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Background and aims: Patient advocacy role in nursing is affected by several barriers, such as the lack of nurses’ ethical knowledge about their roles as patient advocators. Since this role can be learned, these barriers may be overcome by education through an effective method. The present study aimed to investigate the effect of ethics education on nurses’ patient advocacy using ethics narration and lecture compared to a control group. Methods: This quasi-experimental, three-group design study was conducted among nurses of hospitals in Birjand, South Khorasan province in 2016-2017. The sample size (n) was 27 in the narration group, 26 in the lecture group, and 22 in the control group. We used the Protective Nursing Advocacy Scale (PNAS) developed by Hanks to collect data, whose validity and reliability have been confirmed in Iran. Data analysis was performed using a trial version of SPSS 22 by descriptive and analytical statistics appropriate to the research objectives. Results: The results of comparing the three groups after eliminating the effect of age indicated that lecture-based education increased the total patient advocacy (P

BACKGROUND: Living with post-traumatic stress disorder (PTSD) veterans imposes severe stress on relatives especially their wives. Despite of these difficulties these stratum of women suffer insufficient support and less attention. This study aimed to explore the experiences of wives of veterans with PTSD.METHODS: This study was conducted in 2021 using qualitative content analysis approach. Participants were selected purposely from PTSD veterans’ wives. Data were collected using semi-structured interviews with 18 wives of veteran men with PTSD. All the interviews were transcribed verbatim. Data were collected using in-depth and semistructured interviews, up to the point of data saturation, and were analyzed by Graneheim and Lundman’s content analysis method with the support of MAXQDA software.FINDINGS: Through analysis of transcribed interviews, one theme and 4 categories and 13 sub categories were emerged : The theme called “abandoned in miserable life stream” and categories consist of “living in the cage of grief and regret”; “insufficient support resources”; ”marital burnout”; and “selfsacrifice to maintain family cohesion”.CONCLUSION: The results of this study provide a broad range of context-specific challenges faced by wives of veterans with PTSD. In confronting with full of tensions life and lack of support, wives of veteran with PTSD are neglected and need more attention and support. It is essential for healthcare providers to be aware of the complex psychological and social conditions of wives of veterans with PTSD.

Background: Low back pain (LBP) is the leading cause of disability in the world. This study aimed to evaluate the effect of acupressure on LBP intensity and depression among chronic nonspecific LBP patients. Methods: This sham-controlled randomized clinical trial was performed on 84 patients with chronic nonspecific LBP. The data were collected using a demographic information questionnaire, the Visual Analogue Scale (VAS), and the Beck Depression Inventory-II (BDI-II). The participants were randomly assigned to acupressure (n = 42) and sham (n = 42) groups. The acupressure group was trained on how to apply pressure on Yin tang, Feng Chi, and Shu Fu acupoints; nevertheless, the sham group was trained on how to apply pressure on Chen Jiang, Huang Shu, and Ji ache acupoints. The participants in both groups applied acupressure once a day for 4 weeks. Both groups completed the VAS and the BDI-II again one day after the intervention. Results: No significant differences in LBP intensity (P = 0.45) and depression (P = 0.26) were observed between the two groups before the intervention. By controlling the baseline scores of LBP and depression, analysis of covariance revealed that the LBP and depression of the acupressure group significantly improved after the intervention, compared to the sham group (P < 0.05). Conclusions: Applying pressure on Shu Fu, Yin Tang, and Feng Chi points is effective in reducing LBP and depression among chronic nonspecific LBP patients. The findings of this study can be used in designing and evaluating more robust protocols.

Back pain is a common complaint seen in patients after coronary angiography. This study investigated the efficacy of ear acupressure for reduction of back pain in patients after coronary angiography. In this trial, 120 patients recruited from a post-angiography ward were allocated to an ear acupressure or a control group. Pain assessment in intervention group was performed immediately after participants entered post- coronary angiography ward (T0), twenty minutes after entering the ward (T1), and two, four, and six hours after the intervention (T2–T4). Pain in control group was assessed at the times similar to intervention group. Data were analyzed using the SPSS software (v. 19) by Chi-square, Fisher’s exact, independent t tests, Friedman test, Wilcoxon signed-rank, and Mann-Whitney U test. Final data analysis was done on the data gathered from 58 participants in the control group and 59 in the ear acupressure group. The pain intensity at T1–T4 for patients in the control group was significantly higher than T0 (P < 0.001), while patients in the ear acupressure group reported that pain intensity at T2–T4 was significantly higher than T0 for them (P < 0.001). Only at T1 and T2, pain intensity in the ear acupressure group was significantly less compared to the control group (P < 0.05). Ear acupressure in this study was effective to some extent in reducing back pain after coronary angiography. Future studies can be designed to examine the effects of ear acupressure using different ear acupressure points on the back pain after coronary angiography.

