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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: 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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  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: 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: Evidence-based practice (EBP) education is essential in nursing education. Therefore, identifying factors influencing nurses' adoption of EBP is very important to perform optimum quality nursing interventions. The aim of present study was to determine the factors affecting the adoption of EBP based on Rogers' diffusion of innovations models in nurses.

Methods & Materials: This was a descriptive–analytical study. The research subjects were 130 nurses who worked in the hospitals affiliated to Tehran University of Medical Sciences in 2014. The research instruments were four questionnaires including demographic data; knowledge, attitude and the adoption of EBP; individual innovation and perceived attributes of EBP. Data were analyzed by descriptive and inferential statistics (Pearson correlation coefficient and path analysis) on SPSS v.19 and EQS.

Results: The study findings showed that age and the working experiences of nurses had significant inverse relationships with knowledge of EBP (r=-0.809, r=-0.805). There was a direct relationship between individual innovation and knowledge (r=0.776). In addition, knowledge not only had a significant direct relationship with the adoption of EBP but also had the greatest impact on the adoption of EBP compared to other variables of model (r=0.937). Perceived attributes of EBP had significant direct relationships with attitude and the adoption of EBP (r=0.898, r=0.888 respectively). Attitude toward EBP also had a direct and significant relationship with the adoption of EBP (r=0.869). The results of the path analysis indicated the model variables to have an optimal fit (P<0.001).

Conclusion: The results of this study identify the factors affecting the adoption of EBP. Determining these factors can be an effective step to more adopt it in clinical environments.

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Background & Aim: Pedestrians are the most vulnerable road users. In many cases, pedestrian-vehicle crashes are often the result of their risky road crossing behaviors. So, this qualitative study aimed to explore the reasons for risky road crossing behaviors among young people.

Methods & Materials: The current study was designed as a qualitative content analysis. Twelve males and females who had a car-accident were purposefully selected with maximum variation sampling. Data were collected and analyzed by semi-structured individual interviews.

Results: Conformity with the masses including “conformity with peers and conformity with the public space of society”, and anomie emerged as the most important social reasons for young pedestrian’s risky road crossing behaviors.

Conclusion: According to the results of this study, young pedestrian’s risky road crossing behaviors are affected by conformity with the masses and peers and as well as anomie so that risky behaviors have been commonplace and inevitable and a part of their lifestyle.

