Investigating the relationship between compassion fatigue and moral injury in nurses.

Background: Compassion fatigue and professional quality of life are important in health and professional ethics. Aim: This study aimed to determine the relationship between compassion satisfaction, compassion fatigue, secondary traumatic stress, and moral injury in nurses. Research design: This research is a cross-sectional descriptive-analytical study. The research community of this research was all the nurses of the teaching hospitals of Ardabil city. Three questionnaires on demographic characteristics, the Professional Quality of Life Scale (ProQOL), and the Moral Injury Events Scale were used to collect data. SPSS (version 22) software was used for data analysis. Participants and research context: The study recruited 297 nurses randomly selected from five teaching hospitals in Ardabil city. Ethical considerations: Ethical approval was obtained from the Ardabil University of Medical Sciences ethics committee (with the code of ethics IR.ARUMS.REC.1401.198). Informed consent was obtained from the participants. Results: The results showed that the mean compassion satisfaction score of this study's participants was 37.61 ± 8.86, the mean compassion fatigue score of this study's participants was 28.73 ± 7.04, and the mean secondary traumatic stress score of this study's participants was 29.95 ± 7.84. The mean score of moral injury among nurses was 31.19 ± 8.54. The results showed a negative significant relationship between compassion satisfaction and moral injury (p < 0.001). Also, there is a positive significant relationship between compassion fatigue and secondary traumatic stress with moral injury (p < 0.001). Conclusion: The results of this study show a negative relationship between compassion satisfaction and moral injury. According to the results of the present study, nurse managers should implement educational interventions, create ethical processes, and clear ethical guidelines to reduce moral injury and increase compassion satisfaction.

Determining psychometric properties of the Persian version of demoralization scale-II in patients with cancer.

BACKGROUND: One of the emotional problems in patients experiencing cancer is demoralization syndrome. Concerning the importance of demoralization in patients with cancer, having a valid and reliable scale for assessing this problem is crucial. A revised version of Demoralization Scale (DS-II) was designed in 2016. It was necessary to determine its validity and reliability in populations with different cultures. This study aimed to determine the psychometric properties of the Persian version of DS-II (PDS-II) in Iranian patients with cancer. METHODS: The study population comprised 170 Iranian patients with cancer in Ardabil, Iran. The inclusion criteria were: age 18 or more, ability to understand and speak Persian, willingness to consent to participate in the study, having healthy cognitive function, and having an awareness of cancer. To determine the psychometric properties of PDS-II, the content, convergent, construct, and discriminant validity, besides internal consistency, were evaluated. RESULTS: Regarding the high correlation of PDS-II with General Anxiety Disorder, Patient Health Questionnaire, Beck Hopelessness Scale, and Hospital Anxiety and Depression Scale, the convergent validity of the PDS-II was confirmed. Confirmatory factor analyses confirmed both the original 2-factor and one-factor models of PDS-II. Internal discriminant validity of the PDS-II was not confirmed because the Average Variance Extracted from two dimensions of PDS-II (AVE = 0.31 and 0.37) was less than the square correlation between these two dimensions (r2 = 0.79). Cronbach α and coefficient was 0.88 for the PDS-II. CONCLUSIONS: PDS-II is a valid and reliable scale for measuring demoralization among Iranian people with cancer. However, the discriminant validity of the PDS-II was not supported.

Translation and psychometrics of the Persian version of the Good Nursing Care Scale in Iran.

