ad CFI=0.905, indicated the confirmation of the three-factor construct of DSRQ. The value of Cronbach's alpha of the two questionnaires were 0.86. The value of Ω of the TDS-HF and DSRQ-HF were 0.858, and 0.860, respectively. The value of θ of the TDS-HF and DSRQ-HF were 0.858, and 0.861, representing the suitability of both constructs.

The TDS-HF and DSRQ-HF can be used to measure the psychometric effects of diet therapy and behaviors of the elderly with HF in relation to adherence to diet therapy.

Pain and its control is a significant health problem worldwide. The present study aimed to determine the effects of white noise (bird sound) on the severity of muscle vaccination pain in children under two years old.

This study was a case-control study conducted in 2021. The samples included seventy children under two years old referred to the health centers in Ramsar City, Iran. The samples were selected using the convenient sampling method and divided into experimental and control groups. The data were collected using the demographic characteristics questionnaire, facial expression, and pain assessment in pediatric patients (FLACC). They were then analyzed by SPSS16 using an independent t-test and analysis of covariance (P<0.05).

A significant difference was observed between the severity of muscle vaccination pain in children in the two groups (p=0.042); the pain intensity mean in the experimental group (6.45±2.01) was lower than the control group (8.94±1.28).

This method can be a harmless and inexpensive intervention to reduce pain intensity and behavioral pain responses in infants during painful procedures, especially vaccination.

Due to the importance of breastfeeding and the necessity of identifying the factors affecting the creation and promotion of this behavior, this study aims to determine the relationship between sleeping place, duration of weaning time, and breastfeeding in Children aged 2-3 years.

This study was descriptive and analytical-correlational research in 2021. The participants were 214 children aged 2-3 years old from the health centers of Ramsar city, Iran. The sampling method of the present study was convenient. The tool of the study was a researcher-made questionnaire on infant sleeping places and breastfeeding. The data were entered into SPSS 16 and analyzed using the univariate chi-square test, Pearson correlation coefficient, and analysis of variance(P = 0.05).

Exclusive feeding 69.2% (148 people) of children who were exclusively breastfed and in the usual place of sleep, 36.4% (78 people) of children slept in a shared bed with adults, and 57.5% (123 people) shared a room. However, in a separate bed, 1.6% (13 people) slept in a separate room. The average age of weaning in children sleeping in a shared room in the mother’s bed and next to the mother is 1.27 times and 1.30 times that of children sleeping in a separate room, respectively. The relationship between Infant’s sleeping place and the duration of exclusive breastfeeding (P = 0.005), age of weaning onset (P = 0.007), length of weaning (P = 0.018), and definite age of weaning (P = 0.014) was significant. 56.5% of infants (n = 121) were female, and 56.1% (n = 120) had the first birth rank. Breast milk exclusively fed 69.2% (n = 148) of infants.

The results showed that the place of sleep has a significant relationship with the exclusive feeding of milk and the age at which the child is weaned. The results of this study can be useful in planning interventions to promote exclusive breastfeeding and increase the duration of feeding infants with breast milk.

Toddlerhood is an important period of a child’s development to master the functioning of the bowel and bladder sphincters. In this regard, the present study aimed to determine the relationship between parental awareness, self-efficacy, and defecation control skills in Iranian toddlers.

The present study was descriptive cross-sectional research. The questionnaires on Demographic information of children and parents, parental awareness and self-efficacy, and defecation control skills were completed by 72 mothers of children aged 18-24 months old in the city of Ramsar. The data were analyzed using SPSS 18, descriptive tests of mean and standard deviation, analytical tests of analysis of variance, independent t-test, and Pearson’s correlation coefficient.

The results showed that the awareness and self-efficacy level was at a medium level of 17.70 ± 2.9230.54 ± 7.15, and their children’s defecation control skill was at a high level8.88 ± 2.91 respectively. Also, there was a positive significant relationship between parental awareness (r = 0.19, P = 0.02) and self-efficacy (r = 0.20, P = 0.01) with defecation control skills. There was a significant relationship between the mother’s occupation (P = 0.04), the father’s age (P = 0.04), and parental selfefficacy (P = 0.04). In addition, a significant relationship was found between the child’s age (P = 0.03) and the mother’s age (P = 0.01) with the child’s defecation control skill.

