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  Background & Aim: The nature of clinical practice has altered in recent years. It has been affected by different kinds of problem-solving models' so, the problem-solving skill is necessary in practice for nurse practitioners. Besides assertiveness is a critical element which persuades nurses and nursing students to establish good relationships and use their knowledge and professional skills effectively. The aim of this study was to assess the relationship between problem solving and assertiveness skills among undergraduate nursing students .

  Methods & Materials: This was a descriptive correlational study. The study was carried out in the School of Nursing and Midwifery at Iran University of Medical Sciences. The study population included all students enrolled in the four-year nursing program in 2009-2010. Data were collected using the Heppner and Petersen’s problem solving inventory and Rathus assertiveness schedule. Data were analyzed using the ANOVA, independent sample t-test and Pearson Correlation Coefficient tests in the SPSS . 

  Results: Three hundred and twenty two students participated in this study. The students' problem-solving skill (mean=89.5) and assertiveness (mean=12.1) were moderate. The study showed that last year students reported higher assertiveness skill than the freshmen (F=2.85 P≤0.037). The level of assertiveness was correlated with the level of problem-solving skill .

  Conclusion: Educational programs should provide opportunities for nursing students to enhance life skills such as problem solving and assertiveness skills. Nursing schools should improve students' skills in clinical approaches to be better care professional .

  

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  Background & Aim: The present study aimed to investigate the spiritual health among nursing and midwifery students at Kerman University of Medical Sciences in 2012 .

  Methods & Materials: This was a cross-sectional study in which all 222 nursing and midwifery students studying at Kerman University of Medical Sciences were recruited to study. Data were gathered using t he Palutzian & Ellison questionnaire of spiritual well-being. The obtained data were then analyzed in the SPSS-20 using parametric statistical tests such as independent t-test and Anova . 

  Results: Results showed that spiritual well-being of nursing and midwifery students was in the good range. Except gender, no statistically significant relationships were observed between the mean of spiritual well-being and parameters such as age, marital status, academic year, and field of study .

  Conclusion: According to the findings , spiritual health among nursing and midwifery students was moderate. It is necessary to promote spirituality among nursing and midwifery students .

  

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  Nurses’ turnover phenomenon is a major concern in healthcare systems of many countries. In recent years, nursing shortages in Iran has become a major challenge for healthcare system managers. Based on the definition, “turnover” is a process in which employees leave an organization or transfer to other departments or units of the organization. However, in this definition it has not been specified whether members’ turnover is voluntarily or involuntarily (1). Also, nurses are vital components of healthcare systems, so that as the largest group, they constitute about 56% of the hospital staff (2). Lack of knowledge about nurses’ turnover makes it hard for managers of healthcare systems to recognize its effect and it complicates the efforts to fill nurses’ vacancies (3). This complex issue has been affected by several factors. Turnover and relocation of nursing employees have affected medical expenses through impact on patients’ resultants.

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  Background & Aim: Transition from studentship to working life is a stressful and challenging event. The concept of transition is important in nursing education, management, and practice issues. However, despite its supreme importance, there are certain ambiguities about the concept of transition in nursing. The aim of this study was to analyze the concept of transition in the context of nursing in Iran.

  Methods & Materials: We used the three-phase hybrid concept analysis model including the theoretical phase, the fieldwork phase, and the final analytic phase in this study. In the theoretical phase, we conducted an online literature search to find relevant articles published prior to 2012. In the fieldwork phase, five novice nurses, two experienced nurses, and one head-nurse were interviewed. Interviews were transcribed verbatim and analyzed using thematic analysis approach. During the final analytic phase, we compared the findings of the first two phases to provide a clear and comprehensive definition of the concept of transition . 

  Results: The findings of the theoretical phase revealed that transition was a process phenomenon having defined attributes such as detachment, individual perception, awareness, and human response patterns. According to the findings of the fieldwork phase, transition was an interactive, evolutionary, and time-bound phenomenon that embodies attributes such as socialization, unavoidability, and competence and ability development. In the final analytic phase, a comprehensive definition was provided for the concept of transition in the context of nursing in Iran .

  Conclusion: This study provided a comprehensive understanding of the concept of transition from nursing studentship to working life in Iran. The findings of this study can be used to develop theories, instruments, and criteria for evaluation of novice nurses’ transition to experienced nurses .

  

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  Background & Aim: Nurses’ clinical judgment is an evolving complex concept. In order to understand the concept, clarification is needed. This study aimed to conduct the concept analysis of clinical judgment in nursing .

