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Background & Aim: Increasing understanding of death anxiety among different cultures and patient populations is critical to provide quality patient care. Researchers who investigate death anxiety, are looking for a reliable and valid instrument compatible with culture in order to achieve this goal. The aim of the study was to evaluate the psychometric properties of the Templer’s Death Anxiety Scale-Extended (TDAS-E) among a sample of chemical veterans of Iran–Iraq warfare.

Methods & Materials: In this methodological study, 300 veterans completed the Persian version of the 51-item TDAS-E in 2015. The face, content and construct validity (convergent and discriminant validity) of the TDAS-E were assessed. Also, its reliability was measured using Cronbach’s alpha coefficient, construct reliability and intra correlation coefficient.

Results: Results of exploratory and confirmatory factor analyses extracted four stable distinct factors including fear of the hereafter, fear of facing death, fear of the shortness of life, fear of dying following an incident and mishap. The fitness of the four-factor model of the Templer’s death anxiety construct was approved based on standard indices (c²/df=2.832, GFI=.915, AGFI=.873, PCFI=.657, PNFI=.612, RMSEA=.078). Discriminant and convergent validity of all factors were acceptable. Also, scale reliability was confirmed using Cronbach’s alpha coefficient (0.88), construct reliability (higher than 0.70) and intra correlation coefficient (0.87).

Conclusion: The results of the current study revealed that the four-factor construct of TDAS-E had suitable validity and reliability among Iranian chemical warfare veterans. Given the proper psychometric properties, this scale can be used in future research to evaluate death anxiety in this population.

Background & Aim: Increasing understanding of death anxiety among different cultures and illness populations is critical to provide quality patient care. Researchers who investigate death anxiety, are looking for a reliable and valid instrument compatible with culture in order to achieve this goal. The aim of the study was to evaluate the psychometric properties of the Templer’s Death Anxiety Scale-Extended (TDAS-E) among a sample of chemical veterans of Iran–Iraq warfare.

Methods & Materials: In this methodological study, 300 veterans completed the Persian version of the 51-item TDAS-E in 2015. The face, content and construct validity (convergent and discriminant validity) of the TDAS-E were assessed. Also, its reliability was measured using Cronbach’s alpha coefficient, construct reliability and intra correlation coefficient.

Results: Results of exploratory and confirmatory factor analyses extracted four stable distinct factors including fear of the hereafter, fear of facing death, fear of the shortness of life, fear of dying following an incident and mishap. The fitness of the four-factor model of the Templer’s death anxiety construct was approved based on standard indices (c²/df=2.832, GFI=.915, AGFI=.873, PCFI=.657, PNFI=.612, RMSEA=.078). Discriminant and convergent validity of all factors were acceptable. Also, scale reliability was confirmed using Cronbach’s alpha coefficient (0.88), construct reliability (higher than 0.70) and intra correlation coefficient (0.87).

Conclusion: The results of the current study revealed that the four-factor construct of TDAS-E had suitable validity and reliability among Iranian chemical warfare veterans. Given the proper psychometric properties, this scale can be used in future research to evaluate death anxiety in this population.

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Background & Aim: Job satisfaction is of the most fundamental components of mental health in every profession and one of the most important factors in career success. Therefore, identifying factors affecting job satisfaction is necessary. One of these factors is employee empowerment. This study aimed to determine the relationship between structural and psychological empowerment and job satisfaction among nurses.

Methods & Materials: In this cross-sectional correlational study, the study population was all nurses working in public hospitals in Mashhad (N=4300) in 2015. The samples consisted of 340 nurses, were selected by multistage cluster sampling method. Participants were assessed by the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II), Psychological Empowerment Questionnaire and Job Description Index (JDI). In order to analyze the data, Pearson’s correlation coefficient and regression analysis were used through SPSS software v.19, and for validation stage, the confirmatory factor analysis were applied using AMOS software v.21.

