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.

Compassionate care of nurses for the elderly admitted to the COVID-19 wards in teaching hospitals of southern Iran.

BACKGROUND: Compassionate care is the main indicator of the quality regarding nursing care. The importance of this care in the recovery process for the elderly hospitalized for COVID-19 has been under-researched in studies. Therefore, this study aimed to determine the compassionate care level of nurses to the elderly hospitalized in the COVID-19 wards of teaching hospitals in the south of Iran. METHODS: This descriptive-analytical study was conducted on 212 nurses working in the COVID-19 wards of teaching hospitals in the south of Iran, who were selected through census in a cross-sectional study. The data were collected using the Tehranineshat et al. nurses' compassionate care questionnaire and then the data were analyzed using descriptive and analytical statistics along with SPSS software version 22. RESULTS: The mean score of nurses' compassionate care was 130.18 ± 9.42, which was at a high level. The highest and lowest scores were related to professional performance (43.17 ± 2.799) and empathic communication dimension (27.76 ± 2.970). No significant relationship was found between variables such as gender, marital status, education, work experience, and job position with the compassionate care score (P > 0.05). CONCLUSION: Nurses providing care for hospitalized elderly are recommended to consider all aspects of compassionate care, especially empathic communication, in their educational planning.

The effects of using the nurse self-concept mobile application on the retention of nursing students.

BACKGROUND: The high dropout rate among nursing students has become a global concern as it leads to a shortage of nurses on the one hand and a negative impact on the professional motivation of nursing students on the other. The present study was conducted to investigate the effects of using the Nurse Self-Concept Mobile Application (NSCMA) on the retention of nursing students. MATERIALS AND METHODS: The present study is an experimental work of research with a longitudinal design conducted from April to December 2021. The study population was second-year nursing students in a nursing school in the south of Iran who were randomly divided into an experimental (n = 49) and a control group (n = 50). The assessment was based on a pretest-posttest design and a one-month follow-up. The collected data were analyzed in SPSS v. 21 using descriptive statistics (frequency, percentage, mean, and standard deviation) and analytical statistics (repeated measures). The P value was set <0.05. RESULTS: The means of the students' ages and grades were 21.31 ± 2.43 and 15.30 ± 2.13, respectively. The results showed a statistically significant increase in the experimental group's intent-to-stay mean scores as measured in three stages (P = 0.029), indicating that the intervention enhanced the nursing students' inclination to stay in nursing programs. However, the changes in the control group's mean scores were not statistically significant (P = 0.132). CONCLUSION: The Nurse Self-Concept Mobile Application proved effective in enhancing nursing students' inclination to complete their education and follow a career as a nurse. Thus, it is essential that nursing students' education include programs designed to enhance the students' self-concept, especially in the first few years of their education. Also, nursing schools should use this software to encourage students to stay in the nursing major.

Young transgender individuals' lived experiences of facing life's challenges: a qualitative study in Iran.

Introduction: In recent years, several studies have addressed the challenges and psychological issues that transgender individuals face. However, only a few studies have explored the experiences of this population in Iran. Life experiences are heavily influenced by the dominant religious and cultural conditions and common beliefs in a society. The present study aimed to investigate transgender individuals' lived experiences of facing life's challenges in Iran. Methods: This is a qualitative study with a descriptive and phenomenological design conducted from February to April 2022. Data were collected using semi-structured, in-depth interviews with 23 transgender individuals (13 AFAB and 10 AMAB). The collected data were analyzed using Colaizzi's method. Results: Analysis of the qualitative data resulted in the emergence of three themes and 11 subthemes. The three main themes included mental health disparities (fear of having one's secret revealed, depression and despair, suicidal thoughts, and secrecy in the family), gender dysphoria (contradictory gender identity and contradictory behaviors), and stigma and insecurity (sexual abuse, social discrimination, disrupted occupational performance, a lack of support, disrepute, and disgrace). Conclusions: The findings of the study indicated that transgender people in Iran are exposed to considerable mental health disparities. In addition to disrepute, infamy, and stigma, transgender people face sexual abuse, social discrimination, and a lack of family social support. The results of the present study can help mental health experts and the healthcare system as a whole to adjust their mental and physical health programs according to the needs and experiences of transgender people and their families. It is recommended that future research address the problems and psychological challenges that transgender people's families have to confront.

A study of the effects of blended learning on university students' critical thinking: A systematic review.