  Methods & Materials: Based on the Rodgers’s evolutionary method, evolving concept of clinical judgment in nursing was analyzed. Literature was retrieved from scientific databases during 1980 to 2013. Based on the inclusion criteria, 42 articles, three books and one dissertation were analyzed using thematic analysis method . 

  Results: The results showed that clinical judgment in nursing was a complicated process with attributes including intention, observation, data collection and information process, interpretation, prioritization and inference. Antecedents included knowledge, experience, evidences, clinical reasoning, intuition, critical thinking and consequences included nursing diagnosis and clinical decision making .

  Conclusion: Clinical judgment in nursing is a critical thinking process, situational based and beyond observation and assessment. This concept analysis could distinct the transposition concept of clinical judgment and other related concepts. The results of this study would help to develop theories and clinical judgment measurement instruments in practice, research and educational settings .

  

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  Background & Aim: Depression is common among nursing and midwifery students. Problem-solving is a short-term intervention that can be used to treat psychological problems. This study was carried out to evaluate the effect of problem-solving skills training on depression scores among nursing and midwifery students .

  Methods & Materials: This was a clinical trial. Nursing and Midwifery st udents (n=900) studying at Tabriz and Urmia universities were recruited in the study during 2 010-2011. The Beck Depression Scale was administered in both schools. Ninety two students who achieved a score above 10 in the Beck Depression Scale were selected. One school was randomly allocated to the intervention group and the other one was allocated to the control group. Students in the intervention group received six sessions of problem-solving skills training within three weeks. T he questionnaire was completed by the participants in both schools after the intervention. Data were analyzed using the independent t-test . 

  Results: After the intervention, the Beck Depression Inventory score in the intervention group decreased from 18.60 to 13.41 (P<0.01). There were no differences in the control group before and after the intervention (P<0.01) .

  Conclusion: The problem-solving skills training program reduced depression scores. Providing information and using the problem-solving skills training are recommended .

  

 

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  Background & Aim: Transparent and appropriate reporting of studies facilitates critical appraisal, application and combination of findings. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, is a relatively new statement in order to improve the quality of reporting of observational studies. The present study aimed to assess the quality of reporting nursing and midwifery cohort studies according to the STROBE statement published in the Iranian electronic databases .

  Methods & Materials: In this cross-sectional study, we conducted a literature search in the SID, Magiran, Irandoc, Iranmedex databases and Google Scholar using the "cohort" keyword. It produced 1951 articles. After excluding duplicates and irrelevant articles, 241 papers were remained. We included: papers that were published after publishing of the STROBE statement, papers with cohort designs, and papers which their first author or corresponding author were nurse or midwife. Finally, we included 33 papers in our study. We evaluated the papers with the extended STROBE statement. Data were analyzed using the Kruskal Wallis, Mann Whitney and Spearman tests . 

  Results: About half (48.5%) of the papers had a prospective design others were historical cohort. The compliance with the STROBE statement was 56%. The title, abstract and introductions had generally good quality. The missing data, loss to follow-up and sensitivity analyses had poor quality. There were no associations between the papers' reporting quality with the year of publications, authors' specialty, design of the study, and the time of reviewing process .

  Conclusion: The quality of reporting in nursing and midwifery cohort studies was moderate. Reporting the essential elements of cohort studies according to the STROBE statement is recommended .

  

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

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

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

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

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Background & Aim: Extravasation is one of the complications of peripheral intravenous catheters. Doing standard nursing cares leads to more effective and safer treatment and care of extravasation and the reduction in the length of hospital stay for neonates. This study aimed to audit nursing cares related to the treatment of extravasation in neonatal intensive care units.

Methods & Materials: In this descriptive study (the audit), 200 nursing cares regarding neonatal extravasation were observed and assessed. Data gathering tool was a standard check list. The data collection method was the observation and recording of nursing cares related to neonatal extravasation in neonatal intensive care unit of selected hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2015. The data were analyzed using descriptive statistics on SPSS software v.21.

Results: The standard cares were performed by nurses in some cases, and in some standards, nurses showed poor performance. Among 25 common nursing cares of extravasation, 22 cares were far from standards. After third and fourth degree extravasation, none of required nursing cares were done properly.

Conclusion: Nursing cares of extravasation for neonates in NICU are far from standard cares. This could be attributed to the lack of nurses’ awareness of the importance of proper extravasation care and its consequences, failure in nurses’ education, lack of authorities’ supervision on cares, lack of facilities and equipments, and nursing shortage.