Background: Visual thinking strategy (VTS) is an interdisciplinary education that focuses on art. In this method, all students think about complex artistic elements. VTS uses visual literacy to teach communication skills and thinking. Objectives: This study aims to compare the educational effectiveness of Persian pictures with classical painting, which leads to teaching the concepts of medical humanities using medical students’ perspective. Methods: In this cross-sectional descriptive-analytical study, medical students of clinical course (trainees and interns, 4th - 7th year of medicine) in the second semester of the 2021 academic year attended a VTS discussion session, which contained thinking about three paintings, including a classical western painting, a Safavid era miniature, and a contemporary painting. At the end of the session, an opinion poll on the effectiveness criteria was completed by the students separately for each painting, and the results were analyzed. Results: According to the findings, our intervention improved visual and auditory sensitivity, accuracy and attention, interaction and cooperation with others, teamwork, and an understanding of their share in the group. In addition, from the perspective of contemporary miniature students, this field played a prominent role in reducing job exhaustion, anxiety, and stress, and created a sense of calm and aesthetics in students by applying topics and issues of the day and paying attention to socio-cultural issues. Classical western painting conveyed a sense of calm and discomfort to the students. Based on the results of interpretive content analysis, this kind of painting had a profound effect on the meaning transmission so that it exposed the comprehensive views on the subject to the viewer’s sight. Given that the Safavid miniature contains various symbols that express the details of the social context and cultural traditions related to human beings, it conveys a variety of senses. On the other hand, the use of classical painting and contemporary Persian painting in VTS discussions in medical education was more prominent than the Safavid era miniature. Conclusions: Miniature can have helpful effects on improving medical professional skills similar to classical painting in VTS topics.

Background: Rationality is a complex concept that plays a vital role in human choices and decisions. However, this issue has been less addressed in studies on marital life. Objectives: This study was performed to explain the experiences of Iranian women on the verge of divorce regarding rationality. Methods: According to the five-stage Granheim and Landman’s approach, an inductive conventional qualitative content analysis was used to collect and analyze women’s experiences on the verge of divorce. Seventeen women selected through purposive sampling entered the study, and qualitative information was collected using unstructured and semi-structured interviews. Information collection and analysis proceeded simultaneously. The information was saturated with 17 participants, and no new information was extracted. In this study, Lincoln and Guba’s criteria were used to ensure the robustness of the study. Results: After information analysis, two main themes were derived. Limited rationality in marriage was the first one with three main categories: Lack of intellectual preparedness for marital life, irrational marriage decision-making, and unrealistic positive thinking. Lack of marital issues understanding was the second one, categorized into reality shock and negative cognitive-emotional experiences. Conclusions: This qualitative study showed that limited rationality plays a vital role in the lives of women on the verge of divorce. However, learning skills, such as deep thinking and realistic thinking, can help women overcome limitations toward rationality and lack of marital issues understanding.

The quality of family caregiver-patient interaction plays a crucial role in the context of chronic conditions. This study investigated the effects of a caregiver educational program on interactions between family caregivers and patients with advanced chronic obstructive pulmonary disease (COPD). In this trial, 92 pairs of family caregivers and patients in a subspecialty lung care clinic located in Birjand, Iran were allocated into intervention and control groups (n = 46 per group). The intervention consisted of eight sessions, including three educational sessions on COPD, two educational sessions on coping strategies, as well as three peer support sessions. The Dyadic Relationship Scale was completed at baseline, posttest, and follow-up (2 months after intervention). For caregivers in the intervention group, positive dyadic interaction improved significantly from baseline to follow-up and from posttest to follow-up in comparison with the control group (p0.05). Also, for these caregivers, negative dyadic strain enhanced significantly from baseline to posttest and from baseline to follow-up as compared with those in the control group (p0.05). Finally, in patients of the intervention group, negative dyadic strain from baseline to follow-up and from posttest to follow-up significantly improved when compared with that of control patients (p0.05).

Introduction: Mentoring programs have the potential to develop human interaction based on respect, perseverance, and trust. This study aimed to explore the perspectives of a sample of Iranian nursing and midwifery faculty members in Birjand University of Medical Sciences concerning collaborative mentoring.Methods: Experiences from 17 members were collected using semi-structured interviews. Following the approach recommended by Graneheim and Lundman (2004), a qualitative content analysiswas used to analyze the interviews.Results: Two main themes emerged: ‘reaching team satisfaction through an engaging mentorship’ and ‘group journey toward professional actualization’.Conclusions: As a feasible intervention, collaborative mentoring sessions can be used to improve personal life, professional interaction, and satisfaction of nursing and midwifery faculty members.

Poor sleep and fatigue are among the most common complaints of patients with migraine. These problems can lead to different negative consequences such as headaches. This study aimed to examine the impacts of self-administered acupressure on sleep quality and fatigue among patients with migraine.This double-blind randomized controlled trial was conducted in 2016 on 76 patients who suffered from migraine without aura. Patients were conveniently selected from the neurology clinic of Valiasr (PBUH) teaching hospital and randomly allocated to either an acupressure (n = 38) or a sham acupressure group (n = 38) group. Data collection instruments were a demographic questionnaire, Pittsburg Sleep Quality Index, and Fatigue Severity Scale. Patients in the acupressure and the sham acupressure groups were trained to apply acupressure on respectively acupoints and sham points thrice weekly at bedtime for four consecutive weeks. The data were analyzed through the Chi-square, the independent-sample t, the paired-sample t, and the ANCOVA tests at the significance level of less than 0.05.After controlling sleep quality mean scores at baseline, no significant difference was found between the sleep quality of the two groups after intervention (P 0.05). The mean scores of fatigue significantly decreased in both acupressure and sham acupressure groups (P 0.05). However, the decrease in the acupressure group was significantly greater than in the sham acupressure group (P 0.05).As a noninvasive non-pharmacological therapy, acupressure can significantly reduce fatigue among patients with migraine.