BACKGROUND AND AIM: Identifying and evaluating the strengths and weaknesses of nursing care provided to improve the quality of nursing care is increasingly emphasized, and it requires using valid tools in this field. This study aimed to translate and determine the psychometric properties of the Persian version of the "Good Nursing Care Scale" (GNCS-P). METHODS: The present study is a methodological study in which the psychometric dimensions of GNCS-P were studied from the perspective of 200 patients who were admitted to the hospitals of Ardabil University of Medical Sciences. After translating the original version of the scale, its validity and reliability were evaluated and data analysis was performed using statistical package for social science (version 16) and analysis of moment structures (version 24). RESULTS: The effect score of the item in the evaluation of face validity for each item was above 2.4. The content validity ratio for the scale was 0.88, and the content validity index tool was 0.86. The correlation of total instrument scores with the standard instrument was 0.839. According to the results of factor analysis, the values of factor loading of items were between 0.62 and 0.91, which were all significant. Therefore, the seven dimensions introduced in the main tool were approved. In addition, Cronbach's alpha results of 0.865 and correlation of 0.894 in the test-retest showed that the questionnaire has internal consistency and acceptable stability. CONCLUSION: The Persian version of the GNCS-P has acceptable psychometric properties in the Iranian population and can be used as a valid tool in the areas of quality assessment of nursing care, education, and nursing research. IMPLICATIONS FOR NURSING PRACTICE: The results showed the validity and reliability of the tool and its usability as a valid tool in evaluating the quality of nursing care.

Validation of post-traumatic growth inventory in mothers with the experience of having the NICU-Hospitalized newborns "validation of post-traumatic growth inventory".

AIMS: Investigating post-traumatic growth (PTG) in mothers with the experience of having a preterm newborn hospitalized in the NICU requires a valid tool. This study aims to determine the validity and reliability of the Farsi version of the post-traumatic growth inventory (PTGI) in mothers with the experience of having their newborns hospitalized in the NICU. DESIGN: This study was methodological research. METHODS: In this study, 250 mothers who had newborns with a history of NICU hospitalization during the last 3 to 12 months and had visited paediatric clinics of the selected hospitals in Tehran with the aim of having their children's condition examined were selected through convenience sampling. The data were collected using a demographic information questionnaire and PTGI. The face validity, the construct validity (confirmatory factor analysis), and the internal consistency reliability of the inventory were measured using SPSS V22 and LISREL V8.8. RESULTS: According to appropriate values for factor analysis fit indices (FI = 0.94, RMSEA = 0.07, IFI = 0.94, NFI = 0.93, RFI = 0.91, NNFI = 0.93, SRMR = 0.07), 21 items and 5 factors were confirmed for this inventory. Furthermore, Cronbach's alpha coefficient of this inventory was measured as α = 0.94. CONCLUSION: According to favourable psychometric properties, the Farsi version of PTGI is a suitable tool for studying PTG in mothers with the experience of having preterm newborns in the NICU. Using PTGI can help nurses in planning family-centered care interventions to reduce the impact of the mental trauma caused by the preterm newborn's hospitalization in parents. PATIENT OR PUBLIC CONTRIBUTION: Mothers who had newborns with a history of NICU hospitalization during the last 3-12 months.

Psychometric properties of the healthy aging brain care monitor self-report tool in patients discharged from the intensive care unit.

PURPOSE: Intensive care unit survivors experience new and ongoing physical, psychological, and cognitive complications known as postintensive care syndrome. The study aimed to investigate the psychometric properties of the healthy aging brain care monitor self-report tool for assessing postintensive care syndrome in Iranian patients. METHODS: The study is a methodological study investigating the psychometric properties of the healthy aging brain care monitor self-report tool in 153 patients discharged from the intensive care unit. The instrument's psychometric properties were examined to determine content validity, construct validity (factor analysis, convergent validity, and discriminant validity), concurrent validity, and internal consistency. FINDINGS: The factor structure of the healthy aging brain care monitor self-report tool was examined in the form of two models: the three-factor model with 27 items and the three-factor model with 19 items. Regarding fit indices and results of the convergent, discriminant validities and the internal consistency the 19-item model is better than the original 27-item model. CONCLUSIONS: The study showed that the appropriate model for the healthy aging brain care monitor self-report tool in Iranian society is a tool with 19 items with the best conditions in terms of factor structure, internal consistency, and overall psychometric characteristics. IMPLICATIONS FOR NURSING PRACTICE: The present study led to the introduction of a valid instrument with a 19-item factor structure to assess the postintensive care syndrome by nurses and other healthcare providers in hospitals, clinics, palliative care centers, and home care centers.

