The Effect of Spiritual Group Therapy on the Quality of Life and Empowerment of Women with Breast Cancer: A Randomized Clinical Trial in Iran.

This randomized clinical trial was carried out on 74 women with breast cancer between May 2015 and April 2016 in the south of Iran. The patients were selected using a simple sampling method and randomly divided into an intervention (n = 30) and a control (n = 37) group. Five spiritual therapy sessions were conducted for the intervention group. Each session lasted one hour. The quality of life and empowerment of the patients were measured before and one month after the intervention. To collect data, four instruments were used, including a demographic information form, the European Organization for Research and Treatment of Cancer QOL questionnaire Cancer-30 (EORTC QLQ C-30), EORTC QLQ Breast-23 (EORTC QLQ-BR23), and the Cancer Empowerment Questionnaire (CEQ). After the intervention, a difference was observed between the groups concerning the mean score of general health (P = 0.016) and emotional function (P = 0.029), but there was no significant difference between the groups concerning the mean score of empowerment (P = 0.62). Thus, it appears that spiritual group therapy can improve the quality of life of this group of patients.IRCT registration number: IRCT 2014050417546N2.

Care self-efficacy in adolescents with mental disorders: A qualitative study.

BACKGROUND: The promotion of health in adolescents with mental disorders depends on their levels of self-care empowerment. Self-efficacy is a significant prerequisite for successful self-management and behavior change in adolescents with mental disorders. The present study was conducted to explain the concept of care self-efficacy in adolescents with mental disorders. MATERIALS AND METHODS: This qualitative study was carried out using the conventional content analysis approach. Semi-structured interviews (n = 34) were conducted with adolescents having mental disorders, their families, and healthcare providers. The participants were selected from neurology and psychiatry clinics affiliated with University of Medical Sciences using the purposeful sampling method in 2021. Data were analyzed according to Graneheim and Lundman method. RESULTS: According to the findings of content analysis, four main themes were derived from the data: "health information-seeking behavior," "adaptation of life to the disease and treatment conditions," "adaptive coping," and "social self-care." CONCLUSION: Based on the findings, the promotion of adaptive styles and social support is effective in acquiring social competencies. As a result, policymakers are suggested to design health-oriented educational programs based on care self-efficacy principles to promote health in adolescents with mental disorders.

Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting.

BACKGROUND: The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings. METHODS: This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1. RESULTS: The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96. CONCLUSIONS: The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.

Live experience of nursing students with internship program: A phenomenological study.

BACKGROUND AND AIM: The internship is a program for transition of nursing students to the clinical setting. This study was conducted to describe and interpret the experiences of nursing students from the internship program. MATERIALS AND METHODS: This was an interpretative phenomenological study following Van Menen's approach in six steps. Twelve nursing students were selected from 12 different universities in Iran from April to August 2020. Data was collected through 15 in-depth interviews (three supplementary interviews) over the course of 25-90 min and verbatim transcriptions. Data were analyzed with MAXQDA version 10 software. The researcher used four Guba and Lincoln criteria to obtain a rigorous study. RESULTS: In this study, three main themes and eight subthemes were extracted. The main themes included "professional identity development," "moving toward professional self-efficacy," and "developing coping strategies for workplace adversities." The subthemes were "promoting the cognition of profession," "acceptance among colleagues as a nurse," "accepting professional roles," "self-awareness of weaknesses in patient care," "self-reliance," "advancing clinical skills," "adopting effective coping strategies," and "avoiding tension in clinical settings." CONCLUSION: Nursing internship students have experienced moving toward professionalization with professional identity and self-efficacy development, and they succeeded in clinical challenges by learning coping approaches.

The effects of mobile-based education on nurse self-concept among nursing students: an embedded mixed methods study.