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Background & Aim: Pressure ulcers are a common complication in patients hospitalized in intensive care units. This complication continues to be a major problem in all health care systems and reflects the quality of nursing care in hospitals. The aim of this study was to evaluate the correlation between nurses’ knowledge and quality of nursing care for prevention of pressure ulcers in intensive care units.

Methods & Materials: This was a descriptive correlational study on a purposive sample of 92 nurses employed in intensive care units of four hospitals affiliated to Shahid Beheshti University of Medical Sciences in 2014. Data were collected through a questionnaire containing demographic and occupational information, the Pieper’s nursing knowledge questionnaire, and a checklist to assess the quality of nursing care for prevention of pressure ulcers. Descriptive and inferential statistics (independent t-test and Pearson’s correlation) were used to analyze data on SPSS software v. 21. The level of significance was considered at P≤0.05.

Results: The study results showed that the average score of nurses’ knowledge of pressure ulcers prevention was a total of 75.7±6.9. The quality of nursing care in more than half of cases (54.3%) was relatively favorable. There was no significant correlation between nurses’ knowledge and the quality of nursing care for pressure ulcers (P=0.86, r=0.01).

Conclusion: In addition to inadequate knowledge of pressure ulcers prevention, the nurses did not fully implement what they knew in clinical practices. Therefore, a more accurate evaluation is recommended in this regard.

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Background & Aim: Mechanical ventilation is one of the most common treatments in neonatal intensive care unit and is however associated with many complications. One of the ways to reduce complications is providing nursing care according to standards. This study was conducted with the aim of determining the conformity of nursing care related to weaning neonates from mechanical ventilation to the standards in neonatal intensive care units.

Methods & Materials: In this descriptive study (the audit), 105 nursing cares related to weaning neonates from mechanical ventilation in neonatal intensive care units at the selected hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected and observed by the event sampling method in 2015. Data were gathered through a demographic questionnaire for nurses and hospitalized newborns, a checklist of nursing care related to weaning from mechanical ventilation. The data were analyzed using descriptive statistics and Chi-square test at the significance level less than 0.05.

Results: Conformity rate of nursing care related to weaning neonates from mechanical ventilation to standards, was 68.3 percent, and compliance with the standards of care was 71.4 percent before weaning, 65.7 percent during weaning and 66.4 percent after weaning.

Conclusion: Nursing cares related to weaning neonates from mechanical ventilation are far from standards, and for its improvement, applying clinical guideline for neonatal nursing care and clinical supervision by managers for optimizing its implementation are suggested.

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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: 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.

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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: Although the number of kidney donors is increasing in the country, few relatives decide to donate. Decision making on kidney donation to a relative faces many challenges, while how to make this decision is still ambiguous. The aim of the present study was to explore the way of decision making about kidney donation to a relative.
Methods & Materials: The present study was a qualitative study conducted in 2015. The thematic analysis approach was used to analyze the data. In this study, 16 relative donors from the kidney transplant centers of all the teaching hospitals affiliated to Tehran University of Medical Sciences (Imam Khomaini, Shariati, Sina) were selected through purposive sampling. Then, 16 face-to-face, in-depth, semi-structured interviews were conducted. Data were analyzed using the thematic analysis approach proposed by Clark & Braun (2006).
Results: Data analysis led to the identification of two themes “being resolute in decision making” and “mulling over the decision”. The first theme was comprised of three subthemes including donation with a heartfelt desire, consistency in decision making, discretion in decision making, and the second theme was consisted of two subthemes including unsteady in decision making and bargaining in decision making.
Conclusion: Decision making on kidney donation to a relative faces a variety of challenges influenced by the donor’s family background, the supportive role of family members, kinship ties and a sense of love for relatives. By providing knowledge and awareness to donors to address ambiguities and subjective questions, they can have an important role in developing the culture of relative’s kidney donation.
 

