A model for older adults' coping with the death of their child: a grounded theory study.

BACKGROUND: Losing a child at an old age while also facing health problems and physical limitations can have significant negative impacts on parents' lives such as anxiety, depression, and impairment in social functions. The process of coping with the death of a child is particularly unknown among older adults. Therefore, this study aimed to explore how older adults cope with the death of their child. METHOD: This qualitative study was conducted in 2020-2021, using Corbin and Strauss (2015) approach to the grounded theory method. The sampling began purposefully and continued theoretically until theoretical saturation was achieved. Semi-structured interviews were conducted to collect data from Iranian older adults who had experienced the death of their child. To ensure data trustworthiness, the Guba and Lincoln (1985) criteria were utilized. A qualitative data analysis software, MAXQDA2020, was used to manage the data. FINDINGS: The results of this study were obtained from 27 participants. The main concern of older adults was the fear of their lives collapsing following the death of their child. Participants utilized three main strategies to address their concerns: attempting to rebuild themselves, connecting to a higher power, and searching for positivity amidst grief. The central category that emerged from the analysis was "improving physical, mental, and spiritual capacities," resulting in personal growth and improved social relationships. CONCLUSIONS: Through the use of the three aforementioned strategies, older adults were able to overcome their primary concern of the fear of their lives collapsing following the death of their child. Further development of the theory is suggested in order to design a model that can facilitate older adults' coping with this difficult life event.

Status of age-friendly city indicators in Iran cities: a systematic review.

BACKGROUND: The global phenomena of an increasing older population within the total population and the rise in urban older residents have prompted numerous studies on the indicators of an age-friendly city in various Iranian cities. The insights obtained from these studies can aid policymakers in promoting social justice for older adults. Thus, this study aimed to investigate the status of age-friendly city indicators across different cities in Iran. METHOD/DESIGN: A systematic review was conducted by searching for studies in Persian and English databases until March 2024, including Pubmed, Web of Science, Scopus, Cochrane, Google Scholar, and ScienceDirect, using keywords such as "age-friendly", "elderly-friendly", "cities", "older adults", "aging", "elderly", "indicators", "components", "criteria", "features", "characteristics", "indexes", "Iran", and "urban space", along with their MeSH equivalents, employing "AND" and "OR" operators. Additionally, Persian databases such as Magiran and SID were extensively searched using keywords like "elderly-friendly", "city", "urban spaces", "Iran", "indicators", "components", "features", and "criteria". The references of the final articles were also examined to ensure search accuracy. The results from the studies on the indicators of an age-friendly city were reviewed, summarized, and ultimately reported. RESULTS: The initial search yielded 2857 articles, of which 34 were included in the systematic review. Only two studies addressed the indicators based on the needs of the older adults, with the majority reporting unfavorable urban conditions for the older adults. Despite these unfavorable conditions, the index of open spaces and buildings received the highest rank among the examined indicators. However, two indicators-respect for older adults, social acceptance, civic participation, and employment- did not perform well in any study. CONCLUSION: The findings indicated that Iran failed to meet the required standards for age-friendly cities. Therefore, it is recommended that policymakers in the field of geriatric health take measures to identify and mitigate environmental risk factors for older adults. TRIAL REGISTRATION: This systematic review was registered on the Prospero database with the number CRD42023475657 on date 8 November 2023.

Iranian Nurses' Knowledge, Attitude, and Practice of Complementary Therapies for Pain Management.

INTRODUCTION: Complementary therapies (CTs) are being increasingly used by people with health issues and recommended by their health care providers. Although there are numerous studies available that address nurses' knowledge and attitudes regarding pain management, there are few that include the use of CTs by nurses in Iran. Therefore, this study was conducted in selected areas of Iran to assess nurses' knowledge, attitudes, and current practice regarding the use of CTs. METHODS: A cross-sectional study was conducted on a random sample of 850 nurses from various regions of Iran between 2020 and 2022. A questionnaire was used that consisted of seven items addressing demographic characteristics, 15 items to assess knowledge, 25 items to address attitude and 22 items to address the practice of CTs in the area of pain relief. Descriptive and inferential statistics were used to analyze the data. RESULTS: The participants' mean age was 33.26 ± 7.24 years. Most nurses (89.9%) had not received formal education on CTs. However, 78.6% of nurses reported personal use of CTs, and 62.3% reported using or recommending it to their patients at least once. Regarding the knowledge of CTs, nurses scored 5.81 on a 15 points scale indicating a considerable gap in their knowledge of CTs. Regarding attitudes toward the specific therapies, nurses believed that massage is highly (46.4%) or moderately (31.6%) effective in pain relief. Regarding effectiveness, nurses ranked the following as the top four CTs: music therapy, humor, hydrotherapy, and use of cold / heat. CONCLUSION: The nurses in this study scored low on knowledge of CTs, meaning that they knew little about CTs. However, they showed a favorable attitude toward CTs and a majority of them had a history of personal use, and recommending some types of CTs to their patients for pain relief. Therefore, it is crucial for nurse managers to provide opportunities to acquire knowledge of CTs. Moreover, nurse educators should advocate for updating nursing curricula to include CTs as an essential component of pain management education.