OBJECTIVES: This study evaluates the effects of mobile-based education (MBE) on nurse self-concept (NSC) among nursing students. METHODS: This embedded mixed methods study was conducted in 2020-2021 in a main quantitative phase and a supplementary qualitative phase. In the quantitative phase, a quasi-experimental study with the Solomon four-group design was conducted on 117 second-year nursing students of Shiraz University of Medical Sciences, Shiraz, Iran. 70 students in the first (C1: n=37) and the second (C2: n=33) semesters of the 2020 academic year were respectively considered as the control groups, and 40 students in the first semester of the 2021 academic year considered as the experimental groups (I1: n=20 and I2: n=20). Participants in the experimental groups received NSC-related MBE through an Android application, while their counterparts in the control groups received no NSC-related MBE. Cowin's Nurse Self-Concept Questionnaire was used to assess the NSC. In the qualitative phase, six students from the experimental groups were purposively selected and interviewed through face-to-face semi-structured interviews. Moreover, two focus group discussions were held with a six-person and a five-person group of students from the experimental groups. RESULTS: While the mean scores of NSC and its dimensions did not significantly change in the C1 group, the posttest mean scores of them in the E1 group were significantly greater than the corresponding pretest values (p<0.05), expect for the care dimension (p=0.586). Moreover, except for the care dimension (p>0.05), the posttest means scores of NSC and its other dimensions in the E1 and the E2 groups were significantly greater than the C1 and the C2 groups, respectively (p<0.05). Analysis of the qualitative data resulted in the generation of the main theme of multidimensional growth and development with three main categories, namely development of coping strategies, knowing professionalization strategies, and development of managerial potentials. CONCLUSIONS: NSC-related MBE is effective in improving nursing students' NSC.

Development and assessment of validity and reliability of a checklist to evaluate the Circulating and Scrub Skills of Operating Room Novices (CSSORN checklist).

BACKGROUND: Assessment of circulating and scrub skills is an important issue in operating room (OR) programs. However, there is a lack of well-designed tools that are specifically developed for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a checklist to measure the circulating and scrub skills of OR novices. MATERIALS AND METHODS: This cross-sectional methodological study was conducted among 124 OR technology students who were selected during three consecutive academic years (2019-2020 to 2021-2022). The developed checklist was evaluated with face validity, content validity (quantitative and qualitative), construct validity (known-groups validity), criterion-related validity (concurrent and predictive validities), internal consistency (Kuder-Richardson 20, KR-20), and inter-rater reliability (intra-class correlation coefficient, ICC). Known-groups validity was evaluated by comparing the difference between the checklist scores of first-semester and third-semester students using independent samples t-test. Additionally, concurrent and predictive validities were evaluated by ICC through measuring the correlation between the total score of checklist and grades of a multiple-choice test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical Package for Social Sciences software. RESULTS: After reconciling the preliminary checklist in terms of face and content validities, a checklist with 17 sub-scales and 340 items called "Circulating and Scrub Skills of Operating Room Novices (CSSORN)" was developed. Regarding the known-groups validity, the third-semester students had higher scores compared to the first-semester students (p < 0.001 in most sub-scales). Besides, the total score of checklist showed a significant correlation with the criteria of concurrent and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR-20 for the entire checklist was 0.90 (range: 0.60-0.93). The ICC for inter-rater reliability was also 0.96 for the entire checklist (range: 0.76-0.99, P < 0.001 in all sub-scales). CONCLUSION: The CSSORN had appropriate validity and reliability to be used for measuring the circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist on larger populations and in different contexts is suggested.

Using objective structured clinical examination (OSCE) for circulating and scrub skills of first-semester operating room technology students: Is it valid and reliable?