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The essence of nursing is protecting the public and nursing profession believes that receiving high quality and safe services, is the community’s right. During the past decades nursing has been considered as a significant profession with characteristics such as autonomy, professional commitment, expertise and responsiveness (1). The body of contemporary nursing is consisted of knowledge and skills, value system, academic education and professional socialization. Autonomy has been defined as nurse’s capacity for determining their action through independent choosing in all the fields of nursing practice and self-regulatory in nursing practice is necessary for achieving professional freedom of action (2).
Professional self-regulatory is the decision-making power for determining the inclusion criteria for the members to enter the profession and start their activity in that profession. It will determine who, with what specialties and how much knowledge and skills have the inclusion criteria for the profession (3). During the mid-19^th century, combination of knowledge and skills, emphasis on commitment to duty against seeking personal interests and also independence from external interferences in professional matters (autonomy) were mentioned as the most important features of self-regulated professions. From the early 20^th century, the motivations for professionalization got in line with professional self-regulatory (2). According to the Donabedian Model, a “social contract” exists between the society and the profession and under this contract the society will accept profession’s independence in exchange for their services and will give independence to that profession so that they could manage their own matters. In return for this privilege, the profession would act responsively to maintain the public interests (4).
Professional self-regulation would be granted to a profession as a privilege when the public would be able to receive the best possible services after that professions’ self-regulation (4). In fact, professional self-regulatory would guarantee the quality of services (2,5,6). During the past two decades, World Health Organization (WHO), to educate and employ competent and skilled nursing workforce, has recommended the governments to strengthen their professional self-regulatory frameworks. International Council of Nurses (ICN) in cooperation with the WHO has published a statement of their perspective of professional self-regulatory. This statement has mentioned that safe and high quality care, creating a monitoring system for licensing, professional policy making and applying the professional laws and rules could be reached by creating and improving the infrastructures of professional self-regulatory systems. ICN stated that professional self-regulatory is a method for applying discipline, stability and control over the profession and its performance (7, 8). National and international studies have shown that would improve educational and clinical standards which in turn would increase the power of the profession in managing its own matters.
Since professional self-regulatory would lead to the activity of qualified and competent individuals in a profession, it would increase people’s trust in professional services providers as capable and honest individuals and would provide the public interests (1). In professional self-regulatory, by firing professionally unqualified and uncommitted to the ethical codes individuals from the profession, the interests of the profession would be provided (4).
In the main, there are two ways a profession can be regulated: by the profession itself (professional self-regulatory) or directly by government. If the government would take the responsibility of managing the profession, the members of the profession would be forced to accept the laws and rules of the profession; while the approved laws by the self-regulated profession are flexible and would be accepted voluntarily (9).
Self-regulatory professions have two separate bodies for their activities: 1- the monitoring body and 2- the supporting body. The monitoring body maintains the interests of the profession through creating the inclusion criteria for the profession, licensing, certifying and disciplinary actions; while the supporting body would perform toward promoting the economic and professional benefits of the profession’s members. The goal of the supporting body is to develop the profession to assist the members and advance the profession; but the monitoring body will develop the profession to support the public interests. Most of the times, the public interests are not in conflict with the profession’s interest, but in case of such conflicts, professional self-regulatory should act toward achieving the public interest (10).
The condition of professional self-regulatory in Iranian nursing
Iranian nursing has had significant advancements during the recent years which development of academic education, formation of Iranian Nursing Organization (INO), establishment of Scientific Association of Iranian Nursing, establishment of research centers and publishing numerous research-scientific journals in different fields of nursing are some of them (11). However, the profession of nursing in Iran still has many shortcomings. Evaluating the laws of the Nursing Organization of the Islamic Republic of Iran, which is the greatest non-governmental nursing organization in Iran, although the goals of the organization are in line with the self-regulatory goals of the profession, but in most of the self-regulation requirements, no independent role has been defined for the organization, in a way that, in the definition of 6 duties out of 8 defined duties for the INO cooperation with or helping other organizations has been used and only in the third duty, “trying for improvement of the quality, skills and knowledge of nursing graduates” and the seventh duty, “determining standards for issuing, extending or cancelling membership cards”, the legislator has appointed an independent role for the organization. Maybe for this reason, and many other reasons that are not in the scope of this article, the INO has not considered professional self-regulation performances sufficiently. Other nursing associations in Iran, due to lack of regulatory mechanism and also the low number of members from the nursing profession, could not have an effective role in professional self-regulatory. In Iran, regulating the rules and managing the matters of nursing have always been a responsibility of the government (6,12). On the other hand, during the recent years, we have witnessed the establishment of the nursing deputy in the Ministry of Health and Medical Education (MOHME) which indicates the efforts for governmental management of this profession.
The authorities’ approach toward the nursing profession during the recent years for encountering various challenges is one of the examples of governmental management and lack of professional self-regulatory. For example, the nursing shortage could be mentioned which is a global problem. To resolve this problem, the MOHME has increased the capacity of training nursing students and the number of nursing schools. These measures have led to educating students at schools with no infrastructures and no competent educational board which is in conflict with the quality of services (public interests). In return, the next measure to compensate for the shortage in nursing workforce is educating practical nurses by the MOHME. Most of the experts have suggested this solution for the problem of shortage in nursing workforce, but it has been perceived as compulsory by the members of the profession and they disagree with it (13).
Considering that finding an appropriate self-regulatory mechanism for the profession requires the involvement of all the beneficiaries, especially the members of the profession, it is recommended that all of the active organizations in the field of nursing would start determining the characteristics and features of an appropriate self-regulatory organization for the nursing profession of Iran through conversations and then would make their best efforts for its establishment.
 