Missed nursing care and its relationship with nurses' moral sensitivity: a descriptive-analytical study.

BACKGROUND: Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran. METHODS: A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis. RESULTS: Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (ß = 0.213, p < 0.001), age (ß = 0.131, p < 0.001), working in rotating shifts (ß = 0.183, p < 0.001), monthly income (ß = 0.079, p = 0.004), work experience (ß = 0.030, p = 0.010), and monthly work hours (ß = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables. CONCLUSION: Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly.

Nurses' experiences of the role of organizational and environmental factors in the development of love of the profession: a qualitative study.

BACKGROUND: Love of the profession has significant relationship with nurses' job motivation and care quality. However, there is limited information about organizational and environmental factors affecting love of the profession among nurses. AIM: This study aimed at exploring nurses' experiences of the role of organizational and environmental factors in the development of love of the profession. METHODS: This qualitative study was conducted in 2020-2021 using the conventional content analysis approach. Participants were Fifteen Iranian nurses with deep love of the profession, nursing instructors, and nursing managers purposefully selected from different healthcare and academic settings in seven large cities of Iran. Data were gathered via semi-structured interviews and were analyzed via the conventional content analysis method proposed by Graneheim and Lundman. RESULTS: Organizational and environmental factors affecting the development of love of the profession were grouped into three main categories: The social context of the profession (with two subcategories), family support (with two subcategories), and organizational health (with four subcategories). Subcategories were respectively historical context of the profession, the evolving context, emotional family support, instrumental family support, quality of interpersonal relationships in the organization, level of organizational justice, level of authority delegation to nurses, and level of organizational support. CONCLUSION: Different organizational and environmental factors can affect nurses' love of the profession development. Improving public image of nursing, providing nurses with stronger support, improving organizational climate, and strengthening interpersonal relationships in healthcare settings are recommended to develop nurses' Love of the profession.

Effective interventions for reducing moral distress in critical care nurses.

Moral distress (MD) has received considerable attention in the nursing literature over the past few decades. It has been found that high levels of MD can negatively impact nurses, patients, and their family and reduce the quality of patient care. This study aimed to investigate the potentially effective interventions to alleviate MD in critical care nurses. In this systematic review, a broad search of the literature was conducted in the international databases including PubMed/MEDLINE, Web of Science, and Scopus, as well as Google Scholar search engine using keywords such as moral distress, intensive care unit, ICU, nurses, and critical care nurses from 1984, when the concept of MD was first introduced in the nursing literature, up to 29 October 2020. Studies focusing on the interventions for managing MD in critical care nurse were evaluated. The quality of eligible papers was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A total of 8 studies fulfilled the eligibility criteria. Three studies had RCT design and five studies had quasi-experimental design. All studies were conducted in the United States or Iran. Educational workshop, moral empowerment program, social work intervention, nursing ethics huddles, and multifaceted resiliency bundle intervention were effective interventions for managing of MD among critical care nurses. There is limited but promising research evidence evaluating the efficacy of educational interventions for managing of MD among critical care nurses. Although some positive results have been reported, there is limited generalizable evidence due to the variability of interventions. These findings highlight the need for further studies to validate the efficacy of these interventions or develop more potent and efficient interventions for reducing MD in critical care nurses.

The meaning of losing a child in older adults: a qualitative study.