Investigating the psychometric properties of the Persian version of Neonatal Pain, agitation, and sedation scale.

BACKGROUND: The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) is a tool that, in addition to assessing pain, also considers the level of sedation in infants. This study aimed to translate and determine the psychometric properties of pain and sedation parts of the N-PASS in neonates. METHODS: Two evaluators observed 70 non-intubated and 30 intubated infants admitted to the neonatal ward and neonatal intensive care unit. Totally, 1000 observations were done to assess discriminant and criterion validity, internal consistency, and inter-rater reliability. RESULTS: The discriminant validity of both the sedation and pain parts of the Persian version of N-PASS (PN-PASS) was confirmed by significantly increasing the pain score during the painful procedures compared to the rest time. The criterion validity of the PN-PASS was approved by the high correlation (r = 0.85) between the Premature Infant Pain Profile and the PN-PASS. The intraclass correlation coefficient between the two evaluators was in the range of r = 0.71-0.92, and Cronbach's alpha coefficient during non-painful and painful procedures was in the range of α = 0.57 and α = 0.86. CONCLUSION: This study showed that the Persian version of N-PASS is valid and reliable in assessing pain and sedation in term and preterm infants. There were an increase in some items' scores is more related to the mechanism of the procedures than to the painful nature of the stimuli.

Psychometric Evaluation of the Caring Ability of Family Caregivers of Patients With Cancer Scale-Mothers' Version for the Mothers of Children With Cancer.

BACKGROUND: The experience of caring for cancer patients has adverse outcomes for family caregivers. The ability to care for a sick child is affected by the mother's health; to empower mothers, it will be necessary to examine their caring ability. OBJECTIVE: The aim of this study was to carry out a psychometric evaluation of the Caring Ability of Family Caregivers of Patients With Cancer Scale-Mothers' Version (CAFCPCS-Mothers' Version). METHODS: The present study is a psychometric evaluation of the CAFCPCS-Mothers' Version. The sample consisted of 196 mothers of children in treatment for cancer selected through convenience sampling. The face, content and construct validity, internal consistency, and stability of the scale were measured. Data were analyzed using the software SPSS 19 and LISREL 8.8. RESULTS: After removing 2 items during confirmatory factor analysis, the values of root-mean-square error of approximation, comparative fit index, and nonnormed fit index were reported to be 0.066, 0.92, and 0.91, respectively. The Cronbach's α was calculated to be 0.71 and the stability correlation coefficient was 0.75. The final tested scale included 29 items in 5 dimensions: effective role play, fatigue and surrender, trust, uncertainty, and caring ignorance for mothers of children with cancer. CONCLUSION: The CAFCPCS-Mothers' Version has satisfactory content, face, and construct validity and adequate reliability in terms of internal consistency and stability in a sample of mothers of children receiving treatment for cancer. IMPLICATION FOR PRACTICE: The CAFCPCS-Mothers' Version can be used to assess the caring ability of Iranian mothers of children with cancer and to determine maternal care needs.

Post-Intensive Care Syndrome in Covid-19 Patients Discharged From the Intensive Care Unit.

Patients with Covid-19, after discharge from the intensive care unit (ICU), experience some psychological, physical, and cognitive disorders, which is known as the post-intensive care syndrome and has adverse effects on patients and their families. The aim of this study was to evaluate the post-intensive care syndrome and its predictors in Covid-19 patients discharged from the ICU. In this study, 84 Covid-19 patients discharged from the ICU were selected by census method based on inclusion and exclusion criteria. After completing the demographic information, the Healthy Aging Brain Care Monitor Self Report Tool was used to assess post-intensive care syndrome. Sixty-nine percent of participants experienced different degrees of post-intensive care syndrome, and its mean score was 8.86 ± 12.50; the most common disorder was related to the physical dimension. Among individual social variables, age and duration after discharge were able to predict 12.3% and 8.4% of the variance of post-intensive care syndrome, respectively. Covid-19 patients who are admitted to the ICU, after discharge from the hospital, face cognitive, psychological, and functional disorders, and there is a need for planning to prevent, follow up, and care for them by health care providers in the hospice and palliative care centers.

Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units.

BACKGROUND: Nursing Delirium Screening Scale (Nu-DESC) is a new instrument for determining delirium by nurses. The study aimed to investigate the psychometric properties of Nu-DESC and determined the sensitivity and specificity of it. METHODS: Two evaluators assessed delirium by Nu-DESC in nonintubated patients admitted to intensive care unit (ICU) wards of Ardabil educational and medical centers. For determining psychometric properties of the instrument, the methods of determining content validity, structural validity, criterion validity (the DSM-5 criteria was used as a standard tool), internal consistency, and inter-rater reliability were used. RESULTS: Ninety-six participants were assessed two times using the Nu-DESC. The mean age of the participants was 58.84, and 51 (53.1%) of them were male. Due to the high correlation of the Nu-DESC with the study criterion (DSM-5), the criterion validity of the instrument is confirmed. By using DSM-5 instrument, the cutoff score of 2 shows the best sensitivity and specificity. The kappa and alpha coefficients were obtained as r = 0.96 and α = 0.86, which indicate a good agreement between the evaluators and acceptable consistency. CONCLUSION: Nu-DESC can be used as an efficient and reliable instrument by nurses in the ICU. It was also found that taking medical history can help nurses to better interpret the Nu-DESC score at diagnosing delirium. HOW TO CITE THIS ARTICLE: Amirajam Z, Noran EA, Molaei B, Adiban V, Heidarzadeh M, Darghah MH. Psychometric Properties of Nursing Delirium Screening Scale in Patients Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(6):680-684.

Nursing students' attitude and preparedness for nurse prescribing and its relationship with self-efficacy.

AIM: The number of countries where nurses are allowed to prescribe has increased over the past two decades. Nursing students' self-efficacy has the main impact on their clinical and cognitive skills. The aim of this study is to determine nursing students' attitudes and preparedness for nurse prescribing and its relationship with their perceived self-efficacy. DESIGN: The descriptive-correlational study METHODS: This study was conducted at five Nursing and Midwifery schools of Tabriz, Ardebil, Ilam, Ramsar, and Mashhad, Iran from March to July 2018. Through random sampling 250 undergraduate nursing students from the different geographical areas of Iran were selected. The research tool consisted of three parts including demographic information, nurse prescribing questionnaire, and a questionnaire on self-efficacy in patient care. RESULTS: Nursing students had a positive attitudes and relatively high levels of preparedness for nurse prescribing. However, near to half of the participants (48.4%) mentioned that they have not good knowledge of pharmacology. Also there was a significant positive correlation between the students' self-efficacy and their attitudes and preparedness to nurse prescribing (p < 0.001, rs= 0.467;p = 0.00, rs= 0.633). CONCLUSIONS: Given the nursing students' positive attitude to and their preparedness for nurse prescribing, it is possible to make them more prepared for this new role by increasing their pharmacological knowledge and improving their accountability, management, and leadership skills.

The Relationship between Moral Sensitivity, Ethical Climate, and Job Strain with Patient Privacy from Viewpoint of Operating Room Staffs.

