Development and Psychometric Assessment of "Self-Efficacy Scale" for Patients With Beta Thalassemia Major: A Mixed-Methods Study.

Background and Purpose: Since self-efficacy is a significant factor influencing the self-management of chronic diseases, including thalassemia major, it is considered a key concept in chronic diseases. This study aimed to develop and psychometrically evaluate the self-efficacy scale for patients with thalassemia major. Methods: This was a mixed-methods study conducted in two phases. In phase 1, a qualitative study with a conventional content analysis design was conducted. In phase 2, which was a quantitative one, the psychometric analysis of the instrument's phrases was done. Results: The instrument has 35 items and 3 factors. The Cronbach's alpha coefficient and the intraclass correlation coefficient were .93 and .94, respectively. Conclusions: This study confirms the validity and reliability of the Beta Thalassemia Major Self-Efficacy Scale. With this tool, nurses can evaluate the self-efficacy of patients with thalassemia major.

Nursing students' experiences from clinical education using the TPSN model.

BACKGROUND: The TPSN model is an innovative model to create an integration and structured relationship between educational and healthcare provider institutions. This model is done to reduce the theoretical-practical gap in nursing. The present study aimed to explore the experiences of nursing students. METHODS: In a conventional content analysis, 11 undergraduate nursing students, 7 graduate nursing students, and 4 doctoral students were selected. Data was collected through focus group discussions and individual interviews. RESULTS: The findings from analyzing the students' experiences who had received education using this model resulted in four main categories: the feeling of being a nurse, an integrated and collaborative clinical education platform, the development of nursing clinical education, and educational challenges. CONCLUSION: The TPSN model provides a suitable platform for nursing clinical education. This model helps students integrate theoretical knowledge with clinical practice and helps them act as professional nurses in the future.

Adapting the Donabedian model in undergraduate nursing education: a modified Delphi study.

BACKGROUND: Donabedian conceptual and multidimensional framework has been used in several studies in an educational context. In this study, we aimed to adapt the Donabedian three-component model (structure, process, and outcome) in undergraduate nursing education. This conceptual framework provides a comprehensive image of nursing education institutions and can help to evaluate institutions by measuring different aspects of their performance. A comprehensive understanding of the various elements of an educational institution helps to develop a complete, appropriate relevant set of performance indicators. METHODS: This was a modified Delphi study. It had three rounds. The expert panel consisted of nursing faculty members and nursing Ph.D. students. In the first round, a questionnaire was designed based on interviews, focus groups, and a literature review. Experts rated their agreement with each element on a 5-point Likert scale in rounds two and three. The consensus level was set as 75%. The stability between rounds was also determined by calculating kappa coefficients. One Sample T-Test was also calculated for new items in round three. RESULTS: All 55 items of the questionnaire were confirmed in the second round based on the consensus percentage of 75. Five new items were added to the third round based on comments in round two. Eventually, all elements except one were confirmed according to the consensus level, kappa values, means, and One-Sample T-Test in round three. The structure's key elements include staff (academic and non-academic); equipment; guidelines; resources and facilities; and students' demographics and characteristics. Process key elements include communication; education; evaluation; cooperation; and consultation. Outcome key elements include knowledge development; nursing image; alumni's outcome; students' outcome; related medical centers' performance; accreditation and evaluation results; and satisfaction. CONCLUSIONS: Different elements of a nursing education institution at the bachelor's level were determined. The results of this study can help related bodies to develop and implement a comprehensive and systematic evaluation. These results can also be a basis for making this model useful in other nursing courses or education in other fields.

Virtual care in the health care system: A concept analysis.

BACKGROUND: Health care providers need a better understanding of virtual care to recognise and use it for service delivery. AIM: To provide a more comprehensive definition of the concept of virtual care. METHOD: This study was conducted based on Walker and Avant's concept analysis method. A comprehensive review of the published texts in English from 2012 to 2022 was performed using the PubMed, Web of Science, Scopus, ProQuest, Science Direct, Ovid, CINAHL and Google Scholar databases. RESULTS: The main aspects and attributes of virtual care, including the use of any information and communication technology in various formats such as platforms, telephone calls, messages, email consultation, remote monitoring, secure and two-way digital communication between health care providers and patients, the possibility of providing remote care synchronously or asynchronously, more interaction between patients and caregivers, the possibility of transferring information between patients and health care providers and within the teams themselves, symptom management, sending diagnostic results in the form of video visits, and providing follow-up care, are attributes that distinguish virtual care from telehealth, telemedicine and other methods of providing remote healthcare services. CONCLUSION: Considering the positive and negative consequences of implementing virtual care, the findings of this study developed a basis for an operational definition of the concept so that providers can understand the meaning of virtual care and consider it when providing virtual care to patients. The findings of this study can be used in many international and national contexts in the health care system and in future studies on interventions to increase the use of virtual care.

