---

Background & Aim: With the increasing phenomenon of elder abuse in today's societies, understanding the facilitating and inhibiting factors related to abuse seems necessary. The purpose of this study was to explain the facilitators of elder abuse in Iranian society.
Methods & Materials: This is a qualitative study that used a thematic analysis approach to collect and analyze data in order to explain the elderly’s perceptions of the facilitators of abuse. In this study, 20 elderly people in the community were selected by purposeful sampling. The data were collected by in-depth, semi-structured and face-to-face individual interviews. The Braun and Clark’s thematic analysis was used to analyze the data.
Results: The results of data analysis led to the identification of three themes including role modeling, evacuation of failures, and cultural-familial context of the society. The third theme had three sub-themes intergenerational gap, parenting style and society’s indifference.
Conclusion: Abuse is the result of a combination of causes and factors. The elderly’ experiences suggest that abuse goes beyond a personal matter and is rooted in cultural, social, and economic practices. Today, it is not acceptance of each other and disregard for the expectations of the other party that gives rise many contradictions and abuses at the family and community level.

---

Background & Aim: Nurses' organizational loyalty to health systems plays an important role in expanding organizational performance. Investigating the role of factors such as citizenship behaviors and adaptive performance can be helpful in this regard. The aim of the present study was to investigate the relationship between citizenship behavior and adaptive performance with organizational loyalty in nurses.
Methods & Materials: This descriptive, cross-sectional study was conducted in 2019 on 200 nurses working in Valiasr hospital affiliated to Shahrekord University of Medical Sciences in Borujen, and were selected by the random sampling method. A demographic information form, the Lee & Allen’s citizenship behavior questionnaire, the Charbonnier-Voirin and Roussel’s adaptive performance scale, and the Kumar and Shekhar’s organizational loyalty questionnaire were used to collect the data. The data was analyzed by descriptive and inferential statistical tests using the SPSS software version 16.
Results: The Pearson's correlation coefficient indicated a significant positive correlation between citizenship behavior and adaptive performance with organizational loyalty (P<0.05). Regression tests showed that citizenship behavior (ADJ.R²=0.199) and adaptive performance (ADJ.R²=0.131) significantly predicted organizational loyalty. All dimensions of citizenship behavior and some dimensions of adaptive performance such as creativity, learning efforts and job stress management can predict organizational loyalty in nurses. The average scores for citizenship behavior (66.85±18.26), adaptive performance (68.76±16.98) and organizational loyalty (120.67±24.09) were reported to be moderate.
Conclusion: Managers and planners should pay attention to factors such as creativity, stress management, and continuing education along with improving healthy working relationships and nurses’ participation, which can play an important role in expanding organizational loyalty through the development of citizenship behavior and adaptive performance.
 

---

Background & Aim: Patient safety in general and medication errors in particular are the important indicators of hospital care quality. Risk management is an important and fundamental approach to preventing events caused by medication errors. The aim of this study was to determine the effect of risk management program on the rate of medication errors among intensive care unit nurses.
Methods & Materials: The present study was a non-randomized pre-test, post-test study with a control group, conducted in 2020 in two hospitals in Tehran. The hospitals were randomly assigned to either an experimental group or a control group. According to the inclusion and exclusion criteria, 150 nurses (75 nurses in each group) were selected by the convenience sampling method. For the experimental group, a risk management program was implemented. Data collection tools included the nurses’ demographic questionnaire, the 14-item Wakefield medication error self-reporting questionnaire, and the nurses’ medication quality checklist. Data was collected before and after the intervention and analyzed by the SPSS software version 16 using descriptive and inferential statistics.
Results: The results of independent t-test showed no statistically significant difference between two groups in demographic information and the rate of medication errors before the study (P>0.05). After the intervention, difference in the rate of medication errors was statistically significant between the two groups (P<0.005), indicating a decrease in medication errors in the nurses of the experimental group compared to the control group. The results also showed that the rate of medication error observed in nurses was significantly higher than the error reported by them (P<0.001).
Conclusion: The results showed that the implementation of risk management program was effective in reducing nurses’ medication errors. Implementing a risk management program is recommended to nurses as a way to promote safe medication and achieve safe and desirable nursing care.
 