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Nurses are a major part of the health system workforce. Also, this group of healthcare workers has an important role in providing direct care to the patients. Therefore, nurses are considered an important pillar in any health system (1). However, during recent years, the shortage of nursing staff and high rate of job leaving have become a serious concern in many countries (2). To properly and timely deal with this challenge, it is necessary to have accurate information about all its relative factors such as number, age status, years of service, employment of nursing graduates, the number of active beds, their geographical distribution and the prediction of the number of nursing graduates in the next years.
While some studies have recently emphasized the issue that Iran, similar to many other countries, is facing nursing staff shortage (3), no clear picture is available of the current and future needs for nursing workforce due to the poor infrastructures of health information system in our country. Nejatian has stated that “there is still no accurate statistics on the shortage of nursing staff and the required nursing workforce” (4). However, some health ministry officials have suggested that there is a shortage of 200 thousand nursing staff (5).
Currently, if we accept that the country is facing the challenge of nursing shortage, it will be necessary to comprehensively consider all the factors related to supply and demand. One of the efforts made in recent years was to increase the capacity of nursing schools and establish new nursing schools for training a higher number of nurses. But some believe that a number of graduated nurses are not interested in working in the nursing field (6). For example, according to a governmental report, in 2013, about 1.6 million licensed nurses in the United States did not work in nursing (7). Therefore, further workforce training will not necessarily resolve the shortage of staff and it is necessary to consider other important factors influencing the recruitment and retention of nursing workforce. Among these factors, job satisfaction has a great role in the nurses’ intention to leave their profession (8) or decrease their working hours (9). Occupational burnout, social support (10) and the salaries and bonuses system (11) are other important factors that should be considered for resolving the problem of nursing shortage.
Considering the current situation, if the current shortage is caused by the lack of interest in working in nursing field or leaving nursing career, as Florence Nightingale proved that caring for the injured soldiers is less costly for the British army than letting them die and recruiting new soldiers (12), increasing the capacity for training nurses is not a cost-effective approach for resolving the problem of nursing shortage.
Despite what was mentioned above, the policy makers’ main strategy is still to increase the number of graduated nurses. In this regard, there are various experiences about developing and implementing nursing education programs in the world that could be an appropriate choice for resolving the problem of nursing staff shortage. One of these programs is “Accelerated Nursing Program” which has been developed for the graduates of non-nursing bachelor’s degree to be trained as a nurse. The first Accelerated Nursing Programs was developed in the early 1970s which gradually grew over the next years (13). These accelerated programs are based on the previous experiences of the students and provide an opportunity for individuals with a bachelor’s degree in other disciplines to enter the field of nursing (14). Accelerated nursing programs would provide the fastest way for issuing a nursing license to non-nursing graduates and last from 12 to 18 months (15). These programs are intense with courses offered full-time and there is no break between the courses; the students would pass the same hours of clinical internship as their counterparts in traditional nursing programs. Nursing staff value to the graduates of accelerated nursing programs because they would bring a great amount of skill and education to the workplace; they claim that these graduates are more mature and have stronger clinical skills and also are quick in learning the necessities of the job (14). Results of the study by Ouellet showed that accelerated programs would train qualified nurses who could be successfully prepared for clinical activities (16). Results of a retrospective study by Raines revealed that most graduates of accelerated nursing programs were working in nursing field and a great percentage of them were either studying or a higher degree graduates in nursing (15). Studies on the evaluation of accelerated nursing programs revealed positive results and outcomes in implementing these programs (17, 18).
Iran has high rates of unemployment among university graduates in many fields (19). Considering this important issue and our country’s priority in creating employment for them, it seems that applying the accelerated nursing programs rather than untested programs such as nurse training plan using the capacity of hospital, which has no clear structure, process and results, can be appropriate for the current situation in the country. Therefore, in order to find an answer to this challenge, it is recommended that nursing shortage area should be determined and these programs be launched in those areas. In such a framework, the required nursing staff can be provided in a shorter duration of time and with less cost.
 

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Background & Aim: Nurses play an important role in the health system and their turnover disrupts its performance. The aim of this study was to investigate intention to turnover and its relationship with healthy work environment among nursing staff.
Methods & Materials: This cross-sectional study was conducted on 295 nursing staff from Imam Khomeini hospital complex in Tehran in 2016. Nurses were selected by the stratified random sampling with a proportional allocation, and completed a demographic data form, the Healthy Work Environment questionnaire and the Anticipated Turnover Scale (ATS). Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson/Spearman correlation coefficient and multiple linear regression tests using the SPSS software version 20.
Results: The mean score for the intention to turnover was 36.21 (SD=4.38) ranged from 12 to 60. “Authentic leadership” and “skilled communication” domains obtained the highest (9.60±3) and lowest (8.97±2.74) scores respectively. There was poor correlation between the meaningful recognition domain and the anticipated turnover score (r=-0.135, P=0.024). In addition, the anticipated turnover score was significantly higher in male nurses than in female nurses (P=0.023).
Conclusion: Although there was no relationship between anticipated turnover and healthy work environment in this study, considering the importance of nurses’ recruitment and retention, there is a need to investigate the reasons for turnover, including characteristics of work environment, and take necessary measures.
 
 