Background: Despite advances in the treatment of substance abuse disorders, some clients experience lapse and relapse after treatment. As a stage before relapse, the lapse is a major challenge in the treatment of addiction. Objectives: This study attempted to develop and psychometrically assess a lapse management program and its educational content after quitting in patients with substance use disorders. Methods: This study was performed in two parts. In the first part, the program and its educational content were designed, and in the second part, it was validated using the opinions of 10 experts in two phases. For program validation, face validity and content validity were used both qualitatively and quantitatively. Results: The lapse management program and its educational content were designed based on self-awareness skills in eight sessions. The validation results showed that the minimum and maximum CVR values for each component of the program were calculated as 0.8 and 1, respectively. Also, the minimum and maximum CVI values were 0.86 and 1, respectively. Moreover, the average content validity index for the entire program was 0.94. Conclusions: The results showed that the lapse management program and its educational content had a good face and content validity for recovering clients and enjoyed the necessary validity for educational, clinical, and research applications.

Background and Aim: A considerable number of pre-hospital emergency technicians have been negatively impacted by occupational fatigue and depression. This research was conducted to examine the effect of rosemary essential oil on the pre-hospital emergency technicians' occupational fatigue and depression. Materials and Methods: Eight pre-hospital emergency stations were randomly chosen in this community trial study. Subsequently, four stations were randomly assigned to the intervention, and four stations were allocated to the placebo groups. 8 to 10 technicians were chosen from each station. In the intervention group, badges with 25% rosemary essential oil and badges impregnated with refined almond oil in the placebo group were used for two hours in 3 shifts per week. The participants completed the fatigue severity scale and the DASS-42 depression subscale before and one hour after the intervention. In this study, chi-square, paired t-test, and independent t-test were used. Results: The statistical analysis indicated no remarkable distinction between the mean occupational fatigue (p=0.17) and depression (p=0.15) scores in the two groups before the intervention. After the intervention, there were no significant differences with regard to the mean and mean changes in occupational fatigue scores between the intervention group and the placebo group (p=0.65). However, in contrast with the placebo group, significant decreases were observed in the mean and mean changes in depression scores in the intervention group one hour after the intervention (p

Introduction: Disruptive behaviors among nursing educators are a globally recognized problem. They have detrimental effects on nursing educators, the nursing profession, students and patients. This study aimed to explore nursing educators' experiences with disruptive behaviors in the professional work environment. Methods: The current study was conducted in 2019 and used a qualitative content analysis approach. Participants were selected purposely from nursing schools. Data was collected using semi-structured interviews with 20 nursing educators, and then analyzed according to the Graneheim and Lundman method. Results: Through analysis of the transcribed interviews, 4 categories and 10 subcategories were extracted. The categories include disrespectful interactions, inaccurate feedback on work performance, low acceptance in the clinical setting and perceived unfairness. Conclusion: Disruptive behaviors among nursing educators can affect professionalism as well as the quality of education provided by them. Therefore, considering factors that lead to disruptive behaviors in the professional work environment is necessary.

Background: Subjective well-being (SWB) can be a buffer against mental health problems. Patients with multiple sclerosis (MS) tend to experience low levels of subjective well-being. Objectives: The two objectives were (1) to examine whether peer-led and nurse-led self-management training can improve SWB of patients with MS and (2) to compare the effect of these two interventions on SWB of patients with MS. Methods: In this trial, 81 patients were randomly assigned to either nurse-led (n = 41) or peer-led (n = 40) groups. Both groups participated in six weekly-based 1.5‐hr self-management sessions. The cognitive and affective components of SWB were evaluated using the Satisfaction with Life Scale and the Scale for Positive and Negative Experience, respectively. Results: Life satisfaction increased in both groups over time (P < 0.001), although it was not significantly different between the two groups (P > 0.05). Positive and negative experiences increased in both groups over time (P < 0.05), but the increase in positive experience in the peer-led group was significantly larger than those in the nurse-led group (P < 0.05). Conclusions: Peer-led and nurse-led self-management training, are feasible tools to enhance the cognitive component of SWB, i.e., life satisfaction. Considering the affective component of SWB, positive experience in the peer-led group improved better than in the nurse-led group over time. Therefore, if healthcare providers improve the SWB of patients with relapsing-remitting MS, the self-management intervention led by peers is preferred than nurse-led self-management training.

Background and Objective:Cancer is one of the most prominent public health issues. It can put the patient’s hope and quality of life (QOL) at risk. The purpose of this study was to determine the effect of dignity therapy on the hope and quality of life of cancer patients. Materials andMethods:This trial was conducted in 2019. The sample included 76 cancer patients who were randomly divided into an experimental group (n=38) and a control group (n=38). Data were collected using a demographic questionnaire, the Herth-Hope questionnaire (1991), and the EORTC QLQ-C30 scoring (1988). The intervention group received a dignity therapy protocol. The control group received no intervention. The questionnaires were completed again four weeks after the intervention. Data were analyzed by SPSS 16 and several tests (Chi-square, Kolmogorov-Smirnov, independent t-test, paired t-test, Wilcoxon, and Mann-Whitney). The significance level was set at P-value Results:Mean scores for hope and quality of life before the intervention were not significantly different between the experimental and control groups (P=0.11). Four weeks after the end of the intervention, the mean scores of hope in the intervention group (26.88±2.90) were significantly higher than those of the control group (24.60 ± 4.26) (P=0.03). Also, after the intervention, the mean scores of quality of life in the intervention group (69.61±12.71) were significantly higher than those of the control group (50.64 ±12.15) (P Conclusion:Dignity therapy can be an effective intervention method for increasing hope and improving the quality of life among cancer patients.

