جستجوی مقالات مرتبط با کلیدواژه « مراقبت » در نشریات گروه « پزشکی »

breaking the law in caring for patients is one of the important and main pillars of ethical principles in nursing. This study was conducted in the form of a qualitative study in order to examine the experiences of law-breaking nurses in patient care

In this qualitative study, 15 experienced nurses from the Valiasr research educational center affiliated to the Birjand University of Medical Sciences, living in 1401 South, participated in this qualitative study. The sampling method was purposeful and collected through semi-structured individual interviews. The method of qualitative analysis was phenomenology with Man Vanen and with the help of 10MAXQDA software.

interviews with the participants regarding business in breaking the law in nursing care, the emergence of two main classes: the first class is escape from punishment and the second class: inattention of the authorities, escape from punishment: which includes 3 classes: a) forced silence b) illness c) Compulsory lawlessness and the second class, which recklessly took its officials, including the two subclasses of mutual retaliation and slave nurse.

The results showed that there is a positive positive error report in nursing and it should be strengthened more and above all in nursing and human rights in nursing should be implemented by the authorities to protect nurses. Not enforcing the rules by nursing officials.

Implicit rationing of nursing care is a growing concern in health care systems and can cause adverse consequences for patients. Considering the importance of the issue in the health system, it is necessary to clarify the different dimensions of this concept. Therefore, this study was conducted to clarify the concept of implicit rationing of nursing care using Walker and Avant's approach.

Walker and Avant’s approach was used to analyze the concept of implicit rationing of care. The search was conducted in the Web of Science, PubMed, and Scopus, SID, Iran Medex, Magiran databases using the keywords of implicit rationing, nursing care, implicit rationing of nursing care, and rationing of nursing care without a time limit until October 2023. Finally, according to entry and exit criteria, 13 relevant articles were analyzed.

The review of the literature showed that the concept of implicit rationing of nursing care is a complex concept with numerous dimensions. The antecedents of this concept are related to patients, nurses, and the organization. Decision-making, prioritization, outcome assessment, obligation to perform nursing care, and disruptions in the process of performing nursing interventions were identified as the determining features of the concept of implicit rationing of nursing care.

The present study showed that implicit rationing of nursing care was a multifaceted concept. Nursing managers and researchers can use the results of this study to design effective measures and interventions to reduce its incidence.

Respecting the rights of patients is one of the care priorities that should be paid attention to by nurses. In this regard, cultural nursing interventions are one of the effective ways to preserve and promote it. This study was conducted to determining the effect of implementing care based on cultural competence on the attitude towards respecting patients' rights among nurses working in Ayatollah Taleghani Hospital, Kermanshah.

The present study was a semi-experimental study with a pre-test-post-test design and a control group, the research community of which was formed by nurses working at Ayatollah Taleghani Hospital in Kermanshah in the first half of 1400. 60 nurses who met the entry criteria entered the study through available sampling and were randomly classified into two test and control groups. To collect data, the nurses' demographic information form and the attitude questionnaire toward respecting patients' rights were used, which were completed by the participants before and two months after the implementation of the intervention. The intervention group received skills based on cultural competence, including its concepts and components, dimensions, principles and prerequisites, and practical skills to increase it during one month in four sessions in person and virtually. Data were analyzed with SPSS version 20 statistical software and using descriptive and inferential statistical tests.

There was no statistically significant difference between the intervention and control groups in terms of demographic characteristics. The attitude towards respecting patients' rights in nurses before the intervention was 43.50 ± 7.11 in the nurses of the test group and 42.10 ± 4.10 in the nurses of the control group, which did not have a statistically significant difference (p=0.73). However, after the intervention, it reached 49.96 ± 6.93 in the test group and 42.00 ± 4.39 in the control group, which was significant in the test group (P<0.001).

Considering the effectiveness of training and implementation of care based on cultural competence in the attitude toward respecting the rights of patients in nurses, it is suggested that health trustees and nursing managers use the results of this research to preserve and respect the rights of patients and empower nurses in the field of cultural competence.

Spirituality has an undeniable impact on healing power, the ability to cope with and adapt to change, and health-related conditions. Spirituality is an essential component of health care; it is critical, vital, and distinct from other types of care. Therefore, the current study attempted to explain the spiritual caregiver's understanding from the patients' perspective.

