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In this descriptive research, the application of disinfection and sterilization methods in three hospitals of Malayer was surveyed.The objectives of this study were determining disinfection and sterilization application methods in physical place ,surgical hand scrub, sugical site prepartion and preparing the metal, plastic and linen instruments.For collecting data, an observation checklist was used.The results showed that application of disinfection and sterilization methods evaluated in physical place 30.18%, surgical hand scrub 58.68%, Preparing surgical site 39.93%, metal instruments 77. 96%plastic instruments 40.97%and linen instruments 70.46% respectively. The results also indicated that application of disinfection and sterilization methods evaluated totally in hospital number one 54.75%, hospital number two 48.89%and in hospital number three 55.73%) respectively.Using T-test(a=0.05), the findings revealed that there was not a significant statistical difference among the surveyed hospitals.For further investigation ,it is suggested that the effect of training on the application of disinfection and sterilization methods in operating rooms to be studied.

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Background & Aim: Although cervical cancer has high prevalence, few qualitative studies have been carried out to reflect the perceptions of women on the influential factors that affect cervical cancer screening in Iran. The aim of this study was to explore a culturally-based experience of Karaji women regarding the barriers to and motivating factors for Pap smear screening test among Karadj women in 2007.

Methods & Materials: In this content analysis, eight focus groups were conducted using semi-structured guide questions (n=86).

Results: Findings revealed that factors such as medical advice, advice from friends and family, knowledge about symptoms and pap smear screening method, free and accessible services, and perceived threats would influence the women to undergo a Pap test. Major barriers were lack of knowledge about cervical cancer and its causative factors, inappropriate beliefs, fear from cancer diagnosis, and pain related to the procedure.  

Conclusion: Regarding the influencing factors on the rate of Pap smear screening test, it seems that designing appropriate educational programs in order to promote knowledge and correct health beliefs using mass media and local communications will result in referring more women to undergo Pap smear screening test.

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Background & Aim: Blended E-Learning is an educational method which has been used recently in higher education worldwide. So, it seems that it is crucial for the Iranian academic members to accept it as a new educational method. This study was conducted to investigate attitudes of the faculty of Nursing and Midwifery School at Tehran University of Medical Sciences toward blended E-learning.

Methods & Materials: In this cross-sectional study, all faculty members of Tehran University of Medical Science (n=60) were recruited to the study. Data were gathered using validated and reliable self-designed questionnaires. The collected data were analyzed using SPSS software.

Results: The response rate was 93.33% (n=56). Most of the respondents (85.7%) were female. The mean age was 44.88 (SD=5.6). The years of teaching ranged from 5-30 years (mean=16.75). The majority of the respondents (66%) had positive attitude toward blended e-learning thirty four per cent had completely positive attitude and none of them had negative attitudes. About 41% reported that they were eager to provide their course syllabuses according to this approach and 87.5% said that they were willing to attend the blended e-learning education workshops. There were no significant relationships between demographic variables and the attitudes. There was a significant relationship between willing to attend the workshops and positive attitude toward blended e-learning (P=0.012).

Conclusion: According to the positive attitude of the respondents toward blended e-learning, it is recommended that further studies take place in order to design and implement the approach in formal education in the school of Nursing and Midwifery of Tehran University of Medical Science.

 

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Background & Objective: Conflict occurs more frequently in health care organizations than the other settings due to complexity, frequent interaction between personnel, variations in specialties, roles, and hierarchy. Although conflict is not harmful and destructive in its nature and some degrees of conflict can help to improve health care services, high levels of conflict or its continuity may be harmful. Therefore, it is necessary to manage and control conflict. This study was carried out to assess the relationship between components of the conflict control model.

Methods & Materials: In this cross-sectional study, we developed a questionnaire that probed the relationships between components of conflict control model. A total of 290 nurses were recruited to the study using multi-stage sampling procedure from general educational hospitals in Tehran. Data were gathered using a questionnaire. Content validity of the questionnaire was examined by the expert panel. The internal consistency of the questionnaire was 0.81. Data were analyzed in the SPSS using descriptive statistics and spearman statistical test.