One of the basic, constructive needs of humans, which plays a major part in their development is critical thinking. As education is one of the factors in shaping individuals' critical thinking, the present study addresses the effects of blended learning and its subcategories on university students' critical thinking (and its subcategories). The present article is a review study. Data were collected using valid search engines and databases. The keywords which were used included blended learning, integrated learning, blended training, integrated training, critical thinking, critical thinking disposition, and critical thinking skills, as well as the subcategories of blended learning, that is, the flex model, the self-blended model, the enriched virtual model, and the rotation model and its subcategories (the station rotation model, the lab rotation model, the flipped classroom model, and the individual rotation model). The results of 14 sources, out of the selected 15 sources, showed that blended learning and its subcategories, that is, the flex model, the self-blended model, the enriched virtual model, and the rotation model and its subcategories contribute to university students' critical thinking of disposition and skill. One of the essential skills which must be given more serious attention in learning in the twenty-first century is critical thinking. Having the benefits of both lecturing and e-learning, blended learning is a more effective and practical method for promoting critical thinking in university students.

Psychometric testing of the Persian version of the Nursing Care Quality Scale: A methodological study.

AIM: To evaluate the psychometric properties of the Persian version of the Cambodian Nursing Care Quality Scale. DESIGN: Methodological design. METHODS: This study was carried out in several steps: a forward-backward translation was done, face and construct validity was measured using exploratory and confirmatory factor analysis and the reliability was evaluated. A convenience sampling method was employed to recruit 350 nurses from May 2021 to March 2022. RESULTS: The exploratory factor analysis extracted six factors that explained 60.76% of the total variance. The six-factor model is supported by confirmatory factor analysis. The Cronbach's alpha and the intra-class correlation coefficient were 0.94 and 0.85, respectively. PATIENT OR PUBLIC CONTRIBUTION: Evaluation of the quality of care can lead to the enhancement of the quality of nursing services and patient safety. This will subsequently increase the patients' and community satisfaction.

A Study of How Moral Courage and Moral Sensitivity Correlate with Safe Care in Special Care Nursing.

Background: Nursing is a caring profession, and nurses who have moral sensitivity and moral courage presumably can provide safe and better care for patients. This study aims at investigating how moral courage and moral sensitivity correlate with safe care in special care nursing. Methods: This study is a descriptive work of research. The participants consisted of 524 nurses who were in practice in the ICU (intensive care unit), CCU (C\coronary care unit), post-CCU (postcoronary care unit), and dialysis of four hospitals located in the south of Iran selected via census sampling. Data were collected from April to September 2020 using the moral sensitivity questionnaire (MSQ), professional moral courage questionnaire (PMCQ), and the assessment of safe nursing care questionnaire (ASNCQ). The collected data were analyzed using descriptive statistics, t-test, chi-square, multiple regression analysis, and Pearson's correlation coefficient in SPSS v. 22. Results: The mean ± SD of the nurses' age was 33.89 ± 6.91 years, and the mean ± SD of their work experience was 9.16 ± 4.67 years. The total mean score ± SD of the nurses' moral sensitivity was found to be 93.41 ± 2.68, the total mean score ± SD of their moral courage was found to be 96.38 ± 3.63, and the total mean score ± SD of their safe care scores was found to be 321.80 ± 9.76. The values of Pearson's correlation coefficients showed significant correlations between moral courage and safe care (r = 0.54, p < 0.001), moral sensitivity and safe care (r = 0.59, p < 0.001), and moral sensitivity and moral courage (r = 0.52, p < 0.001). Conclusion: There is a positive correlation between moral sensitivity and moral courage. Both positively correlated with special care nursing. Accordingly, through effective planning, education, and giving their support, nurse administrators can promote the abovementioned ethical virtues in the nursing staff, thereby improving the quality of care.

Stress management in nurses caring for COVID-19 patients: a qualitative content analysis.

BACKGROUND: Being in the frontline of the battle against COVID-19, nurses need to be capable of stress management to maintain their physical and psychological well-being in the face of a variety of stressors. The present study aims to explore the challenges, strategies, and outcomes of stress management in nurses who face and provide care to COVID-19 patients. METHODS: The present study is a qualitative descriptive work that was conducted in teaching hospitals affiliated with Shiraz University of Medical Sciences, Iran, from June 2020 to March 2021. Sixteen nurses who were in practice in units assigned to COVID-19 patients were selected via purposeful sampling. Data were collected through semi-structured, individual interviews conducted online. The collected data were analyzed using MAXQDA 10 according to the conventional content analysis method suggested by Graneheim and Lundman. RESULTS: The data collected in the interviews resulted in 14 subcategories under 4 main categories: providing care with uncertainty and anxiety, facing psychological and mental tension, creating a context for support, and experiencing personal-professional growth. CONCLUSIONS: The nurses caring for COVID-19 patients needed the support of their authorities and families to stress management. Providing a supportive environment through crisis management training, providing adequate equipment and manpower, motivating nurses to achieve psychological growth during the pandemic can help them manage stress.