Results: Results showed that there is a significant multiple correlation between structural empowerment, psychological empowerment and job satisfaction (P<0.001, R²=0.286). Of the eight variables entered into the regression analysis using stepwise technique, three variables including meaningfulness (β=0.30, P<0.001), impact (β=0.25, P<0.001) and access to support (β=0.13, P<0.001) altogether predict 28.6% of the variance in job satisfaction.

Conclusion: The results show the importance of psychological empowerment, the sense of meaningfulness, impact, and access to support as strong predictors of job satisfaction. So, providing the conditions needed for the empowerment of nurses is recommended to increase their job satisfaction and subsequently their efficiency and life satisfaction.

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Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures.

Background & Aim: Cesarean rate has had a rising trend in Iran during the last two decades. Natural childbirth promotion plan has been implemented in the form of health sector evolution plan (HSEP) in order to increase natural childbirth. Present study aimed to evaluate the effect of health sector evolution plan on cesarean rate and the average costs paid by mothers hospitalized in Kurdistan province.

Methods & Materials: This descriptive study was conducted as longitudinal and retrospective study. Cesarean rate in all hospitals of Kurdistan province was assessed in 2013 and one year after the implementation of HSEP. Furthermore, data related to the percentage of out of pocket expenditures by pregnant mothers in one of the hospitals of Kurdistan University of Medical Sciences, which was randomly selected, was also studied. Data were analyzed using SPSS v.20.

Results: There was a 14.02% reduction in the rate of cesarean in Kurdistan province one year after the implementation of HSEP compared to its basal rate in 2013 (P<0.001). The average out of pocket expenditures was 16.05% before the implementation of HSEP. This rate was reduced to 4.30% and 2.5% respectively after the implementation of first and third phases of HSEP.

Conclusion: Natural childbirth promotion plan has reached its predetermined goal, which was a 10% decrease in cesarean rate one year after the implementation of HSEP compared to its rate in 2013. In addition, there was a significant reduction in the percentage of out of pocket expenditures by mothers.

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Background & Aim: Fertility is the most important factors affecting population fluctuations. Reproductive behaviors of a community can be studied through different methods. One of the methods is the evaluation of the interval between marriage and the birth of the first child. The aim of this study was to investigate the factors influencing the interval between marriage and first birth using the Cox regression model.

Methods & Materials: In this study, 1230 first-time mothers referred to urban and rural health centers of the city of Bandar Abbas were selected and studied in 2012-2013. The Cox regression model (proportional hazard) was performed to investigate the interval between marriage and first birth and the factors influencing this interval. Descriptive analysis of data was performed using SPSS software version 22 and data modeling was performed by R software version 3.2.1.

Results: In this study, the mean interval between marriage and first birth was 27.63 (±24.35) months. Based on the Cox model, mother’s age at marriage with HR(Hazard-Ratio)=1.13 (1.01–1.25) and place of residence with HR=1.28 (1.12–1.46) had significant effects on the interval between marriage and first birth.

Conclusion: The results of the current study compared to previous studies show that the interval between marriage and first birth has decreased, and some changes are observed in the factors influencing this interval.

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Background & Aim: Ultraviolet (UV) keratitis is an inflammation of the corneal epithelium and conjunctiva caused by UV radiation and is associated with the symptoms including severe eye pain, decreased visual acuity, severe tearing and red eye. The use of primary patching in the patients is doubtful. Therefore, this study aimed to determine the effect of eye patching on the improvement of clinical symptoms in patients with UV keratitis.

Methods & Materials: In this clinical trial, 120 patients with UV keratitis referred to the emergency department of Khatam Al Anbia center affiliated to Mashhad University of medical sciences, were randomly assigned into two groups (each group contains 60 patients) with patching and non-patching in 2015 (IRCT2015092124124N1). In one group, both eyes were patched and the other group was not patched. All other care was similar in both groups. Clinical symptoms were checked and compared between two groups before and after 12 hours. Data were analyzed by descriptive statistics, independent t-test, paired t-test, Chi-square and Wilcoxon using SPSS software version 23. A p-value less than 0.05 was considered significant.