Background: Sexual dysfunction is one of the most common complications of spinal cord injury with potentially negative impacts on sexual satisfaction. Objectives: This study aimed to compare the effects of app-based and lecture-based sexual education on the sexual satisfaction of disabled men with spinal cord injury. Methods: A randomized clinical trial was conducted on disabled men with spinal cord injury in 2019. The participants were selected using a convenience sampling method from the Welfare Organization of Birjand city. A demographic form and Larson’s Sexual Satisfaction Questionnaire were completed before the intervention. Then, the participants were randomly assigned to two groups (app-based and lecture-based groups). In the app-based group, the sexual education content was prepared as an Android app that was accessible for the group participants for two months. Similar content was communicated to the lecture-based group in the form of lectures during ten 60- to 90-min sessions over two months. Six weeks after the end of the intervention, Larson’s Questionnaire was completed again for both groups. Data were analyzed using the Fisher’s exact test, Kolmogorov-Smirnov test, paired t-test, and independent t-test. The significance level was set at P < 0.05. Results: In both groups, the mean scores of sexual satisfaction significantly increased after the intervention (P < 0.05). Nevertheless, the mean change in the sexual satisfaction score was significantly more in the app-based group (18.16 ± 3.31) than in the lecture-based group (7.52 ± 4.59) (P < 0.05). Conclusions: App-based sexual education can be more effective than lecture-based sexual education in improving the sexual satisfaction of disabled men with spinal cord injury.

This study aimed to investigate the effect of peer support group on subjective well-being (SWB) of wives of war veterans with post-traumatic stress disorder (PTSD). Selected participants were randomly assigned into intervention and control groups (n = 40 for each group). The intervention group was divided into four subgroups, with each participating in 8 weekly based 1.5 hr peer support group sessions. SWB and its dimensions in the intervention group increased significantly higher than those in the control group (p 0.001). Peer support group can be a useful tool to enhance SWB in spouses of war veterans with PTSD.

BackgroundAffective organisational commitment (AOC) refers to employees’ emotional attachment to the organisation and identification with it. It is vital that nurses explore contributors to their AOC because they stand as the largest group of employees in healthcare organisations.AimThis cross-sectional, analytical study explored the role of workplace social capital (WSC), compassion satisfaction (CS), and secondary traumatic stress (STS) in AOC in a sample of Iranian nurses.MethodThe study sample consisted of 250 nurses working in eight hospitals affiliated with Birjand University of Medical Sciences, eastern Iran. Participants’ WSC was measured using the Social Capital at Work Scale developed by Kouvonen et al. (2006). CS and STS were measured using CS and STS dimensions of the Professional Quality of Life measure (Version 5) developed by Stamm (2010).ResultsSignificant positive associations were found between WSC and AOC ( p ConclusionEffort to promote WSC and CS on the one hand and prevention and early recognition of STS on the other hand can enhance nurses’ AOC.

Background and Objective: Patients experience full stress condition after open heart surgery. Foot reflexology massage has a potential impact on the comfort of patients with special care. This study was done to evaluate the effect of soles of feet reflexology massage on feeling of comfort in open heart surgery patients. Methods: This clinical trial study was done on 70 patients who were divided into intervention and control groups using permutable blocking method. 35 patients in interventional group were received Soles of feet Reflexology Massage after mesearment of vital sigins for six days. 35 patients in the control group did not receive any intervention received routine care. Data gathering tools were demographic items and HCQ questionnaire, which was completed in two stages, 24 hours after surgery, before massage and the 6th day after massage. Results: The mean total comfort score in the intervention group was 103.1±9.04 and 110.63±7.6 before and after the intervention, respectively. This differnce was not significant. The mean total comfort score in control group was 105.14±10.37 and 111.29±7.56 perior and the end of study, respectively, this difernce was not significant. Also, there was no significant difference between considering the mean scors of comfort between the tow in the intervention and control groups. Conclusion: Reflexotherapy massage had no effect on feeling of comfort in open heart surgery patients.

Background and Aim: Self concept is one of the important aspects of social development that each individual uses for self description. Physical self concept includes the persons’ attitude toward their body dimensions. Lack of proper perception of the physical self concept has been linked to physical, mental, and social disorders. This study was aimed to investigate the relationship between physical activities with physical self concept among male medical students in Birjand University of Medical Sciences in 2016. Materials and Methods: In this descriptive- analytical study, study scale was distributed among all of the male medical students. A questionnaire including of demographic data and physical activity as well as the Physical Self Description Questionnaire (PSDQ: Marsh, 1996) was completed by participants. by SPSS 19 software using statistical method, And analytical (Mann-Whitney and Kruskal-Wallis tests) were analyzed. Results: A total of 452 students with the mean age of 22.11± 2.85 years participated. 350 (77.4%) students don't have physical activity, 76 (16.8%) did regular heavy athletic performance and 26 (5.8%) did regular light sport activity. Results showed a significant relationship between physical self-concept and athletic performance (p=0.02). Conclusion: According to the results of this study, it was found that athletic performance improves physical self-esteem and self-esteem of students. Therefore, health system policy makers can promote the necessary facilities for expanding the culture of sports activities and also create an environment with sufficient facilities in the university.