---

Background & Aim: Physiological and psychological needs of intensive care unit (ICU) patients are not met due to lack of effective communication. To facilitate communication, nurses can use augmentative and alternative communication strategies (AACs). The aim of this study was to determine the effect of using these strategies on the quality of nurses’ communication with patients with endotracheal intubation in the cardiac surgery intensive care units.
Methods & Materials: In this quasi-experimental intervention study with before-after design, 70 patients (35 at each stage) who were unable to communicate verbally after heart surgery due to intubation were recruited by the convenience sampling method, and also 10 nurses in the cardiac surgery ICU were randomly selected. In the pre-intervention stage, nurses communicated with patients using conventional methods, and after training in the post-intervention stage, using AACs. Data were analyzed using descriptive and inferential statistics through the SPSS software version 22.
Results: The lowest content of communication in the pre- and post-intervention stages was related to emotions, the frequency of which was higher in the post-intervention stage compared to the pre-intervention stage. The most commonly used methods in the post-intervention phase were the communication board and head gesture. In both stages, communication was mostly initiated by the patient. In the post-intervention stage, the number of times the nurse started the communication increased (P<0.05). In the post-intervention phase, patients’ and nurses’ satisfaction with communication increased (P=0.0001).
Conclusion: Training nurses about AACs and using them for the ICU patients increase the success of communication and patients’ and nurses’ satisfaction with communication. Therefore, the use of these strategies in these wards is recommended to nurses and nursing managers.

 

---

Background & Aim: Cancer is a disease that affects the quality of life of the patient, and palliative care is a solution that can improve it. However, home palliative care program has not developed in most countries of the world. The aim of this study is to improve a home palliative care program for cancer patients.
Methods & Materials: This research is an action research study that was conducted through quantitative and qualitative approaches in Tabriz over 2018-2020. Eighteen home care nurses were selected for interviews using purposive sampling in order to identify the care needs of cancer patients and the barriers to palliative care at home. In addition, a questionnaire to determine the attitude and knowledge was distributed among 60 home care nurses before and after the action stage. The qualitative data were analyzed using conventional content analysis method, and the SPSS software version 14 was used to analyze the quantitative data.
Results: The care needs of cancer patients were determined in five categories and barriers to palliative care in three categories. Cancer patients have physical, psychological, educational, financial and spiritual needs, and barriers to palliative care include poor instruction, families' desperation, and unprofessional caregivers. In the quantitative phase, nurses had average knowledge and negative attitude towards palliative care. Training through virtual space improved the knowledge and attitude of nurses, and the paired t-test showed that the mean score of nurses' knowledge after the action stage was significant.
Conclusion: according to the findings, to improve palliative care at home, the physical, psychological, educational, financial and spiritual needs of cancer patients should be considered. Removing barriers to palliative care including developing guidelines, supporting the families of cancer patients and training special nurses for palliative care at home can improve care in these patients.

 