Objectives: This study aimed to determine the validity and reliability of an Objective Structured Clinical Examination (OSCE) developed for the summative assessment of the practical credit of the course titled "Principles and Techniques of Circulating and Scrub Persons' Practice." Methods: This applied descriptive study was conducted on 63 first-semester undergraduate Operating Room (OR) technology students. Totally, 17 circulating and scrub skills were incorporated in four 7-min OSCE stations. The content validity of the examination was assessed by an expert panel (n = 14). Additionally, its concurrent validity was evaluated by Intra-Class Correlation (ICC) through measuring the correlation between the total score of OSCE and grade point average, grades of the practical and theoretical credits of the course that were obtained by multiple-choice tests, and the total grade of the course (achieved by the grades of the practical and theoretical credits tests). The Inter-Rater Reliability (IRR) was also calculated by the correlation between the scores recorded by two examiners at each OSCE station using ICC. Meanwhile, the internal consistency across stations (item-total correlation) and across items within a station was determined by Cronbach's alpha (α). Results: The OSCE was deemed to fulfill the content validity criteria. The total score of OSCE showed a significant correlation with the concurrent validity criteria (ICC = 0.66-0.85, p < 0.001). Besides, the IRR was significant for the total score of OSCE as well as for the score of each station (ICC = 0.90-0.98, p < 0.001). Likewise, a good level of internal consistency was found across stations (α = 0.63-0.93) and across items within a station (α = 0.78-0.92). Conclusion: The developed OSCE had appropriate validity and reliability. Thus, it can be used to assess the circulating and scrub skills of first-semester OR technology students.

The effects of mobile-based education on nurse self-concept among nursing students: an embedded mixed methods study / Los efectos de la educación basada en el móvil en el autoconcepto de las enfermeras entre los estudiantes de enfermería: un estudio de métodos mixtos integrados / Os efeitos da educação baseada em dispositivos móveis no autoconceito dos enfermeiros entre os estudantes de enfermagem: um estudo integrado de métodos mistos

Objective. This study evaluates the effects of mobile-based education (MBE) on nurse self-concept (NSC) among nursing students. Methods. This embedded mixed methods study was conducted in 2020­2021 in a main quantitative phase and a supplementary qualitative phase. In the quantitative phase, a quasi-experimental study with the Solomon four-group design was conducted on 117 second-year nursing students of Shiraz University of Medical Sciences, Shiraz, Iran. 70 students in the first (C1: n=37) and the second (C2: n=33) semesters of the 2020 academic year were respectively considered as the control groups, and 40 students in the first semester of the 2021 academic year considered as the experimental groups (I1: n=20 and I2: n=20). Participants in the experimental groups received NSC-related MBE through an Android application, while their counterparts in the control groups received no NSC-related MBE. Cowin's Nurse Self-Concept Questionnaire was used to assess the NSC. In the qualitative phase, six students from the experimental groups were purposively selected and interviewed through face-to-face semi-structured interviews. Moreover, two focus group discussions were held with a six-person and a five-person group of students from the experimental groups. Results. While the mean scores of NSC and its dimensions did not significantly change in the C1 group, the posttest mean scores of them in the E1 group were significantly greater than the corresponding pretest values (p<0.05), expect for the care dimension (p=0.586). Moreover, except for the care dimension (p>0.05), the posttest means scores of NSC and its other dimensions in the E1 and the E2 groups were significantly greater than the C1 and the C2 groups, respectively (p<0.05). Analysis of the qualitative data resulted in the generation of the main theme of multidimensional growth and development with three main categories, namely development of coping strategies, knowing professionalization strategies, and development of managerial potentials. Conclusion. NSC-related MBE is effective in improving nursing students' NSC.

