Effect of augmented reality-based rehabilitation of hand burns on hand function in children: A randomized controlled trial.

BACKGROUND: Despite the use of traditional rehabilitation methods, hand function may still remain impaired in children suffering from burn injuries. PURPOSE: This study aimed to assess the impact of implementing an augmented reality (AR) rehabilitation booklet designed for pediatric hand burn on their hand functionality. STUDY DESIGN: This was a randomized controlled trial. METHODS: Seventy-two children, aged 8-14 years with a hand burn, were randomly allocated into intervention (n = 36) and control (n = 36) groups. Children in the control group received routine rehabilitation program, while in the intervention group, children performed exercises using a printed booklet with related AR application. The Jebsen-Taylor Hand Function Test was completed before the intervention at the time of the patients' discharge and 1 month later. RESULTS: The results of analysis of covariance based on baseline- and fully-adjusted models showed significant intervention effect after discharge as well as after intervention for hand function (mean difference [95% confidence interval] for discharge: -8.2 [-15.0 to -1.4] and for after intervention: -74.0 [-88.8 to -59.1]) and the items (all p < 0.05), except for writing and lifting large light objects for both after discharge and after intervention measures (all p-value > 0.05). CONCLUSIONS: A significant decrease in the total time taking to complete the Jebsen-Taylor hand function test was observed in the intervention group compared to the control group 1 month after discharge. Rehabilitation of children with hand burns, using printed educational booklet with related AR application, improves their hand function.

Family-centred empowerment using telenursing on pressure injury incidence in post-discharge stroke patients.

OBJECTIVE: The aim of this study was to evaluate the effect of a family-centred empowerment intervention on the incidence, stage and status of pressure injury (PI) in patients diagnosed with stroke during the post-discharge period with a telenursing approach. METHOD: This randomised controlled clinical trial (RCT) was conducted with patients admitted to Ghaem Hospital in Mashhad and who were diagnosed with stroke. Patients were randomly assigned to one of two equal-sized groups: intervention and control. Family education and follow-up of the intervention group was performed using WhatsApp messenger for one month. Caregivers of patients in the control group received the routine training programme. The incidence, stage and status of PIs of both groups were measured at the beginning and at one month later using the Braden Scale, the EPUAP/NPUAP Classification System, and the Pressure Ulcer Scale for Healing (PUSH). RESULTS: A total of 60 patients took part in the RCT (30 patients allocated to each group). The incidence of PI in the control group was significantly higher than in the intervention group (p<0.001). The results showed significantly lower stages of PI in the intervention group than in the control group (p<0.001 and p<0.05 for univariable and multivariable models, respectively). The results showed a significantly lower PUSH score in the intervention group than in the control group (p<0.001 and p<0.05 for univariable and multivariable models, respectively). CONCLUSION: The findings of this RCT show that the empowerment and training of caregivers of patients diagnosed with stroke after discharge using telenursing can reduce the incidence and severity of PIs and improve their status in these patients.

Mental Health Triage from the Viewpoint of Psychiatric Emergency Department Nurses; a Qualitative Study.

Introduction: Mental health triage is a new nursing practice concept that is less studied and defined, especially among Iranian nurses. Therefore, this study aimed to explain the concept of mental health triage from the perspective of psychiatric emergency department (ED) nurses. Methods: This qualitative study collected data using semi-structured interviews with psychiatric ED nurses. Sampling was purposive and continued until data saturation. Analysis was conducted using conventional content analysis, as described in Griesheim and Landman approach. Results: 15 psychiatric ED nurses with the mean age of 35.13 ± 8.44 years were interviewed (60% male). Finally, two themes, five categories, and 16 sub-categories emerged from data analysis. Two themes emerged, including mental health triage meaning and mental health triage structure. The former included two categories of the nature and characteristics of mental health triage, and the latter consisted of three categories of mental state exploration from surface to depth, safety control measures, and the degree of emergency. According to the "degree of emergency" category, nurses could not make triage decisions based on their perceptions in an acceptable way. Conclusion: Psychiatric ED nurses have an appropriate understanding of mental health triage meaning. However, according to these nurses, its structure is associated with shortcomings that limit the provision of mental health triage services and reduce their quality.

The effect of threshold inspiratory muscle training on the duration of weaning in intensive care unit-admitted patients: A randomized clinical trial.