A National Survey of the Prevalence of Chronic Pain in Nursing Students and the Associated Factors.

OBJECTIVES: To examine the prevalence of chronic pain and the associated factors among nursing students. METHODS: This study is a descriptive, cross-sectional. The subjects were 1684 nursing students who were selected from the universities of medical sciences in Iran via cluster sampling in 2019. Data were collected using a three-part questionnaire: a demographic characteristics survey, characteristics of chronic pain, and a pain scale. RESULTS: The majority of the students were female (62.1%) and single (87%).The mean age of the participants was 22.4±2.96 years. The results of data analysis showed that 30.2% of the students suffered from chronic pain. The areas which were most affected by pain were: head (31.24%), abdomen (11.98%), and the back (9.23%). 56.4% of the nursing students declared the origin of their pain to be unknown, 22.7% attributed their pain to migraine, and 6.48% reported spinal disorders to be the cause of their pain. There was a significant relationship between the students' chronic pain and the variables of age (higher in the 29-and-above age group), marital status (higher in married subjects), and education (higher in postgraduates). CONCLUSIONS: A relatively large number of nursing students suffer from chronic pains. Nursing schools should contribute to improving students' knowledge of chronic pain prevention and management.

A National Survey of the Prevalence of Chronic Pain in Nursing Students and the Associated Factors / Encuesta nacional sobre la prevalencia del dolor crónico en estudiantes de enfermería y sus factores asociados / Enquete nacional sobre a prevalência da dor crónica em estudantes de enfermagem e seus fatores associados

Objective. To examine the prevalence of chronic pain and the associated factors among nursing students. Methods. This study is a descriptive, cross-sectional. The subjects were 1684 nursing students who were selected from the universities of medical sciences in Iran via cluster sampling in 2019. Data were collected using a three-part questionnaire: a demographic characteristics survey, characteristics of chronic pain, and a pain scale. Results. The majority of the students were female (62.1%) and single (87%).The mean age of the participants was 22.4±2.96 years. The results of data analysis showed that 30.2% of the students suffered from chronic pain. The areas which were most affected by pain were: head (31.24%), abdomen (11.98%), and the back (9.23%). 56.4% of the nursing students declared the origin of their pain to be unknown, 22.7% attributed their pain to migraine, and 6.48% reported spinal disorders to be the cause of their pain. There was a significant relationship between the students' chronic pain and the variables of age (higher in the 29-and-above age group), marital status (higher in married subjects), and education (higher in postgraduates). Conclusion. A relatively large number of nursing students suffer from chronic pains. Nursing schools should contribute to improving students' knowledge of chronic pain prevention and management.

Objetivo. Estimar la prevalencia del dolor crónico y sus factores asociados entre los estudiantes de enfermería. Métodos. Estudio descriptivo de corte transversal. Participaron 1684 estudiantes de enfermería (1496 de pregrado y 188 de Maestría) de las universidades de ciencias médicas en Irán seleccionados mediante un muestreo por conglomerados. Los datos se recogieron a partir de un cuestionario dividido en tres partes: una encuesta de características demográficas, características del dolor crónico y una escala de dolor. Resultados. La mayoría de los estudiantes fueron de sexo femenino (62.1%) y solteros (87%). La edad media fue de 22.4±2.9 años. Los resultados del análisis de los datos mostraron que el 30.2% de los estudiantes sufría dolor crónico. Las zonas más afectadas por el dolor fueron: la cabeza (31.24%), el abdomen (11.98%) y la espalda (9.23%). El origen del dolor fue más frecuentemente atribuido a la migraña (22.7%) y a los trastornos de la columna vertebral (6.5%). Un 56.4% declaró desconocer el origen de su dolor. Hubo una relación significativa entre el dolor crónico de los estudiantes y las variables: edad (mayor en el grupo de 29 años o más), estado civil (mayor en los casados), educación (mayor en los estudiantes de maestría). Conclusión. Un número relativamente elevado de estudiantes de enfermería sufre de dolores crónicos. Las escuelas de enfermería deben contribuir en mejorar el conocimiento de ellos acerca de la prevención y manejo del dolor crónico.