Results: The range of age was 22-53 (34.5±8.2). The majority of the respondents (88.6%) were female, 57.6% were married and 84.8% were staff nurses. From the majority of nurses&apos perspective, the meaning of conflict was discoordination, disagreement and disparity. However, some of the nurses meant it as violence, and difficult issues. About 41.4% of the respondents used negotiation, when they faced up to conflict. Other strategies were aggression, disagreement, avoidance, forgiveness, ignorance, and imposing own ideas to the others. From the respondents&apos point of view, factors that might cause or control the conflict were "mutual understanding and interaction" (32.4%), personality of nurses and their individual characteristics (26.6%), and conditions of the job (21.7%). Interaction was recognized to be the core strategy in conflict control model. Interaction had also significant associations with the five main variables in this study.

Conclusion: Lack of appropriate and efficient communication was an important factor in occurrence of conflict from the nurses&apos point of view. It is essential to improve nurses&apos and managers&apos communication channels by helping personnel to use effective communication skills. This measurement can be helpful for staff in understanding each other and reducing misconceptions. In addition, recognizing additional factors and variables that increases the occurrence of conflict can help to modify effective approaches.

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Background & Aim: Physiologic signs of anxiety usually change hemodynamic variables in patients undergoing heart catheterization. This study carried out to determine the effect of Orientation Program on hemodynamic variables in patient undergoing heart catheterization.

Methods & Materials: In this experimental study, 60 patients undergoing heart catheterization were randomly assigned to either the test or control group. Data were collected using the demographic checklist and a hemodynamic variables checklist for recording hemodynamic variables. The collected data were analyzed using the Chi-square, repeated measurement, and independent t test in the SPSS.

Results: According to the results, there were significant reductions in the systolic and diastolic blood pressures, pulse rate, respiratory rate and systolic left ventricle pressure in the intervention group after the intervention (P<0.05). There were no significant statistical difference between the two groups in systolic aorta pressure (P=0.173), diastolic aorta pressure (P=0.104), and end diastolic left ventricle pressure (P=0.886).

Conclusion: Orientation program had positive effects on most of the hemodynamic variables in the intervention group. The Orientation program is recommended to be used during invasive diagnostic procedures in order to prohibit anxiety&aposs physiologic complications.

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Background & Aim: Infants are very sensitive and special attention is needed to take care of their physical and mental health. Some studies showed that massage by parents can improve infants&apos sleep quality. The aim of this study was to compare the effect of massage with sunflower oil or sesame oil on infants&apos crying and sleep times.

Methods & Materials: This triple-blinded clinical trial was conducted on 120 infants who were 10-15 days old, full-term, single, exclusively breastfed and with no history of hospitalization. The infants were assigned randomly into three groups of sunflower oil massage, sesame oil massage and massage with no oils. Mothers administered 15 minutes of massage to their infants twice per day (morning and afternoon) for 28 days. Times of crying and sleep were measured by a parents&apos information form at baseline, and at the end of the first, second, third, and fourth weeks of the study. Data were analyzed using the repeated measures ANOVA.

Result: Within four weeks of following, decreasing pattern of infants crying time was not significant (P=0.18) however, the mean of crying time between the three groups was significant (P=0.007). The interaction effect of crying time and groups was not significant (P=0.18). Increasing pattern of infant sleep time was statistically significant in the fourth weeks of the following (P<0.001) however, the mean of sleep time between three groups was not significant (P<0.56). The interaction effect of sleeping time and groups was not significant (P<0.10).

Conclusion: Since there were not statistical significant differences between the infants&apos crying and sleep times between the three groups, and despite the fact that increasing pattern of infants sleep time is a normal pattern, it is not possible to have a proper conclusion.

 

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Background & Aim: Diet rich in fruits and vegetables is shown to be an important factor in prevention of chronic diseases. Adolescence is a critical period in adopting eating behaviors. Schools are important social environments in adolescents' lives and are important settings for interventions that aim to improve eating behaviors, including fruit and vegetable intake. This study aimed to assess effectiveness of a school-based intervention based on social cognitive theory on fruit and vegetable (F&V) intake of female adolescents in Tehran.

Methods & Materials: This experimental school based field trial was conducted on 296 female students aged 10-13 years old (157 in the intervention and 139 in the control groups). The intervention included classroom nutrition education on F&V and increasing availability of F&V through school buffet. Psychosocial characteristics of the students were assessed using a questionnaire and F&V intake were measured using 24-hr recall method, at baseline and after three months intervention. Descriptive and inferential statistics were used for data analysis.

Results: After the intervention, vegetable and fruit intake were 0.6 and 0.63 servings higher in the intervention group compared to the controls. Knowledge and self-efficacy scores were significantly higher in the intervention group compared to the control group. Home availability and observational learning scores were significantly decreased in the intervention group.