Background: The purpose of this study was to evaluate the effect of threshold inspiratory muscle training (IMT) on the duration of weaning in intensive care unit (ICU)-admitted patients. Materials and Methods: This randomized clinical trial enrolled 79 ICU-admitted, mechanically ventilated patients in 2020-2021 in Imam Reza Hospital, Mashhad. Patients were randomly divided into intervention (n = 40) and control (n = 39) groups. The intervention group received threshold IMT and conventional chest physiotherapy, while the control group only received conventional chest physiotherapy once a day. Before and after the end of the intervention, the strength of inspiratory muscles and the duration of weaning were measured in both the groups. Results: The duration of weaning was shorter in the intervention group (8.4 ± 1.1 days) versus the control group (11.2 ± 0.6 days) (P < 0.001). The rapid shallow breathing index decreased by 46.5% in the intervention group and by 27.3% in the control group after the intervention (both P < 0.001), and the between-group comparison showed a significantly higher reduction in the intervention group than control group (P < 0.001). The patients' compliance after the intervention compared to the 1st day increased to 16.2 ± 6.6 in the intervention group and 9.6 ± 6.8 in the control group (both P < 0.001), and the between-group comparison showed a significantly higher increase in the intervention group than control group. The maximum inspiratory pressure increased by 13.7 ± 6.1 in the intervention group and by 9.1 ± 6.0 in the control group (P < 0.001). Furthermore, the weaning success was 54% more probable in the intervention group than control group (P < 0.05). Conclusion: The results of this study showed the positive effect of IMT with threshold IMT trainer on increased strength of respiratory muscles and reduced weaning duration.

Rehabilitation of Burn Victims: Improving Quality of Life in Victims With Face and Neck Burn Through an Augmented Reality Coupled Pamphlet.

The present study aimed to investigate the effect of implementing rehabilitation programs using an augmented reality (AR) coupled pamphlet on the quality of life (QOL) of patients with face/neck burns. This randomized clinical trial was conducted on 60 patients (intervention = 30, control = 30) admitted to the burn center of Imam Reza Hospital, Mashhad, Iran. Patients in the intervention group performed their rehabilitation program using AR coupled pamphlet during 6 weeks, while control patients used simple pamphlet. The Burn-Specific Health Scale for Face and Neck (BSHS-FN) was completed at the beginning, and 2 and 6 weeks after the intervention. The results for 2 weeks after intervention measures in model 1 ANCOVA showed significant raise of measures only for Hand function (P = .035). However, for the total QOL score and other domains the differences were not significant (All P > .05). Adjusting for confounders, model 2 ANCOVA showed similar results for 2 weeks after intervention. However, in both models, the results indicated significant intervention effect for 6 weeks after intervention in QOL score and all domains (All P < .05), so that the amount of increase in measures were significantly higher in the intervention group. According to the findings, implementing rehabilitation program for patients with face and neck burns using AR coupled pamphlet can improve their QOL.

The Effect of Peer Teaching on the Quality of Report Writing Based on the Nursing Process.

Background: Considering the importance of report writing and its problems, different teaching methods can be used to improve nurses' knowledge and performance, among which is peer teaching. This study aimed to determine the effect of peer teaching on the quality of report writing based on the nursing process. Materials and Methods: This quasi-experimental study examined 60 nurses working in the surgical and cardiac wards of Razavi Hospital in Mashhad during 2019. These wards randomly assigned to intervention (n = 30) and control (n = 30) groups. For 2 weeks, report writing teaching was implemented for the intervention group based on the nursing process through peer teaching. The control group routinely performed report writing. At the beginning and end of the study, we reviewed nursing reports of both groups using a valid and reliable checklist. Data were analyzed using two-way analysis of variance with repeated-measures analysis of variance. Results: Before the intervention, there was no significant difference between the two groups in terms of scores of report writing quality in structure, content dimensions, and the total scores (p > 0.05). After the intervention, the mean score changes were significantly higher in the structure (Mean Difference (MD) = 4.99, 95%CI: 1. 26-8.72, p < 0.010), content (MD = 8.11, 95%CI: 4.91-11.31, p < 0.001), and the total quality of report writing (MD = 7.54, CI: 4.56-10.53, p < 0.010) in the intervention group than the control group. Conclusions: Peer teaching improved the nurses' quality of report writing. The teaching planners are recommended to use this method to train nursing staff.

The Effect of Inhalation Aromatherapy on Sedation Level, Analgesic Dosage, and Bispectral Index Values during Donor Site Dressing in Patients with Burns: A Randomized Clinical Trial.