BACKGROUND: After losing their child, elderly parents look for a meaning in this phenomenon. This meaning comes out from their experiences, and their responses to and actions in life are shaped based on this meaning. Therefore, this study was conducted with the aim of "understanding the meaning of losing a child in older adults." METHODS: This qualitative study was conducted using conventional content analysis method. Using semi-structured face-to-face interviews, data were collected from 15 older adults who had experienced of losing their adult child. Data analysis was performed according to the steps proposed by Graneheim and Lundman, 2004. To prove the trustworthiness of the data, credibility, dependability, confirmability and transferability were used. RESULTS: The age range of participants was between 61 and 83 years and 73.3% of them were female. The two main categories of "tasting the bitter flavor of life" and "searching for a positive meaning in losing a child" together with the theme of "finding hope in the heart of darkness" were extracted from the participants' experiences. CONCLUSIONS: Despite the grief of losing a child, which had cast a dark shadow over the parents' lives, the child's liberation from worldly sufferings, his/her presence in a better world, and being hopeful about the grace of God had caused the elderly parents to find hope in the heart of darkness. After identifying the parents with a deceased child, they should be helped through psychological counseling and care of the healthcare team so that they can adapt to this situation by finding a positive meaning in losing their child.

Primiparous women's experiences of normal vaginal delivery in Iran: a qualitative study.

BACKGROUND: Childbirth is considered as the most challenging psychological event in a woman's life. It has a major effect on women's lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women's perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women's perception about it. METHODS: This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 h after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one. RESULTS: The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Furthermore, seven subthemes were obtained including 'loss threat', 'stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support. CONCLUSIONS: This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.

Iranian teachers' knowledge about first aid in the school environment.

PURPOSE: School students are at risk of unintentional injuries. Teachers are the main caregivers and the first protectors for school students and must be able to deliver first aid. This study aimed to assess the school teachers' knowledge about first aid in Kashan, Iran. METHODS: A cross-sectional study was undertaken on a sample of 200 teachers working in public and private primary, secondary and high schools in Kashan city, Iran. Data collection was achieved via a questionnaire consisting of items on teachers' characteristics and 20 questions on basic first-aid practices. One point was given for each correct answer. The lowest and highest possible scores were 0 and 20. Then, the sum scores 0-9, 10-16, and 17-20 were ranked as weak, moderate, and good first aid knowledge, respectively. Statistical analyses were performed using descriptive statistics, Chi-square and Fisher's exact tests, and regression analysis. RESULTS: The mean age and working experience of teachers were respectively (41.37 ± 6.35) years and (20.07 ± 7.29) years. Among all teachers 51.0% were males and 66.3% were working in public schools. Totally, 40.3% of the teachers had passed courses on first aid and 48.5% had confronted with situations needing first-aid; 59.7% evaluated their own knowledge of first aid as moderate. The mean score of first-aid knowledge was 10.00 ± 2.58. Teachers who had received first aid training and those with previous experiences of situations requiring first-aid possessed higher scores (p < 0.001). Most teachers answered wrongly to the questions regarding first aid in a child with a fracture (93.4%) or struck by electricity (85.2%). CONCLUSION: Most of the teachers had insufficient knowledge on first aid. They mostly did not pass any training on first aid. Urgent action seems necessary for training teachers on first aid through in-service training programs.

Iranian nurses' professional competence in spiritual care in 2014.

BACKGROUND: The holistic approach views the human as a bio-psycho-socio-spiritual being. Evidence suggests that among these dimensions, the spiritual one is largely ignored in healthcare settings. OBJECTIVES: This study aimed to evaluate Iranian nurses' perceived professional competence in spiritual care, the relationship between perceived competence and nurses' personal characteristics, and barriers to provide spiritual care. RESEARCH DESIGN: A cross-sectional study was conducted in the year 2014. Participants and research context: The study population consisted of nurses working in teaching hospitals in Kashan city. Using a stratified, systematic random method, 250 samples were selected from a total of 1400 nurses. An indigenous instrument was used to assess the nurses' competencies in spiritual care. Ethical considerations: A research ethics committee approved the study. All the participants were briefed on the study aims, were assured of the confidentiality of their personal information, and signed a written informed consent. RESULTS: Among a total of 250 nurses, 239 answered the questionnaire completely, and in total, 23%, 51%, and 26% had poor, moderate, and favorable competence in spiritual care, respectively. No significant differences were found between the mean competence scores of spiritual care in terms of gender, marital status, employment status, and level of qualification. Significant difference was found between nurses' overall score of competence in spiritual care and receiving training on spiritual care, nurses' position, and the ward they worked in. DISCUSSION: Confirming the findings of the international literature, this study puts light on the situation of nurses' perceived competence and barriers to providing spiritual care in Iran as an eastern and Islamic context. CONCLUSION: Three-quarters of the nurses had moderate or unfavorable competence in spiritual care. Due to the crucial role of spiritual care in quality of care and patient satisfaction, nurses should be trained and supported to provide spiritual care.