Objetivo. Este estudio evalúa los efectos de la educación basada en el móvil (EBM) en el autoconcepto enfermero (ACE) entre los estudiantes de enfermería. Métodos. Estudio de métodos mixtos realizado entre los años 2020-2021 tuvo una fase cuantitativa principal y una fase cualitativa complementaria. En la fase cuantitativa se llevó a cabo un estudio cuasi-experimental con el diseño de cuatro grupos de Salomón en los que se asignaron 117 estudiantes de segundo año de enfermería de la Universidad de Ciencias Médicas de Shiraz, Irán. Participaron en los grupos de control 70 estudiantes: 37 del primer (C1) y 33 del segundo (C2) semestres del año académico 2020 y 40 estudiantes del primer semestre de 2021 como los grupos de intervención (I1: n=20, e I2: n=20). Los participantes de los grupos de intervención recibieron EMB relacionados con el CNS a través de una aplicación Android, mientras que sus homólogos de los grupos de control no recibieron este tipo de educación. Se utilizó el Cuestionario de Autoconcepto de Enfermería (ACE) de Cowin. En la fase cualitativa, se seleccionaron intencionadamente seis estudiantes de los grupos experimentales a quienes se les realizaron entrevistas semiestructuradas cara a cara. Además, se hicieron dos grupos de discusión con un grupo de seis y otro de cinco estudiantes de los grupos experimentales. Resultados. Mientras que las puntuaciones medias del ACE y sus dimensiones no cambiaron significativamente en el grupo C1, las puntuaciones medias pos-test de las mismas en el grupo I1 fueron significativamente mayores que los correspondientes valores pre-test (p<0.05), excepto para la dimensión de cuidado (p=0.586). Además, con excepción de la dimensión de atención (p>0.05), las puntuaciones medias pos-test de ACE y sus otras dimensiones en los grupos I1 y I2 fueron significativamente mayores que las de los grupos C1 y C2, respectivamente (p<0.05). El análisis de los datos cualitativos dio como resultado la generación del tema principal de crecimiento y desarrollo multidimensional con tres categorías principales: el desarrollo de estrategias de afrontamiento, el conocimiento de estrategias de profesionalización y el desarrollo de potenciales de gestión. Conclusión. La intervención EBM es eficaz para mejorar el ACE de los estudiantes de enfermería.

Objetivo. Avaliar os efeitos da educação baseada em dispositivos móveis (EBM) no autoconceito de enfermagem (ACE) entre estudantes de enfermagem da Shiraz University of Medical Sciences, Irã. Métodos. Estudo de métodos mistos que teve uma fase principal quantitativa e uma fase qualitativa complementar. Na fase quantitativa, foi realizado um estudo quase-experimental com o desenho de quatro grupos Solomon. 70 alunos participaram dos grupos de controle: 37 do primeiro (C1) e 33 do segundo (C2) semestre do ano letivo de 2020 e 40 alunos do primeiro semestre de 2021 como grupos de intervenção (I1: n=20, e I2: n=20). Apenas os participantes dos grupos de intervenção receberam EMBs relacionados à ACE por meio de um aplicativo Android. A escala de Cowin foi utilizada para avaliar o ACE. Na fase qualitativa, foram selecionados intencionalmente seis alunos dos grupos experimentais aos quais foram realizadas entrevistas semiestruturadas face a face. Além disso, foram feitos dois grupos de discussão (um de seis e outro de cinco) com alunos dos grupos experimentais. Resultados. Enquanto as pontuações médias do ACE e suas dimensões não mudaram significativamente no grupo C1, as pontuações médias pós-teste no grupo I1 foram significativamente maiores do que os valores pré-teste correspondentes (p<0.05), exceto para a dimensão do cuidado (p=0.586). Além disso, com exceção da dimensão atenção (p>0.05), as pontuações médias pós-teste do ACE e de suas outras dimensões nos grupos I1 e I2 foram significativamente maiores do que nos grupos C1 e C2, respectivamente (p<0.05). A análise dos dados qualitativos resultou na geração do tema principal crescimento e desenvolvimento multidimensional com três categorias principais: o desenvolvimento de estratégias de enfrentamento, o conhecimento de estratégias de profissionalização e o desenvolvimento de potenciais de gestão. Conclusão. A intervenção EBM foi eficaz em melhorar o ACE de estudantes de enfermagem.

The Prevalence of Misophonia and Its Relationship with Obsessive-compulsive Disorder, Anxiety, and Depression in Undergraduate Students of Shiraz University of Medical Sciences: A Cross-Sectional Study.