The effect of virtual reminiscence therapy on depression and anxiety in patients with gastric cancer undergoing chemotherapy.

PURPOSE: To determine the effect of virtual reminiscence therapy on depression and anxiety in patients with gastric cancer (PwGC) undergoing chemotherapy. METHODS: In this quasi-experimental study, we randomly allocated 152 PwGC who met the inclusion criteria as 1:1 ratio to control (N = 76) and intervention (N = 76) groups. The patients in the control group received routine post-chemotherapy care, while those in the intervention group received reminiscence therapy over the phone in addition to routine care. The participants of both groups completed Beck's Depression Inventory and Zung's Self-rating Anxiety Scale before the study, 6 weeks after the beginning of the study, and 3 months after the intervention. RESULTS: Although the mean depression score before chemotherapy indicated moderate depression in both groups, the reminiscence therapy group showed a significant reduction in the depression score compared to the control group (P < 0.001) following intervention. The mean anxiety scores indicated mild to moderate anxiety in both groups, which was later placed within the normal range, there was a significant difference between the two groups. Intra-group comparison revealed that the mean depression and anxiety scores decreased significantly in the reminiscence therapy group (P < 0.001). CONCLUSION: This study indicated that virtual reminiscence therapy can decrease anxiety and depression in PwGC undergoing chemotherapy. Therefore, it can be a supportive psychological method for these patients.

The development and validation of a standardised eight-station OSCE for registration of undergraduate nursing students: A Delphi study.

AIM: To develop and validate a set of OSCEs for use as a nationally applicable final exam of undergraduate nursing students' clinical and professional competencies. BACKGROUND: Tertiary recommendations for nursing registration require student achievement of a prerequisite level of both nursing knowledge and skill. Assessment of nursing skills prior to provision of nursing registration is an increasingly important focus of university nursing education. Objective Structured Clinical Examinations (OSCEs) are an appropriate tool for assessing the competencies of nursing students, but the mode and content of OSCEs varies widely. Thus, for nationally-based registration, development of a standardized set of OSCEs to determine the clinical competence of nursing students is important. DESIGN: A modified Delphi study, informed by a systematic scoping review of relevant literature. METHODS: A two-phase study was conducted. Initially, a scoping review was conducted to establish internationally agreed competences for graduating nursing students. These were included in an online questionnaire send to national experts to develop a validated and accepted nursing competency framework and associated implementation strategies. This was round 1 of a three-round modified Delphi study. A Content Validity Index (CVI) was calculated and thematic analysis was used to analyze the experts' opinions. RESULTS: Details of a set of OSCEs for final exam of undergraduate nursing students were developed and validated. These OSCEs included nine competencies addressed in eight 10-minute stations. CONCLUSION: A 'best-practice' OSCE evaluation system, designed from both international literature and the opinions of nation-wide experts was achieved. This well-designed OSCE was shown to be a reliable and valid method for assessing the clinical competence of nursing students. It reflected global procedures as well as the local conditions and Iranian expectations. The results of this study can be used by nursing schools across the country. They can also be used to model equivalent development of locally relevant OSCEs in countries around the world.

Baccalaureate nursing education institutions' key performance indicators: a review of the existing indicators and qualitative analysis of expert interviews.

BACKGROUND: Improvements in nurses' and midwives' education will increase workforce quantity and quality. Continual improvement of organization performance is based on continual measuring; Appropriate indicators must be selected to measure and appraise the performances. This study aimed to recognize and categorize key performance indicators (KPIs) for baccalaureate nursing education institutions' performance measurement. METHODS: This study had two phases: (1) Interview: Seven semi-structured interviews were conducted with faculty members and nurses. (2) Narrative Literature review: schools' and universities' reports and web pages were assessed to recognize KPIs. The data analysis method was directed content analysis. The Donabedian Model components were used to guide the data analysis. RESULTS: The total number of indicators retrieved was 468; 75 were from interviews with faculty members and nurses and 393 were from the literature review. Indicators were categorized into: Structure (staff; equipment, resources, and facilities; guidelines), Process (education; communication and collaboration; evaluation), and Outcome (survey and accreditation; national and international recognition; satisfaction; sustainability and financial efficiency; students; alumni; knowledge related to the field). CONCLUSIONS: A number of indicators were identified that were categorized into various groups related to the performance of nursing schools. Further investigations are needed with different groups of stakeholders including students, professional associations, healthcare institutions, alumni, and clients. As well in some areas, new or composite indicators may need to be developed. Also, each institution needs to select appropriate indicators based on its context, policy goals, and infrastructure.