OBJECTIVE: To determine the effect of inhalation aromatherapy on sedation level, analgesic dosage, and bispectral index (BIS) values during donor site dressing in patients with burns. METHODS: This trial was conducted on 62 patients with burns requiring donor site dressing who were admitted to the Burn Center of Imam Reza Hospital, Mashhad, Iran. In the intervention group, the patients inhaled damask rose 40% and lavender 10% essential oils during donor site dressing change, whereas in the control group, the site was dressed using routine protocol. Sedatives and analgesics were prescribed until the levels of brain activity achieved light sedation. The brain activity and sedation levels were measured before and after the donor site dressings using the BIS. Data were analyzed using the analysis of covariance and the two-way analysis of variance with repeated measures. RESULTS: All 62 patients completed the study. The required doses of ketamine (P < .001), fentanyl (P = .003), morphine (P < .001), and propofol (P < .001) were significantly lower in the intervention group. The BIS was also significantly lower in the intervention group (P < .001). Heart rate decreased significantly during the aromatherapy, as well as after analgesic and sedative consumption (P < .001). CONCLUSIONS: The inhalation of damask rose and lavender essential oils is an effective intervention to reduce the doses of sedative and analgesic drugs administered as well as BIS during donor site dressing change in patients with burns.

The Effect of a Recreational Therapy Program on the Pain Anxiety and Quality of Life of Patients With Burn Injuries: A Randomized Clinical Trial.

Pain anxiety and dysfunction are among the most prevalent complications of burns, impacting the quality of life (QOL) of patients with burn injuries. As a nonpharmaceutical approach, recreational therapy can be effective in reducing the complications of burns. This study aimed to examine the effect of a recreational therapy program on the pain anxiety and QOL of patients with burn injuries. This controlled randomized clinical trial was conducted on 58 patients admitted to the burn center of Imam Reza Hospital in Mashhad, Iran. These patients were randomly allocated to the intervention and control group. The intervention group received a recreational therapy program three sessions a week, for 2 weeks. The control group performed routine daily activities. As the main variable of the study, the Burn Specific Pain Anxiety Scale and Burn Specific Health Scale-Brief were completed for both groups before and 2 weeks after the intervention. After controlling confounders, the pain anxiety score in the intervention group was significantly lower than in the control group (P = .002). The total QOL score was significantly higher in the intervention group than the control group (P = .001). In addition, the intervention significantly increased the scores of QOL in the physical (P < .001), emotional (P = .009), and social (P < .001) dimensions. As it reduces pain anxiety and promotes the QOL of patients with burn injuries, this recreational therapy program is recommended for promoting the mental health and QOL of these patients.

Improving respiratory muscle strength and health status in burn patients: a randomized controlled trial.

PURPOSE: Pulmonary complications are among the major disadvantages of burns. The present study aimed to determine the effect of inspiratory muscle training on respiratory muscle strength and health status in burned patients. METHODS: The current randomized clinical trial was conducted on 64 burned patients in Burn Center of Imam Reza Hospital, Mashhad, Iran. In the intervention group, a Powerbreathe device (KH1 digital model) was used twice a day for 10 days, accompanied by the routine procedures and in the control group, only chest physiotherapy and incentive spirometer were used. RESULTS: Before the intervention, the mean scores of respiratory muscle strength were 38.8 ± 10.1 and 35.8 ± 9.0 in the Powerbreathe group and control group, respectively (p = .206). After the intervention, the mean score of respiratory muscle strength of Powerbreathe group was 49.2 ± 11.8 and in the control group was 39.3 ± 8.5 (p < 0.001). Moreover, the mean scores of health status before the intervention in the burned patients were 66.3 ± 14.8 and 63.0 ± 17.3 in the Powerbreathe group and control group, respectively (p = 0.550). In the post-intervention phase, the mean health status score of the burned patients in the intervention and control groups were measured at 75.9 ± 14.1 and 66.7 ± 15.9, respectively (p = 0.019). CONCLUSION: It seems that inspiratory muscle training improves respiratory muscle strength and health status in the burned patients. Therefore, the use of Powerbreathe is recommended for the prevention and improvement of pulmonary complications in patients with chest burns.

Nurse Managers' Perceptions and Experiences during the COVID-19 Crisis: A Qualitative Study.