Background: Misophonia is a severe emotional response to repetitive sounds. This disorder may limit a person's communication, reduce his/her ability, or disrupt his/her social and personal life. This study aimed to determine the prevalence of Misophonia and its relationship with obsessive-compulsive disorder, anxiety, and depression in undergraduate students of Shiraz University of Medical Sciences. Methods: The present study is an analytical descriptive study conducted in October 2020. The study samples consisted of 390 undergraduate students of Shiraz University of Medical Sciences. A relative and systematic sampling method was used. In this study, demographic questionnaire, misophonia questionnaire (A score of 7 or higher is considered as misophonia), Beck anxiety questionnaire, Beck depression questionnaire, and Maudsley obsessive-compulsive inventory questionnaire were used, and the data were analyzed using SPSS 24 software. In this study, chi-square test was used to examine the relationship between the variables. Due to the non-normality of the data, the Spearman correlation coefficient was used for data analysis. The significance level was considered equal to and less than 0.05. Results: Of the 390 participants in the study, 93 (23.8%) had experienced misophonia. Among these 93 students, 37 (39.8%) had obsessive-compulsive disorder, 8 (8.6%) suffered anxiety, and 9 (9.7%) were depressed. There was a significant and direct relationship between misophonia and obsessive-compulsive disorder,anxiety and depression respectively(P<0.001). Conclusion: Due to the prevalence of misophonia among students and its direct relationship with obsessive-compulsive disorder, anxiety and depression, we recommend that future studies should be conducted to find the ways to prevent and reduce the incidence of misophonia.

Psychometric analysis of Persian version of patient safety competency self-evaluation in psychiatric wards.

BACKGROUND: Assessment of the patient safety competency is necessary for the growth of nursing and safe care profession as well as evaluation of the nurses' educational needs. The present study was conducted to determine psychometric properties of the Persian version of the patient safety competency self-evaluation (PSCSE) tool in Iranian psychiatric wards. MATERIALS AND METHODS: All nurses (n = 209) working in two psychiatric hospitals of Kerman, Iran, were included in the present cross-sectional study using census method. This tool contains 41 items: six items are related to knowledge, 14 items deal with attitude, and 21 items are about skill dimension. Psychometric properties of the questionnaire including its content and face validity were also examined. The factor structure of the questionnaire was evaluated using exploratory factor analysis. The internal consistency and reliability were assessed by test-retest method with an interval of 14 days. Cronbach's alpha and corrected item-total correlation were used to measure reliability. RESULTS: The content validity index was 0.65 and the content validity ratio was 0.89. Item 14 was removed from the skill domain because it was not related to the psychiatric ward. According to the results of factor analysis, there was a significant relationship between the questions and the relevant factors. The correlation coefficient for test-retest with 14 days interval was intraclass correlation coefficient = 0.92 for the whole instrument and 0.89, 0.89, and 0.92 for the domains of knowledge, attitude, and skill, respectively. The internal consistency coefficient (Cronbach's alpha) of the whole tool was 0.95 and 0.95, 0.79, and 0.95 for the domains of knowledge, attitude, and skill, respectively. Finally, PSCSE Questionnaire was obtained with 40 items in dimensions of knowledge (6 items), attitude (14 items), and skills (20 items). CONCLUSION: Persian version of the nurses' competency tool in ensuring patient safety in psychiatric wards has acceptable psychometric characteristics.

Nurses' patient safety competency, a predictor for safe care in psychiatric wards?

PURPOSE: This study examined the relationship between patient safety competence and safe care from the viewpoints of nurses working in psychiatry wards. DESIGN AND METHODS: The present descriptive correctional study was conducted in two psychiatry hospitals in Iran in 2020. All the nurses were selected as the study participants using the census sampling method (N = 209). FINDINGS: Nurses' patient safety competency was at a low level (2.54 ± 0.52), but nurses' safe care was at a moderate level (242.08 ± 61.32). A strong positive relationship was found between the patients' safety competency and nurses' safe care (p = 0.001, r = 0.84). PRACTICE IMPLICATIONS: Nursing managers should support nurses by providing the required resources and operational strategies to improve their competency and safe care in providing quality care.