Conclusion: Through the intervention process, many valuable experiences were gained to be used in future interventions.

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Background & Aim: Caregivers of elderly with Alzheimer&aposs disease, particularly females, encounter challenges. Their different roles in giving care to the patients could result in physical and mental disorders. The self-efficacy seems to be an essential factor in empowering individuals coping with stressful situations and challenging tasks. The aim of this study was to investigate general self-efficacy among women as family caregivers of elderly with Alzheimer&aposs disease.

Methods & Materials: In this cross-sectional descriptive study, 112 women reffered to the Iran Alzheimer Association, Tehran were selected through convenience sampling method. The General Self-Efficacy Scale (GSE-10) was used to collect data. Data were entered into the SPSS-16 and then processed using descriptive statistics and independent t-test, ANOVA and Scheffe.

Results: The mean score of the general self-efficacy was 28.24±6.34 indicating that considerable percentage of the participants had unsatisfactory level of self-efficacy (65.2%). In addition, there were significant relationships between the women&aposs general self-efficacy with educational and economic statuses (P<0.05). There were no significant relationships between general self-efficacy with age, marital status, occupational status and duration of caring.

Conclusion: According to the findings, a considerable percentage of the participants had unsatisfactory level of self-efficacy. Therefore, it is essential to promote the caregivers self-efficacy in order to give them the ability of better adaptation with the life&aposs challenges. In particular, the self-efficacy promotive programs should be implemented among caregivers with lower educational and economic status.

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Background & Aim: Quality of nursing care is a major issue in nursing management. In the last year of nursing studies (internships) in Iran, nursing students are going to independently carry out responsibilities of graduated nurses. Patients&apos satisfaction is a main indicator for nursing care quality. This study was to determine the correlation between the quality of caring behaviors among internship students with the patients&apos satisfaction with nursing care quality.

Methods & Materials: In this cross-sectional study, 200 patients were selected using convenience sampling method from the hospitals affiliated to the Tehran University of Medical Sciences. Data were gathered using two questionnaires including: 1) quality of the caring behaviors and 2) patient satisfaction with nursing care quality questionnaire (PSNCQQ). Data were analyzed using statistical tests in the SPSS-13.

Results: Regarding quality of caring behaviors, the subscale scores of the knowledge and skills were good and patient education was low. The relationship between the nurses and patients, and nursing morality were in average level. Regarding the patient satisfaction, the highest level of satisfaction was related to nursing knowledge and skills and the lowest level was related to the patient education. Significant correlation was found between the total quality of the caring behaviors with the patients&apos satisfaction and their subscales (P<0.001).

Conclusion: Based on the findings, patients are more satisfied with the caring behaviors of the students who focus on the communication with patients, nursing ethics, and especially patient education during the care.

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Background & Aim: Nurses are informed from patients needs using effective mutual communications. This study aimed to explore the communication strategies between nurses and patient.

Methods & Materials: This study had a qualitative approach with the content analysis method. Participants included 23 nurses, patients and their families in medical and surgical wards of Imam Khomeini hospital of Tehran University of Medical Sciences. Data were collected using interviews and observations. The first and second interviews were conducted unstructured. The semi-structured interviews were then conducted according to the derived concepts from the first and second interviews. We used observation in order to gain a deeper understanding and verifying data from interviews. The observations focused on the interactions between nurses and patients during mutual communications.

Results: A final theme was emerged through the data analysis: adaptation of nurses&apos attitudes and performances. This theme derived from three main categories: caring according to acute needs of patients, creating a professional realm, and participation. The caring according to acute needs of patients included subcategories such as identifying patients&apos acute needs and nurses&apos communication behavior. Creating the professional realm implicated on the clarifying roles and maintaining of privacy communication. Participation was defined as the audience and content.

Conclusion: The findings showed that nurses, in response to the underlying conditions of nursing care, assimilate their attitudes and performances to be able to meet their professional needs and their patients&apos needs. In fact, the main character of nurse-patient communication is nurses&apos active role and patients&apos passive role.

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Production of knowledge in nursing and midwifery is essential to develop body of knowledge and improve quality of health care. In recent years, growth rate of scientific publication in Iran was significant as it could be considered as a scientific jihad. Although everyone is proud of this accomplishment, an important question remaining in nursing and midwifery is that how the pace of scientific publication in these fields is consistent with the pace of scientific publication in other scientific fields. This editorial tries to answer this question.