BACKGROUND: Coronavirus disease-2019 (COVID-19) pandemics are an international threat to global health and health systems and then healthcare providers. Nurses' managers who are responsible for organizing the nurses and their activities grapple with even more challenges, which are overlooked. This study was conducted to elaborate on the nurse managers' experiences facing the Coronavirus pandemic. MATERIALS AND METHODS: This study adopted a conventional approach to qualitative content analysis. Semi-structured interviews were conducted with 18 nurse managers working at the University Hospitals of Mashhad University of Medical Sciences from April 5, 2020 to June 15, 2020. The interviews continued until data saturation. Data analysis was performed using the method proposed by Lundman and Graneheim. RESULTS: Participants described their experiences about facing COVID-19 pandemic into three categories of 'facing the personnel's mental health', 'Managerial and equipment provision challenges', and 'adaptability and exultation process', with 13 sub-categories. CONCLUSIONS: Dealing with critical conditions could make the frontline managers, and specially nurse managers, face serious challenges. However, in case of proper crisis management andadaptation of sufficient supporting strategies, these threats could turn into an opportunity to exault the individuals and consequently the organizations engaged.

The effect of rehabilitation education through social media on the quality of life in burn patients: a randomized, controlled, clinical trial.

BACKGROUND: Burn is one of the most brutal harms to the human body and mind and its wide-ranging complications have many adverse effects on the patients' quality of life. The present study was conducted to investigate the effect of rehabilitation education through social media on burn patients' quality of life. METHODS: The present randomized, controlled, clinical trial was conducted on 60 patients admitted to Imam Reza Hospital Burn Center in the city of Mashhad, Iran, who were randomly assigned to either the intervention or control groups (n = 30 per group). The researcher then created a WhatsApp channel to provide educational content and a WhatsApp group for burns patients to join and get their questions answered. The intervention group patients pursued their post-discharge education through the social media for a month. The control group patients received their discharge education according to the ward's routine procedures through pamphlets and face-to-face training by the personnel. As the study's main variable, the Burn Specific Health Scale-Brief was completed by both groups before and 1 and 2 months after the intervention. Data were analyzed using the ANCOVA and repeated-measures ANOVA. RESULTS: There was no significant differences between the intervention and control groups in terms of the QOL score and any of the domains at baseline. The results indicated the significant effect of the intervention both 1 and 2 months post-intervention on the QOL score and all the domains (P < 0.05), except for body image (Pmodel1 = .550 and  Pmodel2 = .463) and skin sensitivity (Pmodel1 = .333 and Pmodel2 = .104). CONCLUSION: The post-discharge rehabilitation education of burns patients through social media improves their quality of life and can be used as an appropriate educational and follow-up method in different stages of the rehabilitation of burn patients. TRIAL REGISTRATION NO. : IRCT20190622043971N1, 05-10-2019.

The effect of music therapy on physiological parameters of patients with traumatic brain injury: A triple-blind randomized controlled clinical trial.

OBJECTIVE: This study aims to investigate the effect of music therapy integrated with family recollection on physiological parameters of patients with traumatic brain injury who are admitted to Intensive Care Units. METHODS: Sixty patients were selected through convenience sampling and were then randomly assigned to the intervention group and control group. In the intervention group and for 6 consecutive days, the patients received a combination of music and auditory stimulation twice a day for 15 minutes. The patients' physiological parameters were measured before the intervention, and then 10 minutes and finally 30 minutes after the intervention. The data were analyzed using multilevel modeling method through MLwiN version 2.27. RESULTS: The results showed that there was no significant difference between the two groups in terms of demographic factors and the duration of coma. However, the results of the two-level multiple linear models which were performed for 6 consecutive days indicated a significant decrease in systolic blood pressure, diastolic blood pressure, respiratory rate and heart rate for the patients in the intervention group as compared to the patients in the control group (P < 0.0001). Nevertheless, no significant difference was observed in temperature and oxygen saturation (P > 0.05). CONCLUSION: Integration of music therapy with family recollection can moderate physiological parameters. Therefore, it is recommended to use this cost-effective treatment along with the routine treatments, especially for patients with traumatic brain injury.

Comparison of "cough peak expiratory flow measurement" and "cough strength measurement using the white card test" in extubation success: A randomized controlled trial.