Results: The results showed that redness (P<0.001) and tearing (P<0.001) were more improved in the non-patched group but there was no statistically significant difference between the two groups in visual acuity (P>0.05).

Conclusion: Eye patch does not have effect on the improvement of clinical symptoms such as tearing and redness, and these symptoms are more improved without patching.

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Background & Aim: Restless leg syndrome (RLS) is one of the common complications in patients under treatment with hemodialysis. Progressive muscle relaxation is a method which has been designed for reducing patients’ stress, pain and anxiety. The present study aimed to determine the effect of progressive muscle relaxation on the severity of RLS in hemodialysis patients.

Methods & Materials: In this quasi-experimental study (IRCT2015102824769N1), 74 hemodialysis patients were selected by convenience sampling method and divided into intervention and control groups based on records numbers. The intervention group was trained in progressive muscle relaxation technique in two half-hour sessions and they were asked to practice it twice a day for one month. RLS severity was measured using the standardized RLS questionnaire. Data were analyzed by descriptive and inferential statistical tests (independent and paired t-test, analysis of co-variance) using SPSS software version 23.

Results: There was no significant difference in the distribution of variables in the intervention and control group before intervention (P>0.05). Before the intervention, RLS severity score was 28.24±7.33 in the intervention group and 25.57±9.85 in the control group (P=0.189). After the intervention, the score for the intervention group was reduced to 10.67±5.66 (P>0.001) while there was no significant change in the control group after the intervention (26.16±9.69). Also, a significant difference was observed between the two groups in the mean score of RLS severity after removing the effect of RLS severity on pretest (P>0.0001).

Conclusion: The use of progressive muscle relaxation technique reduces RLS severity in patients under treatment with hemodialysis. Therefore, this technique is recommended to be used as one of the non-pharmacological methods to improve RLS in these patients.

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Background & Aim: Nowadays in the NICU, family-centered care is the foundation of care, and communication is at the core of family-centered care. This study aimed to compare the perceptions of nurse-mother communication between neonatal intensive care nurses and mothers of hospitalized neonates.

Methods & Materials: This is a cross-sectional study. 70 mothers of hospitalized newborns and 70 nurses working in the NICU ward of university hospitals and social security hospitals in Yazd, were selected by convenience sampling in 2015. The study questionnaires included the mothers’ and nurses’ demographic characteristics questionnaire, “nurses’ perceptions of nurse-mother communication” questionnaire and “mothers’ perceptions of nurse-mother communication” questionnaire. The data were analyzed using descriptive statistical tests and independent t-test on SPSS software version 19.

Results: The mean age for nurses was 33.36±6.99 years and for mothers was 29.77±6.40 years. Mean score and standard deviation of perception of “nurse-mother communication” for nurses was 69±6.92 and for mothers was 57.66±11.99. Independent t-test showed statistically significant differences between mean scores (P<0.001).

Conclusion: Due to difference in nurses’ and mothers’ perceptions of nurse-mother communication, it seems necessary that interventions be designed and implemented to familiarize nurses with mothers’ expectations of quality and way of nurse-mother communication.

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Background & Aim: The challenges that patients face after intestinal ostomy surgery can lead to impaired adjustment and self-efficacy. There is evidence suggesting these variables have reciprocal effects on each other. Therefore, the present study aimed to determine the correlation between adjustment and self-efficacy in patients with intestinal ostomy.

Methods & Materials: This descriptive correlational study was conducted on 76 patients with intestinal ostomy hospitalized in hospitals affiliated to Mashhad University of Medical Sciences using convenience sampling method in 2015. Research instruments were comprised of the demographic and disease information questionnaire, the Stoma Self-efficacy Scale, and the Ostomy Adjustment Inventory. The SPSS software v.19 using descriptive and inferential statistics was used to analyze the data.

Results: The results of Pearson correlation test showed a significant and positive linear correlation between the mean score of self-efficacy and the dimensions of adjustment: acceptance (P<0.001, r=0.518), anxious preoccupation (P<0.001, r=0.438), social engagement (p<0.001, r=0.488), and anger (P<0.001, r=0.384). Moreover, multiple regression analysis indicated that the dimensions of social engagement and acceptance have a significant and positive linear correlation with self-efficacy in patients with intestinal ostomy.