Assessing the Expectations and Perceptions of Nursing Students regarding the Educational Services in a School of Nursing and Midwifery Based on the SERVQUAL and Kano Models: A Case Study.

This study determined the gap between student expectations and perceptions to achieve a relatively accurate description of student satisfaction. Student expectations and perceptions regarding educational services across a number of different dimensions were evaluated using SERVQUAL model, and the nature of each educational factor was determined using the Kano model. Three characteristics of 30 educational services indicators were placed in the cluster of students' basic needs, 26 characteristics were placed in the performance and one-dimensional needs cluster, and one characteristic was placed in the neutral needs cluster. No characteristics were put in the cluster concerning the motivational needs of students.

Empowering health volunteer's through participatory action research in a comprehensive healthcare center.

BACKGROUND: Health volunteers act as the link between the society and the healthcare system and are a symbol of people's participation in the health maintenance and promotion. Despite the important role of health volunteers in the health system, it seems that they experience several problems. The aim of this study was empowering health volunteers through an action research. METHODS: This participatory action research was conducted through two continuous cycles of reflection and acting for change over 20 months, in a comprehensive health center in Southern of Fars province in Iran. Participants included 25 health volunteers; two instructors and an academic researcher as facilitator. In the first cycle the participants discovered the challenges of health volunteers, prioritized them, designed an action plan, and implemented it. At the end of this cycle, evaluation was done with the participants' cooperation. The second cycle began with reflecting on the results of the first cycle and then after designing and implementing second action plan, final evaluation was done. RESULTS: Qualitative content analysis in the first phase led to the emergence of four categories, including role confusion, inadequate volunteer training, deficits in attracting and keeping volunteers, and being unfamiliar to the public. After the implementation of the action plan the participants learned through reflection and immersing in action. Finally, quantitative and qualitative data showed improvement of knowledge and performance, satisfaction, effectiveness of programs and improvement in volunteer's competence. CONCLUSIONS: Clarification of volunteers' roles, supporting volunteers to improve their knowledge and skills with coherent planning based on their educational needs, are appropriate management plans to attract and retain volunteers. By presenting their services to the society, they will be empowered and motivated to continue.

Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial.

BACKGROUND: Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. OBJECTIVE: This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. METHODS: An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. RESULTS: A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI -17.44 to -8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI -9.20 to -4.21, P<.001, d=0.88 and trait anxiety: 95% CI -8.50 to -4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001). CONCLUSIONS: This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882.

Spiritual needs of mothers having children with cancer: A qualitative study.

BACKGROUND: Diagnosing cancer, as a life-threatening event, in children and adolescents stops the normal course of life for all family members. Spirituality, which plays an essential role in coping with illness and death, can increase resistance against psychological crises induced by cancer diagnosis and treatment. This study aims to discover the spiritual needs of mothers having children with cancer aged 1-12 years old. MATERIALS AND METHODS: In this qualitative study, the conventional content analysis approach was used. The research environment was three pediatric oncology wards of Amir Hospital in Shiraz, Iran. Data were collected from September 2019 to March 2020 through face-to-face semi-structured in-depth interviews. Fifteen participants including 12 mothers and 3 nurses were interviewed through purposive method considering maximal variation. The interviews were recorded, transcribed, and subjected to a qualitative analysis. Credibility, dependability, confirmability, and transferability of data were confirmed. RESULTS: The mean (± standard deviation) age of the mothers was 35.76 (±5.96) years old. The spiritual needs of the mothers were classified into three categories, including religious well-being, existential well-being, and growth and excellence as well as seven subcategories. Religious well-being included subcategories of direct and indirect connection with God, existential well-being included subcategories of need for hope, multifaceted support, and rethinking, growth, and excellence consisted of subcategories of devoting yourself and surrender. CONCLUSION: Mothers of children with cancer face important spiritual needs. Therefore, it is necessary for the treatment team to identify these needs and use them to provide appropriate spiritual care.

