Nurses' experiences of the attributes of the organizational citizenship behavior: a qualitative content analysis.

BACKGROUND AND AIM: Organizational citizenship behavior (OCB) among nurses, as the key human resources in healthcare systems, is of paramount importance to nursing care quality and patient outcomes. The present study was to reflect on Iranian nurses' experiences of OCB. METHODS: This qualitative study was completed in Iran from December 2022 to October 2023. In total, 20 nurses involved in hospitals, meeting the inclusion criteria, were recruited by purposive sampling with maximum variation. The data were then collected using 20 semi-structured interviews, each one lasting 30-60 min, and finally analyzed through qualitative content analysis. RESULTS: The data analysis revealed the nurses' experiences of OCB under nine subcategories and three main categories, including (i) "helping behavior", comprised of four subcategories of helping colleagues at work, helping colleagues outside of work, boosting morale, and creating a culture of support and appreciation, (ii) "extra-role behavior" with two subcategories of cooperation in advancing tasks, and creativity and efforts to promote services, and (iii) "contribution to professional growth and development", consisting of two subcategories of individual professional development and support for colleagues' professional development. CONCLUSION: Nursing managers and instructors can use the study results to enhance nurses' OCB by evaluating and employing nurses, and incorporating OCB into nursing curricula and continuous training programs.

The effect of seven-step educational strategy on knowledge of diabetic foot ulcer prevention, critical thinking and self-efficacy of nursing students: A randomized controlled trial.

BACKGROUND: Diabetic foot ulcer is a significant complication of diabetes that carries a high mortality risk and is associated with substantial financial costs. Choosing a suitable educational model for nursing students as future nurses is necessary to improve knowledge and manage issues related to caring for diabetic patients. OBJECTIVES: To determine the effect of education based on the 7E learning cycle model on the knowledge of diabetic foot ulcer prevention, critical thinking, and self-efficacy in nursing students. DESIGN: A single-blind, randomized controlled trial with a parallel group. SETTINGS: This study was conducted in a nursing school and hospitals covered by it in Iran. PARTICIPANTS: 98 students studying in the fourth semester of the Bachelor of Nursing course. METHODS: Students were divided into two distinct groups at random: an experimental group (class A, with 51 participants), and a control group (class B, with 47 participants). The participants of the experimental group were provided with an education based on the 7E learning cycle model, while the control group received conventional teaching method. Data collection methods included pre- and post-tests using research instruments (demographic questionnaire, Kaya Diabetic Foot Prevention Knowledge Questionnaire, Ricketts' Critical Thinking Disposition Questionnaire, and General Self-Efficacy Scale). The data were analyzed using descriptive statistics, non-parametric Mann-Whitney and Wilcoxon tests, parametric independent sample t-tests, ANCOVA, and paired sample t-tests. RESULTS: The difference in mean scores of diabetic foot ulcer prevention knowledge (Z = -6.232, p < 0.001), critical thinking (t (50) = -4.382, p < 0.001), and self-efficacy (Z = -4.427, p < 0.001) in the experimental group were statistically significant between the time interval before the intervention and one month after its completion. CONCLUSIONS: Compared to conventional method of teaching, education based on the 7E learning cycle model is a more effective method to improve nursing students' knowledge of diabetic foot ulcer prevention, critical thinking, and self-efficacy.

The impact of the education program based on dimensions of quality of work life among emergency medical services providers.