The current study was carried out in the educational and medical centers of Qom University of Medical Sciences in 2020 using a qualitative approach and conventional content analysis. Data were collected and analyzed concurrently through semi-structured in-depth interviews with 12 participants using purposive sampling.

The participants included 7 women and 5 men. The mean and standard deviation of the participants' age was 44.16±10.1. From the analysis of interviews conducted with patients, 366 primary codes, 10 subcategories and 3 main categories were extracted, which indicated the participants' understanding of spiritual care. "Religion" (belief in the presence of God, observance of Sharia rules, honoring religious beliefs), "Morality" (respect for privacy, responsibility, honesty, confidentiality), and "aegis"(protection, support, follow-up and continuity of care).

In light of the findings of this study, spiritual care has a religious and ethical foundation, and its supportive aspects should receive more emphasis. According to patients, spiritual care entails responsibility, honesty, and confidentiality, as well as considering moral values and religious beliefs as a valuable resource that maximizes patient's self-care control and recovery.

The time of umbilical cord clamping is an important strategy for better prognosis of preterm and full-term infants, and all health care providers should be informed about the components and importance of this approach. The present study was performed with aim to investigate the time and duration of umbilical cord clamping in the delivery or operating room of Khorasan Razavi Hospitals.

This descriptive study was conducted on 1237 babies born in the delivery or operating room of Khorasan Razavi public Hospitals between 2020 and 2022 with available sampling. In each hospital, a researcher assistant midwife who was not involved in the delivery process recorded the time of umbilical cord clamping after birth, and in the next step, she recorded the possible cause of early umbilical cord clamping by asking the obstetrician. Data were analyzed by SPSS software (version 26) and descriptive statistics tests. P<0.05 was considered statistically significant.

In this study, 165 neonates (13.4%) were premature and 1072 neonates (86.6%) were born full term. In addition, 915 neonates (73.96%) were born naturally and other 322 neonates (26.04%) by cesarean section. The mean duration of the umbilical cord clamping of the newborns was 35.25 ± 27.29 second, which was reported as 21.29 ± 14.95 second in cesarean section and 40.22 ± 28.92 second in natural delivery. In 719 neonates (58.1%), the umbilical cord is closed before 30 seconds and in 322 neonates (26%) before 15 seconds. Among the causes of early umbilical cord clamping, hasting by obstetrician (30%), caesarean section (3.7%), doctor's routine (2.1%) and mother's non-cooperation (1.5%) were the most common causes.

Umbilical cord clamping is done quickly or very quickly in the delivery room of Khorasan Razavi public hospitals, and in caesarean section, this urgency is very noticeable, and the most common cause of hasting is obstetrician. Therefore, correcting the thinking of the obstetrician in order to improve the time of umbilical cord clamping seems necessary. Delaying umbilical cord clamping plays an important role in the transition from fetal to newborn blood circulation and improves the health of newborns.

Considering the role of nurses in promoting oral health and early identification of related problems and the importance of nursing students' education, this study aims to explain the experiences of nursing faculty members in teaching oral health to students based on the undergraduate nursing curriculum.

Methods & Materials: 

This qualitative study was conducted with conventional content analysis approach. Data were collected using 14 semi-structured, in-depth interviews and with 14 faculty member of nursing in Mashhad, Rafsanjan, Zabul, and Shiraz medical universities from 2021 to 2022. Data analysis was carried out simultaneously as they were collected using Elo and Kyngas method.

After the transcribing and reviewing the texts, 662 codes were extracted. after eliminating the repetitive themes, 6 themes and 19 categories were obtained. Themes include "attention to the importance of providing oral and dental care in theoretical-practical courses and nursing internships", "attention to the types of methods for evaluating the skills of providing oral and dental care", "oral health as one of the indicators of patient's health and recovery", "influence of rapid diagnosis and follow-up of oral and dental problems on the clinical process of the disease", "Patient's oral and dental health: on the edge of care", "Defects in the existing organizational and cultural structure in the organization of oral and dental nursing care". the central theme obtained from the data analysis is "Oral care in nursing curriculum: from special to weak or missing focus".