Promoting awareness and self-efficacy in training defecation control skills is a necessity for parents, and the policymakers should include the integrated care of children in the educational programs of the Ministry of Health so that it is included in the agenda of routine care of health centers in the country.

The safe performance of nurses during the outbreak of the coronavirus disease (COVID-19) is effective in reducing the costs and deaths caused by COVID-19 and reducing the hospitalization of patients. The aim of the present study was to investigate the head nurses' perspective on nurses' performance in providing safe care to patients during COVID-19 epidemic.

This descriptive cross-sectional study was conducted during 2021-2022. The research population included all nurses with at least a bachelor's degree in nursing and at least six months of work experience. In this study, head nurses who were as evaluators had at least six months of leadership experience. The sample size was 118 subjects. The data were collected using a Safe Nursing Care Tool. Data were analyzed with SPSS 18 using an independent t test, analysis of variance and multiple regression. A value of P< 0.05 was considered significant.

The mean and standard deviation of the nurses’ age was 71.37±32.7 years. The mean of the nurses' total safe behavior score was 27.255±97.30 (at average level). There was a statistically significant relationship between nurses’ safe behavior and age (P=0.047) and nurses' working hours (P=0.005).

From the results, nurses' safety behaviors were average during COVID-19 outbreak. Therefore, to improve nurses' safety behaviors, it is recommended that nurses be regularly trained in safety concepts and provided with feedback, and their safety performance be monitored and evaluated.

The availability of information regarding people's experiences of returning to work after heart surgery, taking into account the socio-cultural context of Iranian society, is limited. The aim of this study is to discover the process of returning to work after heart surgery.

Methods & Materials:

A qualitative study using the grounded theory approach was conducted between 2021 and 2022. Through purposive and theoretical sampling, 21 participants who had undergone heart surgery and were in the process of returning to work were selected. They were chosen from the cardiac surgery ward of Amiralmomenin Hospital in Kordkuy, as well as among patients seeking treatment from cardiac surgeons in Golestan province. Data were collected through conducting semi-structured interviews and taking field notes. Data analysis was conducted using the method proposed by Corbin and Strauss in 2015.

"Feeling of doubt about return-to-work", "perceived psycho-social support", "personal and occupational factors", "unfavorable consequences of heart surgery" and "limited support from governmental/non-governmental institutions" were determined as contextual factors influencing the process of return-to-work. Moreover, "effort to adjust the job", "situation evaluation" and "self-management" were introduced as strategies, while "adaptability to the job" were identified as the consequence of returning to work. Finally, the core variable of the study was determined to be "the thoughtful effort to match the job".

Based on the results, it was determined that several individual and environmental factors influence the process of return-to-work for people who have undergone heart surgery. To facilitate a successful return to work, it is crucial to provide psycho-social support from both the family and work environment. It is recommended that policy makers in the health and social affairs sectors take active steps to empower people during the post-recovery period. Additionally, fostering collaboration between the Ministries of Labor and Health, as well as insurance organizations, can greatly facilitate the return to work of individuals after heart surgery.

Frailty and fear of falling (FOF) are highly prevalent in older adults undergoing hemodialysis (HD). However, there is no reliable evidence of the association between FOF and frailty in older adults undergoing HD. This study aimed to determine the association between FOF and frailty in older adults undergoing HD. This cross-sectional study was conducted on 194 older adults undergoing HD in the east of Mazandaran province, Iran. Data were collected using of demographic and clinical characteristics questionnaire, Edmonton Frail Scale (EFS), and Falls Efficacy Scale–International (FES-I). Independent t-test, analysis of variance, Pearson’s correlation coefficient, and stepwise multiple regression were used to analyze the data. The mean score of the FOF was 34.41±12.20, and most of the participants (38.4%) had moderate FOF. The mean score of the frailty was 6.91±3.12 and most of older adults (34.3%) were vulnerable to frailty. There was a positive and significant association between FOF and frailty in older adults undergoing HD (r=0.802, P<0.001). The majority of older adults receiving chronic HD have moderate to high FOF and are prone to frailty. Therefore, it is necessary to perform appropriate educational, behavioral, and cognitive interventions to reduce the FOF in these patients.

