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Most sports and leisure activities involve repetitive movements in the upper limb, which are typically linked to pain and discomfort in the neck and shoulder area. Movement variability is generally expressed by changes in movement parameters from one movement to another and is a time-dependent feature of repetitive activities. The purpose of this study was to examine the effect of repeated movement-induced fatigue on biomechanical coordination and variability in athletes with and without chronic shoulder pain (CSP). In this controlled laboratory study, 24 overhead athletes in two groups of athletes with (N = 12) and without (N = 12) CSP were recruited. Biomechanical and Electromyographical data were recorded while the athletes were asked to perform repeating reaching tasks (RRT). Kinematic data was recorded every 30 s of the minutes of the repetitive pointing task (RPT). The kinematic and electromyography data were recorded at the first 30 s of "Fatigue-Terminal" (FT) and the last 30 s of "No-Fatigue" (NF) in the repetitive pointing task (RPT). Raw data was analyzed by using MATLAB code to extract the relevant coordination and movement variability data. Different fatigue conditions led to significant kinematic changes during the repetitive pointing task. In the CSP group, trunk lateral flexion decreased after fatigue, while it increased in the CON group (p < 0.013). Trunk rotation and shoulder elevation angles were smaller before fatigue than after in both groups (p < 0.001). Variability in joint angles, including trunk lateral flexion and elbow flexion, increased after fatigue, indicating less stability in movement patterns (p < 0.001). The coordination between trunk movement and shoulder elevation was altered post-fatigue, with significant changes in EMG variability for muscles like the Lower Trapezius and Long Head of the Biceps (p < 0.001). Results of our study indicate that both groups were able to accomplish fatigue, but they employed different movement strategies. The CSP group primarily focused on controlling the shoulder joint, while the CON group utilized both the shoulder and elbow joints in their strategy. This difference suggests that individuals in the CSP group who experienced chronic pain may have developed a strategy to minimize pain and fatigue during the task. Specifically, the CSP group's approach appeared to involve adjustments in movement patterns to manage the task despite fatigue. This adaptation contrasts with the CON group's more complex movement strategy, which involved greater variability and adjustments in both the shoulder and elbow joints., Competing Interests: Declarations. Ethics approval and consent to participate: Prior to starting the investigation, study approval was obtained from the Biomedical Research Ethics Committee of Allameh Tabatab’i University (Ethics code: IR.ATU.REC.1401.084), and all participants gave written informed consent. The authors confirm that all methods were performed in accordance with the relevant guidelines and regulations. Moreover, informed consent has been obtained to publish the images in an online open-access publication. Consent for publication: Written consent for publication has been obtained from the patient, as shown in Fig. 2. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To estimate the possible associations between posture and physical activity (PA)., Design: A systematic review and meta-analysis., Data Sources: The search was conducted in seven databases (PubMed, Web of Science, SportDiscus, EMBASE, Scopus, Cochrane Library, and CINAHL) for studies published from inception to January 2023., Eligibility Criteria for Selecting Studies: Studies were required to meet following criteria: (1) study design: cross-sectional, case control and cohort studies. (2) Participants: people of all ages without any diagnosed diseases. (3) Exposure and outcome: studies that examined the possible effect or correlations between PA, physical inactivity, physical exertion and human body posture., Results: Sixteen cross-sectional studies, two cohort studies and one case control study involving a total of 16772 participants aged from 6 to 79 years were included. Correlational studies showed that there was a significant relationship between PA and posture (C = 0.100, CI 95% = 0.012-0.186). However, regression studies demonstrated that there was not a significant association between PA and posture (C = 1.00, CI 95% = 0.998-1.002). Three studies investigated the association between PA and the lumbar lordosis and showed that there was not a significant association between the lordosis and PA (CI 95%: -0.253-0.048, P = 0.180). In addition, four studies showed that there were not any associations between scoliosis and PA (CI 95%: 0.819, 1.123, P = 0.607). The evidence of heterogeneity and publication bias was found among all analyzed data (P < 0.05). Also, meta regression was used for age and BMI and the results were not significant., Conclusion: Although a weak correlation was shown to exist between PA and human posture, the odds ratio indicated that there was not a significant association between PA and human posture. The lack of a significant relationship may indicate that multiple biopsychosocial factors may be involved in human posture. In summary, our study highlights the need for caution when interpreting the results of meta-analyses, particularly when there is significant heterogeneity and publication bias in the included studies., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: Osteoarthritis (OA) of the knee is one of the most common global joint disorders, especially in aging population, and is among leading health-related concerns of societies. Therefore, this systematic review and meta-analysis was done to investigate the results related to the effects of exercise interventions on knee repositioning sense in patients with knee OA., Methods: An extensive search was independently performed in electronic databases including PubMed, MEDLINE, Web of Science, SCOPUS, and Google Scholar, to identify randomized clinical trials (RCTs) conducted on knee OA and to evaluate knee repositioning sense before and after different exercise interventions. After extracting relevant data from eligible studies, results of the studies were pooled using a random-effects model of meta-analysis. The Physiotherapy Evidence Database (PEDro) of clinical trials was used for quality assessment of eligible studies., Results: Among 2702 studies identified in the initial search, 17 studies were eligible for final systematic review and meta-analysis. The results showed that the patients who participated in different exercise interventions had significantly less knee repositioning error (mean differences: -1.141 degrees (95%CI: -1.510, -0.772, P < .001) compared to those who did not undergo exercise interventions. The eligible studies exhibited publication bias (Intercept: -6.69, P = .002), and the data showed significant heterogeneity (I2 = 85.633%, Q = 153.125, P < .001). Moreover, meta regression showed more prolonged exercise duration might have more effects on knee repositioning error (Coefficient=-0.860, 95% CI=-1.705, -0.016, Z=-2.00, P = .045)., Conclusion: There is strong evidence that exercise interventions may effectively reduce knee repositioning error. Moreover, it seems that more prolonged exercise duration may be associated with the greater effect size., (© 2023. The Author(s).)

Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory. Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients. Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R). Results: Forty-five (30 male, 15 female) cases, 18-69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone ( N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was -3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = -0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70-0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58-0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg. Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ceccherini-Nelli, Bucuci, Burback, Li, Alikouzehgaran, Latif, Morin, Ganapathy, Salsali, Abdullah, Westwood, Orris and White.)

The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: This study aimed to determine comprehensive and applicable indicators for assessing the quality of nursing clinical services., Design: Methodological research., Methods: The checklist was designed in three phases (conceptualization, item generation and item reduction). In the first phase, a qualitative study using conventional content analysis was performed to clarify the concept of accreditation of clinical nursing services. In the second phase, using the views of experts was obtained in phase 1 and then by a review of the literature, related items were extracted, and item pool was formed. In the last phase, validity and reliability of the checklist were examined., Result: Based on three phases (Conceptualization, Item Generation and Item Reduction), the accreditation indicators of clinical nursing services were extracted in three dimensions including structure, process and outcome at two levels of organizational (including structural and outcome indicators) and individual performance appraisal (process indicators) in 19 main categories., Competing Interests: The authors declare no conflicts of interest., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services., Methods: The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire., Results: In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance., Conclusion: Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

Background: patient advocacy is a major nursing role, which is linked to supporting, encouraging and reinforcing self-advocacy in patients. Patient safety is an important nursing outcome, especially in older adults., Aims: older adults' self-advocacy regarding patient safety behaviour and its relationship with some demographic characteristics were assessed., Methods: a valid older adult patients' self-advocacy questionnaire, which included subscales of behaviour, self-efficacy, attitude and outcome efficacy (range of scores=0-63), was used. In this cross-sectional study, 230 patients aged over 60 years were selected using a stratified sampling method., Findings: an association was found between total self-advocacy score (mean=40.16; SD=9.6) and rural living (β=-0.168; P=0.016) using multiple linear regression analysis. Similar findings were found between questionnaire subscales and sex, rural living, occupation and age., Conclusion: older adults, especially women, those of advanced age and those in rural areas, may benefit from nursing interventions to improve their self-advocacy in patient safety.