Comparing the effects of Bentonite & Calendula on the improvement of infantile diaper dermatitis: A randomized controlled trial.

BACKGROUND & OBJECTIVES: Infantile diaper dermatitis is a common, acute inflammatory reaction of the skin around diaper among infants. This study was undertaken to compare the effect of topical application of Bentonite and Calendula creams on the improvement of infantile diaper dermatitis. METHODS: This double blind randomized controlled trial was undertaken on 100 patients of infantile diaper dermatitis. The 100 participants were randomly assigned into two groups of 50 each, and were prescribed the coded medicine. The mothers were trained to apply the cream and level of improvement was judged by observing the affected area on the first visit and then after three days of receiving treatment. RESULTS: The mean age of infants was 6.45±5.53 months in Calendula group and 7.35±6.28 months in Bentonite group. Overall, 88 per cent of lesions in the Bentonite group started improving in the first six hours while this rate was 54 per cent in Calendula group (P<0.001). The risk ratio for the improvement in the first six hours was 2.99 folds in the Bentonite group. Also, lesions in 86 per cent infants in the Bentonite group and 52 per cent in the Calendula group were completely improved in the first three days after treatment (P<0.001). INTERPRETATION & CONCLUSIONS: Our results showed that in comparison with Calendula, Bentonite had faster healing effect and was more effective on the improvement of infantile diaper dermatitis (IRCT ID: IRCT 2012112811593N1).

The Correlation of Social Support and Social Participation of Older Adults in Bandar Abbas, Iran.

Social participation is a criterion for successful aging. Research has shown that social participation decreases in older adults. However, the role of social support on older adults' social participation has received little attention, especially in eastern countries, such as Iran. Using the Social Participation Questionnaire, the relationship between social support and social participation was investigated in 525 Iranian older adults. A correlation was found between social support and social participation of older adults. Older adult women were found to have less social support and social participation compared with men.

An audit of eye dryness and corneal abrasion in ICU patients in Iran.

BACKGROUND: The use of sedation and muscle relaxants can predispose intensive care unit (ICU) patients to poor eyelid closure and eye disorders. These complications may not get the nursing care and attention that they require; this and the predisposing factors need to be further investigated. AIMS AND OBJECTIVES: The aim of this audit was to use the standard eye-care technique and determine the incidence of eye dryness and corneal abrasion, on day 5 after admission, in comatose patients in the ICU. DESIGN AND METHODS: This was an audit, in the four ICUs in two teaching hospitals in the cities of Kashan and Tehran. An ophthalmologist examined the corneal abrasion and eye dryness on the day of admission and then day 5. The eye-care method and other variables such as sex and age were also recorded. Statistical tests of χ(2) , spearman and multiple linear regressions were used to determine the relationships between variables. RESULTS: Eighty-seven patients participated in the audit. On day 5, 28 patients (32·2%) had dry eyes and 12 patients had developed corneal abrasion (13·8%). The mean of Schirmer tear value on admission was 21 ± 4·5 mm. This value decreased to 16·1 ± 5·6 mm on day 5. About 10·3% of patients who received eye lubricant products, and 20·7% of those receiving adhesive tape as eye-care method developed corneal abrasion. CONCLUSIONS: Corneal abrasion and eye dryness were common problems in ICU patients. Eye dryness was the main risk factor for the development of corneal abrasion. Patients receiving adhesive tape as an eye-care method were twice more likely to develop corneal abrasion. RELEVANCE TO CLINICAL PRACTICE: Eye care and eye assessment should be essential parts of nursing care for patients in ICU. To prevent corneal abrasion, using eye lubricants is more effective than closing eyes by adhesive tape.

The effects of Bentonite and Calendula on the improvement of infantile diaper dermatitis.