Fatty liver is one of the most common liver diseases. Some treatments used in breast cancer may be associated with development of fatty liver. The present study aimed at investigating the prevalence of fatty liver in breast cancer patients.

In this cross-sectional study, 117 patients with breast cancer attending Ramsar Imam Sajjad Hospital in 2017-2022 were selected using available sampling. Patients who had fatty liver before the treatment or had a history of alcohol consumption were excluded from the study. Relevant information, including age, BMI, underlying diseases, time since cancer diagnosis, type of treatment/s, and liver enzyme levels were obtained. Liver ultrasound and measurement of liver enzyme levels were done to study fatty liver. Data were analyzed in SPSS V26 applying Chi-square test.

According to findings, 54.7% of the patients were suffering from fatty liver. The majority had Grade I fatty liver. Among the patients 53.8% received all four types of treatments (surgery, chemotherapy, hormone therapy, and radiotherapy). The study showed significant relationships between the incidence of fatty liver and type of treatment, underlying disease, liver enzyme levels, and duration of breast cancer (P<0.05).

Non-alcoholic fatty liver is seen in many patients with breast cancer. Treatment methods used in these patients are associated with the development of fatty liver. Therefore, clinicians are suggested to use appropriate diagnostic and treatment methods for fatty liver to reduce the incidence of complications caused by this condition in patients with breast cancer.

Recognition of the factors influencing returning to work by people after heart surgery is very significant in performing supportive interventions. Factors affecting return to work of Iranian patients after surgery are unknown. Therefore, a qualitative study is in demand in order to close this knowledge gap. This study was aimed to explore the facilitators and barriers of return to work after heart surgery.

This qualitative study was conducted during 2020–2021. People after heart surgery were studied in this research. Nineteen interviews were performed with 17 participants. The main participants were selected from the cardiac surgery ward of Golestan Province Hospital. The sampling method was purposeful. Data were collected through semi‑structured interviews. Questions were asked in an unguided and open‑ended manner. Data analysis was performed by qualitative content analysis.

According to the results, “perceived psychosocial support,” “individual characteristics,” and “occupational factors” were considered as facilitators and “effects of heart surgery” and “limited support of public and private institutions” were introduced as barriers to return to work in patients after heart surgery.

The effects caused by heart surgery and limited support of public and private institutions were identified as barriers to return to work. Cardiac rehabilitation after surgery can reduce the impact of heart surgery and can help people to return to work. It is recommended that the planners of the Ministry of Labor and Social Welfare and Health, with the support of insurance organizations, help solve the work problems of people after heart surgery.

Frailty is one of the most common syndromes that can affect the prognosis and outcomes of the disease in the elderly undergoing hemodialysis. Therefore, it is important to identify the factors associated with frailty in this group of elderly people. The aim of this study was to determine the degree of frailty and its related factors in the elderly undergoing hemodialysis.

This descriptive-analytical cross-sectional study was conducted on 198 older adults undergoing hemodialysis, selected using the convenience sampling method. Data were collected using questionnaire of demographic and clinical characteristics, Edmonton Frail Scale (EFS), and Fall Incidence Questionnaire. The data were analyzed using SPSS 26 through independent t-test, analysis of variance (ANOVA) and Pearson correlation coefficient.

The mean age of the elderly undergoing hemodialysis was 68.10.±7.40 years, as well as 55.4% of them were male. The mean and standard deviation of the frailty score of the older adults undergoing hemodialysis were 6.91±3.12, and most of them were susceptible to frailty. The results indicated that there was a positive and significant relationship between frailty with demographic and clinical characteristics and falling history in these people.