Through searching the Scopus for Iranian papers during 2008-2012 articles, I found 1063 articles in nursing and midwifery indexed in the Scopus. The number of articles was almost doubled per year within the last five years, excluding 2012. It implies coordination of scientific publication in nursing and midwifery with rapid growth of total scientific activities in other scientific fields in the country.

On the other hand, findings showed that only 29 articles (2.7%) published by Iranian nursing and midwifery researchers were review articles. While, in the UK, 13.5% of articles in nursing and midwifery was review articles. This finding along with the importance of review articles as credible scientific evidence for clinical decision-making and improving management procedures shows the necessity of writing review articles by senior researchers in Iran.

Comparing nationality of authors between Iranian articles with the UK articles showed that only 154 Iranian articles (about 10%) had a non-native author while, in the UK articles, about half of the articles had non-English collaborating authors. This finding reveals the necessity for further efforts to international studies.

Through searching the Pubmed and Web of Science for Iranian articles during 2008-2012, we found 390 and 174 Iranian articles, respectively. The lower rate of articles indexed in these two databases, comparing to the Scopus, indicates the necessity of designing and conducting high quality studies and submitting articles in journals indexed in these two databases. Writing articles which observe principles of scientific writing in proper English language can increase the probability of acceptance of articles in more valid journals. Indexing Iranian nursing and midwifery journals in authoritative indexes can increase the rate of scientific publication. It requires more attention of administrators and editors of Iranian scientific journals to this critical issue.

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  Background & Aim: Access to quality care is important in delivering health services. Patients' safety and satisfaction are indicators of quality of care evaluation. Competent nurses may deliver quality care . This study aimed to investigate the impact of using competent nurses on patients’ safety and satisfaction .

  Methods & Materials: In t his interventional study with non-equivalent control group, we selected 120 patients admitted to the emergency department of Imam Khomeini hospital in 2012 using convenience sampling method . Nursing care for the experimental group (n=40 ) was provided by nurses who had high competency scores and in the control group ( n=80), nursing care was provided by usual emergency department nurses . Data were collected using the patient satisfaction with nursing care quality (PSNCQ), and patient safety inventory. Data were analyzed in the SPSS v.16 using descriptive and inferential statistics . The significance level for all statistical tests was considered at P<0.05 .

  Results: Mean age of the intervention and control groups were 48.1 ( ±12.5) and 40.5 ( ±16.7), respectively (P<0.018). There was a significant difference between the two groups in terms of employment (P<0.009). The two groups were similar in terms of other variables such as gender, marital status, level of education, having health insurance , and the reasons for seeking admission . The results showed that there were significant differences between the two groups in patients’ safety and satisfaction with nursing care (P<0.001). Regression test was used to eliminate the effects of age and job satisfaction the results showed effect of intervention on the patients’ safety and satisfaction with nursing care .

  Conclusion: These findings indicated that using competent nurses in providing nursing care promotes patients’ safety and satisfaction with nursing care. Training nurses focusing on the level of competency is required in scheduling, staffing, and implementing nursing care to enhance safety, patient satisfaction , and quality of care.

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During several years of cooperation with scientific journals in Iran as referee, member of
editorial boards and editor in chief, I have faced with multiple non-ethical behaviors in
publication. These days, I am witnessed to submitting articles to two or more journal
simultaneously. Due to the growing pattern of this illegal action, this editorial will assess its
dimensions and consequences.
The Article 1, Chapter VI of the National guidelines on Ethics of Publishing Medical
Research has clearly stated: "If a manuscript is published or is being considered for publication
in print or electronically, re-publishing in or submitting to other journals is not allowed. This
statement is so important that the editors of the scientific journals have mentioned it in the
author guidelines of the journals. However, what make authors, especially beginners, to submit
their articles to more than one journal are perhaps requirements of the Institutes for defending a
thesis, annual and/or academic ranks promotions.
Republishing articles in scientific journals, especially in the same language, result in
spending cost and taking time of the scientific and executive teams of the Journals and has no
added value. The negative effects of this action are more highlighted when the role of scientific
journals in promoting health care quality through publishing new and valid scientific evidences
and limited spaces of the journals are noticed.

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  Background & Aim: Implantable Cardioverter Defibrillator is the most effective treatment for cardiac dysrhythmias. Having such life-saving device is the unique experience with important changes in the patient’ life. Understanding of these experiences can lead to success in treatment and follow- up.This study aimed to understand the experiences of patients with Implantable Cardioverter Defibrillator .