Background: The prevalence of stress and anxiety in pre-hospital emergency personnel is high. Objectives: The present study was conducted to investigate the effect of inhaling the Aroma of Rosemary essential oil on stress and anxiety of emergency medical personnel. Methods: In this quasi-experimental study, 8 pre-hospital emergency stations affiliated to Birjand University of Medical Sciences in Birjand city were randomly selected. Then, 4 stations were randomly allocated to the intervention group and 4 stations were assigned to the control group. In the next step, among personnel of each station about 8-10 participants were selected according to the inclusion criteria (39 participants in each group). Afterwards, these participants completed demographic and DASS-42 questionnaires (stress and anxiety subscales). Badges with 25% rosemary essential oil in the intervention group and badges impregnated with refined sweet almond oil were used in the control group for two hours in 3 shifts per week for one month. The anxiety and stress subscales of the DASS-42 questionnaire were completed by the participants one hour as well as 30 days after the last intervention in each group. In this study, chi-square, Mann-Whitney and Friedman tests were used. Results: The statistical analysis showed that the mean stress and anxiety scores in the two groups did not have significant differences before intervention (P > 0.05). One hour after the last intervention, statistical analysis showed that the mean of stress scores in the intervention group was significantly reduced compared to the control group (P 0.05). In the case of anxiety, one hour after the intervention the mean scores in the intervention group were significantly decreased compared to the control group (P 0.05). Conclusions: Aromatherapy with rosemary essential oil can have positive effects in reducing stress and anxiety in pre-hospital emergency personnel.

Back pain is among the most common complaints of patients during the first hours after coronary angiography (CA), i.e. when they are restricted to complete bed rest. This study aimed to evaluate the effects of foot reflexology on back pain after CA.This randomized controlled trial was conducted in 2018-2019 on patients hospitalized in the post-angiography unit of Razi hospital, Birjand, Iran. Through convenience sampling, 120 patients were recruited and their demographic characteristics and baseline back pain intensity were assessed immediately after angiography using a demographic questionnaire and a visual analogue scale, respectively. Then, patients were randomly allocated to a control (n = 60) and a reflexology (n = 60) group through block randomization. Patients in the reflexology group received 8-min foot reflexology for each foot (16 min for both feet) while their counterparts in the control group solely received routine post-angiography care services. Back pain assessment was repeated for all participants immediately, two, four, and 6 h after the intervention. Data were analyzed using the SPSS software (v. 16.0).Back pain intensity significantly increased after angiography in both groups (P 0.05). Yet, pain intensity in the reflexology group at all post-intervention measurement time points was significantly less than the control group (P 0.001).Foot reflexology is effective in significantly reducing back pain after CA.

Background: Forgiveness has the potential to resolve painful feelings arising from nurse–patient conflicts. It would be useful to evaluate direct and indirect important factors which are related to forgiveness in order to design interventions that try to facilitate forgiveness. Aim/objective: The purpose of this study was to evaluate the intermediating role of empathy in the cultural competence–forgiveness association among nurses using structural equation modeling. Research design: The research applied a cross-sectional correlational design. Participants and research context: The study included 380 nurses eight hospitals in southern Iran. Ethical considerations: The Ethics and Research Committee of Birjand University of Medical Sciences approved the study protocol. The voluntary nature of participation was explained consent was obtained from participants, and anonymity was guaranteed. Findings: Most of the participants were married and female and fell in the 20- to 30-year-old category. Most of them (89.5%) had a working experience of 1–10 years. The proposed model showed that nurses’ empathy intermediated the association between nurses’ cultural competence and forgiveness which has fitted the data acceptably (root mean square error approximation = 0.070; comparative fit index = 0.993; goodness-of-fit index = 0.983; and χ2/df = 2.85). Conclusion: Empathy skills and cultural competence training were essential for interventions aimed at increasing the tendency to forgive patients. In such interventions, planners should aim at increasing nurses’ cultural competence in order to enhance their empathy toward patients, which can, in turn, lead to a greater wish to forgive patients.

supplementary_file_(1) for Empathy and cultural competence in clinical nurses: a structural equation modelling approach by Bahare Zarei, Mohaddeseh Salmabadi, Alireza Amirabadizadeh, and Seyyed Abolfazl Vagharseyyedin in Nursing Ethics

An accurate understanding of workplace mistreatment and its impacts on nurses is crucial to hospital managers. A qualitative approach using conventional content analysis was adopted in this study to describe the perspectives of a sample of Iranian nurses concerning workplace mistreatment. After analyzing the transcribed interviews, three main themes emerged: (i) Demand for a more humanistic and appreciative environment; this theme consisted of three categories: "incompetent management practice", "invisibility of nurses", and "unethical behaviors"; (ii) Unprofessional interpersonal encounters which included three categories: "poorly defined job characteristics", "nurses' poor performance", and "inefficient supportive means and structures"; and (iii) Inaction despite injury, consisting of two categories: "passive and ineffective ways of coping with mistreatment", and "personal and professional negative impacts". Findings from this study can guide further investigation within diverse populations of Iranian nurses, as well as worldwide, in order for firm conclusions to be drawn. Future research could compare the perspectives of other stakeholders - patients and relatives, physicians, and managers concerning workplace mistreatment.

Background and Purpose: Subjective well-being plays a crucial role in human life given the positive impacts it has on mental and physical health, longevity, and quality of life. Therefore, it is important to evaluate and promote subjective well-being and its relevant factors. This study aimed to assess the role of social capital in subjective well-being among Iranian adolescents. Methods: This cross-sectional, analytical study was performed on high school students (10th to 12th grades) residing in Birjand city, center of the Southern Khorasan Province, Iran, in 2015. The main inclusion criteria were being a student of public high schools and living with parents. Using multi-stage cluster sampling, 400 students were selected. A demographic characteristics form, the Social Capital Index, and the Adolescent Subjective Well-Being Scale were employed for data collection. The data were analyzed using descriptive statistics (including mean, frequency, and standard deviation) and inferential statistics (e.g., Pearson and Spearman's coefficients, step-wise multiple regression, Mann-Whitney U test, and Kruskal-Wallis test). Results: The participants reported a high level of social capital (89.06±12.87) and a moderate level of subjective well-being (29.82±6.91). There was a significant positive correlation between social capital and subjective well-being scores (r=0.5,P