To improve the prognosis in the elderly undergoing hemodialysis, health care professionals should evaluate frailty using standard tools, especially considering factors such as age, gender, comorbidities, and other relevant factors and should help prevent and reduce the adverse consequences of frailty on the quality of life of this group of elderly people by designing individual care and support programs.

Health promotion nursing activities for the elderly with COPD is different in various health care structures, and research in this area can help to identify the existing knowledge gap. The aim of this study was to determine health promotion nursing activities for the elderly with COPD.

 This descriptive, cross-sectional study was conducted in 2020. A total of 180 nurses working in teaching hospitals affiliated to Mazandaran University of Medical Sciences were selected using the convenience sampling method. Data collection tools included a demographic questionnaire and a researcher-made questionnaire on health promotion nursing activities for the elderly with COPD. The data was analyzed through the SPSS software version 18 using t-test, ANOVA and multivariate regression.

The mean age of nurses was 34.58±8.05 years, 84.4% were female and 70.6% were married. The mean score of health promotion nursing activities was 197.10±37.90. Among the dimensions related to health promotion activities, “drugs/smoking cessation” (34.4%) and “self-empowerment” (32.8%) had the lowest frequency. There was a significant relationship between health promotion nursing activities with the work place (P=0.034), age (P<0.001), gender (P=0.022) and marital status (P=0.014).

The health promotion nursing activities for the elderly with COPD was above moderate levels. In-service training programs and internal conferences are needed especially in the area of ​​counseling behaviors and smoking cessation in order to improve the professional competency of nurses.

Nursing students can play a major role in transmitting infection. The aim of this study was to evaluate the performance of nursing students in observing hand hygiene.

This cross-sectional descriptive study was conducted on 200 nursing students participated in an internship at Fatemeh Zahra (PBUH) Nursing School in Ramsar in 2019. The sampling method was simple random. The hand hygiene behavior of nursing students was observed in 200 situations. For data collection, the observational checklist of hand hygiene of the Ministry of Health was used. Data were analyzed using SPSS18 through descriptive statistics, Chi-square and T-test.

Among 200 students, 113 (56.5%) and 87 (43.05%) were female and male, respectively. The average number of cases of hand hygiene was 62.5%. The results showed that there was a statistically significant difference between different semesters in relation to hand hygiene behavior (P <0.05). Thus, the rate of hand hygiene compliance by students was lower in higher semesters. The highest rate of hand hygiene (37.6%) was performed in the position after contact with the patient. Handwashing with soap and water (60.8%) was done more frequently by the students than using an alcoholic solution (39.2%).

The results indicate that the higher the semester of students was the lower the level of hand hygiene. It is suggested that further studies should be conducted on nursing students in order to determine the causes and find practical solutions to promote hand hygiene among students and to teach them basic values.

Older adults waiting for colonoscopy are anxious due to the lack of knowledge about the procedure, its preparations, and aftercare.

The aim of this study was to evaluate the effect of the Neuman systems model (NSM) on anxiety of older adults waiting for colonoscopy.

A pre‑ and postintervention study was conducted on 72 older adults who were waiting for colonoscopy. The participants were randomly allocated to either a control (n = 36) or an intervention group (n = 36). The intervention was performed in four steps, namely determining the potential and actual stressors, setting the goals, nursing interventions, and evaluation, according to the four‑step nursing process in the NSM. A need assessment checklist based on the NSM and the Geriatric Anxiety Scale was completed before and after the intervention. Data analysis was performed using Fisher’s exact, independent, and paired t‑tests.

At baseline, the mean score of total anxiety was 35.66 ± 7.58 in the intervention group and 35.29 ± 6.52 in the control group. After the intervention, these values changed to 26.71 ± 7.48 and 34.06 ± 7.23. Before the intervention, there was no statistically significant difference between the anxiety scores of the two groups in cognitive, affective, and somatic dimensions and total anxiety scores (P > 0.05). However, after the intervention, statistically significant differences were found between the two groups in the mean scores of the aforementioned components (P < 0.001).