BACKGROUND: Failed extubation and subsequent re-intubation in ventilated patients can lead to many adverse consequences, including organizational and personal expenditures. Extubation decisions based on subjective methods are a major contributor to extubation failure. This study compared the effect of cough peak expiratory flow (PEF) measurement and cough strength measurement using the white card test (WCT) on extubation success. MATERIALS AND METHODS: This randomized clinical trial was conducted in two groups in 2018 on 88 ventilated patients in intensive care units of Imam Reza Hospital in Mashhad, Iran. Ninety patients were divided into two groups of 45, but two were excluded from the white card group. The criteria established for extubation included PEF ≥60 L/min during coughing in the cough PEF group and noticing card humidity in the WCT group. In both groups, extubation success was determined as the sole outcome and was compared with the standard PEF and cough strength. The researcher who assessed the outcome and statistician were blinded about group allocation. RESULTS: Extubation success was measured as 97.8% in the cough PEF group and 76.7% in the WCT group (P = 0.003) during the first 24 h. In the second 24 h, however, successful extubation was reported as 90.9% in the cough PEF group and 60.6% in the WCT group (P = 0.002). CONCLUSION: Using the cough PEF rate increases the likelihood of extubation success and reduces adverse effects, and is recommended to be used for extubation decision-making.

Continuing nursing education: use of observational pain assessment tool for diagnosis and management of pain in critically ill patients following training through a social networking app versus lectures.

BACKGROUND: Nursing staff training in using observational pain assessment tools is highly important to improve the assessment of pain. The present study was conducted to examine the effect of two different training methods (lectures vs. a social networking app) on the diagnosis and management of pain in mechanically-ventilated patients. METHODS: This quasi-experimental study was conducted on 70 nurses working in two Intensive Care Units (ICU) in Mashhad, Iran. The nurses were trained in the application of observational pain assessment tools by lectures or through a social networking app. Before and after the intervention, the nurses' performance was evaluated in both groups using a checklist based on Critical-Care Pain Observation Tool (CPOT). RESULTS: In the pre-intervention phase, the nurses' performance scores in the domains of pain diagnosis and pain management were not significantly different between the two groups (P > 0.05). Following the intervention, the mean score of pain diagnosis was 82 ± 19 in the lecture group and 97 ± 8 in the social networking app group (P < 0.01), and the mean pain management scores were 30 ± 17 and 90 ± 18 (P < 0.01), respectively. CONCLUSION: This study showed that learning through a social networking app led to improved diagnosis and management of pain in mechanically-ventilated patients when compared with lectures. Training through social networking applications can therefore be considered as a feasible instructional method for developing nurses' pain management skills.

Subjective hemodialysis adequacy can also be measured: Development and psychometric properties evaluation of subjective adequacy questionnaire.

Long-term prognosis of chronic hemodialysis patients is affected by dialysis adequacy that can have effect on the hemodialysis (HD) outcomes, especially mortality rate. Given the limited knowledge about HD patient's perceptions and experiences about subjective HD adequacy (SHA) and the lack of SHA measuring questionnaire (SHAMQ), this study was conducted with the aim of developing the SHAMQ and evaluating its psychometric properties based on the operational definition of SAH concept. This mixed-method sequential exploratory design study was conducted from 2016 to 2018 in eight HD units of Mashhad, Iran. In qualitative phase, conventional content analysis method was used, and participants were recruited through purposive, snowball, and selective sampling techniques. Data were collected through semi-structured interviews with 25 HD patients, dialysis nurses, caregivers, and nephrologists, and analyzed using MAXQDA software (V10). SHAMQ was developed based on operational definitions extracted from qualitative phase. Quantitative and qualitative face and content validity; construct validity; internal consistency; and stability were used for psychometric properties evaluation of SHAMQ. Data were analyzed using Statistical Package for Social Sciences version 22.0 (IBM Corp., Armonk, NY, USA). Physical vitality, inner consistency, a sense of well-being, positive social interactions, effective self-empowerment, and weathering financial crisis were 6 generic categories emerged from qualitative phase. The final version of SHAMQ included 30 itemsin four factors (subscales). Scale-content validity index, Θ, and intraclass correlation were 0.92, 0.88, and 0.91, respectively. The results of this study showed that factors such as well-being, self-enforcement to effective care, physical vitality, and spiritual health are the most important SHA outcomes. The development of a scale for measuring SHA can help to the better evaluation of HD patients' conditions and accordingly perform effective interventions.

The design and psychometric evaluation of the emergency medical services resilience scale (EMSRS).