Competencies expected of undergraduate nursing students: A scoping review.

AIM: Nursing competencies are crucial indicators for providing quality and safe care. The lack of international agreement in this field has caused problems in the generalization and application of findings. The purpose of this review is to identify the core competencies necessary for undergraduate nursing students to enter nursing work. DATA SOURCES: We conducted a structured search using Scopus, MEDLINE (PubMed), Science Direct, CINAHL, Web of Science, and Google Scholar. REVIEW METHODS: We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute, supported by the PAGER framework, and guided by the PRISMA-ScR Checklist. Inclusion criteria included full-text articles in English, quantitative and qualitative research related to competencies for undergraduate students or newly graduated nurses, competency assessment, and tool development from 1970 to 2022. We excluded articles related to specific nursing roles, specific contexts, Master's and Ph.D. curricula, hospital work environment competencies, and editorial. RESULTS: Out of 15,875 articles, we selected 43 studies, and data analysis with summative content analysis identified five themes named individualized care, professional nursing process, nursing administration, readiness, and professional development. CONCLUSION: Considering the dynamics of competencies and their change with time, experience, and setting, it is necessary to update, localize, and levelling of the proposed competencies based on the culture of each country. IMPACT: These competencies provide a guide for undergraduate nursing curriculum development and offer a framework for both clinical instruction and the evaluation of nursing students.

Evaluation and comparison of knowledge translation patterns in selected countries with Iran: A comparative study.

BACKGROUND: One of the main issues related to the inefficiency of the health system is the lack of sufficient communication between researchers and health policymakers regarding the exchange of the latest findings and the use of inappropriate evidence to manage cases. The knowledge translation removes this disconnect. MATERIALS AND METHODS: In this comparative study, to obtain appropriate data on the status of knowledge translation, refer to the databases of reputable centers and governments and the knowledge translation models were reviewed in the title of main articles, abstracts, guidelines, and reports of reputable international organizations between 2005 and 2020. The origin of the models was determined, then the countries with the largest number of models were selected and analyzed using Walt and Gilson's "Policy Triangle framework in four dimensions: context, content, process, and actors." RESULTS: All the three countries have politically, socially, and economically made knowledge translation one of their policy priorities. Iran's centralized health system is a major obstacle. The USA and Canada have clear strategies and coherent and practical infrastructures that implement the knowledge translation in the form of operational plans. In contrast, in Iran, it has been enough to establish the knowledge translation centers at the level of universities and knowledge translation websites. In Iran, the Ministry of Health and universities of medical sciences play a direct role, but in Canada, they also use knowledge broker to apply knowledge. CONCLUSION: Iran is building capacity in the field of knowledge translation. That the implementation of interventions with the cooperation of macro policymakers can strengthen it.

Senior nursing student's confidence in learnt competencies and perceptions of patient safety competency: a multisite cross-sectional study.

OBJECTIVE: Nursing students' attainment of patient safety (PS) competency has always been a global concern among health and educational organisations. Therefore, this study was conducted to determine senior nursing students' confidence of their PS competencies, and associated predictive factors. DESIGN: Cross-sectional study. SETTING: Four faculties from the nursing faculties of East Azerbaijan province. PARTICIPANTS: 253 senior nursing students in Iran. PRIMARY AND SECONDARY OUTCOME MEASURES: Using the modified version of the Health Professional Education Patient Safety Survey, data related to the level of confidence of nursing students in acquired competencies in seven sociocultural dimensions of PS in classroom learning and clinical settings were collected. In addition, the predictors of the patient's safety competencies were identified by linear regression statistics. RESULTS: Mean scores of all dimensions of PS competencies both in the classroom and in clinical settings were higher than 3.11 (out of 5). The nursing students were most confident in their learning of 'understanding human and environmental factors' in the classroom and the clinical setting. Nursing students displayed the least confidence in learning 'work in teams with other health professionals' in both the classroom and the clinical settings. Type of university, prior experience with PS competencies education, and coverage of PS competency issues in the curriculum predicted the students' perceived competency scores in the classroom (R2=0.53, p<0.001). Also, perceived competence in the clinical settings was predicted by the variables of reporting errors to personnel and peers and the type of university (R2=0.65, p<0.001). CONCLUSION: Study findings emphasise the role of learning environments and educational experiences of nursing students especially the clinical environment, clinical instructors and the hidden curriculum in improving safety competence. Nursing educators can use this information to revise and develop the undergraduate nursing curriculum, paying close attention to lesson plans and content in relation to teaching safety issues.