The faculty members considered oral health to be one of the indicators of patient's general health and recovery. The oral health of the clients is given special focus in some parts of the training, and in other parts it is weak or missing. The participants considered the oral health of the patients to be on the sidelines of care and considered the structural and cultural defects in the educational structure and hospitals, including the lack of interfaculty cooperation between the nursing and dental schools, as a factor in not providing efficient and basic oral care.

Aging care ethics by nurses have a particular importance, but its extent is different in clinical nurses. The aim of this study was to examine ethics in nurses care of elderly patients in the western Golestan province.

This cross-sectional study was conducted in 2017. The study population consisted of 183 nurses working in centers sheltered western Golestan University of Medical Sciences that took care of elderly patients. Quota sampling method was performed in 3 cities. Quotas on the number of nurses in each hospital were different. Data collection tools included demographic information and questionnaire for the Ethical Treatment of elderly care. Data were analyzed with SPSS version 16, descriptive statistics, chi-square test, and Spearman, Friedman and ordinal regression with the significant level of p< 0.05.

Total number of 142 cases (77.6%) nurses was female. The average ethics was 63.4±13.1 (IQR=15). The 158 individuals (86.3%) were in the moderate and high level of ethics. Cooperation and empathy (Mean Rank=5.4) had the highest area of ethics based on the Friedman test. Kindness and valuating the patient aspect (P=0.0001, OR=5.91) had the most effective areas in ethics based on ordinal regression. A Chi-square test showed the significant relationship between ethics and gender (P=0.003), marital status (P=0.005), the nurses ward (P=0.013), and employment (P=0.001).

The study showed that the ethics of nurses in the care of elderly patients was moderate and high. The ethics of care can be improved by developing evaluation systems, moderating non-essential activities of nurses, gender proportionality between patients and nurses and focusing on patient education.

As the maternal role is critical, it is necessary to identify the psychological mechanisms related to this role. This study aimed to evaluate the relationship between the mother’s attachment style and mother-infant bonding in the first pregnancy considering the mediating role of mentalization.

This was a descriptive-correlational study. The sample population included the women who had gone through their first pregnancy and were referred to the health centers in Neyshabur, Iran in 2021-2022. In total, 330 women were selected by convenience sampling. To collect data, we used a demographic questionnaire, the Attachment Style Questionnaire (ASQ), the Mother-Infant Bonding Scale (MIBS), and the Reflective Functioning Questionnaire (RFQ). Data analysis was conducted using descriptive indices, correlation coefficients, and structural equation modeling in Spss-24 and Amos-24.

Overall, the findings showed that the studied model adequately fits the data. Further, the obtained results confirmed the mediating role of mentalization in the relationship between the mother’s attachment style and mother-infant bonding. A significant correlation was also observed between attachment styles, and mother-infant bonding (p<0.01).

Mother-infant bonding is correlated with the mother’s attachment style and mentalization. Thus, we can help vulnerable mothers by improving the quality of psychological care before the first pregnancy or during pregnancy.

Due to the decrease in fertility rate and the increase in the number of aging people, middle-aged adults are more important than ever as an important source for keeping elderly people in families. Understanding and insight into aging care by middle-aged people is necessary to promote health in middle age and old age. The present study was conducted with the aim of understanding the meaning of caring for aging parents in middle-aged people.

The current research is based on the interpretative phenomenological approach that was conducted in Tehran in 1401. 12 middle-aged caregivers of aging parents were selected by purposive sampling method. In-depth and semi-structured interviews were used to collect data. Then the text of the interviews was analyzed after writing with Van Manen's hermeneutic approach based on the reliability of the qualitative data.

4 themes were extracted from the data analysis (compassionate care, calm worried heart, unknown journey and dual atmosphere of home).

In this study, the meaning of caring of aging parents by the participants was a compassionate and responsible care, combined with calmness and worry, and the vagueness of the caregiving time in a safe and tense atmosphere. For this reason, middle-aged people were forced to sacrifice too much for their relatives and parents in order to continue living with their aging parents. Therefore, understanding the experiences and concerns of these people can be useful for providing counseling assistance to the middle-aged, policy makers, health providers (especially nurses) and gerontologists.