BACKGROUND: The privacy of patients in the operating room is in particular importance. The results of previous studies have shown that various factors are affecting in this context. The aim of this study is to evaluate the relationship between moral sensitivity, ethical climate, and job strain with respect to patients' privacy in operating rooms. MATERIALS AND METHODS: All of operating rooms nurses of teaching hospitals affiliated to Ardabil University of Medical Sciences were entered into this descriptive-analytical study with census sampling method in 2019. To collect data, standard surveys of moral sensitivity, ethical climate, job strain, and privacy were used. Data were analyzed by SPSS15 software using descriptive and analytical statistics methods (independent t-test, ANOVA, Pearson correlation, and regression analysis). RESULTS: There was a positive significant relationship between moral sensitivity and privacy (r = 0.56, p < 0.001) and ethical climate and privacy (r = 0.60, p < 0.001), too. But, there was an inverse and significant correlation between job strain and privacy (r = -0.69, p < 0.001). The results also showed that moral sensitivity is the best predictor of patients' privacy. CONCLUSIONS: Despite the predictability of all variables, results showed that moral sensitivity is the most important component in patients' privacy. In this regard, by increasing the moral sensitivity of nurses, the privacy of patients can be improved.

Psychometric Properties of the Farsi Version of Posttraumatic Growth Inventory for Children-Revised in Iranian Children with Cancer.

OBJECTIVE: Coping with childhood cancer, as a stressful incident, can lead to a growth in various aspects of the child's life. Therefore, this study aims to validate Posttraumatic Growth Inventory for Children-Revised (PTGI-C-R) in children with cancer. METHODS: This methodological research was carried out in referral children hospitals in Tehran. PTGI-C-R was translated and back-translated. Content and face validity were assessed. Confirmatory factor analysis (CFA) was performed on 200 children with inclusion criteria, using LISREL V8.5. Due to the rejection of the model, an exploratory factor analysis (EFA) was done, using SPSS V21. The correlation of posttraumatic growth (PTG) with the variables, i.e., age and gender, was investigated. RESULTS: Some writing changes were made in phrases in the sections concerning face and content validity. CFA rejected the five-factor model due to the undesirable fit indices. Therefore, an EFA was used and the three-factor model was not approved, either despite the statistical appropriateness or due to the lack of similarity between the items loaded on factors. The results also indicated a significant relationship between PTG and age (r = 0.13, P = 0.05). There is no significant relationship between PTG and gender (z = -1.35, P = 0.83). CONCLUSIONS: PTGI-C-R does not have desirable psychometric properties in Iranian children with cancer and may not be able to reflect all the aspects of PTG experienced by them. Therefore, it cannot be used as an appropriate scale, and it is necessary to develop and validate a specific tool through a qualitative study.

Specific prodromal symptoms in patients with acute coronary syndrome.

AIMS: Assessing the prodromal cardiac symptoms in patients with acute coronary syndrome (ACS) and compare them with healthy population. BACKGROUND: Identifying specific prodromal cardiac symptoms can play an important role in screening people at risk. DESIGN: A comparative study of prodromal symptoms. METHODS: In this comparison study, an 80-item checklist of prodromal symptoms was designed and completed by 337 participants in three groups (Patient group I, Patient group II and Healthy group). All participants were studied over a period of six months (from May to October 2017). SPSS-15 software was used to analyse the data. RESULTS: The symptoms of pain/discomfort in chest, pain/discomfort centred in the superior part of chest, pain/discomfort in the left breast and numbness or burning of both arms were the most important symptoms to predict ACS incidence in the two patient groups (odds ratio > 4 and p ≤ .05).

Investigating the Psychometric Properties of the Pieper-Zulkowski Pressure Ulcer Knowledge Test among Nurses in Iran.

OBJECTIVE: To evaluate the psychometric properties of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) in Iranian nurses. METHODS: A convenience sample of 323 nurses and 161 nursing students from the Ardabil University of Medical Sciences in Iran agreed to participate in the study. To determine the psychometric properties of the PZ-PUKT content and differential validity, item analysis (difficulty and discriminative indices), internal consistency, and test-retest were performed. RESULTS: Because the total PZ-PUKT score for critical care nurses (39.84 ± 7.10) was higher compared with general nurses (37.01 ± 8.47) and nursing students (24.59 ± 12.95), the differential validity of the tool was confirmed. The mean difficulty indices of questions with and without considering the "I don't know" option were 0.53 and 0.65, respectively, and 0.27 and 0.13 for discriminative index. Cronbach α coefficient was .92 for the 72-item test. The correlation coefficient between test and retest for 30 nurses was 0.81. CONCLUSIONS: This study showed that the Persian version of the PZ-PUKT is valid and reliable for use in Iran. It can be used in education and research to assess nurses' knowledge as well as to evaluate the effectiveness of training programs on prevention and care of pressure injuries.