Implementing an educational program based on NSM reduced anxiety in older adults waiting for colonoscopy. Nurses should be trained about the NSM to be able to use similar programs in reducing the anxiety of patients waiting for colonoscopy

Multiple physical problems and psychosocial issues among chemical injured patients can be a source of stress. They often use mental strategies to cope with their problems. The aim of this research was to assess these issues and problems experienced by chemical warfare victims and how they cope with it.

This qualitative study was conducted in 2017 using content analysis. Seventeen chemical weapons victims were selected based on purposeful sampling from veteran’s recreation referral to therapeutic and training center in Chaboksar (A city in northern of Iran). Data were collected through conducting in-depth semi-structured interviews and making filed notes. Data analysis was performed according to the proposed steps by Granhym & Lundman.

During the data analysis, one main theme (Coping with pain in the shadow of values), four categories and twelve subcategories including physical pain (acute pain and chronic pain), psychological discomfort (nightmare, depression and misconception), unsuitable social context (feeling abandoned, fearing from an unforeseen future and stigmatization) and coping (coping because of patriotism, religious coping, family coping and coping by force) emerged from the interviews.

Coping might be a way for facing to pain but it is certainly neither easy nor joyful. Putting to suffer the necessary facilities, social and family support and changing the culture beliefs for decreasing the social stigma are the most effective ways of their treatment.

Instructors and students have many challenges in completing and presenting logbooks. This study endeavored to investigate the views of nursing students and instructors of Ramsar School of Nursing on logbook-based evaluation.

This cross-sectional descriptive study was performed in the second semester of the academic year 2020-2021. The study population was all nursing students studying and clinical instructors working in Ramsar School of Nursing. Seventy-five individuals (65 nursing students and 10 nursing instructors of the internal medicine-surgery internship unit) were included in the study by census method. The researcher-made questionnaire on the perspective of nursing students of logbook-based and traditional method evaluation were used for data gathering. Data analysis was performed using paired and independent t-test and Chi-square.

The perspective of nursing students and clinical instructors about the use of logbooks showed a significant difference concerning order, evaluation, satisfaction, and clinical skills. The mean scores of the perspective of instructors in the dimensions of order and evaluation were higher than students (t=-4/38, p=0.001; t=-5/36, p=0/001). The instructors’ mean score of satisfaction and clinical performance with logbook evaluation was more than students (t=-4/06, P=0.001 vs. t=-3/27, P=0.002). Students believed that the use of logbooks led to more supervision of instructors over their work (t=4/17, P =0.001), but it did not affect their clinical performance (t=-1/8, P= 0.077).

The clinical Instructors evaluated the priority of the logbook over the traditional method to achieve the expected outcomes more positively towards the students. Because the logbook should meet the learning needs of students, using students' opinions in compiling the logbook can be effective in improving student satisfaction and performance.

Nurses at the forefront were concerned about experiencing high levels of job stress due to their initiative and that of family members, lack of personal protection, and tolerance of protective cover during the Covid-19 outbreak. Tolerating this stress on a regular basis may lead to physical illness and reduced sleep quality. The aim of this study was to determine the relationship between sleep quality and job stress of nurses in the Covid-19 outbreak.

In this descriptive cross-sectional study, 102 nurses working in Imam Sajjad (AS) Ramsar and Shahid Rajaei Tonekabon Hospitals were selected using an available sampling method. A questionnaire of Pittsburgh sleep quality and nurses' job stress was used to collect information. The collected data were analyzed using SPSS 18 and Pearson correlation coefficient. The significance level was considered less than 0.05.

Based on the results, the average work experience of 102 nurses 27 (5.26%) males and 73 (71.6%) females was 15.14 ± 7.7 years. The mean total score of nurses' sleep quality was 15.5±8.7 (undesirable). The nurses' stress level was 82.16 ±18.98 (very high). The Pearson correlation test indicated that there was a statistically significant relationship between sleep quality and job stress (P-value=0.001).