Clinical guidelines play a significant role in improving the quality of patient care. Considering the lack of clinical guidelines for the care of central venous catheters in the country, this study aimed to compile a contextualized central venous catheter clinical guideline for being used in Iranian clinical settings.

Contextualizing central venous catheters guideline was based on a developed approached by ADAPTE international collaboration network with three stages of set-up, adaptation and finalization. In the preparation stage, after establishing an organizing committee, the initial search of resources was done to check the feasibility of the study, to identify the required resources and skills and to also write the adaptation proposal. The adaptation phase started with a comprehensive search of resources to retrieve the maximum number of related guidelines. The search of sources led to the retrieval of 410 guidelines, which were reduced to 14 after screening the titles and abstracts based on the purpose of the study and the inclusion criteria. Then, the full text of the 14 included guidelines was reviewed in terms of methodological quality and the result was presented in the expert panel meeting. The methodological quality of the guidelines was evaluated with the AGREEII and a score of more than 70% was considered as an acceptable quality. In this way, one of the guidelines was selected and the adaptation process began. Finally, a translated draft of the guideline recommendations was reviewed in the expert and users panel, respectively. While making the suggested amendments, the level of their agreement with each of the recommendations were reviewed based on Likert scale from 1 to 9 (completely disagree to completely agree). Achieving a consensus more than 80 to assign grades 7 to 9 to each recommendation was resulted in keeping the recommendation. Finally, in the finalization stage, the contextualized version of the selected clinical guide was compiled for being used in Iranian clinical settings.

The full text of the 14 retrieved guidelines were reviewed. Among them, the “Central Venous Access Device (CVAD) Post Insertion Management” clinical practice guideline developed by NSW Agency for Clinical Innovation, with a quality score of 90.4% was selected for adoption. In addition, more than 80% of the stakeholders and expert panel agreed with assigning grades 7 to 9 to all recommendations of this guideline. As a result, all of the 50 recommendations of the guideline in assessment and intervention domains were accepted to be applied in Iranian clinical settings with a few modifications to make recommendations clearer and more understandable for users.

The adopted version of CVAD post-insertion management clinical practice guideline with all 50 recommendations is applicable in caring of Iranian hospitalized adult patients with CVAD.

Caring behaviors are the main essence of nursing actions. Creating a favorable clinical environment for the use of nurses' capabilities is subject to many external and internal organizational factors and conditions. By choosing the appropriate leadership style, nursing managers increase the participation of employees in decision-making and delegation of authority to them, help empower them, create work motivation, increase job satisfaction and reduce tension and improve the performance of the treatment team. And as a result, they maintain and improve the quality of care and the health level of the society. This study was conducted with the aim of determining the relationship between the leadership style of nursing managers and the caring behaviors of nurses in the selected medical training centers of Iran University of Medical Sciences in 2019 and from the perspective of the nurses working in these centers.

The current research was a descriptive correlational study that was conducted cross-sectionally in 2019. The views of 214 nurses working in selected medical training centers of Iran University of Medical Sciences were collected about the type of leadership style and caring behaviors using the MLQ leadership style questionnaire and the WOLF caring behavior questionnaire. The information was collected through a self-report questionnaire and the time required to complete them was about 20 to 30 minutes. Data collection started from May 1400 and ended in August 1400. Data analysis was done using SPSS version 16 statistical software and descriptive statistics (mean and standard deviation) and inferential statistics (independent t, analysis of variance) and significance level was considered less than 0.05.

The highest mean was related to the dimension of professional knowledge and skill (5.17 ± 0.66), and the lowest was the dimension of respect for others (4.71 ± 0.64), which indicates that the physical dimension of care is more than The psychological dimension of care has been taken into account. The results showed a statistically significant relationship between the dimension of respecting others and non-interference leadership (p=029). Transformational leadership style (3.43±0.82) was the dominant style in nursing managers and there was a statistically significant relationship between caring behaviors with age (p=0.032) and work experience (p=0.003).