BACKGROUND: Quality of work life is a vital factor for health care providers. This study aimed to determine the impact of the education program based on dimensions of quality of work life among emergency medical services employees. METHODS: The quasi-experimental study was conducted on 100 emergency medical services employees in Tehran, Iran, who were chosen using a convenience sampling method (50 in the intervention group and 50 in the control group). The information was gathered using a Demographic Questionnaire and a Walton Quality of Work Life Questionnaire with eight dimensions. The research was carried out in three stages: design, implementation, and evaluation of the education program. During the design phase, the educational needs of the participants were determined in terms of the dimensions of the quality of work life and work and total living space. The education program on work-life quality was implemented in four virtual group sessions, emphasizing the educational needs identified through uploading educational content to the WhatsApp application. The evaluation was conducted in two stages: before the education program and three months after the program. With a significance level of 0.05, the data was analyzed using SPSS version 24 software. RESULTS: The results revealed that an education program on the quality of work life and its dimensions, emphasizing strategies to improve work and total living space, can improve the score of this dimension in the intra-group comparison of both the intervention and control groups (p = 0.046), as well as in the inter-group comparison, at the three-month post-intervention stage, there is a significant difference and a significant increase (p = 0.030), but it does not have a significant effect on the quality of work life and its other dimensions. CONCLUSION: It is recommended that emergency medical services managers plan to improve the quality of working life of their employees, particularly in terms of work and total living space.

Self-directed learning and clinical competence: The mediating role of the clinical learning environment.

Introduction: Recognizing the factors affecting clinical competence among internship nursing students is crucial. This study was aimed at determining the effects of self-directed learning on internship nursing students' clinical competence under the mediating role of the clinical learning environment. Methods: This cross-sectional research was performed on 300 internship nursing students selected by convenience sampling with a structural equation modeling (SEM) approach. Data were collected in one stage with three tools: the Self-Directed Learning Readiness Scale for Nursing Education, Education Environment Measure, and Clinical Competence Questionnaire. Data analysis was performed in SPSS version 21 and Smart-PLS version 3 with partial least squares-SEM. Measurement and structural model data were assessed with a significance threshold of p < 0.05. Results: A total of 20.5 % of the variance in clinical competence was explained by self-directed and clinical learning environments. Self-directed learning had a significant positive effect on clinical competence (path coefficient = 0.14, 95 % CI: 0.02, 0.26; p = 0.027), and on the clinical learning environment (path coefficient = 0.41, 95 % CI: 0.31, 0.52; p < 0.001). A relationship was observed between the clinical learning environment and clinical competence (path coefficient = 0.38, 95 % CI: 0.25, 0.50; p < 0.001). The indirect effect of self-directed learning on clinical competence was positive and significant (path coefficient = 0.11, 95 % CI: 0.07, 0.17; p < 0.001). Self-directed learning had a significant total effect on clinical competence (path coefficient = 0.30, 95 % CI: 0.19, 0.40; p < 0.001). Conclusions: According to the results, we recommend that nursing education managers and instructors consider plans to enhance self-directed learning among nursing students and improve the clinical learning environment.

A concept analysis of cultural competence in nursing: A hybrid model approach.

BACKGROUND: Cultural competence is considered one of the criteria for high-quality nursing care. AIM: This study aimed to analyse cultural competence in nursing. METHODS: This study was performed using the hybrid concept analysis approach in three phases. In the theoretical phase, literature was reviewed by searching Persian and English language databases, and 94 articles were included. In the second or fieldwork phase, 11 semi-structured interviews were conducted with purposefully selected nurses. The results of both theoretical and fieldwork phases were analysed using conventional content analysis, and in the final analysis phase, the results of the previous phases were triangulated. RESULTS: The attributes of cultural competence were obtained in the theoretical phase in six and the fieldwork phase in three categories. In the final phase, the categories obtained in both previous phases were triangulated: cultural competence in nursing is a continuous, developmental, flexible, extensive and complex process that is patient- and justice-oriented and emerges through learning and skills acquisition, including cultural knowledge, attitudes and practices. CONCLUSION: Managers and planners of nursing education can use the results of this study to educate nursing students and nurses and evaluate outcomes as one of the criteria for quality care.

Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study.

BACKGROUND: This study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management. METHOD: This experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05. RESULTS: Inter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05). CONCLUSION: The findings of this study can be used in various fields of healthcare in the hospital and community.

A Protection Motivation Theory-Based Empowerment Intervention for Promoting Health Behaviors in Women With Human Papillomavirus: An Experimental Study.