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World’s health systems have entered a critical period of human resource shortage. The shortage of qualified nurses has been suggested as one of the most important barriers to achieve effective healthcare systems (1). According to the WHO (2014), there is currently a shortage of 7.2 million health care providers at the international level. This shortage is estimated to reach 12.9 million by 2035 (2). In other words, in order to develop healthcare systems, achieve positive outcomes and ensure patient’s safety, recruiting well-qualified nurses is a global concern (3). Nursing shortage in Iran has also become a concern for managers and a major challenge to the healthcare system. The nursing deputy of the Iran Ministry of Health and Medical Education reported that the number of nurses working in health care settings is estimated to be 140,000, but there is a need for 2,60,000 nurses to deliver ideal levels of health care (4). While, qualified nurses adequacy is one of the essential components of the nursing professional practice environment (5). Poor nursing work environment, inadequate resources, imbalanced workload, disproportionate nurse-patient ratio, high bureaucracy (5), lack of supportive management, low salaries, and reduction in employment are major challenges that have caused Iran’s healthcare system to face a serious crisis of nursing shortage despite a large number of young nursing graduates (6). Evidence suggests that the nursing practice environment has a significant role in the retention of expert nurses, the quality of care and, safety of patients (7). Poor nursing work environments are related to adverse patient outcomes, including an increase in mortality rate, patient falls, and medication errors (8, 9). In addition, unhealthy workplaces are important causes of turnover, efficient nurses’ intention to leave, early retirement, job dissatisfaction and burnout (10, 11). Therefore, efforts to create environments that attract and retain nurses are worthwhile. Different strategies have been proposed to improve the nurses’ work environment. In this regard, making workplace attractive is a basis for increasing the quality of nursing practice environment (12).
Today, there are hospitals called "Magnet Hospital" that are renowned for attracting and retaining expert nurses. The Magnet hospital was first used in the United States. In the early 1980s, concurrent with nursing shortage crisis in the United States, extensive studies were begun to examine the organizational structures of Magnet hospitals. In a study, the American Academy of Nursing (AAN) identified 41 hospitals that were known to attract and retain qualified nurses, and used the term "Magnet" as a gold standard for nursing practice in these hospitals (13). Magnet hospitals are evaluated in terms of achieving goals in five areas including transformational leadership, structural empowerment, new knowledge, innovation, and empirical outcomes and development (14). Magnet hospitals with a more different organizational structure than non-Magnet ones play an important role in nurses’ job satisfaction and retention (15). One of the main reasons for the attractiveness of these hospitals is the existence of work environments focusing on decentralized decision-making, autonomy, control over practice, resource adequacy, supportive management, effective inter-professional communication, and career development (16). In other words, the organizational attributes of Magnet hospitals lead to the nurses’ empowerment by increasing autonomy and authority, and subsequently improving job satisfaction. These hospitals have designed a set of work environment standards to support professional nursing practice (17). Many studies have shown that Magnet hospitals provide a healthier environment with higher job satisfaction for nurses and better outcomes for patients, compared to non-Magnet ones (18, 19). In recent years, the development of Magnet hospitals has rapidly grown in various countries. Considering the complexity of nursing shortage phenomenon, paying attention to the factors influencing the nurses’ attraction, retention and productivity is important to overcome the challenge of nursing shortage (20).
Conclusion
The nurses’ dissatisfaction with the work environment and consequently, the shortage of competent and educated nurses, is a major challenge to Iran’s health system. Therefore, solving this crisis is vital to prevent adverse health consequences. In this regard, nursing managers and health policy-makers can create a quality work environment using the features of Magnet hospitals to increase the attraction and retention of health care professionals, especially nurses. This will not only result in the nurses’ job satisfaction but will also increase the quality of care and ensure the patients’ safety.
 

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Background & Aim: Spiritual care along with other nursing interventions balance body and soul. This study aimed to determine the effect of spiritual care on death anxiety in hemodialysis patients with end-stage of renal disease.
Methods & Materials: A clinical trial (IRCT2016308226961N1) was performed in Hamadan’s Shahid Beheshti and Besat hospitals in 2016. A total of 60 hemodialysis patients with end-stage of renal disease were randomly assigned into two groups of intervention (30 patients) and control (30 patients). In the intervention group, the spiritual care program consisted of protective care, supporting the patient’s rituals and using the support systems, was performed in hemodialysis ward at the patient’s bedside. The control group only received routine nursing care. The Templar’s death anxiety questionnaire was completed by both groups before and after the intervention. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
Results: The average score for death anxiety before the intervention between the intervention group (8.10±2.26) and control group (8.53±2.47) had not significant difference (P=0.482), while the average score for death anxiety after the intervention had statistically significant difference (P=0.004) between the intervention group with median value of 8.0 (6.00-8.25) and control group with median value of 9.0 (7.00-10.25), and the patients’ death anxiety reduced in the intervention group.
Conclusion: Spiritual care program reduced death anxiety in hemodialysis patients with end-stage of renal disease. Nurses can use spiritual care program to reduce patients’ death anxiety.