Barriers to the implementation of virtual care programmes for patients with chronic wounds: Qualitative empirical research.

AIM: To assess the barriers to the implementation of virtual care for patients with chronic wounds from wound therapists' perspective. DESIGN: A qualitative study. METHODS: The study was conducted in two consecutive phases: (1) literature review, (2) descriptive qualitative study. In the first phase, texts published in English until 2023 were identified using international databases. The entire text of the selected studies was evaluated independently by two reviewers. Data analysis was carried out using textual content analysis. In the second phase of the study, twelve participants from Iranian wound care clinics participated. Data were collected through focus group discussion and analysed using conventional content analysis. Integration of both phases was conducted in the data analysis stage. RESULTS: The most important barriers in providing virtual care to patients with chronic wounds were identified into five categories including lack of policymaking in virtual care, ethical challenges in virtual information and communication technology, social, economic and cultural issues, IT users' insufficient knowledge and limitation of virtual care scope of practice. CONCLUSION: The findings of the present study identified different barriers in the implementation of virtual care for patients with chronic wounds. In order to successfully develop a virtual care programme, it is necessary to adopt suitable policies regarding information and communication technology, provide the necessary legal frameworks, assign an adequate budget and consider the ethical, cultural, social and social issues. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Identifying barriers to developing a virtual care programme will help manage patients with chronic wounds at home. IMPACT: This study accurately identifies barriers to providing virtual care for patients with chronic wounds and helps plan to address these barriers and facilitate the development of a virtual care programme for these patients at home. REPORTING METHOD: This research has adhered to the SRQR reporting guideline. NO PATIENT OR PUBLIC CONTRIBUTION: The involvement of patients or the public in the design, or conduct, or reporting, or dissemination plans of this research was not suitable.

Identifying self-presentation components among nursing students with unsafe clinical practice: a qualitative study.

BACKGROUND: Maintaining patient safety is a practical standard that is a priority in nursing education. One of the main roles of clinical instructors is to evaluate students and identify if students exhibit unsafe clinical practice early to support their remediation. This study was conducted to identify self-presentation components among nursing students with unsafe clinical practice. METHODS: This qualitative study was conducted with 18 faculty members, nursing students, and supervisors of medical centers. Data collection was done through purposive sampling and semi-structured interviews. Data analysis was done using conventional qualitative content analysis using MAXQDA10 software. RESULTS: One main category labelled self-presentation emerged from the data along with three subcategories of defensive/protective behaviors, assertive behaviors, and aggressive behaviors. CONCLUSION: In various clinical situations, students use defensive, assertive, and aggressive tactics to maintain their professional identity and present a positive image of themselves when they make a mistake or predict that they will be evaluated on their performance. Therefore, it seems that the first vital step to preventing unsafe behaviors and reporting medical errors is to create appropriate structures for identification, learning, guidance, and evaluation based on progress and fostering a growth mindset among students and clinical educators.

Translation, cross-cultural adaptation and evaluation of the Iranian Persian version of student survey on writing nursing care plan.