---

Background & Aim: Presenteeism and productivity are two crucial aspects within the realm of human resources. Presenteeism poses a significant challenge as it refers to employees being present at the workplace despite being unwell. In the context of nursing services, the productivity objective encompasses attaining a level of nursing care that is both suitable and cost-effective. Due to the importance of presenteeism and productivity, this study was conducted to determine the relationship between physical presenteeism and productivity of nurses in intensive care units of hospitals affiliated with Tehran University of Medical Sciences.
Methods & Materials: The present study is a descriptive-analytical study that was conducted in 2020-2021. The sample included 305 nurses working in intensive care units within hospitals affiliated with Tehran University of Medical Sciences. The participants were selected using a stratified simple random sampling technique. The data collection was conducted using a demographic questionnaire, the Stanford presenteeism Scale 6-item questionnaire and the Productivity Assessment Questionnaire. Data were analyzed through SPSS software version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (Pearson correlation coefficient, Spearman correlation coefficient, t-tests, ANOVA and regression analysis).
Results: The levels of presenteeism and productivity among nurses were found to be average based on the mean scores of 19.15±4.7 and 47.4±10.19, respectively. Furthermore, there was a significant inverse correlation between productivity and presenteeism (r=-0.345). Regarding the demographic variables, only age, working experience in intensive care units, hospital and current department showed a significant inverse relationship with nurses' productivity (P<0.001). The inclusion of these demographic variables and the two main research variables in the regression analysis produced a significant impact on this relationship.
Conclusion: The results of this study showed that nurses' presenteeism diminishes their productivity, which imposes considerable indirect costs on the organization. Given the high prevalence of presenteeism among nurses and its detrimental consequences, it is recommended to undertake various measures aimed at mitigating this issue. These measures can encompass adjusting organizational and managerial policies, revising administrative rules and regulations to permit sick leave during illnesses, and creating conditions conducive to employees taking time off when unwell.

 

---

According to a global report, 47 million people are currently living with dementia, and due to the aging population, its prevalence is expected to triple by 2050. In the future, Iran is expected to experience a significant increase in the elderly population. Currently, in Iran, the prevalence of dementia among individuals over 60 years old is 7.9%. Therefore, this group represents a significant population that warrants further research (1).
The best understanding and explanation of human experiences come from first-hand sources, specifically from people who have experienced those phenomena. Therefore, reliable research sources place great emphasis on including the voices of these individuals (2). Qualitative research out for its collaborative, inclusive, and flexible structure, enabling the exploration of complex issues, including mixed or ambiguous attitudes (2). It can reveal the profound experiences and core values of people with cognitive impairment that may not emerge in quantitative studies. Additionally, qualitative research excels in vividly portraying these experiences and values (3).
Throughout history, people with cognitive impairments have been marginalized from engagement in health and social research, resulting in their voices being inadequately represented in such studies. (2, 4). Instead, their perspectives have been channeled through their legal representatives or guardians, a practice that often entails constraints. These limitations include the inability to accurately predict the patient's decision-making process, the amount and manner of information provided, and the weight of decision-making responsibility placed on them (5).
Furthermore, excluding these individuals from the research process can dehumanize them and perpetuate negative stereotypes about people with cognitive disorders. This also contributes to power imbalances (2). Therefore, it is crucial to develop strategies that ensure the safe participation of these individuals in research endeavors. Through these efforts, we can improve our understanding of policy and measures aimed at promoting health and well-being (6).
 

---

As explained in the first part, the acquisition of firsthand experiences is an essential element of qualitative research for uncovering and enriching study findings. However, individuals with cognitive disorders are often excluded due to various challenges. In these cases, researchers may rely on caregivers or close associates to understand their feelings and views. This approach not only reduces these individuals to mere objects but also presents ethical dilemmas, thereby impacting the depth and richness of study findings (1). Given that the methods of data collection significantly impacts the results of studies (2), it is imperative for qualitative researchers to strive towards directly gathering information from the individuals themselves. Understanding the experiences of people with cognitive impairments is crucial for providing evidence-based services. However, these patients often encounter challenges such as speech difficulties (3), ‘pseudo-reminiscences’ (4-6), mood fluctuations and behavioral problems (7), and other issues. Therefore, researchers should take into consideration certain factors when conducting interviews with these individuals as in-depth interviews aim to gain a deeper understanding of participants' life experiences (8,9). These interviews require specialized skills across various stages, encompassing the development of interview guides, participant recruitment, obtaining consent, conducting effective interviews, data analysis and interpretation, and proficient communication and dissemination of research findings. This section delves into the key aspects of each of these phases. During interviews, it is important to prioritize the well-being of both the researcher and the participant while reflecting on and ensuring the depth and richness of the interview content (6).
 