Background Objectives: A nurses’ job satisfaction is a significant factor behind their motivation for quality care delivery. The aim of this study was to examine the relationship of communication skills with job satisfaction among hospital nursing staff. Methods: In this descriptive-correlation study, 162 nursing staff were recruited through stratified random sampling from teaching hospitals in Birjand, Iran. They were asked to complete a demographic questionnaire, job descriptive index, and burton’s communication skills questionnaire. The SPSS program (v. 18.0) was employed to analyze the data via the analysis of variance, the independent-sample t, the Tukey’s tests, Pearson correlation analysis, and the stepwise multiple linear regression analysis. The level of significance was set at less than 0.05. Results: The mean scores of participants’ communication skills and job satisfaction were 63.83 ± 7.56 (out of a 18 - 90 range) and 3.25 ± 0.53 (out of a 1 - 5 range). Participants’ communication skills mean score had a significant correlation with their job satisfaction mean score (r = 0.36; P < 0.001). Stepwise, multiple linear regression analysis revealed that the scores of the feedback and the verbal domains of communication skills explained 11% of the total variance of job satisfaction (R2 = 0.11, β= 0.17). Conclusions: Hospital nursing staff’s communication skills can significantly affect their job satisfaction. In-service training programs are recommended for improving nursing staff’s communication skills.

Background: Adolescence is among the most critical stages of life, during which assertiveness starts to develop. Parents and their communication patterns have significant roles in adolescents’ successful transition to adulthood. The present study aimed to examine the relationship of family communication patterns with adolescents’ assertiveness. Methods: This descriptive - analytical study was conducted on 400 high - school students in Birjand, Iran. Students were selected via multistage random sampling. A demographic questionnaire, the 26 - item Revised Family Communication Patterns, and the 30 - item Rathus Assertiveness Schedule were employed for data collection. The SPSS software (v. 16) was used to analyze the data by conducting the one - way analysis of variance, the Chi - square test, and the stepwise multivariate regression at a significance level of less than 0.05. Results: The most and the least common family communication patterns among participants were pluralistic (73 students, 28.1%) and protective (58 students, 22.3%) patterns, respectively. Students with pluralistic family communication patterns obtained significantly higher assertiveness scores than those with laissez - faire (P < 0.001) and protective (P = 0.004) patterns. The conversation orientation dimension of family communication pattern explained 9% of the total variance of students’ assertiveness. Conclusions: The conversation orientation dimension of family communication pattern is a significant predictor of adolescents’ assertiveness. Parents can increase their adolescents’ assertiveness through creating a more hospitable and open atmosphere in their families and encouraging adolescents to express and discuss their ideas and feelings.

Objective The aim of this study was to examine the effect of peer group support on family adaptation of wives of war veterans suffering from post-traumatic stress disorder (PTSD). Design and sample In this randomized controlled trial, 80 wives of war veterans with PTSD were incorporated, and selected participants were randomly assigned into intervention and control groups (n = 40 per group). The intervention group was divided into four subgroups, with each participating in eight weekly based 1.5-hr peer support group sessions and the control group received no intervention. Measures Demographics form and Family Adaptation Scale (FAS) developed by Antonovsky and Sourani (1988) were applied. Results The total mean scores of family adaptation increased significantly more in the intervention group than in the control group (p = .033). Furthermore, the time × group interaction effects were significant for internal family fit (p = .013) and a combination of both family fit and family community fit (p = .020) dimensions. Nonetheless family fit dimensions mean scores had no significant increase in the intervention group than the control group over time (p = .948). Conclusions Peer support group can be a useful tool for health care professionals to enhance family adaptation in spouses of war veterans with PTSD.

Background Infertility is a common clinical problem. Psychological adjustment to infertility refers to changing the viewpoint and attitude of an infertile person toward infertility problems, treatments and possible outcomes. The present study aims to prepare a valid and reliable scale for assessing the psychological adjustment to infertility, by determining the cultural adaptation, validity and reliability of the Persian version of the Fertility Adjustment Scale. Materials and Methods This is a cross-sectional study performed to localize and validate the Fertility Adjustment Scale, in which 40 infertile women and 40 healthy subjects (fertile or having children) were detected by a gynecolo- gist and the subjects who completed the Fertility Adjustment Scale (FAS) questionnaire were recruited. This study had four steps: in the first step, the literature was reviewed, in the second step, the scale was translated, in the third step, the content and construct validity indicators were calculated, and in the fourth step, reliability of the scale was validated. Results The mean (± SE and range) of fertility adjustment total scores in the infertile group and the control group were 43.2 (1.2 and 27-57) and 42.3 (1.5 and 18-57), respectively (P=0.623). The content validity was good according to Con- tent Validity Index score (0.7-0.8). A two-component structure was extracted from factor analysis which approximately justifies 52.0% of the cumulative variations. A Cronbach’s alpha value of 0.68 showed moderate reliability. Conclusion The results of this study revealed that the infertility adjustment scale is a useful tool for the analysis of psy- chological reactions towards infertility problems and evaluation of the consequences of treating this social-clinical problem.