AIM: The objective of this study was to validate the Iranian translation and cross-cultural adaptation of the Student Survey on Writing Nursing Care Plan (SSW-NCP). BACKGROUND: To provide supporting evidence about the nursing students' skill in planning and documenting nursing care plans based on nursing process, Salvador et al. developed the SSW-NCP to measure the extent to which nursing students are qualified in writing nursing care plans. However, an Iranian version of the SSW-NCP is presently not available. METHOD: The cross-cultural adaptation and linguistic translation of the SSW-NCP adhered to World Health Organization (WHO) guidelines. The reliability and validity process followed the COSMIN checklist. RESULTS: The survey was well translated to Persian language and culturally adapted through confirming the relevancy, appropriateness and logical representation of all aspects on nursing process by bilingual experts and pre-tested on Persian-speaking nursing students. The Cronbach's Alpha coefficient (α) and test-retest stability assessing affirmed the reliability, and convergent validity of the adapted survey was confirmed through comparison to Influencing Factors of Nursing Students' Clinical Judgment (IFNSCJ). The adaptation process of the SSW-NCP resulted in a conceptually equivalent translated version, which is comparable to the original version and is acceptably valid and reliable. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing the proficiency of nursing students as future nurses in writing nursing care plans can provide accurate professional information for better educational and practical level programming and management that can enhance nursing practice. PATIENT OR PUBLIC CONTRIBUTION: The target group of survey was nursing students who contributed and participated in the current study.

The impact of institutionalizing the nursing process based on TPSN model on the quality and quantity of nursing diagnoses.

AIM: Nursing diagnosis is the basis of applying nursing process and evidence-based care in nursing. This issue has been affected by the gap between theory-practice in nursing. The attending nursing teachers Project aims to create an organizational link between health care centres and nursing schools, reducing the gap between theory-practice and empowering nurses to apply nursing diagnosis. DESIGN: The present study was part of the second cycle of an action research study conducted in the cardiology ward in 2019-2020. METHODS: Interventions were performed in the form of Teacher, Patient, Student, Nurse Model to empower nurses in quantity and quality of nursing diagnosis. RESULTS: The results indicated a significant increase in the number of nursing diagnoses recorded. Moreover, the qualitative criteria based on PES components were found to have changed significantly after the interventions. Empowering nurses in the form of this Project could suggest that creating proper structures between nursing schools and health care centres, full-time presence of faculty members in hospitals, and enhancing their roles in these institutes will lead to improvements in educational as well as health care systems.

Stress management protocol for nurses working in the COVID-19 wards.

Purpose: Due to necessity of immediate support strategies for nurses during COVID-19 pandemic and lack of comprehensive and applied standard guidelines, the present study was conducted to develop stress management protocol for nurses working in COVID-19 wards with an approach based on the best scientific evidences. Methods: This descriptive methodological and validation study was conducted with evidence-based approach based on Stetler model in two hospitals of Iran in 2020. In order to identify the resources of stress and the solutions provided to deal with it to design the protocol, a comprehensive literature review was performed. After extracting evidence, they were ranked based on the levels of evidence and designed as a protocol. Quality appraisal of guideline was done using AGREEII instrument by an expert panel. The applicability of the protocol was assessed by a group of nurses through focus group discussion. Results: Out of 184 studies, 28 articles related to the topic were selected. According to the expert panel, in the AGREEII domains, Scope and Purpose (87.5%) and Applicability (70.5%) were the highest and the lowest scores respectively. The "Stress Management Protocol for Nurses Working in COVID-19 Wards" was designed in six sections, which was elaborated relative to each stress resources. Members of the focus group mostly considered the evidence-based recommendations feasible by making suggestions to some items. Conclusion: This study emphasized the important role of proper planning by health care system officials according to the designed protocol to manage stress and increase the self-efficacy of nurses in critical situations.

Clarification of ethical principle of the beneficence in nursing care: an integrative review.

BACKGROUND: Ethics-based nursing practice can transform health care practices. As the biggest human capital in the health care system, nurses are obliged to follow ethical principles in this field. One of these ethical principles; is beneficence, which is considered the core of nursing care. This study aimed to investigate clarification of the principle of beneficence in nursing care and its related challenges. METHODS: This integrative review was conducted using the Whittemore & Knafl method in 5 stages, including problem identification, searching the literature, evaluating primary sources, analyzing data, and presenting the results. Databases like SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, and Scopus were searched using the keywords; "beneficence", "ethic", "nursing" and "care" in English and Persian in the time range of 2010 to 10 February, 2023. After applying inclusion criteria and assessing the articles using Bowling's Quality Assessment Tool, finally, 16 papers were included from 984. RESULTS: After reviewing and evaluating the qualified articles, the findings were classified into four main categories: (1) nature, (2) applicability, (3) Relevant and influential factors, and (4) challenges related to the ethical principle of beneficence in nursing care. CONCLUSION: Based on the results of this review it seems that paying attention to clarification the principle of beneficence in nursing care can provide positive outcomes for patients to benefit from this principle and finally, it leads to increasing the well-being and health of patients, reducing their mortality rate, increasing satisfaction and maintaining the respect and human dignity of patients.