Conclusion: The results revealed that the dimensions of social engagement and acceptance of ostomy were the most important factors in relation to self-efficacy. Therefore, in order to care for patients with intestinal ostomy especially in the early months after surgery, it was recommended to help patients adjust themselves to the physical appearance of ostomy and maintain their social engagement, by designing and implementing appropriate educational and supportive interventions.

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Background & Aim: Post-traumatic stress disorder is one of the psychiatric disorders and exposure to trauma is a key factor in its development. This disorder affects important aspects of a person’s life such as professional quality of life. The aim of this study is to determine the relationship between post-traumatic stress symptoms and professional quality of life among psychiatric nurses.

Methods & Materials: In this descriptive analytical study, 160 nurses in psychiatric wards affiliated to Kerman University of Medical Sciences, were selected using census sampling in 2013. Data were collected using questionnaires including professional and demographic characteristics, the Weathers’ PTSD checklist (PCL-C) and Hudnall Stamm’s Professional Quality of Life (PQOL). Data were analyzed by the SPSS software v.20 using the Pearson correlation coefficient, independent t-test, one-way ANOVA and linear regression.

Results: There was a significant correlation between PTSD score and professional quality of life scores in psychiatric nurses (r=0.32, P<0.001). Also, PTSD was positively correlated with burnout (r=0.36, P<0.001) and secondary traumatic stress (r=0.61, P<0.001), and conversely correlated with compassion satisfaction (r=-0.29, P<0.001). After removing the effects of age, work experience, previous experience of traumatic events, the correlation between two main research variables was significant as well (P<0.001).

Conclusion: Post-traumatic stress has a correlation with professional quality of life in psychiatric nurses. Therefore, factors related to PTSD are suggested to be identified and prevented.

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Background & Aim: Concerns about death may negatively affect health-related quality of life. However, little is known about the relationship between death anxiety and quality of life in life-threatening illnesses especially in hemodialysis patients. This research aimed to determine the relationship between death anxiety and quality of life in hemodialysis patients.

Methods & Materials: In this descriptive correlational study, 200 hemodialysis patients were selected via stratified random sampling from hospitals affiliated with Zanjan University of Medical Sciences from April to May 2016. Data collection instruments included a demographic questionnaire, the Templer Death Anxiety Scale and the McGill Quality of Life questionnaire. Data analysis was performed by descriptive statistics, correlation test and linear regression model using SPSS v.22.

Results: The average score of death anxiety and quality of life were respectively 46.54±10.85 and 82.55±19.01. There was not a significant relationship between death anxiety and quality of life (P>0.05, r=0.044). In the regression analysis, gender was the only significant predictor for death anxiety. This model explained 11.3% of the variance of death anxiety. Moreover, the results of regression model indicated that social support and religious beliefs were only significant predictors for quality of life in hemodialysis patients, and 17.2% of its variance was explained by this model.

Conclusion: In the current study, no significant relationship was observed between death anxiety and quality of life in hemodialysis patients. Therefore, it is suggested that further research should be conducted in this area.

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Background & Aim: Moral courage is a virtue that helps people overcome their fears and limitations and make the right decision and take the right action when encountering any situations. Due to the nature of their profession, nurses daily face many moral issues, and their correct decisions and performances require moral courage. The aim of this study was to determine the moral courage of nurses employed in hospitals affiliated to Shahid Beheshti University of Medical Sciences.

Methods & Materials: This descriptive, cross-sectional study was conducted in 2015. The research population was composed of nurses employed in hospitals affiliated to Shahid Beheshti University of Medical Sciences. The study samples were 155 people. The moral courage questionnaire of Sekerka and colleagues (2009) was used to collect the data. Data were analyzed using descriptive statistics, Pearson correlation coefficient, independent t-test and one-way ANOVA on the SPSS software v.22.