This study purposed to explore and describe the experiences of Iranian female students with the role of motherhood. This 2015 qualitative study used purposeful sampling to select 20 student mothers aged 24-50 who were studying at a state or non-state university in an urban area in northwest Iran. Data was collected through individual semi-structured interviews and analysed using a qualitative content analysis approach. Three main themes were developed during data analysis: "simultaneous management", "facilities", and "barriers". The management of maternal and family affairs by female students in universities where motherhood is not supported is a challenge. The significance of mother-student roles must be emphasized and support and education provided for women to gain skills useful in playing these roles. Policy makers should devise strategies for bringing change to the traditional perspective that motherhood and educational responsibilities cannot be met at the same time by one person.

Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

Background: Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care., Methods: Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach., Results: We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force., Conclusions: We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

Background and Purpose: Nurse-physician professional communication affects the effectiveness and performance of the health care team and the quality of care delivered to the patient. This study aimed to explore the perspectives and experiences of physicians on nurse-physician professional communication in an urban area of Iran., Methods: Semistructured interviews were conducted with 15 physicians selected using a purposive sampling method. Physicians from different medical specialties were chosen from 4 teaching hospitals in an urban area of Iran. The data were analyzed with content analysis and themes developed., Results: Three themes developed during data analysis: "seeking the formal methods of communication to ensure patient care," "nurses' professional attributes for professional communication," and "patients' health conditions as the mediators of professional communication.", Implications for Practice: Nurses need to be informed of the perspectives and experiences of physicians on professional communication. Our findings can improve nurses' understandings of professional communication that could inform the development of educational and training programs for nurses and physicians. There is a need to incorporate communication courses during degree education and design interprofessional training regarding communication in clinical settings to improve teamwork and patient care. Open discussions between nurses and physicians, training sessions about how to improve their knowledge about barriers to and facilitators of effective professional communication, and key terms and phrases commonly used in patient care are suggested.

Aim: To develop an instrument for the assessment of safe nursing care (ASNC) within the Iranian context and psychometrically evaluate its reliability and validity., Background: There is a need for a valid and reliable instrument to assess how nurses employ the components of safe nursing care in clinical practice in non-Western countries., Method: This methodological study was conducted in two phases: (1) a qualitative phase of instrument development, and (2) a quantitative phase of psychometric evaluation of the assessment of safe nursing care (ASNC). The instrument's content validity was assessed by experts in the field of safe nursing care. The reliability of this instrument was examined using internal consistency reliability and intra-rater reliability analysis. Exploratory factor analysis was then conducted to establish the instrument's initial construct validity., Results: The instrument developed was a questionnaire with 32 items. The Cronbach's alpha of the scale was 0.92, and Intra-class Correlation Coefficient for intra-rater reliability was 0.78. Exploratory factor analysis resulted in a four-factor solution: (1) evaluation of nursing skills, (2) assessing the patient's psychological needs, (3) assessing the patient's physical need, and (4) Assessing nurses' teamwork. The four factors accounted for 63.54% of the observed variance., Conclusion: The ASNC can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of safe care, and its initial reliability and validity., Implications for Nursing Management: The ASNC can help nurse managers assess whether clinical nurses are prepared to apply their safe care skills in clinical practice. It can also be used by clinical nurses to assess their own and peers' practice to detect potential areas for improvement in nursing care and help nurse managers with planning appropriate quality improvement programmes., (© 2016 John Wiley & Sons Ltd.)

Introduction: Recognition the nurses' communicative roles can influence quality of patient's care. Therefore, this study was aimed to explore nurse's role in nurse-patient relations. Methods: This study was a qualitative research in which collected data was analyzed by content analysis method. The participants were 23 nurses, patients and their families in medical and surgical wards of a referral hospital in Tehran, Iran. Data were collected by semi-structured interview and observation. Results: Data analysis was led to the emergence of a main conceptual category: The patient's need-based communication. This category was derived from two categories: 1) Identifying the patient's needs; and 2) Communicative behavior in the face of the patient's needs. "Identifying the patient's needs" was related to "type of the patient's problem", "patients' inquiring about their health status" and "monitoring the patient's health status". "Communicative behavior in the face of the patient's needs" was composed of four subcategories: "caring attention", "informal education of the patient", "inducing calmness to the patient", and "obtaining the trust of the patient". Conclusion: The nurse's role in relationship with patients is designed according to patients' needs. Therefore, if the patients' needs in clinical settings are defined and clarified appropriately, the nurse-patient relations will be enhanced and thereby the quality of care will be improved.