  Methods & Materials: A qualitative study using interpretative phenomenological approach was used. Thirteen participants were selected purposefully from heart clinics of Imam Khomeini hospital (Tehran). Each semi-structured interview was conducted in the period 30 to 45 minutes. Data analysis was performed using the six steps of van Manen . 

  Results: The main theme of ‘Start Living Again’ was extracted from patients with implantable defibrillator.This theme consist of ‘a sense of security’, ‘living with angel’, ‘attachment to the device’ and ‘attempt to maintain power’ .

  Conclusion: The participants with an Implantable Cardioverter Defibrillator have a life again with a sense of security and peace of mind. They try to keep this life-saving device.Therefore, health care providers, especially nurses can help this patients and their families by providing appropriate self care education .

  

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  Background & Aim: Patients often build their perceptions about the quality of health services on the care provided for them in hospitals by nurses. The present study aimed to assess the relationship between the job satisfaction and burnout among nurses with patients' satisfaction in Shiraz hospitals in 2012 .

  Methods & Materials: In this cross-sectional study, participants were selected through a multi-stage sampling . A total of 280 nurses and 560 patients were recruited to the study. Data were collected using the Spector's job satisfaction and the Maslach Burnout questionnaire s. The structural equation modeling and the confirmatory factor analysis were used to analyze the data in the SPSS and AMOS . 

  Results: There were significant relationships between the nurses' job satisfaction and burnout with the patients' satisfaction. Also , there was a negative and significant relationship between the job satisfaction with burnout among nurses (P<0.001) .

  Conclusion: T he factors affecting job satisfaction and burnout among nurses should be considered in promoting health care provided by nurses .

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  The results of several studies show the relationship between the ratio of nurses/patients with quality of care and patient outcomes (1-3). This means that less the ratio, more expected adverse outcomes for patients. These findings have led some institutions to establish mandated nurse-patient ratios (4). Establishing standard ratios could potentially improve patients' outcomes such as patients' safety (5, 6), decrease length of stay (3) and readmission rates (7), and improve recruitment and retention of nurses in the system and reduce their burnouts (8).

  According to Mohammad Aqajani, Deputy of the Iran Ministry of Health and Medical Education (MOHME), the country is facing a serious nursing shortage as about 80 thousand nurses serve 80 thousand beds in public hospitals, i.e. one nurse per hospital bed. However, the national standards suggest at least two nurses per bed. Now each year there are nine thousand graduates of nursing baccalaureate program thus, even if no nurse is retired or leave the system and all graduates could be recruited to work in the nursing field, still at least nine years will be needed to provide adequate nurses. In fact, a significant number of nurses leave their job due to retirement, early retirement, turnover and migration so achieving the standard of nursing staffing in a ten-year timeframe seems impossible. ...

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  Background & Aim: The ultimate goal of self-care behavior is patients' empowerment. There are limited studies on perspectives of patients with Parkinson's disease on self-care. This study aimed to explore for the process of self-care in patients with Parkinson’s disease during 2011 to 2013 .

  Methods & Materials: This exploratory qualitative study was carried out using grounded theory method. Data were collected via semi-structured in-depth interviews and field notes. We interviewed with 12 patients with Parkinson 's disease and four family caregivers . Participants were selected from two neurology clinics. Interviews were conducted at participants' homes or nursing homes. Data were analyzed using the Corbin and Strauss (2008) approach . 

  Results: Concepts of study were identified using a micro and general analysis. The 'fear of becoming crippled' was identified as a main concern. Strategies used in response to context included 'independency', 'spiritual care', 'informed self-care' and ‘seeking treatment’. 'Striving for taking independent self-care' was the most important process. Demographic, familial and social factors had important roles in self-care processes of patients with Parkinson's disease .

  Conclusion: The process of self-care in patients with Parkinson’s disease depends on the context and severity of the signs and symptoms. Health care providers especially nurses can support patients with Parkinson's disease in achieving maintain independence in self-care. In addition, attention to self-care behaviors with focus on person as self-care agent can considerably increase control and management of life .

  

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  Background & Aim: Premenopausal syndrome affects daily activities of many women. This study aimed to compare the effects of Vitexagnus and Flaxseed on premenstrual symptoms in women referred to health centers of Tabriz from October 2013 to September 2014 .

  Methods & Materials: This randomized controlled trial was conducted among 159 women suffered from premenstrual syndrome (PMS). The PMS was measured using the premenstrual assessment form (PAF) . The participants were allocated into three groups (n=53 per group) using block randomization. The group I received 25 grams/d Flaxseed powder and placebo of the Vitexagnus group II received 3.2-4.8 mg/d Vitexagnus tablets and placebo of the Flaxseed and the control group received both placeboes. The PAF was completed at baseline and 1 and 2 month after the intervention. Data were analyzed using the general linear model . 