ABSTRACT: This experimental study on 70 women with human papillomavirus, referred to the specialized obstetrics and gynecology clinics of public hospitals in Iran in 2021, revealed that implementing the protection motivation theory-based empowerment intervention could promote their health behaviors.

Correlation between critical thinking dispositions and self-esteem in nursing students.

BACKGROUND: Critical thinking has been acknowledged as a key component of clinical decision-making and professional competency. Therefore, it is of great importance to reflect on how critical thinking is acquired and investigate its determinants, including self-esteem, in nursing education. The present study was thus to assess the correlation between critical thinking and self-esteem in nursing students. MATERIALS AND METHODS: This descriptive correlational study was fulfilled in 2019 on 276 nursing students selected via the random sampling method. For this purpose, Ricketts' Critical Thinking Disposition Questionnaire and Eysenck's Self-Esteem Scale were employed to collect the data, which were then analyzed using the SPSS Statistics (ver. 22) software along with independent-samples t-test, Pearson correlation coefficient, and one-way analysis of variance, considering the significance level of P < 0.05. RESULTS: The study findings showed a significant correlation between critical thinking and self-esteem (r = 0.529, P < 0.001) as well as self-esteem and critical thinking dispositions, that is, commitment, perfectionism, and creativity (r = 0.40, P < 0.001). Moreover, these dispositions had a significantly increasing trend during various academic years, but the difference was not significant with regard to perfectionism (P < 0.001). CONCLUSION: Given the positive correlation between self-esteem and critical thinking, commitment, perfectionism, and creativity in nursing students, it is essential to develop self-esteem skills in such students, using appropriate approaches to boost self-esteem as one of the important missions of higher education systems. As well, a lack of perfectionism during academic years confirms that it is possible that determinants other than educational environments, for example, families, are involved. Therefore, managers are suggested to hold meetings with parents and nursing students.

Protection Motivation Theory and Prevention of Breast Cancer: A Systematic Review.

Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has been introduced to motivate health behaviors using coping appraisal and threat appraisal. We aimed to systematically review the applicability of PMT to predict and improve the knowledge and intention (the patient's intent to undergo breast cancer screening with self/clinical breast exam or mammography) for protective behaviors among women. A systematic search was performed in May 2022 in electronic databases to investigate the role of PMT in the prediction of protection behaviors in addition to improving the knowledge about the prevention of breast cancer using specific keywords. The relevant studies were then included for data extraction. Seventeen articles including 7 interventional and 10 prediction studies were selected for data assessment. Findings demonstrated that PMT could be used to predict the rate of knowledge and intention about breast cancer risk among women. It was also shown that PMT could be considered as a framework for the prevention of breast cancer by changing the behaviors of individuals by training the participants. Fear arousal, response efficacy, and response cost were found as the main determinants of knowledge and intention rate. PMT can provide a useful framework to evaluate the factors associated with women's intentions about breast cancer. Periodical educational programs should be implemented to improve protection behaviors by increasing the intention of women to regular self-examination.

Comparison of the Effect of the Person-Centered and Family-Centered Training via Telenursing on the Quality of Life in COVID-19 Patients.

Background: Education of the patients with Coronavirus Disease 2019 (COVID-19) and their families is necessary to improve the quality of life. This study investigated the effect of person and family-centered training via telenursing on the quality of life in patients with COVID-19. Methods: This interventional study was performed on 88 patients with COVID-19 18--65 years and 44 family members referred to the Bank Melli Hospital, Tehran, Iran. The samples were randomly assigned into two groups person-centered and family centered. A cyberspace group including patients and their families was created. Four educational sessions planned (15--30-min-every day) and three sessions planned for completing the questionnaires via phone. The data were collected using demographic characteristics form and the 12-item Short-Form Health Survey version 2 before and 6 weeks after the intervention and were analyzed in SPSS 22 using Chi-square test, paired t-test, and independent t-test. Results: The mean scores of quality-of-life increased significantly in the person-centered group from 26.81 ± 5.15 to 34.4 ± 4.39 before and six weeks after intervention, respectively (p < 0.001). The means scores of quality-of-life increased significantly in the family-centered group from 28.11 ± 4.79 to 35.86 ± 3.85 before and 6 weeks after the intervention, respectively. (p < 0.001). Conclusions: The person and family centered methods increase the mean scores of quality-of-life of patients with COVID-19. The family centered method can be more effective to improve the quality of life of these patients.