The results showed that the quality of nurses’ sleep was unfavorable which could be due to the job stress of nurses during the COVID-19 epidemic. Nursing managers need to help improve the physical and mental health of nurses during the COVID-19 epidemic by holding workshops on coping strategies and improving sleep quality.

Coronavirus Disease 2019 (COVID-19) is currently one of the most challenging and worrying epidemics. One of the ways to combat the COVID-19 pandemic is to use primary health care (PHC), which is a community-based approach. The present study is based on the authors' experiences and the references at the end of the article. This approach includes health promotion, disease prevention, treatment, rehabilitation, and palliative care. PHC principles include multifaceted problem solving, people participation and self-reliance, use of appropriate technology, government political commitment, principle of justice, principle of comprehensiveness of services, use of reliable information system, use of appropriate research results, motivation, love of service staff, logistical support, and facilities at the national and international level to set up and continue the work of primary health care. These principles can be used as an appropriate solution to combat the COVID-19 epidemic.

Lifestyle modification and self‑care have potential effects on hypertension management among older women.

The aim of this study was to assess the effects of using Orem’s Self‑Care Deficit (OSCD) theory on self‑care behaviors among older women with hypertension.

This clinical trial was conducted in 2018–2019. A Seventy old women with hypertension were conveniently recruited from healthcare centers in Ramsar, Iran, and randomly allocated to a control and an intervention group. Participants in the intervention group received self‑care education based on the OSCD theory. The control group received no intervention. Data were collected using a personal characteristics questionnaire, a researcher‑made self‑care need assessment checklist, and the Hypertension Self‑Care Activity Level Effects questionnaire. The Wilcoxon and the Mann–Whitney U‑tests were used to analyze the data.

There were no significant differences between the groups respecting the pretest mean scores of medication adherence, weight control, physical activity, and nutrition‑related self‑care behaviors (P > 0.05). However, after the intervention, the between‑group difference respecting the mean scores of these behaviors were statistically significant (P < 0.001).

The OSCD theory is effective in promoting self‑care behaviors among women with hypertension. Therefore, its use is recommended to improve hypertension management and quality of life and reduce treatment‑related costs in these patients

Background:

 Neonates are the most vulnerable population in terms of temperature control. In general, neonates are not able to protect themselves against fluctuations in ambient temperature. We aimed to compare the effect of the prone and supine positions on temperature of premature neonates.

In this crossover clinical trial, a total of 22 premature neonates between 32-36 weeks of gestation admitted to the Neonatal Intensive Care Unit of Amir Kabir Hospital, Arak, Iran, were selected through purposive sampling technique, and were randomly assigned into groups 1 and 2. Newborns in group 1 were first placed in a prone position (i.e., the first period for 3 hours), and then in a supine position (i.e., the second period for an additional 3 hours). The reverse procedure was applied to the intervention group 2. A trained nurse measured body temperature every minute for three hours with a digital thermometer.

Mean age of newborns was 10.38±9.69 days and mean birth weight was 2297.72±693.75 g. The mean temperature at various times in the prone position was significantly higher than the prone position (p <0.05). The mean of body temperature at 1st, 2nd and 3rd hours in the prone position was 36.66 (±0.30), 36.57 (±0.29), and 36.88 (±0.35) and in supine position was 37.18 (±0.09), 37.16 (±0.16), and 37.17 (±0.17), respectively and in all three times, the temperature difference between the two positions was statistically significant (p <0.01).

Based on the results, placing of premature neonates, admitted to the NICU, in the prone position reduced the body temperature of those with fever or hyperthermia in a non-invasive and non-pharmacological manner and minimized their thermal fluctuations.

Weaning methods play an important role in children’s future feeding status. Poor maternal practices, such as early or late weaning and applying unsafe methods, can be influenced by prevailing cultural beliefs in a society. Recognition of mothers’ cultural beliefs about weaning by health care providers can be helpful in providing culture-based education and consultations. The aim of the present study was to determine Iranian mothers’ cultural beliefs about weaning.