The Relationship between "Self-Care Ability" and Psychological Changes among Hemodialysis Patients.

AIM: The study investigates and analyzes the relationship among the concepts of demoralization, posttraumatic growth, and self-care ability in patients undergoing hemodialysis. METHODS: The cross-sectional descriptive correlational study was conducted in 2017 on 150 hemodialysis patients selected through census in Buali Hospital, Ardabil, Iran. Demoralization scale, the posttraumatic growth inventory, and self-care questionnaire were used for cross-sectional data collection. Data were analyzed using descriptive statistics, Pearson and Spearman correlation coefficient. RESULTS: The mean and standard deviation of demoralization, posttraumatic growth, and self-care were 36.25 ± 18.84, 63.17 ± 17.71, and 33.89 ± 6.40, respectively. Self-care ability was positively associated with posttraumatic growth (r = 0.287) and negatively related to demoralization (r = -0.168). Self-care ability was also found to be desirable in 84.7% of the patients. CONCLUSIONS: Hemodialysis patients can experience both positive and negative psychological changes. Self-care ability is associated with reductions in negative psychological problems and increases in positive psychological changes. Health-care providers can, therefore, help hemodialysis patients to improve their psychological conditions by making plans for improving self-care abilities.

Evaluation of Health-Care Providers' Perception of Spiritual Care and the Obstacles to Its Implementation.

OBJECTIVE: Cancer patients face many health challenges, including spiritual issues. Therefore, an awareness of health-care providers' perspective on spiritual care provision is important. This study aimed to determine health-care providers' perception of spiritual care and to examine the individual barriers to its implementation in cancer patients. METHODS: The present descriptive study included 136 physicians and nurses. The Spiritual Care Survey was used as a research tool. Data were analyzed through descriptive statistics using IBM SPSS Statistics for Windows, version 20.0. RESULTS: In this study, 70.6% of the participants considered spiritual care to be influential in the patients' quality of life. However, 64.7% had received no spiritual care training, while 82.4% indicated a willingness to attend these courses. Regarding the obstacles to providing spiritual care, the highest and lowest scores, respectively, belonged to the lack of time and the person's reluctance to talk about spiritual issues. CONCLUSIONS: Spiritual care has not yet found its proper place in the care setting of Iran, and health-care team members do not have sufficient training to provide this kind of care despite their belief in its positive impact on patients' quality of life.

The Critical care Pain Observation Tool is reliable in non-agitated but not in agitated intubated patients.

OBJECTIVE: The Critical-Care Pain. OBSERVATION: Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. OBSERVATION: Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). STUDY DESIGN AND METHODOLOGY: 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures). Patients were divided into four groups according to their RASS score: 1. All patients (RASS -3 to +2), 2. Sedated patients (RASS -3 to -1), 3. Restless patients (RASS +1), 4. Agitated patients (RASS +2). RESULTS: Discriminant and criterion validity, confirmatory factor analysis and internal reliability showed good validity and reliability in the critical care pain observation tool in all groups except agitated patients. The results showed that, in general, the CPOT has good version of the critical care pain observation tool has good psychometric properties to evaluate pain in non-verbal patients admitted to intensive care units who have a RASS score ranging from -3 to +1, but it is not a good tool to evaluate pain in patients who are agitated according to RASS.

Dimensions of Posttraumatic Growth in Patients With Cancer: A Mixed Method Study.