Needs of Family Members of Intensive Care Patients.

This article reports the results of a research project designed to identify the needs of family members and others who are coping with hospitalization of loved one in the intensive care unit, thus alleviating stress. The health care provider's viewpoints were also considered. Study participants were 9 family members of intensive care unit patients and 24 health care providers working in intensive care units. Data were collected and analyzed from 24 individual interviews (average of 35 minutes per interview) and 1 focus group interview (1 hour). The findings revealed 2 basic needs: (1) reducing concerns and (2) being supported. The first need could be addressed by open visitation, access to information, assurance of quality of care, and empowerment via education and involvement. The second need could be met by emotional support, access to facilities, and postdischarge support. Health care providers and decision makers can use these results to respond to these needs and increase people's satisfaction of intensive care unit services.

Relieving care burden and promoting health-related quality of life for family caregivers of elderly people with Alzheimer's disease via an empowerment program.

BACKGROUND: Effective strategies should be adopted to reduce care burden (CB) and improve health-related quality of life (HRQoL) in family caregivers (FCGs) of elderly people with Alzheimer's disease (AD). Therefore, the purpose of this study was to determine the impact of empowerment program (EP) on CB and HRQoL of FCGs. METHODS: The present two-group experimental study was conducted on 70 FCGs of the elderly with AD who were selected by convenience sampling and randomly assigned to the empowerment program group (EPG, n = 35) and control group (CG, n = 35). Data collection tools were 12-item Short Form Health Survey and Zarit Burden Interview. The EP was held for 5 weeks, one session of 20 to 30 min each week. Data were collected before, immediately and 3 months after EP and analyzed by SPSS version 25 software at a significance level of 0.05. RESULTS: The results showed a significant decrease in the mean CB score in FCGs of elderly with AD in EPG before, immediately and 3 months after EP (p < 0.001). The result also revealed that there was a significant increase in the mean HRQoL score in EPG immediately and 3 months after EP (p < 0.001). CONCLUSIONS: According to the results of this study, EP can reduce CB and increase HRQoL in FCGs of elderly with AD. Policymakers and planners active in the field of healthcare for the elderly can benefit from the results of our study to improve the health of FCGs of the elderly with AD.

Pediatric palliative care for children with cancer: a concept analysis using Rodgers' evolutionary approach.

BACKGROUND: Providing access to pediatric palliative care (PPC) for children living with a serious illness, such as cancer, is of critical importance, although this specialized intervention, as a novel concept, still seems vague and complicated. The present study analyzed the concept of PPC for children with cancer. METHODS: Rodgers' evolutionary method was employed for the concept analysis. Articles on PPC, particularly those for children suffering from cancer, published between 2010 and 2021 were searched in valid academic research databases. The inclusion criteria for the full-text articles were based on the characteristics, antecedents, and consequences of PPC for children with cancer. RESULTS: In total, 19 relevant articles were selected and then reviewed and analyzed after applying the inclusion criteria and the final sampling. The analysis of the concept of PPC for children affected with cancer revealed four characteristics, including "PPC as holistic and integrated care", "PPC as patient- and family-centered care", "PPC as early-start continuous care", and "PPC as interdisciplinary and team-based care". Some effective factors could also act as antecedents for this concept, i.e., health care providers' training and expertise as well as human resources and financing. Moreover, improved quality of life, symptom reduction, and coordination between patient care and family support were among the PPC consequences for such children. CONCLUSIONS: The study results demonstrated that delivering PPC to children with cancer demanded a comprehensive view of its various dimensions. Furthermore, numerous factors need to be delineated for its accurate and complete implementation.