This was a cross-sectional study with 310 mothers recruited from health centers in ...in cities of west Mazandaran province (Ramsar, Tonekabon, Chalus, Noshahr), Iran. Data were gathered with questionnaires assessing ‘demographic characteristics ‘and ‘mothers’ cultural beliefs about weaning’. SPSS software were applied for data analysis.

The mean age of mothers was 31.6±5.2. The last child average age was 3.0±46.85. Most mothers had High school education (51.6%), were housewife (59.7%) and had city living (89%). Current duration of breastfeeding was 19-24 months in the majority (38.8%). Scores vary from 19 to 245. The mean score of weaning beliefs was 147.14±3.47; while the highest mean component score (59.74±2.71) was related to ‘‘contexts’’. There were also statistically significant relationships among the variables of age (p = 0.01), number of children (p = 0.001), breastfeeding duration (p = 0.001), living location (p = 0.001), and children’s gender (p = 0.03) with cultural beliefs about weaning.

The results of this study have shown the obvious role of negative beliefs about weaning. Therefore, healthcare providers can increase mothers’ awareness regarding appropriate weaning times and methods during pregnancy and post-childbirth care programs by holding both educational and consulting sessions for mothers.

Considering the role of ethics in the field of nursing, performing interventions related to professional ethics from the student period is an undeniable necessity and has a significant role in improving the quality of patientschr('39') medical services. The aim of this study was to review the interventions related to professional ethics in nursing students.

This narrative review study was conducted to search interventional articles without time limit in Pub Med, Ovid, IranMedex, CINAHL, PsycINFO, Elsevier and Science Direct databases with Persian and English keywords such as ethical codes, nursing students and nursing ethics. After searching from 1980 to 2020, 34 articles were found, of which15 articles were selected based on inclusion criteria. These studies were analyzed in 5 steps based on a review framework of Sidani & Braden’s articles.

The content of the interventions was done in 3 areas: "Ethics in general", "Identification of ethical problems" and "Ethical empowerment". In all studies, standard tools such as the Ethical Environment Scale, Corley’s Moral Distress Scale and Ethical Sensitivity Scale were used to collect information. According to the results of the studies, educational interventions lead to improve studentschr('39') knowledge, attitudes and practices related to ethical codes as well as improve outcomes related to the patient and organization.

The findings showed that the interventions related to professional ethics lead to the implementation of ethical codes for nursing students in the clinical setting. Therefore, administrators and professors of nursing schools can improve the knowledge, attitude and practice of nursing students by holding training workshops for students.

Older adults who receive hemodialysis face different physiological and psychosocial stressors. Management of physiological and psychosocial stressors is among their basic needs for a desirable life.

This study aimed to evaluate the effects of telephone‑based telenursing on perceived stressors among older adults receiving hemodialysis.

This quasi‑experimental study was conducted in 2018 on sixty older adults who were receiving hemodialysis. Participants were conveniently recruited from the hemodialysis centers of Shahid Beheshti and Imam Khomeini hospitals, Babol and Behshahr, Iran, and were randomly allocated to a control and an intervention group. A 3‑month telephone‑based telenursing program was implemented for participants in the intervention group. Physiological and psychosocial stressors were assessed before and after the study intervention. Data were analyzed using the Chi‑square, paired‑samples t, and independent‑samples t‑tests.

The mean score of physiological stressors in the intervention group statistically significantly reduced from 17.33 ± 1.74 at pretest to 11.96 ± 3.16 at posttest (P < 0.001), whereas it statistically insignificantly changed in the control group from 17.30 ± 1.66 to 17.16 ± 3.03 (P = 0.747). Moreover, the mean score of psychosocial stressors in the intervention group statistically significantly reduced from 57.80 ± 8.17 at pretest to 32.53 ± 5.84 at posttest (P = 0.001), but statistically insignificantly changed in the control group from 61.2 ± 9.03 to 62.53 ± 6.04 (P = 0.416). Although the between‑group differences respecting the pretest mean scores of physiological and psychosocial stressors were not statistically significant (P > 0.05), there were significant between‑group differences respecting the posttest mean scores and the pretest‑posttest mean differences of both physiological and psychosocial stressors (P < 0.05).