  Results: The PMS improved significantly in both intervention groups during the first and the second month after the intervention. In the Vitexagnus and Flaxseed groups, the mean total PMS score were significantly lower than that in the control group at the first months after the intervention (adjusted mean difference: -3.3 (95% CI: -4.0 to -2.1) -4.3 (-5.5 to -3.0), respectively). In the second month after the intervention, the mean total PMS score was -5.8 (-7.0 to -4.7) in the Vitexagnus group and -6.6 (-8.1 to -5.7) in the Flaxseed group. There was no significant difference between the Vitexagnus and Flaxseed groups in terms of the PMS score .

  Conclusion: According to the results of this study, Flaxseed and Vitexagnus are effective in improving PMS .

  

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Background & Aim: In the view of the importance of evidence-based clinical practice in recent years, clinical disciplines such as nursing and midwifery have found a special need to systematic review and meta-analysis. However, systematic reviews and meta-analysises like any other studies may be poorly designed and implemented. Therefore, certain guidelines have been considered for reporting of such studies. The PRISMA statement is one of the most recent developments to improve the reporting quality of systematic reviews. The present study aimed to assess the reporting quality of systematic reviews and meta-analysises in the Iranian journals of Nursing and Midwifery, based on the PRISMA statement.

Methods & Materials: In this study, we conducted a comprehensive search on the Iranian journals of Nursing and Midwifery (Persian and English), indexed by the SID, Magiran, Irandoc, Iranmedex and Google Scholar databases during 2010 to 2015 years. The search was implemented using the key words such as systematic review and meta-analysis. Of the 44 articles found, after considering the inclusion criteria, 16 articles remained that were investigated using the PRISMA statement. Data were analyzed through the descriptive statistics and chi-square test using SPSS software version 16.

Results: The compliance rate of studies on the basis of PRISMA statement was estimated to be about 63%. The most common deficiency in the reporting quality was related to methodology estimated to be about 57%. The most visible deficiencies in the reporting of systematic reviews and meta-analysises were related to bias in the primary studies and bias in combining the results of these studies and lack of reporting these biases.

Conclusion: In this study, the reporting quality of systematic reviews and meta-analysises in the Iranian journals of nursing and midwifery was in the moderate level. The most probable reason for this may be the lack of enough attention of researchers to the PRISMA statement or not using this statement in reviewing articles. Therefore, it is recommended that an appropriate share of the educational programs on research methodology be allocated to systematic reviews and familiarizing with valid criteria such as PRISMA statement.

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Background & Aim: Caring viewpoint is a requisite of high quality nursing care. It must be operational through the nursing education program. The present study was conducted to compare the viewpoints of undergraduate nursing students at the first, fifth, and eighth semesters about the importance of caring behaviors during their nursing education.

Methods & Materials: The present study is a descriptive-analytical study. In this study, three groups of 40 nursing students (semester one, five and eight) were selected by random sampling from Shahid Beheshti University of Medical Sciences in 2014. Caring Behavior Inventory completed through self-report by the students, was used for collecting data. Data were analyzed by the descriptive and inferential statistics (with the significance level<0.05) using SPSS software (version 20).

Results: The mean scores based on Caring Behaviors Inventory in three groups were: semester 1: 148.2, semester five: 123.6, semester eight: 122.05. ANOVA showed statistically significant differences between the mean scores for three groups of students (P<0.001). Also, the scores of students’ viewpoints were different in all instrument domains included respectful deference to the other (P<0.001), assurance of human presence (P<0.001), positive connectedness (P<0.001), professional skills and knowledge (P=0.004), attentiveness to the other’s experience (P<0.001). Considering the lack of homogeneity in the groups in terms of age and sex, analysis of covariance was used to eliminate their confounding effects on main variable, and despite controlling for the confounding role of age and sex, differences were significant (P<0.001).

Conclusion: The viewpoints of the higher-year students about the importance of caring behaviors not only had not promoted but also it had decreased compared to the lower-year students. Considering the fact that caring viewpoint is the requisite of high quality nursing care that must be operational through nursing education programs, and due to the fading of emotional aspect of care, more emphasis on clinical instructors and nurses and using mentors in clinical practice are needed to practically and concretely show nursing students the emotional aspect of caring.