Reducing care burden and improving adherence to health-promoting behaviors among family caregivers of patients with multiple sclerosis through a healthy lifestyle empowerment program.

BACKGROUND AND AIM: The chronic, progressive nature of multiple sclerosis (MS) demands long-term family-centered care for patients. In view of that, inadequate education and support provided for the family caregivers (FCGs) of MS patients increase their care burden (CB) and affect their lifestyle. This study aimed to investigate the impact of a healthy lifestyle empowerment program (HLEP) on CB and adherence to health-promoting behaviors (HPBs) in the FCGs of patients suffering from MS. METHODS: In this experimental study with parallel groups, conducted in Iran in 2020, a total of 60 FCGs of MS patients were recruited, and then randomized into intervention (n = 30) or control (n = 30) groups. The intervention program, the HLEP, was thus implemented virtually via WhatsApp in the intervention group upon coordinating with the MS Association in the city of Yasuj, Iran, and selecting the participants. The data were collected at three stages, including baseline, follow-up 1 (immediately after the HLEP), and follow-up 2 (three months after HLEP). The research tools were a 14-item demographic survey questionnaire, the 24-item Caregiver Burden Inventory, and the 52-item Health-Promoting Lifestyle Profile-II. Independent-samples t-test, repeated measures analysis of variance, and a linear mixed model were further used for statistical analyses, considering the significant level of 0.05. RESULTS: The study results revealed a significant decrease in the CB scores from the baseline to the follow-up 2 (77.03 ± 15.76 to 42.33 ± 12.37), and a significant increase in the values of adherence to HPBs from the baseline to the follow-up 2 (123.53 ± 14.01 to 148.06 ± 15.04) were obtained in the intervention group (p < 0.001). The linear mixed model also showed that the significant absolute changes in the scores of CB and adherence to HPBs during the follow-ups in the intervention group, compared to those in the controls, were - 8.92 and 16.47 units, respectively (p < 0.001). CONCLUSION: Health care managers, planners, and providers are highly recommended to start developing and implementing various HLEPs for reducing CB and improving adherence to HPBs among the FCGs of patients with MS.

The predictors of COVID-19 preventive health behaviors among adolescents: the role of health belief model and health literacy.

Aim: The present study aimed to evaluate the predictive role of the Health Belief Model (HBM) constructs and health literacy (HL) in shaping the coronavirus disease 2019 (COVID-19) preventive health behaviors (PHBs) among adolescents. Methods: This cross-sectional study was conducted with 503 adolescent girls and boys, randomly selected via cluster sampling. For this purpose, the data were collected online through four research tools, including the demographic-clinical characteristics information questionnaire, the COVID-19 PHB Scale based on HBM, and the Health Literacy Scale for COVID-19. The data analysis was then performed by regression analysis along with the structural equation modeling (SEM), considering the significance level of 0.05. Results: The regression analysis results demonstrated that following the one-unit increase in the values of self-efficacy and cues to action, the COVID-19 PHBs elevated by 0.063 and 0.078 units, respectively. In addition, the COVID-19 PHBs subsided by 0.018 with the rise in the value of perceived barriers (P < 0.001). According to the path analysis, the direct path from the COVID-19-related HL to the COVID-19 PHBs (B = 0.097, ß = 0.087, 95% confidence interval [CI] = 0.005 to 0.189) was significant. Furthermore, the indirect path from the COVID-19-related HL to the COVID-19 PHBs through perceived susceptibility (B = 0.017, ß = 0.015, 95% CI = 0.001 to 0.032), perceived barriers (B = 0.029, ß = 0.026, 95% CI = 0.004 to 0.055), self-efficacy (B = 0.094, ß = 0.084, 95% CI = 0.031 to 0.156), and cues to action (B = 0.153, ß = 0.137, 95% CI = 0.092 to 0.215) was significant. Conclusion: In keeping with the study results, it is essential to take some effective measures to boost the HBM constructs and HL among adolescents to improve their PHBs during pandemics such as COVID-19.

