Background & Aim: Pain can detrimentally affect physical functioning, psychological well-being and social interaction. Various attitudinal factors may be associated with inadequate pain control. Hence, studies should be undertaken to gain a better understanding of association between pain control attitudes and use of analgesics and cancer pain intensity. This study aimed to determine relationship between pain control attitudes and use of analgesics and pain intensity in cancer patients with pain.

Methods & Materials: A descriptive cross-sectional study was conducted with 200 cancer patients who underwent chemotherapy or radiotherapy and experienced pain in previous 24 hours. The pain control attitudes, use of analgesics, worrisome about using analgesics and physical and psychological impacts of pain were measured using questionnaires. The cancer pain intensity was measured using the visual analogue scale. Validity and reliability of the instruments were evaluated. Data were analyzed using independent t-test and ANOVA.

Results: About 58% of patients agreed that they would wait before asking for help. Beside, the findings indicated that willing to tolerate pain and perceived control over pain were associated with the time and frequency of taking analgesic and pain intensity in previous 24 hours and last week. Also concerns about addiction to pain-relieving medications were related to the analgesic type and pain intensity within last week (P=0.03), and fear of injection was related to analgesic use and pain intensity within last week (P<0.001).

Conclusion: Many cancer patients had attitudes which could interfere with pain relieving. Suggestions are made for developing patient education programs, accessing effective cancer pain controls and decision making for cancer pain relief.

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

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

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

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

Background & Aim: Breast milk provides many healthy nutrients to infants. Support provided by health care provider has positive effects on duration of breastfeeding. The purpose of this study was to determine the effects of telephone counseling on continuity and duration of breastfeeding among primiparus women.

Methods & Materials: This clinical trial was conducted on 140 primiparus women referred to the selected health centers of Tehran University of Medical Sciences in 2010. The participants were randlomly allocated into two equal groups (each: 70 indviduals). The participants in the intervention group received telephone counseling by one of the researchers. The control group received routine care. Data were collected using a questionnaire including demographic characteristics and a breastfeeding check list. Exclusive breastfeeding rates were recorded one and three months after childbirth in both groups. Also, the continuity and duration of exclusive breastfeeding were recored three months after childbirth in both groups. Data were analyzed using the Chi-square test, Fisher&aposs exact test, standard logistic regression and linear regression in the SPSS-16 and the Win Pepi.

Results: The average duration of exclusive breastfeeding in the intervention group (8.05±3.99) was significantly more than the control group (6.23±4.03) (P=0.008). In the third month of delivery, continuity of exclusive breastfeeding in the intervention group was more than the control group (P=0.03). Results also showed that telephone counseling was effective in the duration of exclusive breastfeeding (P=0.02).

Conclusion: Telephone counseling was effective in continuity and duration of exclusive breastfeeding. Using this inexpensive and easy method can help to increase exclusive breastfeeding, especially in primiparus women.

Background & Aim: The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention.

Methods & Materials: In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses&apos performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test.

Results: Findings showed that the CPOT could not lead to improved nurses&apos function in relation to documentation of pain in the patients records (P=0.209) and recording palliative measures related to pain (P=0.117). However, there were significant statistical differences between nurses&apos function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention.

Conclusion: The critical-care pain observation tool can increase nurses&apos sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures.

Background & Aim: Pain is an unpleasant experience related to potential or actual tissue damage. Distraction is an effective technique to control pain. This study aimed to examine the effect of pressing a small soft ball during intravenous catheter insertion on pain related behavioral responses of children.

Methods & Materials: A randomized clinical trial study was conducted in surgical ward of the Qods hospital in Qazvin, Iran in 2010. Sixty children aged 4-6 were selected through a simple randomized sampling method. The children were allocated into two equal intervention and control groups. Data were collected using the FLACC scale. In the intervention group, children were asked to press a soft ball during IV catheter insertion. The researcher marked the FLACC during the procedure. In the control group, no distraction was made during the IV catheter placement. The data were analyzed using descriptive statistics, independent-sample t-test, Chi square at P<0.05.

Results: There was no significant difference between the two groups in terms of demographic variables including gender, birth order, race, age and type of disease. In the intervention group, none of the children experienced severe pain during IV catheter insertion and 63.3% of the children had moderate pain. In the control group, 50.0% of children had moderate pain and 23.3% of them experienced severe pain during IV catheter insertion. There was a significant difference in perceived pain between the children of two groups (P<0.001).