Results: The mean score of moral courage of nurses was 63.72±5.91 (15-75). The highest and lowest mean scores were for the dimensions of moral agency (13.73±1.22) and endures threats (11.40±1.80) respectively. The work experiences of nurses had a significant positive relationship with moral courage and beyond compliance (P<0.05).

Conclusion: In this study, moral courage of nurses was at a desirable level. According to the findings, while taking steps to strengthen this virtue, we could strengthen nurses’ moral reasoning to make right decisions and perform ethical practices. In addition, strengthening nurses’ moral courage and reasoning can help them play their role as the patient advocate.

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Background & Aim: Diabetes is a chronic disease that needs lifelong special self-care behaviors. Adolescents with type 1 diabetes need self-care education for the control of diabetes and the prevention of its complications. Therefore, this study aimed to determine the impact of self-care education on the control of diabetes complications, medications and HbA1C in adolescents with type 1 diabetes.

Methods & Materials: This study is a non-randomized clinical trial (IRCT2015051322258N1) carried out on seventy four adolescents aged 12-18 years old with type 1 diabetes referred to the Iran diabetes association. They were selected using convenience sampling method and allocated into two groups (intervention: 34 people, control: 40 people). An educational intervention was performed in five sessions for the intervention group. After education, the patients were trained and followed up using mobile services for three months. The instruments consisted of a demographic characteristics form and a section of the self-care behaviors scale evaluating medications and the control of complications. Data were analyzed by the SPSS software v.18.

Results: Before the education, no significant difference was observed in the mean scores of medications and control of complications and level of HbA1C between the two groups of intervention and control (P>0.05). After the education, there was a significant difference between two groups in the mean scores of medications and control of complications and level of HbA1C (P<0.05).

Conclusion: Self-care education and the follow up after educational sessions can lead to the reduction in diabetes complications and HbA1C level among adolescents with type 1 diabetes.

Background & Aim: Diabetes is a chronic disease that needs lifelong special self-care behaviors. Adolescents with type 1 diabetes need self-care education for the control of diabetes and the prevention of its complications. Therefore, this study aimed to determine the impact of self-care education on the control of diabetes complications, medications and HbA1C in adolescents with type 1 diabetes.

Methods & Materials: This study is a non-randomized clinical trial (IRCT2015051322258N1) carried out on seventy four adolescents aged 12-18 years old with type 1 diabetes referred to the Iran diabetes association. They were selected using convenience sampling method and allocated into two groups (intervention: 34 people, control: 40 people). An educational intervention was performed in five sessions for the intervention group. After education, the patients were trained and followed up using mobile services for three months. The instruments consisted of a demographic characteristics form and a section of the self-care behaviors scale evaluating medications and the control of complications. Data were analyzed by the SPSS software v.18.

Results: Before the education, no significant difference was observed in the mean scores of medications and control of complications and level of HbA1C between the two groups of intervention and control (P>0.05). After the education, there was a significant difference between two groups in the mean scores of medications and control of complications and level of HbA1C (P<0.05).

Conclusion: Self-care education and the follow up after educational sessions can lead to the reduction in diabetes complications and HbA1C level among adolescents with type 1 diabetes.

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Background & Aim: Although compassionate care is recognized as a core component of nursing care, there is not still a precise definition about this complex and challenging concept. This study aimed to analyze the concept of compassionate care in nursing using a hybrid model.

Methods & Materials: A three-phase hybrid model (theoretical, field work, and final analysis) was used in this study. In the theoretical phase, the concept of compassionate care was searched in main databases from 2000 to 2016. In the field work phase, in-depth, face to face interviews were done with 11 nurses. The content analysis method was used to analyze the data. Final analysis was done in the last phase.

Results: The results of the final analysis showed that compassionate care is a process in which nurses interactively communicate with patients, try to explore patients’ concerns by putting themselves in their positions and understanding their situations, and do their utmost to eliminate these concerns.

Conclusion: According to this concept analysis, the constructive interaction between nurse and patient is one of the most important features of compassionate care that has not been mentioned in previous definitions. Also in this study, the nurses emphasized that they did their best to resolve the patients’ concerns. Therefore, the current study could be the basis for future studies in the area of compassionate care.