Telenursing is effective in significantly reducing perceived stressors among older adults receiving hemodialysis. Nurses can use telenursing to reduce stressors among this patient population.

One of the most at-risk groups for COVID-19 is elderly with chronic diseases. However, many elderly patients with COVID-19 may seem "silent" after being infected with the virus, or have non-specific symptoms such as decreased activity, drowsiness, reluctance to eat, indifference, confusion, delirium, loss of awareness of the environment, speech disorders, urinary incontinence, falling following a loss of balance and fainting. Fever is a hidden symptom in the elderly. If the elderly body temperature is 100 degrees Fahrenheit, it is necessary to undergo further diagnostic tests for COVID-19. On the other hand, other patients with heart failure, vascular diseases, and COPD experience normal symptoms of COVID-19 (cough, shortness of breath, etc.). Thatchr('39')s why itchr('39')s much harder to diagnose COVID- 19 in the elderly with chronic disease than others. In order to diagnose the disease in a golden time, it is necessary to carry out diagnostic tests in order to confirm COVID-19. Therefore, it can be concluded; elderly people with COVID-19, and with a history of chronic diseases have a more severe form of respiratory distress syndrome than other people with COVID-19, which can lead to death. Regardless of the severity of the disease, supportive care for these patients is essential.

Patients with hardiness personality could better control the psychological distress induced by multiple diseases. The present study aimed to clarify the concept of health related hardiness in older individuals with multiple diseases.

A hybrid method was used to analyze the concept of health related hardiness. This model consists of theoretical review, field work, and final analysis. After first phase, nine older people with multiple diseases were selected via purposive sampling from Ramsar Imam Sajjad Hospital and Tonekabon Shahid Rajaee Hospital and interviewed in autumn-winter 2019-2020. In third phase, information from the theoretical phase was combined with the fieldwork phase, and the concept of health related hardiness was clarified.

Health-related hardiness in older individuals with multiple diseases means that they could achieve the expected health-related outcomes (successful control of the disease, reduced disease burden, and adaptation to disease) by purposeful management of health-related stressors, simultaneous management of several diseases, and personality traits such as stubbornness, patience, tolerance, and having cognitive abilities. Meanwhile, family and social supports, as facilitators, are of great benefit in reducing physical and psychological pressures induced by diseases burden.

The health-related hardiness model could be applied in further studies and used to implement promotion protocols in older people with multiple diseases and development of health-related hardiness scales.

Nurses’ lack of knowledge about domestic elder abuse and their limited ability to recognize it can result in negative consequences. Education has the potential to improve nurses’ ability to recognize elder abuse. Yet, there is no conclusive result about its effectiveness.

The main objective of the present study was to assess the effects of education on nurses’ ability to recognize elder abuse.

This randomized controlled trial was conducted in two public hospitals in Ramsar and Tonekabon, Iran. Participants were 120 nurses who were randomly recruited and allocated to an intervention (n = 60) and a control (n = 60) group. The study intervention was an educational program implemented in two successive 2‑h sessions in 1 day. Data were collected using a demographic questionnaire and The Nurses’ Recognition of Elder Abuse by Family Caregiver Questionnaire. The possible total score of the latter questionnaire was 67–335. The data were analyzed using the Chi‑square, the Fisher’s exact, and the paired‑ and the independent‑samples t‑tests as well as the one‑way and the repeated‑measures analyses of variance.

The mean score of elder abuse recognition ability significantly increased in the intervention group (P < 0.001), while it did not significantly change in the control group (P = 0.85). Participants had a good ability to recognize physical elder abuse and limited ability to recognize sexual abuse.

In‑service education about elder abuse for nurses not only improves their elder abuse recognition ability but also can help them take appropriate measures for its management.