It is recommended that nurses pay more attention to the communication and emotional aspects of care while maintaining their knowledge and skills and continuing to increase their professional knowledge and continue to provide it. The training and application of transformational leadership style by nursing managers should be considered, because in this leadership style there is a realistic vision and the participation of nurses in decisions and attention to the individual needs of employees, the possibility of developing and empowering nurses in order to communicate. It provides respectful.

 Despite numerous studies in the field of home care, the role of unmarried girls in caring for their parents and the problems caused by this care for them, is still neglected or lost due to the study of other caregivers. In this regard, the present study aimed to investigate the care pressure resulting from the care of elderly parents among single girls in Ilam, Iran.

 This descriptive, cross-sectional study was conducted in 2019. The statistical population included all single girls over 30 years old in Ilam (n=5134 cases), and the sample size was determined at 370 people. The data were collected using a 24-item Novak & Guest Care Burden Questionnaire by cluster sampling. The obtained data were entered into SPSS statistical software (version 20) and analyzed at two levels of descriptive (median, mean, standard deviation, and frequency percentage distribution) and inferential statistics (analysis of variance).

 The findings indicated the existence of weak care pressure (26.91±21.13) among respondents. In comparison to the dimensions of care pressure, the time dimension (8.8±5.68) was more intense than other dimensions. Moreover, the girls who were government employees and had university degrees, in all respects, tolerated lower care pressures than their peers. The analysis of variance of the dependent variable considering the independent variables showed a significant difference in the care pressure of girls regarding age, employment status, education level, and mental class affiliation (P<0.001).

 Based on the results of the study, it is inferred that the low care pressure of the studied girls is due to the low pressure of care.

Crohn’s disease is a chronic  and common bowel disease caused gestational tract (GI) inflammation. In recent years, the prevalence of this disease has been increasing slowly  in the world and Iran .This study briefly introduces Crohn's disease with a review of related articles published during 2004-2021.
The most accepted theory of the pathophysiology of Crohn's disease is having a genetic background (CARD25/NOD2 mutations and polymorphisms of TLR), along with the abnormal response of the intestinal normal flora. Diarrhea, abdominal pain, bloating, and weight loss are the most common symptoms of the disease. To diagnose, clinical symptoms, physical examination, laboratory tests, endoscopy and colonoscopy are helpful.The aim of the treatment is to control the symptoms, reduce clinical symptoms, prevent the progression of the disease, reduce the need for surgery, nutritional support, and reduce its side effects.Moreover,anti-tumor necrosis factors  and corticosteroid medications to regulate the immune system are used. New biological agents such as anti-integrin medications have opened a better perspective for patients. To reach a good care and treatment, it is requires a team including the patient, health care workers, internal specialists, endocrinologists, infectious disease specialists, and epidemiologists to work together to meet health and treatment needs, physical and psychological support, creating health and preventive measures, approaches fast diagnosis and timely action. Due to the unknown cause of the disease and the lack of adequate treatment response to the existing medications, investigate and research more widely about Crohn's disease is needed.

Care is a fundamental aspect of nursing services. To identify the effective factors in the promotion of caring behaviors of nurses, this research aimed to analyze the relationship between responsible leadership and caring behaviors of nurses with mediating role of organizational pride.

The present descriptive-correlation research was performed on a statistical population consisting of 470 nurses in Besat hospital, Hamadan, Iran. The statistical sample included 240 nurses who were selected using the simple random sampling method. Data collection tools were responsible leadership questionnaires (Doh et al., 2011), organizational pride (Nouri et al., 2017), and the caring behaviors of nurses (Wolf et al., 1998). The collected data were analyzed using Pearson's correlation test and structural equation modeling. The software used for data analysis were SPSS (version 16) and Lisrel (version 8.5).

Based on the findings, there was a positive and significant relationship between responsible leadership and the caring behaviors of nurses (r=0.373). The relationship between responsible leadership and organizational pride was positive and significant (r=0.706). Moreover, there was a positive and significant relationship between organizational pride and caring behaviors (r=0.592). The direct effect of responsible leadership on the caring behaviors of nurses was not significant (p>0.05). However, the direct effect of responsible leadership on organizational pride was significant (p<0.05). Besides, the direct effect of organizational pride on caring behaviors was significant (p<0.05).