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Background & Aim: Unhealthy snacks consumption has an important role in childhood obesity. The aim of this study was to evaluate the effect of an educational intervention for mothers on the consumption of healthy snacks in children aged 1-5 years using social cognitive theory.

Methods & Materials: This quasi-experimental study was (IRCT2013062912456N2) conducted on 126 mothers who had children 1-5 years old in 2013. The mothers were selected from Hamadan health centers and divided into two groups of intervention and control. The intervention consisted of four sessions, a booklet, a short video, and 6 written messages. The constructs of SCT and food consumption frequency were assessed at baseline, 10 days after the last session and 2-months after the intervention. The data were analyzed by Chi-square test, independent t-test, repeated measures and covariance analysis using SPSS software version 16.

Results: At baseline, the two groups were similar in the demographic characteristics, the constructs of SCT, and unhealthy snacks consumption frequency (P>0.05). Considering that the interaction effects of group and time in the repeated measurement analysis of variance were significant, the means of two groups were compared at each stage using independent t test and significant differences between the two groups were observed at two stages after the intervention.

Conclusion: This intervention had a positive effect on the consumption of healthy snacks. Therefore, SCT and the implemented procedure could be used to develop interventions to modify snack consumption patterns in children.

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Background & Aim: Improving and modifying lifestyle is necessary for health maintenance and promotion. Modification of lifestyle can have an important role in the long-term health of women with Poly Cystic Ovarian Syndrome (PCOS). Therefore, this study aimed to determine the status of health promoting lifestyle and its socio-demographic predictors in women with PCOS.

Methods & Materials: This analytical descriptive cross-sectional study was conducted on 174 women with PCOS referred to gynecology and infertility clinics in Urmia-Iran, in 2015. The data were collected through the socio-demographic and Health Promoting Lifestyle Profile questionnaires. Descriptive statistics, independent t-test, one-way analysis of variance and multivariate linear regression were used to analyze the data through SPSS software version 21.

Results: The mean (standard deviation) of total score of the health promoting lifestyle was 2.2 (0.3) out of 4. The highest mean score was in nutrition subscale [2.9 (0.5)] and the lowest mean score was in the subscale of stress control [1.2 (0.5)]. Based on the multivariate linear regression model, the variables of BMI, spouse’s education level, the first supporter and menstrual bleeding amount were predictors of the health promoting lifestyle in women with PCOS.

Conclusion: Considering that the mean of total score of the health promoting lifestyle and some of its subscales were in the middle of the range of possible scores, it is necessary that besides other therapies, the improvement of health promoting lifestyle in women with PCOS, according to the influencing socio-demographic determinants, be on the agenda of health providers.

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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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Background & Aim: Restless legs syndrome (RLS) is a sensorimotor disorder that is frequently observed in patients with multiple sclerosis. This study aimed to determine the effect of stretching exercises on the severity of restless legs syndrome symptoms in patients with multiple sclerosis.

Methods & Materials: This quasi-experimental study with control group (IRCT2016041627427N1) was conducted on 60 patients with multiple sclerosis (30 in the intervention group and 30 in the control group) referred to the multiple sclerosis society of Kermanshah in 2015. “The demographic questionnaire”, “the symptoms of restless legs syndrome and their severity”, and “exercise recording form” were used to collect the data. The intervention group was taught the correct way to exercise during four half-hour sessions. The severity of RLS symptoms was measured before the intervention and the end of the fourth and eighth weeks. Data were analyzed by descriptive and inferential statistics using SPSS software version 20.

Results: Before the intervention, the mean score for the severity of RLS symptoms was respectively 19.08±8.12 and 17.42±5.24 in the intervention and control groups (P=0.569). One month (P=0.002) and two months after the intervention (P<0.001), the score was changed to 9.70±5.24 and 7.08±4.08 in the intervention group and 17.61±5.31 and 17.92±5.52 in the control group.