[Factors affecting nursing students' professional self-concept in Iran: a qualitative study]. / Fattori che influenzano il concetto di sé professionale degli studenti infermieri in Iran: uno studio qualitativo.

INTRODUCTION: Professional self-concept is a contextualized multidimensional concept that describes the subjective experiences and feelings of nurses with regard to nursing roles. Professional self-concept starts to develop during the academic years. Yet, there is still limited understanding about the factors affecting nursing students' professional self-concept, which is a potential problem. Poor professional self-concept negatively affects nurses' clinical practice, job satisfaction, and retention in the profession. AIM: This study aimed to explore factors affecting Iranian nursing students' professional self- concept from the perspectives of nursing students, nursing instructors, and hospital nurses. METHODS: This exploratory qualitative study was carried out from June 2018 to April 2019. Participants were four hospital nurses, three clinical nursing instructors, and four nursing stu- dents who were purposively selected from the Shiraz University of Medical Sciences, Shiraz, Iran. Data were gathered via in-depth semi-structured interviews and were analyzed via con- ventional content analysis proposed by Graneheim and Lundman. FINDINGS: In total, 610 primary codes were generated and grouped into eleven subthemes and five main themes. The main themes of the study were professional instructors, competent nur- ses, informed choice of nursing profession, difficulties of nursing profession, and congruence between students' personal-professional values and nursing profession. CONCLUSION: Professional self-concept is affected by different personal, educational, envi- ronmental, and social factors. Nursing instructors, hospital managers, and nurse managers can use the findings of this study to support nursing students, promote their professional self-con- cept, and ensure their retention in the profession.

Effect of Cardiac Rehabilitation on Hope Among Cardiac Patients After Coronary Artery Bypass Graft Surgery.

PURPOSE: Following coronary artery bypass graft (CABG) surgery, some patients experience psycho-mental problems such as hopelessness. The Phase 2 cardiac rehabilitation (CR) program is an important element of the secondary prevention program in treating patients with cardiovascular disease (CVD). The present study aimed to determine the effect of the Phase 2 CR program on the level of hope in cardiac patients after CABG surgery. PATIENTS AND METHODS: A clinical trial was conducted from July 2017 to late January 2018 at the Heart Surgery Centre, Al-Zahra Hospital, Shiraz, Iran. The target population was patients who sought CR therapy after CABG surgery. A total of 104 cardiac patients were recruited and equally divided into control and intervention groups. The intervention group received 20 sessions of Phase 2 CR program combined with education and counselling during 8 weeks. The control group only received routine observations and education. The data were collected pre- and post-intervention using a demographic form and the Miller Hope Scale (MHS). Descriptive statistics were expressed as percentages, frequency distribution, mean and standard deviation. Paired t-test and independent t-test were used for statistical inference. Data were analyzed using the SPSS statistical software (version 23.0) and P values <0.05 were considered statistically significant. RESULTS: There was no significant difference in the mean score of hope between the control and intervention groups before the intervention. However, a significant difference between the groups was observed post-intervention (P<0.001). The results showed a significant difference in the mean score of hope between pre-intervention (182.36±23.07) and post-intervention (216.94±23.05) in the intervention group (P<0.001), whereas the difference in the control group was not significant (P=0.095). The measured post-intervention effect size was high (1.05). CONCLUSION: The Phase 2 CR program combined with education and counseling increased hope in CVD patients after CABG surgery.

The Experiences of Multiple Sclerosis Patients' Family Caregivers at the First Hospitalization of Their Patients: A Qualitative Study.