Finally, the indirect effect of responsible leadership on the caring behaviors of nurses through organizational pride was significant.

COVID-19 could potentially disrupt routine care management in health systems. One of such problems is associated with HIV surveillance. The aim of this research was to study the effects of COVID-19 pandemic on HIV care indicators.

This retrospective cohort study was performed using data at individual and aggregate levels obtained from center for disease control and prevention in Mazandaran province affiliated with Mazandaran University of Medical Sciences. We modulated upon Poisson regression
for analyzing the impact of COVID-19 pandemic on HIV incidence, mortality, treatment failure, hospitalization, refer to counselling center, HIV viral load (VL), and CD4 cell count monitoring. 

One year after COVID-19 pandemic, the incidence of HIV was 0.44 per 100,000 people less compared with one year earlier (P= 0.051). CD4 counting and patients follow up at this time were 0.32 less (P< 0.001) and 1.11 more (P= 0.045) per 100,000 people, respectively compared with those before the COVID-19 pandemic.

Current study showed that COVID-19 pandemic disrupted HIV care. It seems that despite regular follow up services provided by health center staff, coronaphobia was a huge barrier to care programs in HIV patients.

The spiritual crisis due to the lack of explanation about the cause of life's sufferings, its purpose and meaning along with the consequences of the care burden of parents as informal caregivers, disrupt the spiritual health of cancerous children's families which need "family-centered" spiritual care. Art as a spiritual phenomenon along with enlightenment and intuition, leads human to health. The aim of this study was to explain the integration method of art therapy in the spiritual care protocol of the sound heart model of cancerous children's families.

This combined study was performed in 1401 based on the Cresswell et al. model (2003) with a sequential-variable approach (exploratory and explanatory) and the Islamic theory of spiritual health (sound heart model). Qualitative data of unsystematic review and contractual content analysis of applications of art therapy in the treatment of patients' distresses were combined with quantitative data of numerous clinical trials based on the sound heart model as a protocol for conducting spiritual counseling sessions. The meta-inferential validations were performed in two sections, - in the quantitative data section through "internal-external validity”, - in the qualitative data section with "reliability or capability index".

Family-centered spiritual care for spiritual self-care empowerment is implemented in four steps: 1. Establishing spiritual relationship with the patient and family based on compassion with the aim of gaining trust and attention to spiritual suffering; 2. Increasing knowledge with the aim of developing self-awareness along with self-compassion and understanding the positive aspects of problems; 3. Developing communication for strengthening a secure attachment to God, strengthening the spiritual connection with people and the world of creation for creating the courage to face the crisis of disease, hope, positive thinking; 4. Motivation for strengthening the adaptation ability, creating a sense of self-efficacy. The use of different types of art in spiritual care sessions was explained.

Considering the effect of art and spirituality in promoting the spiritual health of the family, the use of a combined protocol of spiritual care of sound heart with art therapy in the care of cancerous children's families is recommended.

With the spread of the COVID-19 pandemic in Iran and considering that nurses were in a crisis, it is of particular importance to examine nurses’ intention to care for patients with COVID-19. If the intention to care is improved, the quality of care can also be affected; accordingly, this study is conducted to examine the relationship between the factors that influence the intention to care for patients with COVID-19.

This cross-sectional study was designed in 2020. The study population included 200 nurses who were directly involved in the care of COVID-19 patients in selected hospitals in Tehran City and Amol City, Iran. The demographic form and the Persian version of the nurses’ intention to care scale (P-NICS) questionnaire were used to measure the intention to care for patients with COVID-19.

Based on the results, factors, such as gender (β=0.15, P=0.02), positive behavioral beliefs (β=0.51, P<0.001), family subjective norms (β=0.43, P<0.001), work subjective norms (β=0.27, P<0.001), and positive control beliefs (β=0.21, P=0.002) had a significant and positive relationship to predict the intention to care. 

According to the findings, factors, such as behavioral beliefs, control, and social norms influence nurses’ intention to care for COVID-19 patients. Meanwhile, promoting the intention to care improves the quality of care; therefore, health care managers should pay attention to psychological and social factors that affect the intention to care in nurses.