Conclusion: Stretching exercises can improve the severity of RLS symptoms in patients with multiple sclerosis. Therefore, the stretching exercises program is recommended for this group of patients.

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Background & Aim: Error always occurs in the health system and it can lead to irreparable consequences. Therefore, error prevention must be taken into account by the health systems. Detection of factors contributing to error is a key factor for the prevention of error. Hence, the aim of this study was to explore factors contributing to nursing error in emergency department.

Methods & Materials: This study was conducted using a qualitative approach. 17 emergency nurses participated in this study. Semi-structured interview was used to collect the data. Sampling was started as the purposive sampling and continued until the saturation of data was reached. Data were analyzed using the Elo & Kyngas (2008) qualitative content analysis approach. To achieve trustworthiness, participants were selected with maximum variation in terms of age, gender, work experience, and educational background.

Results: The analysis of data led to the emergence of 500 open codes and four categories including the predisposing factors of nurse-related error, predisposing factors of organization-related error, predisposing factors of error related to the culture of emergency department and predisposing factors of patient-related error.

Conclusion: Factors contributing to nursing errors in emergency department were very wide and multifactorial. Identifying the factors contributing to error is a first step to prevent errors. For reducing nursing error, nursing managers should pay special attention to the contributing factors of error identified by this study and implement interventions to reduce and mitigate these factors.

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Background & Aim: Besides medical treatment, self-care education is necessary for patients with heart failure. The aim of this study is to compare the effect of telenursing and education without follow-up in the caregivers of heart failure patients on the self-care behavior and clinical status of heart failure patients.

Methods & Materials: This clinical trial (IRCT2016080829184N2) was performed on 66 heart failure patients referred to the clinic of Taleghani hospital in Abadan in 2015-2016. The patients were randomly divided into three groups: control, intervention-1 and intervention-2 groups. Control group did not receive any intervention. Patients and caregivers in the intervention-1 group received verbal education, and caregivers in the intervention-2 group received continuous phone follow-up plus verbal education. Self-care behavior, fatigue severity and exercise tolerance were assessed in the patients by the self-care behavior questionnaire, fatigue severity scale and six minutes walking test at baseline and the end of 3 months. Descriptive statistics, chi-square, paired t-test, ANOVA, ANCOVA and Scheffe post hoc test were used to analyze the data using the SPSS software v.18.

Results: At baseline, three groups were consistent in terms of demographic variables and three variables. At the post-test, there was a significant difference between the intervention-2 group with the control group and intervention-1 group in self-care behavior (P<0.001) and the patients’ fatigue score mean (P<0.004). But, no significant difference was observed between three groups in the patients’ exercise tolerance score mean.

Conclusion: Telenursing for the caregivers of heart failure patients can lead to the improvement of self-care behavior and decrease in fatigue among the patients.

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Background & Aim: Culturally sensitive care is an essential component of professional development process and one of the predictive factors of nurses’ cultural competency. This care is the most important approach to improve the quality of nursing care in culturally diverse groups. The current study aimed to explore the consequences of culturally sensitive care in pediatric nursing.

Methods & Materials: This study is a qualitative study using conventional content analysis. 25 nurses and 9 parents were purposefully selected with maximum variation sampling from the pediatric wards of three referral teaching hospitals in Tabriz and Tehran in 2015-2016. Data were collected through in-depth interviews and field notes and simultaneously analyzed using MAXQDA software version 10.

Results: The consequences of culturally sensitive care in pediatric nursing emerged in two categories: justice-based care (with three subcategories: the lack of cultural bias, culture-based communication and effective participation) and cultural satisfaction (with two subcategories: reduced cultural stress and safe care). Culturally sensitive care prevents misunderstandings and improves nurse-child/parents communication and leads to parents’ honesty to share information and express cultural needs. The expression of cultural needs decreases stress levels in parents and children and results in safe care by reducing intractable traditional treatment.

Conclusion: According to the findings of this study, it is suggested that effective culturally sensitive interventions in pediatric wards should be included in in-service courses and nursing curriculum.