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Health (hygienic) literacy is a cognitive skill and an important and effective issue in the healthcare system that was first proposed in 1974 in an educational panel about health education. Since then, this concept has been discussed by the researchers in various fields of literacy and health, and many definitions have been presented for it. Usually, health literacy is defined as a wide range of knowledge and skills in accessing, appraising, understanding and applying health information (1).
The importance of health literacy impact on the health outcomes of the patients has been well recognized and it has an important role in individual’s decision-making regarding their health needs (2). Health literacy as a social and cognitive skill has various aspects including accessing, appraising, understanding and applying. The ability to understand the educational content, as one of its aspects, has a significant importance in the patients (3-6). In recent years, health literacy has been recognized as an important skill that patients require for making an appropriate health decisions in difficult situations they encounter. Improving patients’ health literacy would cause outcomes such as increasing the patients’ potential to make informed decisions, decreasing health-threatening risks, increasing prevention of the diseases, improving patient safety, and improving quality of life and patient care (7-9).
To educate people, usually their general literacy would be considered, not their health literacy; while there is a significant difference between general literacy and health literacy. General literacy means having the ability to read and write and having basic skills. In contrast, health literacy is defined as a cognitive and social skill determining the individuals’ ability to access, understand, and apply information in order to promote health (10). Studies have shown that limited health literacy is associated with various complications in different aspects of health including lack of access to appropriate health services, less willingness to follow up treatments, less compliance with medication, increased number of visits to the emergency ward, increased duration of hospitalization, and increased mortality rate, and it has a significant effect on using healthcare services (3-6).
Furthermore, the negative economic effect of low health literacy on the patients and healthcare system could not be ignored. These issues would indicate the need for paying more attention to individuals’ health literacy.
According to a study conducted by Montazeri et al in Iran, it has been revealed that half of the Iranian population has a limited health literacy and this limitation is more common in the vulnerable groups such as the elderly, housewives, unemployed people and those with lower education levels; this would put them at more health risks (2). Also, results of various studies have shown that some health information is not appropriate for the audience and would not address their needs; whereas the effect of limited health literacy could be improved using appropriate health information. So, the challenging issue regarding these individuals is how to train them (regarding understanding health information); there are various strategies for resolving this issue such as limiting the information provided at each patient’s visit, avoiding technical terms, speaking slowly, finding educational content tailored to individuals’ ability to read, using pictures for explaining important concepts, encouraging people for asking more questions and assessing individuals’ understanding of the education provided using teach back and show me methods (11).
In this regard, in 2011, Centers for Disease Control and Prevention (CDC) designed the Health Literacy Index as a tool for providing appropriate educational content based on people’s health literacy. This comprehensive checklist comprises 63 items organized into 10 criteria; its criteria and items are shown in table 1. According to this checklist and based on its ten criteria, the educational process (content, procedure and evidence) would completely be evaluated to limit the effect of health literacy on the understanding of information provided to individuals (12).
 
Table 1. The criteria of the health literacy index

Criterion	Items	Evaluated subject
Plain language	8	Writing style (short and easily readable sentences) Terms (avoiding technical terms) numbers and data (ease in understanding the content)
Clear purpose	8	Precision, summaries and reviews Number of key points purpose of material (purposiveness) Using visual elements in the educational content
Supporting Graphic	6	Explanatory labels Graphic and images of the educational content in relation with the text to help the understanding of the abstract concepts
User involvement	7	Interactive strategies (the level of attention received by the audience and the extent of their active participation through the column of counseling, answer and question, games or competitions and storytelling narrations) Audience response
Skill-based learning	3	Focus on behavioral skills (modifying a health behavior and providing examples related to this modification)
Audience appropriateness	6	Match between audience and material (cultural and social appropriateness to the audience in terms of their experiences, values and beliefs) Audience identified
Instructions	6	User instructions Instructions for using the educational content regarding its technicality, applicability and comprehensiveness
Development details	3	Authors’ contact information Recent review of the studies
Evaluation methods	13	Process, formative and outcome evaluations
Strength of evidence	3	Evaluation findings

 
Andrade and colleagues studied the impact of using this index in providing educational materials for falling in the elderly. The results of this study showed that all the educational information is not suitable for audience and does not meet their needs. However, with the help of Health Literacy Index, it is possible to provide educational materials that are fit for the level of health literacy of elderly (7).
Due to the Low health literacy is very common particularly in the elders, it is crucial to provide educational materials that are consistent with the level of health literacy in target groups. Regarding the small number of studies have been conducted on the impacts of using health literacy index, It is imperative that the researchers in the related fields provide empirical evidence for its efficiency and effectiveness.
 
 
 

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Background & Aim: Cultural competence is one of the main components of health care. Attention to cultural competence is essential to reduce healthcare inequalities and identify potential for improving healthcare delivery. The aim of this study was to investigate cultural competence and its related factors in health care providers working in comprehensive health centers affiliated with Tehran University of Medical Sciences (TUMS).
Methods & Materials: In this descriptive, cross-sectional study, 250 health care providers working in health centers affiliated with TUMS were selected using the convenience sampling method in 2020. The demographic characteristics form and the cultural competence scale for health workers (CCSN) were used to collect the data. Data were analyzed using descriptive and inferential statistical tests (t-test and ANOVA) through the SPSS software version 16 at a significance level of 0.05.
Results: The mean total score of cultural competence in health care providers was 162.66±28.41 (range: 33-231). According to the findings, the mean score of cultural competence for all dimensions was desirable. The mean score of cultural competence had a statistically significant relationship with intra-ethnic marriage (P>0.005) and work experience (P=0.012) while no statistically significant difference was observed with other demographic variables.
Conclusion: The study results showed that cultural competence in health care providers was at the desirable level. These results may be useful for managers and planners in the development and management of human resources and quality assurance of health services delivery.