Background: Lifestyle is a set of health-promoting behaviors, which empower individuals to maintain and promote their health and prevent illnesses. Poor lifestyle habits in adolescence endanger individuals’ health in adulthood. The present study was performed to analyze the relationship between social capital and lifestyle among a group of Iranian adolescents. Methods: This cross-sectional descriptive-analytic study was performed during year 2014. A stratified random sample of 400 tenth-, eleventh- and twelfth-year students was recruited from boys’ and girls’ high schools located in Birjand, Iran. Data were collected via a demographic questionnaire, the social capital index, and the adherence to a healthy lifestyle questionnaire. The data were entered in the SPSS software (v. 16). Descriptive statistics measures, such as frequency, mean, and standard deviation, were used to describe the data. Moreover, pearson and spearman correlation analyses, one-way analysis of variance, stepwise regression analysis, as well as independent-sample t, Mann-Whitney U, and Kruskal-Wallis tests were performed for data analysis. Results: Most participants had good social capital and a moderately healthy lifestyle. Social capital was positively correlated with lifestyle (r = 0.49; P < 0.001). Stepwise regression analysis showed that gender and social capital explained 33% of the total variance of lifestyle (R2 = 0.33; F = 100.52; and P < 0.001). Conclusions: Improvement of adolescents’ social capital could promote their lifestyle.

Background and Aim: Organizational effectiveness is the main goal of organizational development and excellence. Improvement of staff’s quality of work life may improve organizational effectiveness. The aim of this study was to analyze the relationship between quality of work life and organizational effectiveness among hospital nurses. Methods: This descriptive-analytical study was conducted on 225 hospital nurses who worked in teaching hospitals affiliated to Birjand University of Medical Sciences, Birjand, Iran. Nurses were recruited through random multi-stage cluster sampling. Data were collected using a demographic questionnaire, Brooks and Anderson quality of nursing work life questionnaire, and parsons organizational effectiveness questionnaire. SPSS software (v. 16.0) was used for data analysis via Mann-Whitney U, Kruskal-Wallis, and independent-sample t tests, one-way analysis of variance, and Pearson and Spearman correlation analyses. Results: From 225 nurses, 201 completely filled out their questionnaires. The mean of their work experience in nursing was 7.87 ± 7.62 years. Nurses’ organizational effectiveness was significantly correlated with their quality of work life (P < 0.001) and working ward (P = 0.04). The work context subscale of quality of work life was a significant predictor of nurses’ organizational effectiveness in which, each one-point increase in quality of work life was associated with a 0.66-point increase in organizational effectiveness. Conclusions: Nurses’ quality of work life is significantly correlated with their organizational effectiveness. Therefore, improving nurses’ quality of work life can improve their organizational effectiveness.

Background Self-management after myocardial infarction is fundamental to effective medical treatment. Objectives The current study aimed to investigate the effects of applying the continuous care model on self-management of a sample of Iranian patients with post-myocardial infarction. Methods Sixty hospitalized patients were randomly allocated into control (n = 30) and intervention (n = 30) groups. Before the intervention and at the end of it, self-management of both groups was evaluated by chronic disease self-management questionnaire. The continuous care model was performed for the intervention group for three months. The data were analyzed by SPSS version 16. In addition to descriptive statistical tests, Chi-square, the exact Fisher, Willcoxon and Mann-Whitney, and analysis of covariance (ANCOVA) tests were used. The significant level was set at P < 0.05. Results There was no significant difference between the two groups in terms of sub-dimensions of self-management scores before the intervention (P > 0.05). At the end of the intervention, in all self-management sub-dimensions expect for shortness of breath, the status of intervention group improved significantly more than that of the control group (P < 0.005). Moreover, mean of changes in all sub-dimensions of self-management showed no significant difference, but fatigue and health care utilization between the two groups had significant difference. Conclusions The continuous care model can be considered as a useful tool to improve patients’ self-management after myocardial infarction.

Background Many patients with multiple sclerosis (MS) have a type of sleep disorder. Objectives The current study aimed to investigate the effect of implementing a program based on the Orem self-care model on sleep quality of patients with MS. Patients and Methods Seventy eight patients referred to the multiple sclerosis association of Zahedan city, Iran, enrolled in the current randomized controlled trial conducted in 2015. The demographics form and Pittsburgh sleep quality index were completed by the patients. The selected patients were then randomly allocated into intervention and control groups (n = 39 for each group). An instructional program consisted of nine, 45 minutes sessions was performed in the intervention group. Afterwards, a three-month follow-up was performed after intervention. When the follow-up ended, the two groups completed the Pittsburgh sleep quality index again. Descriptive statistical tests, independent t-test, Chi-square test and paired t-test were used to analyze the data. Results Before the intervention, there was no significant difference between the two groups with regard to mean scores of sleep quality (P = 0.22). Both groups reported a significant improvement in sleep quality three months after intervention (P < 0.05). However, mean score changes of sleep quality before and three months after the intervention were significantly higher in the intervention group than the control group (P = 0.004), indicating a greater sleep quality improvement in the intervention than the control group. Conclusions The Orem-based self-care model program can be a useful tool to improve sleep quality of patients with MS. Future studies can be directed to investigate the effects of such interventions on other common problems of patients.

The purpose of this qualitative study was to describe the experiences of Iranian nurses concerning their quality of work life. A purposive sample of nurses (n = 14) was recruited from two university hospitals. The data were collected through unstructured interviews and were analyzed by using qualitative content analysis. The results indicated that the participants discerned their quality of work life by assessing how favorable were their working conditions, the level of fulfilment of their personal needs, and the impact of their working conditions on their private life and their social life. Three main themes were identified: quality of work life, as experienced from a personal perspective; quality of work life, as experienced from a sociocultural perspective; and quality of work life, as experienced from an organizational-professional perspective. The results of the present study will help Iranian nurse administrators to adopt effective strategies in order to improve nurses' quality of work life. Future research can broaden the scope of the current results and offer a more comprehensive understanding of nurses' quality of work life.