Objetivo. Estimar a prevalência da dor crónica e seus fatores associados entre os estudantes de enfermagem. Métodos. Estudo descritivo de corte transversal. Os participantes foram 1684 estudantes de enfermagem (1496 de graduação e 188 de Mestrado) das universidades de ciências médicas no Irã que foram selecionados através de uma amostragem por conglomerados. Os dados se recolheram mediante um questionário dividido em três partes: uma enquete de características demográficas, características da dor crónica e uma escala de dor. Resultados. A maioria dos estudantes foram do sexo feminino (62.1%) e solteiros (87%). A idade média dos participantes foi de 22.4±2.9 anos. Os resultados da análise dos dados mostraram que 30.2% dos estudantes sofriam dor crónica. As zonas mais afetadas pela dor foram: a cabeça (31.24%), o abdômen (11.98%) e as costas (9.23%). A origem da dor foi mais frequentemente atribuída à enxaqueca (22.7%) e aos transtornos da coluna vertebral (6.5%). Um 56.4% dos estudantes de enfermagem declararam desconhecer a origem da sua dor. Houve uma relação significativa entre a dor crónica dos estudantes e as variáveis: idade (maior no grupo de 29 anos ou mais), estado civil (maior nos casados), educação (maior nos estudantes de mestrado). Conclusão. Um número relativamente elevado de estudantes de enfermagem sofre de dores crónicas. As escolas de enfermagem devem contribuir em melhorar o conhecimento dos estudantes sobre a prevenção e manejo da dor crónica.

Dignity of Nursing Students in Clinical Learning Environments.

As an important professional value, dignity has always been an ethical concern in nursing education and practice. However, the dignity of nursing students in clinical environments has remained a little-discussed topic. This study aims to explore and describe nursing students' dignity in clinical learning environments. This study is a qualitative descriptive work in which data were collected via semi-structured, in-depth, individual interviews and subsequently analyzed according to conventional content analysis. Based on the inclusion criteria of the study, nursing students were selected from different departments of university hospitals in the south of Iran from October 2019 to December 2020 (n = 21). Sampling continued to the point of data saturation. This study has been approved by the institutional review board of the university. Two themes emerged from the data collected in the interviews: trust-based relationships and formation of professional identity. The findings of the study show that nursing students need to be supported by their instructors and perceive that the personnel and patients believe in their ability. In an effectively supportive, trust-based atmosphere, these factors can contribute to maintaining nursing students dignity. Also, showing respect for their personal identity, projecting a positive image of nursing, and giving them authority to perform executive and clinical tasks in hospital departments play a major role in the formation of nursing students' professional identity and development of their dignity. Accordingly, it is recommended that in cultural contexts and clinical learning environments, more attention should be given to nursing students' dignity.

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.

Barriers to efficient management of in-home care: A qualitative content analysis.

AIM: Inefficient management is one of the major barriers to development of in-home care in the society. Accordingly, the present study aims to identify the barriers to efficient management of home care nursing using a qualitative approach. DESIGN: The present study is a qualitative-descriptive work of research. METHOD: Data were collected using semi-structured, in-depth, individual interviews with 19 nurses from November 2020 to May 2021. The collected data were analysed using Graneheim and Lundman's method. RESULTS: The findings of the study were categorized into four main themes, namely lack of effective standards, ineffective interactions, inappropriate cultural/social context and professional issues, and 15 subthemes. CONCLUSION: In-home care nurses in Iran experience various problems in their practice. Creating an appropriate cultural/social context in Iranian societies, providing the necessary infrastructure, including insurance, providing comprehensive, clear guidelines for in-home care, encouraging teamwork and organizing workshops to promote effective interactions between the personnel and patients can improve the quality of in-home care nursing.

Exploring the experiences of operating room health care professionals' from the challenges of the COVID-19 pandemic.