BACKGROUND AND AIM: Being diagnosed with multiple sclerosis is usually accompanied by emotional trauma for patients and their families. The chronic, progressive, and unpredictable nature of the disease spells the patients' long-term need for care from their families. As soon as a diagnosis is made, family caregivers are faced with many challenges. The present study aims to identify family caregivers' experiences at the first hospitalization of their patients. MATERIALS AND METHODS: The present study is a work of qualitative research and uses the conventional content analysis approach. It lasted from July 2019 to March 2020. The subjects were selected via purposeful sampling. To collect data, the researchers conducted in-depth, semi-structured interviews with 18 family caregivers of patients with multiple sclerosis. The collected data were analyzed using MAXQDA 2007. RESULTS: Analysis of the data yielded three themes: peaceful environment, need for continuing full support, and religion-based coping strategies. CONCLUSION: The findings of the present study can be used to develop support programs that address family caregivers' problems and needs to assist them in accepting and coping with the conditions of their patients, thereby increasing the quality of care provided to patients with multiple sclerosis.

The Relationship between Anxiety and Self-Esteem in Women Suffering from Breast Cancer.

BACKGROUND: Breast cancer is the most common cancer in women worldwide that has great impact on their lives. Women with breast cancer are at increased risk for anxiety and low self-esteem. OBJECTIVE: The purpose of this study was to explore the relationship between anxiety and self-esteem in women suffering from breast cancer. MATERIALS AND METHODS: In this descriptive correlational study, all 261 women diagnosed with nonmetastatic breast cancer referred to cancer care clinics in winter 2016 were assessed. Data were gathered using demographic information inventory, Spielberger's State-Trait Anxiety Inventory and Rosenberg's Self-Esteem Scale, and were analyzed using SPSS statistical software (version 22). Descriptive statistics, the t-test, ANOVA, the Pearson correlation and the Spearman's correlation were also used. RESULTS: The mean ± standard deviation (SD) age of participants in the study was 48.33 ± 10.837 years. The mean score of state and trait anxiety was 46.29 ± 11.745 and 46.61 ± 10.936, respectively. The mean ± SD score of self-esteem was 18.38 ± 5.08. The study results show an indirect correlation between anxiety and self-esteem in women suffering from breast cancer (r = -0.690). CONCLUSIONS: According to the considerable influences of anxiety and self-esteem on other aspects of physical, psychological, and social health, it is suggested that health-care professionals pay more attention to the self-esteem and psychological state of women diagnosed with breast cancer besides other medical treatments. Screening strategies for detecting psychiatric disorders in breast cancer patients and planning of effective interventions to promote self-esteem and reduce anxiety and its consequences are recommended.

Relationship between occupational burnout and demographic variables among nurses in Jahrom, Iran.

INTRODUCTION: Occupational burnout is a psychological syndrome caused by the accumulation of work-related stress and characterized by intolerance, high levels of emotional exhaustion, depersonalization, and the perception of low personal accomplishment. The present study aimed to evaluate the relationship between occupational burnout and all demographic variables among the nurses in Jahrom, Iran. METHODS: The present descriptive-analytical study was carried out during 2016 among nurses employed at Motahari Hospital and Peymanieh Hospital, both affiliated to Jahrom University of Medical Sciences (Iran). Based on the inclusion criteria, a total of 250 participants were selected. The data collection instruments included a demographic questionnaire and the Maslach burnout inventory. The data were analyzed using the SPSS statistical software (version 16.0) by descriptive statistics and Spearman's test. RESULTS: Among the participants, 223(89.2%) nurses suffered from a moderate to high level of occupational burnout. There was a significant correlation between personal accomplishment and age (r=0.21, P=0.002) and education level (r=-0.16, P=0.01). Additionally, income level had a significant correlation with emotional exhaustion (r=-0.38, P=0.001), depersonalization (r=-0.3, P=0.001), and personal accomplishment (r=0.35, P=0.001). A significant relationship was also found between sex and depersonalization (r=-0.15, P=0.02). However, there was no significant relationship between occupational burnout subscales and the number of children, type of hospital ward, type of employment, and marital status (P>0.05). CONCLUSION: A significant positive correlation was found between the subscales of occupational burnout and younger age, low income, high education, and male nurses.