BACKGROUND: Diaper dermatitis is one of the most common skin disorders of infancy and childhood. The present study aimed to compare the effects of Bentonite and Calendula on the improvement of diaper dermatitis in infants. MATERIALS AND METHODS: A double-blind randomized controlled trial, which was conducted on 60 out-patient infants referred to health care centers or pediatric clinics in Khomein city and diagnosed with diaper dermatitis. Data were collected by checklist and observation, and analyzed using t-test, Chi-square, and Fisher's exact test. RESULTS: Mean (standard error) age of the total sample was 6.55 ± 0.69 months. Totally, 93.3% of lesions in the Bentonite group started its recovery in the first 6 h, while this rate was 40% in Calendula group (P < 0.001). Furthermore, 90% of infants in the Bentonite group and 36.7% in the Calendula group were improved completely in the first 3 days (P < 0.001). CONCLUSION: Bentonite was effective on the improvement of diaper dermatitis, and also had faster effects compared with Calendula.

Whole body massage for reducing anxiety and stabilizing vital signs of patients in cardiac care unit.

BACKGROUND: Patients admitted in coronary care units face various stressors. Ambiguity of future life conditions and unawareness of caring methods intensifies the patients' anxiety and stress. This study was conducted to assess the effects of whole body massage on anxiety and vital signs of patients with acute coronary disorders. METHODS: A randomized controlled trial was conducted on 120 patients. Patients were randomly allocated into two groups. The intervention group received a session of whole body massage and the control group received routine care. The levels of State, Trait and overall anxiety and vital signs were assessed in both groups before and after intervention. Independent sample t-test, paired t-test, Chi-square and Fischer exact tests were used for data analysis. RESULTS: The baseline overall mean score of anxiety was 79.43±29.34 in the intervention group and was decreased to 50.38±20.35 after massage therapy (p=0.001). However, no significant changes were occurred in the overall mean anxiety in the control group during the study. The baseline diastolic blood pressure was 77.05±8.12 mmHg and was decreased to 72.18±9.19 mmHg after the intervention (p=0.004). Also, significant decreases were occurred in heart rate and respiration rate of intervention group after massage therapy (p=0.001). However, no significant changes were occurred in vital signs of the control group during the study. CONCLUSION: The results suggest that whole body massage was effective in reducing anxiety and stabilizing vital signs of patients with acute coronary disorders.

Intensive care nurses' opinions and practice for oral care of mechanically ventilated patients.

CONTEXT: Oral care is an essential aspect of critical care nursing. However, no study has been published on oral care practice of Iranian and Asian nurses. The majority of published studies were conducted in western and European countries. AIMS: This study aimed to evaluate the nurses' opinions and practice about oral care in patients under mechanical ventilation. SETTINGS AND DESIGN: A cross-sectional study was conducted on 130 intensive care nurses from 6 intensive care units in the university hospitals of Iran. MATERIALS AND METHODS: A questionnaire was used to gather the data and charts of 45 patients were evaluated. STATISTICAL ANALYSIS: Descriptive statistical analysis are presented. RESULTS: Oral care obtained the 7(th) rank in prority and a mean score of 5.7 on a scale of 1-10. More than 21% of subjects did not perform oral care in their usual duties. High load of writing tasks and personnel shortages were the major barriers to oral care. Only 20% of the patients' charts contained a report on oral care. CONCLUSIONS: Nurses did not consider oral care in intensive care patients as a high priority. This result highlights the need to continue education programs on oral care for improving the knowledge and attitude of intensive care nurses with respect to oral care.

Effect of acupressure of Ex-Le7 point on pain, nausea and vomiting after appendectomy: A randomized trial.

BACKGROUND: The Le7 acupoint had been known as an acupoint for reducing pain of appendicitis. However, no study on the effect of its acupressure on post-appendectomy pain is available. The objective of this study was to evaluate the effects of acupressure of Le7 acupoint on pain, nausea, and vomiting after appendectomy. MATERIALS AND METHODS: A single-blind randomized controlled trial was conducted on 70 post-appendectomy patients in a general surgical ward. Patients with inclusion criteria were selected consecutively and were randomly assigned into two groups. The intervention group received acupressure to the Le7 acupoint and the second group was the control group. The severity of post-operative pain, nausea, and vomiting measured hourly till the seventh post-operative hour. T-test was used to compare the mean of pain and nausea severity of two groups. Paired t-test was used to compare the mean of pain intensity of each group before and total mean of pain at post-intervention hours. Chi-squared test and Fisher exact test were used for nominal data. RESULTS: The mean of pain intensity in the intervention group was 5.10 ± 3.52 before intervention and decreased to 3.53 ± 0.75 in the post-operative hours (P = 0.018). The mean of pain intensity in the control group was 4.45 ± 3.16 before intervention and changed to 4.01 ± 0.92 in the post-operative hours (P = 0.32). However, the mean of pain intensity in the intervention group was less than the control group till 6(th) h after the surgery. No significant differences were observed between the two groups in terms of nausea and vomiting (P = 0.74). CONCLUSION: Acupressure on Le7 acupoint was effective on post-appendectomy pain but did not affect nausea and vomiting. Further investigations are suggested with starting acupressure at the onset of pain or nausea and vomiting.