BACKGROUND: The operating room nurses have encountered several challenges during the current COVID-19 Pandemic, which subsequently impact their clinical performance. The present study aimed to investigate the experiences of operating room health care professionals' regarding the COVID-19 pandemic challenges in southern Iran. METHODS: This is a descriptive qualitative study. The required data were collected using in-depth and semi-structured interviews. Accordingly, 19 operating room health care professions were included in this study through purposive sampling. The data were collected from February 2020 to August 2021 and then analyzed using the Granheim and Lundman's method. RESULTS: Three main themes and 9 sub-themes were presented in this study. They included: 1- Challenges of applying protocols and standards of care in the COVID-19 pandemic in the operating room (lack of specific guidelines regarding care protocols and standards for crisis management of Covid-19 in the operating room and impossibility of keeping social distance in the operating room). 2- Professional challenges (tedious and hard work, professional burnout, lack of adequate support by the managers and lack of personal protective equipment). 3-Psychological crises (indescribable anxiety and worry, parenting stress, and weakened resilience). CONCLUSION: Based on the findings of the present study, it was indicated that lack of a specific guideline in the COVID-19 pandemic led to a sense of indecision and confusion among operating room staff. In this regard, performing tedious tasks, feelings of tiredness and exhaustion, lack of support by the authorities, and lack of access to adequate facilities and equipment were reported as the professional challenges of the healthcare staff in the current COVID-19 pandemic, which consequently affected the quality of care and patient's safety. It seems that hospital officials can use the results reported in this study for efficient planning and effective management during the COVID-19 pandemic.

Development and assessment of the psychometric properties of a compassionate care questionnaire for nurses.

BACKGROUND: Compassionate care is emphasized within professional ethics codes for nursing and is a key indicator of care quality. The purpose of the present study is to develop and assess the psychometric properties of a compassionate care instrument for nurses. METHODS: This methodological study was carried out in two phases -qualitative and quantitative-from February 2016 to October 2018. In the qualitative stage of the study, a content analysis approach was used to establish the concept of compassionate care through interviews with nurses, patients, and family caregivers. The initial draft of the questionnaire was developed based on the qualitative findings and a subsequent review of the literature. In the second phase, the psychometric properties of the questionnaire were assessed for validity and reliability. Data analysis was performed using descriptive and inferential statistics in SPSS v.16. RESULTS: From the results of the qualitative phase and review of literature, 80 items were extracted. In the quantitative phase, after evaluation of the face and content validity, 40 items were kept. After measurement of the construct validity, 28 items whose factor loading was above 0.4 were retained. Measurement of convergent validity showed a moderate correlation between the questionnaire and the nurses' caring behaviors scale (r = 0.67, P = 0.01). The reliability of the 28-item questionnaire was tested by measuring its Cronbach's alpha coefficient and intra-class correlation coefficient which were found to be 0.91 and 0.94 for the whole questionnaire, respectively. CONCLUSION: The questionnaire has enough validity and reliability to be used for measuring the nurses' compassionate care. Therefore, the instrument can be used to measure and record the quality of nursing care.

The dignity of burn patients: a qualitative descriptive study of nurses, family caregivers, and patients.

BACKGROUND: As an ethical principle, showing respect for human dignity is a professional duty of all nurses. The aggressive nature of severe burn injuries makes it hard to respect the existential values and dignity of burn patients. However, only a few studies have been conducted on the preservation of the dignity of burn patients. The purpose of this study is to identify and describe burn patients' dignity as perceived by nurses, family caregivers, and burn patients. METHODS: The present study has a descriptive, qualitative research design. Nurses, family caregivers and patients in the biggest burns hospital in the south of Iran were selected via purposeful sampling from October 2017 to August 2018 (n = 25). Data were collected using semi-structured, in-depth, individual interviews. Thereafter, data analysis was performed through conventional content analysis. RESULTS: Three main themes were extracted from the information obtained in the interviews: empathic communication, showing respect, and providing comprehensive support. CONCLUSION: The care provided to burn patients should be combined with effective communication, spending time with them, and attending to their repetitive requests, so that they can freely express their feelings and concerns. In addition, the patients' human values and beliefs should be respected and all aspects of their existence should be taken into account to preserve their dignity. Workshops designed based on the findings of the present study can help with improving the quality of burn nursing care.

Management of COVID-19-related challenges faced by EMS personnel: a qualitative study.