The predictors of nursing students' clinical competency in pre-internship objective structured clinical examination: The roles of exam anxiety and academic success.

BACKGROUND: Identifying the predictors of nursing students' clinical competency in objective structured clinical examination (OSCE) is of utmost importance. Therefore, the present study was to investigate the predictive roles of exam anxiety and academic success in nursing students' clinical competency in the pre-internship OSCE. METHODS: In this descriptive-analytical study, a total number of 102 nursing students, meeting the inclusion criteria and enrolled in the sixth semester (third year) of the graduate nursing program in Iran, were firstly selected by the census method. The pre-internship OSCE was then implemented at eight stations based on a pre-designed schedule template. The required data were also collected through a demographic-academic characteristics questionnaire and the State-Trait Anxiety Inventory to determine the exam anxiety score, the nursing program grade point average (GPA) to reflect on the levels of academic success, and the OSCE score to control clinical competency. The data analysis was also performed at the significance level of 0.05. RESULTS: The linear regression model, in which the exam anxiety, the nursing program GPA, and the demographic-academic characteristics variables had been imported, could explain 33.52% of the variance of the nursing students' clinical competency in the pre-internship OSCE (R2 = 0.616). Of the variables concerned, only the nursing program GPA could be a significant predictor of the nursing students' clinical competency scores in the OSCE, so that 0.8 points were added to the clinical competency scores in the OSCE as the nursing program GPA increased by one unit (p = 0.000, ß = 0.717), but no significant relationship was observed between exam anxiety and clinical competency in the pre-internship OSCE among the nursing students. CONCLUSIONS: The results of this study endorsed the use of the OSCE in assessing the nursing students' clinical competency and implementing learning strategies to strengthen the levels of academic success in such individuals.

The Role of Family Caregiver's Sense of Coherence and Family Adaptation Determinants in Predicting Distress and Caregiver Burden in Families of Cancer Patients.

BACKGROUND: Most cancer patients' families suffer from maladaptation which increases family distress and caregiving burden. This study was conducted to explore the relationship between these maladaptation indicators, and the sense of coherence (SOC) of family caregivers alongside other family resilience determines among family caregivers of cancer patients. METHODS: A total of 104 family caregivers of cancer patients were included in this cross-sectional study. They answered three questionnaires to assess family resilience factors: Family Inventory of Resources for Management (FIRM), Family Crisis Oriented Personal Evaluation Scales (F-COPES), and SOC scale. In addition, family maladaptation factors were determined by two instruments, including Family Distress Index (FDI) and Caregiver Burden Inventory (CBI). RESULTS: The results of this study showed that the FIRM and the SOC together were responsible for 35% and 43% of the variances in FDI and CBI scores, respectively (P < 0.001). "Reframing", the subscale of the F-COPES, significantly predicted the variances of FDI (ß = -0.26, P = 0.01) and CBI scores (ß = -0.21, P = 0.04). Moreover, "Mastery and health", the subscale of the FIRM, significantly predicted the variances of FDI (ß = -0.38, P < 0.01) and CBI scores (ß = -0.21, P = 0.02). CONCLUSIONS: Family caregiver's SOC alongside other family resilience determinants plays a significant role in alleviating family distress and caregiver burden. It is suggested that palliative care providers consider family caregivers' SOC in developing a psychological intervention plan to improve family resilience in families of cancer patients.

Predictors of osteoporosis preventive behaviors among adolescent: a cross-sectional study.