 Today, pediatricians face many ethical challenges and dilemmas in clinical practice. The present study has been conducted with the aim of explaining these challenges in the domain of pediatric and adolescent care from the perspective of pediatricians.

 This study has been conducted through qualitative approach and content analysis method in 2022. The samples were selected using purposive sampling method and included 20 pediatricians working at Children's Medical Center Hospital, affiliated to Tehran University of Medical Sciences. The data were collected through in-depth and semi-structured individual interviews and analyzed using the conventional content analysis approach.

Ethical Considerations: 

In this study, consent was obtained from the participants before conducting the interviews and none of their names have been published. Besides, the study has been conducted under the code of ethics (IR.TUMS.CHMC.REC.1399.165).

 Through analyzing the interviews, three categories of challenges were extracted: "The challenges faced by both children and adolescents", "The challenges exclusively faced by adolescents" and "The challenges existing in the pediatric intensive care unit". The challenges faced by both children and adolescents include three sub-categories: "The factors related to the healthcare staff"," The factors related to parents" and "organizational and policy making issues". The challenges exclusively faced by adolescents include two sub-categories: "The society-related problems" and "The problems related to the healthcare environment". The challenges existing in the pediatric intensive care unit include three sub-categories: "The mental and psychological effects of hospitalization in intensive care units on children, adolescents and parents", "The lack of resources and structural facilities" and "The problems related to dying and recently lost children".

 The results of this study indicate that many of the ethical challenges in pediatric medicine either stem from the healthcare staff or parents’ unfamiliarity with ethical and legal issues, or are the result of structural problems in the healthcare system such as the lack of executive policies and procedures or the shortage of resources and equipment. Therefore, paying attention to teaching these issues and explaining these policies and procedures, in line with the implementation of the law on the protection of children and adolescents and providing the necessary resources, is the main need and challenge that must be addressed.

For improving the quality of reproductive health services and providing appropriate health care to mothers to reduce their mortality and morbidity, it requires to apply the effective cost models used in the world. In this regard, the aim of the current study is to critically review the related literature on cost management of healthy reproductive services with the continuous midwifery care model.

This is narrative review study. A search was conducted in national and international online databases including using the keywords: Midwifery, reproductive health, continuous care, model, healthy reproductive services, cost, economic, cost effectiveness in Persian and English on studies published from 2010 to 2020 in English and had available full texts.

The continuous midwifery care model plays an important role in reducing the costs of medical care and a healthy reproductive program by reducing unnecessary interventions and prevented complications such as cesarean delivery and episiotomy rates. On the other hand, by improving the quality of mothers' services through improving health indicators, motivation, self-efficacy, and empowerment of mothers, this model encourages them to receive regular and more reproductive services.

The continuous midwifery care is an effective model. Considering the economic limitations of the country, it seems that the use of this model in the healthy reproductive program can lead to a reduction in the treatment costs and improve the quality of midwifery care by providing continuity care and reducing unnecessary interventions.

Covid-19 reduces the quality of service to patients with physical and emotional problems. This study aimed to determine the problems of nurses caring for patients with coronavirus hospitalized in Kashan medical sciences hospitals in 2021.

The cross-sectional study was performed on 260 nurses working in Shahid Beheshti Hospital and Seyed Al-Shohada who had at least one month of care for patients with Covid-19. The researcher selected the samples and asked them to complete the questionnaire of demographic informations and problems of nurses in caring for patients with Covid-19. Then the results were analyzed using chi-square, ANOVA and Pearson correlation coefficients in SPSS 16 software.

The mean care of patients with Covid-19 in nurses was moderate (94.13±19.01) with frequency (51.1%). Also, the highest rate of problems was in the personal domain (22.16± 4.54) with a frequency (61.5%) and the lowest was in the motivational domain (6.20±2.98) with a frequency (38.7%). And knowledge and experience (4.93±1.74) with frequency (41.1%). The domain of physical and mental problems had a significant relationship with gender (P<0.05). The domain of personal problems was significantly related to the type of hospital and the number of children (P<0.05), also.

The results of the study showed that rate of nurses' problems in caring for patients with Covid-19 is moderate. Therefore, it is suggested that hospital managers should make the necessary plans to solve the problems of nurses.