Aim: To explore the perspectives and experiences of nurse instructors and clinical nurses regarding the assessment of safe nursing care and its components in clinical practice., Background: Safe nursing care is a key aspect of risk management in the healthcare system. The assessment of safe nursing care and identification of its components are primary steps to establish patient safety and risk management and enhance the quality of care in clinical practice., Methods: This was an interview study, with qualitative content analysis. Semi-structured interviews were conducted with 16 nurse instructors and clinical nurses including nurse managers chosen by purposive sampling based on theoretical saturation. Data collection and analysis were carried out simultaneously until data saturation was reached., Results: Data analysis led to the extraction of four main themes: holistic assessment of safe nursing care; team working and assessment of safe nursing care; ethical issues; and challenges of safe nursing care assessment., Conclusion: Identifying these four components in the assessment of safe nursing care offers a contribution to the understanding of the elements of safe care assessment and the potential for improved patient safety., Implications for Nursing Management: Safe care management requires the accurate and reliable assessment of safe nursing care and the need for strategies for reporting actual or potential unsafe care and errors to ensure patient safety., (© 2015 John Wiley & Sons Ltd.)

Aim: The aim of this study was to explore cardiac patients' perception of patient-centred care., Background: Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction., Design: This study is a descriptive qualitative study., Methods: Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews., Findings: The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions., Conclusions: Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care., Implications for Practice: Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care., (© 2014 British Association of Critical Care Nurses.)

Purpose: The present study was conducted with the aim of clarifying and reducing the semantic ambiguities around the concept of professionalism., Methods: The concept analysis method of Walker and Avant was used., Findings: The analysis demonstrated that professionalism in nursing consists of three main pillars: principles of care, communication, and ethics., Conclusions: Given that the process of professionalism in nursing may have positive outcomes for the nurse, the nursing profession, and the health system of the community, these items have been attended to., Implications for Nursing Practice: The present concept analysis can open the way to conducting more extensive research and devising tools to identify the barriers, facilitators, and administrative arrangements by clarifying the concept., (© 2015 NANDA International, Inc.)

Background: Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion., Objectives: In this study we explored the process of Iranian nurses' development in clinical judgment., Patients and Methods: This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method., Results: The study participants' main concern was 'being non-professional in clinical judgment'. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was 'struggling for becoming professional in clinical judgment development'. When nurses were supported professionally, they were able to develop their professional clinical judgment., Conclusions: The findings of this study provided critical information about nurses' professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses' clinical judgment ability.

Background: Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally., Objectives: This study aimed to audit nursing care based on a nursing process model., Patients and Methods: This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses' compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests., Results: The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses' age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001)., Conclusions: Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools.

Background: Studies introduce maternal and neonatal safety phenomena as important challenges to the public health, particularly in low-income countries. However, few researches are conducted on the identification of safety issues in maternity hospitals in Iraq. It was the first study on nurses' perspectives on safety issues in Kurdistan, Iraq., Objectives: The current study aimed to describe nurses' perspectives on what constitutes a safe maternity service in Kurdistan, Iraq., Patients and Methods: A qualitative design, based on a content analysis approach, was used. Ten Kurdish nurses who worked in the delivery room of Kurdistan, Iraq maternity hospital were recruited through purposive sampling. Semi-structured interviews were performed to collect data. All interviews were audiotaped and transcribed verbatim. Sampling continued to the level of data saturation. Data analysis was performed based on the steps suggested by Graneheim and Lundman., Results: Thematic analysis led to the identification of six main categories including stressful job, lack of schedule and job description, providing care with limited resources, professional unaccountability, regional sociopolitical factors, and inadequate training., Conclusions: Iraqi nurses identified factors such as limited health resources, lack of job description, and professional unaccountability as major safety issues in maternity services. These findings alarm the need to ensure the provision of females and neonates with appropriate care. This, however, would require coordination between Iraqi Kurdistan health authorities to provide midwifery care facilities, high-quality and relevant staff training, and an effective healthcare system in the maternity units.