BACKGROUND: As the first link in the chain of providing healthcare services in the frontline of the battle against COVID-19, emergency medical services (EMS) personnel are faced with various challenges, which affect their professional performance. The present study aimed to identify some strategies to manage the COVID-19-related challenges faced by the pre-hospital emergency care personnel in the south of Iran. METHODS: In this qualitative descriptive study, 27 pre-hospital emergency care personnel who were selected through the purposeful sampling method. Data were collected through 27 semi-structured, in-depth, individual interviews. The collected data were then analyzed based on the Granheim and Lundman's method. RESULTS: Analysis of the data resulted in the identification of 3 main themes and eight sub-themes. These three main themes were as follows: comprehensive and systematic planning, provision of medical equipment, and reduction of professional challenges. CONCLUSION: The findings of the present study showed that, during the COVID-19 crisis, emergency medical services personnel should be provided with a comprehensive and systematic protocol to provide pre-hospital care and their performance should be assessed in terms of a set of scientific standards. Due to lack of equipment and work overload in the current crisis, emergency medical services personnel are faced with many psychological challenges, which adversely affect their quality of pre-hospital emergency care. Furthermore, emergency care senior managers should develop comprehensive protocols, provide more equipment, and eliminate professional challenges to pave the ground for improving the quality and safety of the healthcare services in pre-hospital emergency care during the current COVID-19 crisis.

The effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients.

BACKGROUND: Delirium is one of the prevalent complications of post open heart surgery. The present research aimed to assess the effect of multi-component interventions on the incidence rate, severity, and duration of post open heart surgery delirium among hospitalized patients. METHODS: In this quasi-experimental study, 96 patients under open heart surgery were selected using convenience sampling and divided into a control and an intervention group. The interventions included the patients' preoperative education, nurses' education, and in-ward environmental interventions. The demographic information and Mini-Mental State Examination (MMSE) questionnaires were completed a day before surgery. The patients in both groups were also surveyed after extubation until the fourth day post operation using Delirium Observation Screening (DOS) scale considering the incidence, severity, and duration of delirium. The data were analyzed using the SPSS statistical software, version 20. RESULTS: The incidence rate of delirium was 14.6 and 6.2% in the control and intervention groups, respectively (p > 0.05). Besides, the mean severity of delirium was 0.53 in the control group and 0.40 in the intervention group (p > 0.05). Finally, the mean duration of delirium was 4.5 and 3.25 h in the two groups, respectively (p > 0.05). CONCLUSIONS: Since prevention of delirium can play a considerable role in the patients' recovery after heart surgery, it is necessary to carry out some measures to prevent such complications. Even though the interventions performed in this study did not cause significant changes in this regard, the results suggested that prevention interventions should be performed with stronger and more integrated planning for achieving better outcomes.

Posttraumatic Growth: An Analysis of the Concept Based on Rodgers' Concept Development.

The concept of posttraumatic growth appears frequently in the psychology literature. However, there is no clear definition of it. The purpose of this study was to determine its attributes, antecedents, and consequents. Rodgers' evolutionary concept analysis method was used. Data analysis was implemented using thematic analysis. The results showed that posttraumatic growth is a complex concept with four main attributes including spiritual changes, compassion toward others, appreciation of life, and improved self-understanding. Clarifying the concept of posttraumatic growth and identifying its features can be used to design nursing interventions to develop posttraumatic growth.

Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis.

BACKGROUND: Having to work in unpredictable and critical conditions, emergency care services (EMS) personnel experience complicated situations at the scene of accidents which, inevitably, influence their clinical decisions. There is a lack of research into the challenges which these professionals encounter. Accordingly, the present study aims to explore the major challenges and barriers which affect clinical decision-making from the perspective of EMS personnel. METHODS: The present study is a qualitative work with a content analysis approach. Selected via purposeful sampling, the subjects were 25 members of the EMS personnel in Iran who met the inclusion criteria. The study lasted from December 2019 to July 2020. Sampling was maintained to the point of data saturation. Data were collected using semi-structured, in-depth, individual interviews. The collected data were analyzed via qualitative content analysis. RESULTS: The results of data analysis were categorized into four themes and eight categories. The main themes were professional capabilities, occupational and environmental factors, inefficient organizational management, and ethical issues. CONCLUSION: The results of the present study show that clinical knowledge, experience, and skills contribute to emergency care personnel's professional capabilities in making clinical decisions. Good teamwork skills and time management can prevent feelings of confusion when the number of the injured to be attended to is large. Effective clinical decision-making skills can not only help the personnel make the right decision, but enhances their resilience and enables them to adapt to hard and unpredictable conditions. Professional factors, organizational management, and ethical matters constitute the other major factors which influence the clinical decision-making of emergency care personnel at the scene of accidents and determine the quality of their clinical performance. Thus, it is essential that pre-hospital emergency care managers improve the quality of EMS personnel's clinical decision-making skill.