INTRODUCTION: The nature of pre-hospital emergency medical care can expose healthcare workers to significant stresses that might lead to psychological problems such as job burnout and impaired resilience. A valid and reliable tool is, therefore, needed to investigate resilience in emergency medical services (EMS) personnel. This study was conducted to design a tool for assessing the resilience of emergency medical personnel in Iran and to examine the psychometric properties of the designed tool. METHODS: This methodological study was conducted in two phases: A qualitative stage with individual interviews and a review of literature to generate items, and a quantitative stage of psychometric evaluations that assessed the face, content, and construct validity of the tool. The reliability of the tool was also assessed using the internal consistency and test-retest methods. RESULTS: Exploratory factor analysis was used to design a 31-item scale with a six-factor structure. These six factors, i.e. job motivation, communication challenges, social support, remaining calm, self-management, and consequences of stress, explained 51.8% of the variance. The scale's Cronbach's alpha coefficient and intraclass correlation coefficient were calculated as 0.91 and 0.85, respectively. CONCLUSION: The scale developed on the resilience of EMS personnel can be used as a valid and reliable tool for assessing resilience in EMS personnel. It can also assist emergency service managers to plan courses to improve their staff's resilience.

The Relationship between Resiliency and Burnout in Iranian Nurses: A Systematic Review and Meta-Analysis.

BACKGROUND: The impact of resiliency on professional burnout in nurses has been evaluated in several studies. AIM: This meta-analysis was conducted to examine the effect of resiliency on different aspects of nurses' professional burnout. MATERIAL AND METHODS: Publications were identified through targeted literature review in national and international databases between 1980-2017, in Persian and English. Two independent coders assessed and extracted articles. Data analysis was done by a random effects model. Study heterogeneity was measured by the I2 test. The data were analysed by STATA software v. 14. RESULTS: Initially, 227 articles were extracted. After titles and abstract screening, 108 articles were selected for full-text review. Only five of them had the necessary inclusion criteria for analysis. The meta-analysis performed on these observational studies showed that the correlation between resiliency and burnout was -0.57 with a 95% confidence interval of -0.354 to -0.726. CONCLUSION: Regarding the inverse relationship between resiliency and burnout, it is recommended to plan for the interventions that can improve the resilience of nurses against burnout. Conducting interventional and resilient training courses for nurses in nursing education can be considered.

Improving Nursing Care Documentation in Emergency Department: A Participatory Action Research Study in Iran.

BACKGROUND: Standardization of documentation has enabled the use of medical records as a primary tool for evaluating health care functions and obtaining appropriate credit points for medical centres. However, previous studies have shown that the quality of medical records in emergency departments is unsatisfactory. AIM: The aim of this study was improving the nursing care documentation in an emergency department, in Iran. MATERIAL AND METHODS: This collaborative action research study was carried out in two phases to improve nursing care documentation in cooperation with individuals involved in the process, from February 2015 to December 2017 in an affiliated academic hospital in Iran. The first phase featured virtual training, an educational workshop, and improvements to the hospital information system. The second phase involved the recruitment of human resources, the implementation of continuous codified training, the establishment of an appropriate reward and penalty system, and the review of patient education forms. RESULTS: The interventions improved nursing documentation quality score of 73.20%, which was the highest accreditation ranking provided by Iran's Ministry of Health and Medical Education in 2017. In other words, this study caused a 32% improvement in the quality of nursing care documentation in the hospital. CONCLUSION: The appropriate practices for improving nursing care documentation are employee participation, managerial accountability, nurses' adherence to documentation standards, improved leadership style, and continuous monitoring and control.

Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study.

BACKGROUND: One helpful strategy adopted for pain management in non-verbal, intubated patients is the use of a proper pain assessment scale. The purpose of the present study is to achieve a better and deeper understanding of the existing nurses' challenges in using pain assessment scales among patients unable to communicate. METHODS: This qualitative study was conducted using content analysis. Purposive sampling was used to select the participants and continued until data saturation. The participants included 20 nurses working in intensive care units. Data was collected using semi-structured interviews and analysis was done using an inductive approach. RESULTS: Four categories and ten sub-categories were extracted from the experiences of the nurses working in the intensive care units in terms of nursing challenges in using non-verbal pain assessment scales. The four categories included "forgotten priority", "organizational barriers", "attitudinal barriers", and "barriers to knowledge". CONCLUSIONS: The findings of the present study have shown that various factors might influence on the use of non-verbal pain assessment scales in patients unable to communicate. Identifying these challenges for nurses can help take effective steps such as empowering nurses in the use of non-verbal pain assessment scales, relieving pain, and improving the quality of care services.