INTRODUCTION: Osteoporosis is a preventable progressive metabolic disease. Girls have an increased risk of occurrence of osteoporosis in their old age. The BASNEF model can be employed to change behaviors related to health. The BASNEF model was employed to determine the predictors of osteoporosis preventive behaviors among adolescent girls. MATERIAL AND METHODS: This cross-sectional study was carried out on 209 adolescent girls selected from high schools in the Quchan County in 2016 using path analysis by stratified sampling. The data was collected through a demographic questionnaire and a 52-item researcher-made questionnaire, based on the BASNEF model constructs. The data was analyzed using Shapiro-Wilk test, bootstrapping, and path analysis. RESULTS: The average age of the students was 16.10 ±0.59. The results of path analysis showed that Model 1 matched the BASNEF model relationships completely; however, it could not predict osteoporosis preventive behaviors. The constructs of Model 2 (modified) was able to predict 50% of variances in osteoporosis preventive behaviors. There were positive and direct relationships between the following pairs of constructs: knowledge and attitudes (B = 0.23, p < 0.001); attitudes and the intention of osteoporosis preventive behaviors (B = 0.37, p < 0.001); subjective norms and the intention of osteoporosis preventive behaviors (B = 0.53, p < 0.001); behavioral intention and osteoporosis preventive behaviors (B = 0.36, p < 0.001); subjective norms and osteoporosis preventive behaviors (B = 0.33, p < 0.001), and enabling factors and osteoporosis preventive behaviors (B = 0.29, p < 0.001). CONCLUSIONS: The community health nurse can use the constructs of the BASNEF model to change the osteoporosis preventive behaviors like knowledge, attitudes subjective norms and enabling factors.

Improving health-related quality of life and adherence to health-promoting behaviors among coronary artery bypass graft patients: a non-randomized controlled trial study.

PURPOSE: This study aimed to determine the impact of a healthy lifestyle empowerment program on health-related quality of life and adherence to health-promoting behaviors in coronary artery bypass graft patients. METHODS: This non-randomized controlled trial was conducted in 2019 on 97 coronary artery bypass graft patients in Iran. Participants were selected by culturally pragmatic and non-randomized method and assigned to healthy lifestyle empowerment program group (HLEPG) (n = 49) and conventional education group (CEG) (n = 48). Data were collected by the 12-item short-form health survey (SF-12) and health-promoting lifestyle profile II (HPLP2), which were administered at baseline and three-month follow-up. The healthy lifestyle empowerment program and conventional education as two interventions were performed for HLEPG and CEG, respectively. Data analysis was performed using the paired t-test, independent t-test, analysis of covariance and linear mixed method at the 0.05 significance level. RESULTS: In the follow-up, both groups showed a significant increase in the mean score of health-related quality of life (p ≤ 0.001) but this increase was visibly greater in the HLEPG (from 23.47 ± 7.48 to 35.60 ± 5.95) than in the CEG (from 22.93 ± 5.93 to 27.6 ± 4.90). The healthy lifestyle empowerment program also significantly increased the mean score of adherence to health-promoting behaviors in the HLEPG (p ≤ 0.001), whereas no such change was observed in the CEG. The results of the linear mixed model showed that the follow-up scores health-related quality of life and adherence to health-promoting behaviors of the HLEPG were 27.26 and 7.56 units significantly greater than the CEG after HLEP, respectively (p < 0.001). CONCLUSION: Considering the results of this study, health care providers are recommended to devise and implement healthy lifestyle empowerment programs to improve the health-related quality of life of coronary artery bypass surgery patients. CLINICAL TRIAL REGISTRATION: Registered at Iranian Registry of Clinical Trials (IRCT20171213037860N1).

How is family involved in clinical care and decision-making in intensive care units? A qualitative study.

Background: Involving family members in patient care is considered as a significant dimension of family-centered care in intensive care units (ICUs). Aims: To describe family members' perceptions and experiences regarding involvement in clinical care delivery and decision-making in ICUs in Iran. Design: A qualitative research method using conventional content analysis. Methods: A total number of 24 participants were selected through purposive sampling method between 2018 and 2019. Each interview also lasted between 30 and 60 min and the inductive data analysis was used. Results: The findings revealed that non-agreed involvement in clinical care delivery and family involvement in decision-making is being implemented on a continuum of paternalistic views. Conclusion: Healthcare providers, particularly nurses, and policy makers can thus exploit these findings to strengthen family involvement in this regard and consequently improve quality of care. Impact statement: A non-agreed approach and paternalistic views along with some barriers can affect family members' involvement in providing clinical care and making decisions in ICUs in Iran.