Human dignity of patients in nursing: A concept analysis.

To understand the concept of dignity in care and use it in practice, nurses need a clear understanding of the dignity of patients, which can help them improve quality of care and provide services of a higher standard. This study aims to clarify the concept of human dignity of patients in nursing. Walker and Avant's method (2011) was used for this concept analysis. Published literature from 2010 to 2020 was identified using national and international databases. The full text of the included articles was reviewed. The main dimensions and attributes include valuing the patient, respecting patients' privacy, autonomy, and confidentiality, having a positive mental image, having a sense of altruism, respecting human equality, observing patients' beliefs and rights, adequately educating patients, and paying attention to secondary caregivers. Nurses should consider the subjective and objective aspects of dignity in their daily care activities by cultivating a deeper understanding of the concept of dignity and its attributes. In this regard, nursing tutors, managers, and policymakers in healthcare should emphasise human dignity in nursing.

Development and psychometric testing of a clinical reasoning rubric based on the nursing process.

BACKGROUND: To facilitate the development of clinical reasoning skills in nursing students, educators must possess the ability to teach and evaluate them. This study aimed to describe the development and validation process of an analytic rubric of clinical reasoning skills based on the nursing process in undergraduate nursing students. METHODS: A seven-step method was used for rubric development. The initial validation process of the rubric of clinical reasoning was performed with the participation of key stakeholders to assess its face and content validity as well as applicability in the classroom and bedside. An initial pilot test was performed based on scenario-based examinations in the nursing process training course so that convergent validity was used to show how closely the new scale is related to the previous measure for evaluating students' tasks. Internal consistency and inter-rater correlation coefficient measurement for reliability were assessed. RESULTS: The rubric to assess clinical reasoning skills was developed into eight categories according to the five stages of the nursing process. Content and face validity of the rubric were done qualitatively and resulted in a clear, simple rubric relevant to clinical reasoning skills assessment. The convergent validity was confirmed by the conventional method. The reliability was approved by a high inter-rater correlation coefficient based on the assessment by two random independent raters. CONCLUSION: The clinical reasoning meta-rubric developed in this study meets the purpose of the study. This analytical rubric can be applied to guide teaching and learning as well as evaluate clinical reasoning based on the findings. Testing the applicability confirmed its validity and reliability for assessing clinical reasoning skills in nursing process education during the undergraduate nursing program.

A scoping review of virtual care in the health system: infrastructures, barriers, and facilitators.

For virtual care models to be able to improve the safety and quality of care, it is essential to identify the strengths and weaknesses of virtual care. In this Scoping review, literature published on virtual care was identified using international databases. The results of the included studies were summarized using a predefined taxonomy. In total, 20 studies were included in the present review. Extracting the findings of the articles showed four main topics, including "virtual care delivery models," "Video conference software platforms to provide virtual care," "virtual care delivery challenges," and "virtual care implementation facilitators." Therefore, with the development of emerging digital technologies, unique opportunities to provide virtual care and improve the provision of health services have been created in the health care system worldwide. Multifunctional video conference software platforms using specific models for each scope of care practice should be considered.

Iranian nursing applicants' perception of the nursing profession: A qualitative study.

AIM: This study was conducted to describe the perceptions of nursing applicants about their chosen profession and to explore the factors which influenced their understanding. DESIGN: A qualitative study with a conventional content analysis design. METHODS: Participants were 19 nursing applicants enrolling in nursing schools in three provinces of western Iran. Data were collected using semi-structured interviews. The content analysis of the interviews was done according to the steps proposed by Zhang and Wildemuth. RESULTS: The mean age of participants was 20 years (SD = 2.5), and 11 of them (57.9%) were females. Participants understood the nature of nursing work to encompass only a limited level of independence; they viewed it as a feminine profession, and as a job with spiritual rewards. The perceived content of nursing work included providing help and patient care in the hospital with a focus on performing procedural tasks. Applicants' perceptions of nurses' characteristics included strong physical endurance, communication skills, emotional strength and low intellectual skills. The professional status of nursing was perceived simultaneously as having high job security but limited potential for career advancement and professional growth. The factors reported to influence applicants' perceptions were related to the media, academic-career counsellors, personal factors, and family and friends.