Rationing of nursing care: A concept analysis.

Rationing of nursing care (RONC) refers to necessary nursing tasks that nurses refuse or fail to do because of limited time, staffing level, or skill mix. As an important process factor, it affects the quality of patient care. The concept of rationing of nursing care has not yet been clearly defined and analyzed and there are different views regarding this issue. Using Walker and Avant's eight-step method, this concept analysis was conducted to analyze the meaning, attributes, dimensions, antecedents, and consequences of nursing care rationing. The literature was collected by searching in electronic databases including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar with no date limitation. Both qualitative and quantitative studies on rationing of nursing care, which were open-access and published in English, were included in this study. Thirty-three articles were investigated in the present study. The four defining attributes of RONC included the duty of performing nursing care, dealing with problems of doing nursing care, decision-making and prioritizing, and outcome. The antecedents included nurse-related, organization-related, care-related, and patient-related antecedents. A theoretical definition and a conceptual model of RONC were developed. The attributes, antecedents, and consequences of RONC identified in this study can be used in nursing education, research, and managerial and organizational planning.

Health literacy and quality of life in Iranian persons with COPD.

BACKGROUND: Chronic obstructive pulmonary disease is a progressive disorder with significant physical, psychological, and social consequences and adversely affects the persons' quality of life (QOL). OBJECTIVES: This study aimed to determine the health literacy (HL) and QOL of persons with COPD and some of the contributing factors. METHODS: A cross-sectional study was conducted from May to December 2019 on 270 persons with COPD referring to Shahid-Beheshti Hospital of Kashan, Iran. Data were collected using a demographic questionnaire, the 33-item Health Literacy Questionnaire of the Urban Population of Iran (with a total score ranging from 33 to 165, higher score indicates higher HL) and the 50-item St. George's Respiratory Questionnaire for assessing the QOL (with a total score ranging from zero to 100, greater score means lower QOL). Descriptive statistics, Pearson and Spearman correlation coefficient, Chi-square test, t-test, analysis of variance, and linear regression analysis were used to analyze the data. RESULTS: The mean age and the mean duration of COPD were 59.48±13.31 and 3.85±3.47 years, respectively. The mean HL score and the mean QOL were 81.44±23.89 and 57.41±10.70, respectively. A significant correlation was found between HL and QOL (r=-0.21, p<0.001). CONCLUSION: Participants had moderate levels of HL and QOL. There was a significant correlation between HL and QOL. Health care providers are recommended to take effective steps to improve the HL of persons with COPD by developing comprehensive educational programs for them.

Human Caring: A Concept Analysis.

Introduction: Human caring combines science, art, and humanity. Humanity is the heart of care and interpersonal interactions. Despite the critical emphasis on human caring and concern for nursing care without humanity, there is no clear definition for human caring in nursing. This study aimed to analyze the concept of human caring. Methods: Walker and Avant's strategy for concept analysis was used. Electronic databases such as PubMed, Scopus, Ovid, Google Scholar, Magiran, Iran Doc, SID, and a number of dictionaries were searched without any limitation in date. Search keywords were "care", "caring", "human caring", "humanization", "patient care", "comprehensive care" and "nursing care". We searched all documents published before September 2020. In the initial search, 1637 articles were found but finally, 39 relevant articles remained in the study. Results: The nine defining attributes of human caring were establishing therapeutic communication, presence at the patient bedside, empathy, providing scientific care, subjectivity, dynamicity, respecting the patient's rights and ethics of care, helping the patient achieve a feeling of well-being, and art and creativity. Antecedents of human caring were categorized into three categories namely, human, personal, and organizational factors. The consequences were also categorized into consequences related to nurse, profession, patient, and organization. Conclusion: A theoretical definition and a conceptual model of human caring were developed. This concept should be included in the nursing curricula at all undergraduate and graduate levels and even in nurses' in-service training programs.