This study aimed to evaluate the reliability and validity of the Iranian version of the Uncertainty In Illness Scale — Family form. For this purpose, the Uncertainty In Illness Scale — Family form was translated from English into Persian and tested for psychometric properties. The analyses were carried out with data from a sample of 310 patients’ family members at one general hospital in Birjand city, the center of the Southern Khorasan province. The Iranian version of the Uncertainty In Illness Scale — Family form demonstrated an acceptable level of content validity with a content validity index of 0.91. The Cronbach’s alpha of 0.83 showed that the scale had reasonable internal consistency. This preliminary validation study of the Iranian version of the Uncertainty In Illness Scale — Family form showed that it is an acceptable measure to be used with Iranian patients’ family members. Additional research is recommended for further evaluation of the psychometric properties of the scale.

This study aimed to describe the meaning of the concept 'workplace incivility' and promote consistency in its application in nursing research and practice. The methodology introduced by Walker and Avant was used to analyze this concept. A total number of 50 studies that had essentially addressed the concept of incivility in employees' work environment was selected. Ambiguous intent, violation of mutual respect, low intensity and lack of physical assault were identified as the defining attributes of workplace incivility. The necessary antecedent of workplace incivility consisted of the presence of two or more people, with one or more as the source of the incivility, and another or others as its target in the workplace. Moreover, certain individual and organisational factors were the potential antecedents of workplace incivility. Possible negative outcomes for victims, witnesses, organisations, society and perpetrators of such behaviours, such as increased cost for the organisation, reduced citizenship performance, psychological distress and anxiety were identified as outcomes of workplace incivility. Results of the current concept analysis can guide nurse managers to design interventions so that the occurrence of workplace incivility can be reduced. Further studies can focus on testing the psychometric properties of the existing workplace incivility scales, especially uncivil behaviours experienced by nurses across different societies or cultures.

An accurate understanding of workplace mistreatment and its impacts on nurses is crucial to hospital managers. A qualitative approach using conventional content analysis was adopted in this study to describe the perspectives of a sample of Iranian nurses concerning workplace mistreatment. After analyzing the transcribed interviews, three main themes emerged: (i) Demand for a more humanistic and appreciative environment; this theme consisted of three categories: "incompetent management practice", "invisibility of nurses", and "unethical behaviors"; (ii) Unprofessional interpersonal encounters which included three categories: "poorly defined job characteristics", "nurses' poor performance", and "inefficient supportive means and structures"; and (iii) Inaction despite injury, consisting of two categories: "passive and ineffective ways of coping with mistreatment", and "personal and professional negative impacts". Findings from this study can guide further investigation within diverse populations of Iranian nurses, as well as worldwide, in order for firm conclusions to be drawn. Future research could compare the perspectives of other stakeholders - patients and relatives, physicians, and managers concerning workplace mistreatment.

Background: This integrative review was aimed to examine in literature and integrate the determinants of nurses′ organizational commitment in hospital settings. Materials and Methods: In this study, an integrative review of the literature was used. The search strategy began with six electronic databases (e.g. CINAHL and Medline). Considering the inclusion criteria, published studies that examined the factors influencing nurses′ organizational commitment in the timeframe of 2000 through 2013 were chosen. Data extraction and analysis were completed on all included studies. The final sample for this integrative review comprised 33 studies. Results: Based on common meanings and central issues, 63 different factors contributing to nurses′ organizational commitment were integrated and grouped into four main categories: Personal characteristics and traits of nurses, leadership and management style and behavior, perception of organizational context, and characteristics of job and work environment. Conclusions: In general, categories emerged in this study could be useful for formulating initiatives to stimulate nurses′ OC. However, little is known about the relative significance of each identified factor among nurses working in different countries. Qualitative research is recommended for narrowing this gap. Future research should be directed to examine the psychometric properties of the organizational scales for nurses in different cultures.

The purpose of this qualitative study was to describe the experiences of Iranian nurses concerning their quality of work life. A purposive sample of nurses (n = 14) was recruited from two university hospitals. The data were collected through unstructured interviews and were analyzed by using qualitative content analysis. The results indicated that the participants discerned their quality of work life by assessing how favorable were their working conditions, the level of fulfilment of their personal needs, and the impact of their working conditions on their private life and their social life. Three main themes were identified: quality of work life, as experienced from a personal perspective; quality of work life, as experienced from a sociocultural perspective; and quality of work life, as experienced from an organizational-professional perspective. The results of the present study will help Iranian nurse administrators to adopt effective strategies in order to improve nurses' quality of work life. Future research can broaden the scope of the current results and offer a more comprehensive understanding of nurses' quality of work life.

Studies that have examined the nursing quality of work life (QWL) have not been systematically reviewed in the recent years. Thus, the current study was aimed to identify the predictors of the nurses’ QWL and determine the definitions of QWL for nurses. The authors used an integrative review of the literature and identified six themes as the major predictors of the nurses’ QWL: leadership and management style/decision-making latitude, shift working, salary and fringe benefits, relationship with colleagues, demographic characteristics, and workload/job strain. Although different researchers had varied perspectives on the QWL in nursing, most viewed QWL as a subjective phenomenon that is influenced by personal feeling and perceptions. A closer review of definitions of QWL indicated that some authors considered QWL as an “outcome,” whereas others saw it as a “process.” Further research needs to be conducted to determine the relative importance of QWL predictors, and implementation programs to improve the QWL.