BACKGROUND: Posttraumatic growth (PTG) refers to positive outcomes after exposure to stressful events. Previous studies suggest cross-cultural differences in the nature and amount of PTG. OBJECTIVE: The aim of this study was to explore different dimensions of PTG in Iranian patients with cancer. METHODS: A mixed method study with convergent parallel design was applied to clarify and determine dimensions of PTG. Using the Posttraumatic Growth Inventory (PTGI), confirmatory factor analysis was used to quantitatively identify dimensions of PTG in 402 patients with cancer. Simultaneously, phenomenological methodology (in-depth interview with 12 patients) was used to describe and interpret the lived experiences of cancer patients in the qualitative part of the study. RESULTS: Five dimensions of PTGI were confirmed from the original PTGI. Qualitatively, new dimensions of PTG emerged including "inner peace and other positive personal attributes," "finding meaning of life," "being a role model," and "performing health promoting behaviors." CONCLUSION: Results of the study indicated that PTG is a 5-dimensional concept with a broad range of subthemes for Iranian cancer patients and that the PTGI did not reflect all growth dimensions in Iranian cancer patients. IMPLICATIONS FOR PRACTICE: Awareness of PTG dimensions can enable nurses to guide their use as coping strategies and provide context for positive changes in patients to promote quality care.

The Psychometric Properties and Factor Structure of Persian Version of Edmonton Symptom Assessment Scale in Cancer Patients.

CONTEXT: Edmonton Symptom Assessment Scale (ESAS) was developed to assess objective and subjective symptoms in patients with cancer in all stages of their disease. AIM: The aim of the study was to translate and determine the psychometric properties of ESAS in an Iranian population. MATERIALS AND METHODS: The current study was carried out to determine reliability and validity of ESAS using 246 patients with cancer in Imam Khomeini Hospital, Ardabil, Iran. After translating the instrument to Persian, content and face validity, discriminant validity, internal consistency, and test-retest were done to determine psychometric properties of ESAS. Furthermore, the construct validity was determined using confirmatory factor analysis to evaluate factor structure of the tool in two models: single factor and three factor. RESULTS: With regard to goodness of fit indices including comparative fit index, incremental fit index, and normed fit index, factor structure of ESAS was confirmed with one factor and nine items. Because the values of average variance extracted of each dimension were less than the square of correlation coefficients between the three dimensions of ESAS, three-factor model was not confirmed. Discriminant validity was confirmed by finding significant differences between the two groups, patients with good general and critically ill conditions. Cronbach's alpha for the overall ESAS was 0.88, and correlation between test-retest with 4-6 h interval was 0.86 (r = 0.86 P < 0001). CONCLUSIONS: This study showed that Persian version of ESAS with same factor structure mentioned in the original version is an applicable tool for assessing objective and subjective symptoms in Iranian patients with cancer.

Evaluating the Factor Structure of the Persian Version of Posttraumatic Growth Inventory in Cancer Patients.

PURPOSE: This study aimed to assess the factor structure of the Persian version of posttraumatic growth inventory (P-PTGI). METHODS: Participants included 272 Iranian people of Azari ethnicity (111 women and 161 men), aged between 21 and 91 years (mean 52.65 years), who were diagnosed with cancer and were referred to the oncology department of the university hospital. The P-PTGI was assessed to determine the construct validity, using various indices of confirmatory factor analysis and standardized lambda coefficient, followed by further assessment of the discriminant and convergent validities by using the structural equation model. LISREL 8.8 for Windows and SPSS were used for data analysis. RESULTS: The calculated values of comparative fit index, incremental fit index, normed fit index, and non-normed fit index > .90 and the values of standardized root-mean-square residual < .08 indicate an acceptable fit for the original PTGI. Considering that the values of average variance extracted (.52-.74) were greater than the square of correlation coefficients between the five dimensions of P-PTGI, discriminant validity was approved. Convergent validity was confirmed through a high value of standardized lambda coefficient (.52-.92) between the items and their related factors. CONCLUSIONS: This study revealed that P-PTGI has an acceptable validity and reliability for posttraumatic growth assessment in Iranian cancer patients and its factor structure is similar to that of the original form developed by Tedeschi and Calhoun.