---

Content analysis is a systematic and reproducible method through which large quantities of textual words are condensed into smaller, more understandable categories. This is achieved through coding principles. The approach is used objectively and systematically to study and analyze messages, enabling meaningful interpretation through precise measurement of variables. Content analysis is one of the oldest and most reputable methods for examining textual data, initially used in religious studies to understand metaphors and implicit meanings in sacred texts such as the Bible. The method traces its roots to eighteenth-century Scandinavia and, in the twentieth century, developed in the United States as a research technique with both quantitative and qualitative orientations. Qualitative content analysis, through coding, categorizing, and theme extraction, organizes data and provides a coherent, in-depth understanding of the phenomenon (8).
One important and widely used method in qualitative content analysis is the Graneheim and Lundman approach, which is commonly applied in conventional (inductive) studies. This method emphasizes coding, identifying main topics, and extracting fundamental concepts to offer a coherent and reliable framework for analyzing qualitative texts. Two key studies published in 2004 and 2020 by Graneheim and Lundman both presented approaches to qualitative content analysis, but their focus and details differ. Although both studies aim to extract meaning and offer precise interpretation of qualitative data, a precise understanding of their similarities and differences is of high importance for researchers.
 

---

The recent war between Iran and Israel exemplifies modern hybrid warfare, combining traditional and emerging threats, including cyberattacks, psychological and informational warfare, and biological operations. The healthcare system, as a critical target in such conflicts, is highly vulnerable both humanly and digitally, and any disruption to its infrastructure or digital systems can have severe human, social, and economic consequences. Experiences from countries like Ukraine, and South Korea demonstrate that enhancing cyber, human, and managerial resilience in healthcare—including establishing backup facilities, multi-skill training, advanced cybersecurity, and rapid response protocols—is crucial to ensure continuity of medical services and minimize damage. Therefore, developing national policies and programs to strengthen the resilience of healthcare systems against hybrid threats is essential, as preparedness today guarantees the continuity of health tomorrow.

 

---

Background & Aim: With the growing elderly population and increased survival rates, it is crucial to focus on the palliative care skills and knowledge of nursing students. This study aimed to assess the effect of palliative care education on the knowledge, attitude, and perceived self-efficacy of nursing students.
Methods & Materials: This quasi-experimental study took place in 2025 with 32 nursing intern students from the Meybod/Yazd Nursing School. Participants' knowledge, attitude, and perceived self-efficacy were evaluated before and after a palliative care education intervention using a questionnaire. Perceived self-efficacy was also measured one-month post-intervention. The intervention consisted of six four-hour sessions of a palliative care education program. Data analysis was conducted using SPSS version 21 and descriptive and inferential statistical methods (paired t-test and analysis of variance with repeated measures).
Results: Prior to the intervention, the mean scores for knowledge, attitude, and self-efficacy in palliative care were 26.90±3.76, 81.87±9.42, and 28.50±8.10, respectively. Following the intervention, the mean scores for knowledge (33.40±2.84), attitude (84.68±10.29), and self-efficacy (29.75±5.72) increased. One month later, the mean self-efficacy score rose to 32.37±6.52. The results indicated that only the increase in knowledge scores before and after the intervention was statistically significant (P<0.001).
Conclusion: The findings suggest that palliative care education positively impacts the knowledge level of nursing students. Therefore, implementing educational programs in this area during the educational period can be beneficial.
 

---

 Spiritual care is a fundamental component of holistic care that addresses patients’ needs for meaning, hope, and existential concerns alongside physical treatment. Despite its importance, it is not widely implemented in nursing practice due to conceptual ambiguity, lack of structured education, professional challenges, and organizational limitations. Heavy workload, absence of clear assessment frameworks, and concerns about invading patients’ privacy are among the main barriers. Strengthening specialized training, providing organizational support, using spiritual assessment tools, and developing multidisciplinary teams can improve its implementation. Ultimately, spiritual care serves as a bridge between treatment and humanity, enhancing the quality of care and the satisfaction of both patients and nurses.