Conclusion: Distraction is an effective, non-expensive, and easy-to-access technique to control and reduce pain in children during IV catheter placement. This study showed that distraction through pressing a soft ball was effective in reducing the behavioral responses of pain in children who underwent IV catheter placement.

Background & Aim: Most of the psychological turmoil of marital conflicts is related to sexual dissatisfaction. Sexual satisfaction is influenced by physical and mental illnesses. Pelvic floor muscle relaxation is a major health problem in which prolapsed pelvic floor muscles causes paralysis, pelvic organs&apos prolpases, pelvic organs&apos dysfunction, dyspareunia, and back pain. The aim of this study was to assess the effect of pelvic floor muscle exercise on sexual satisfaction in primiparous women.

Methods & Materials: This clinical trial was conducted among 100 primiparous women selected through cluster randomized sampling from five clinics of Tehran University of Medical Sciences. Samples were randomly divided into two equal groups. The intervention group received pelvic floor exercises (Kegel) for 16 weeks. The control group did not receive any intervention. Data were collected using the Linda Berg questionnaire before the intervention and 16 weeks after the intervention in both groups. Data were analyzed using descriptive statistics and chi-square, t-test in the SPSS v.18.

Results: After 16 weeks, significant differences were reported in the levels of sexual satisfaction in the intervention and control groups (P<0.001).

Conclusion: The Kegel exercises are easy and non-expensive methods that should be offered by health professionals to increase sexual satisfaction in women after childbirth.

Background & Aim: Asthma is one of the most prevalent chronic diseases worldwide. About 6.5 million people suffer from asthma in Iran. The Effective strategy to control asthma is related to education. The self-management has a major role in the standard education program. This study aimed to assess the effect of education on using peak flow meter and follow up via SMS on asthma self management.

Methods & Materials: This study was a quasi-experimental controlled clinical trial. The samples included 98 patients, suffering from asthma referred to the pulmonary clinic in Imam Khomeini and Shariati hospitals. Patients were selected using convenient sampling method and were randomly assigned into the experiment (n=47) and control (n=51) groups through blocking method. Two educational sessions were held in the experiment group about how-to-use peak flow meter. Accordingly, the patients in the experiment group sent their peak flow rates via SMS to the researcher within 12 weeks. The researchers provided feedback to the patients about their asthma control via phone, weekly. Patients in the control group did not receive any education. Data were collected using the Asthma Control Test before and three months after the intervention. Data were analyzed using the statistical tests of Chi-square, Mann-Whitney, Independent t-test and Kolmogorov-Smirnov.

Results: There was a significant statistical difference between the two groups of experiment and control in terms of asthma control (P=0.002).

Conclusion: The education using peak flow meter and following up via SMS promotes asthma self-management. With regard to the significant role of nurses in patient education, educating patients with asthma by nurses is recommended at the Iranian Society of Asthma and Allergies clinics and medical centers.

Background & Aim: Poor sleep quality is a common problem among patients hospitalized in the CCUs. This study aimed to determine the effect of environmental factors modification strategies on quality of sleep among patients admitted to CCU.

Methods & Materials: This was a quasi-experimental study with a single-blinded design. Sixty patients admitted to the CCU of Shariati hospital were divided into two experiment and control groups. Sleep quality was measured in the first day of admission and three days later using the Pittsburgh sleep quality index in both groups. In the intervention group, we implemented a modified work environment between the two measurements. Data were analyzed using the Chi-squared and t-test in the SPSS v.18.

Results: Findings showed a significant decrease in sleep quality in the control group after hospitalization, compared with the intervention group (P<0.001). There were no statistically significant changes in the sleep quality before and after hospitalization in the intervention group (P=0.053).

Conclusion: Using environmental factors mitigation strategies can improve sleep quality of patients admitted to CCUs.

Background & Aim: Stress is a main problem among nurses which affects their professional performance and personal life resulting in conflict between work and life. The aim of this study was to determine the effect of stress management on work-family conflicts.

Methods & Materials: In a quasi-experimental two-group study, 64 medical nurses were selected randomly to the study from Shahid lavasani hospital in Tehran. Data were gathered using a questionnaire including demographic characteristics, work-family conflict items, and nursing stress scale. Then, the experimental group participated in a 2-day stress management course. The questionnaire was completed by the participants one month later. Data were analyzed in the SPSS v.18.

Results: The mean work-family conflict score was 3.97 in the experimental group at baseline. It declined after the intervention to 3.357 (P<0.001). There was statistically significant difference between the two groups on work-family conflict after the intervention (P=0.007). There was a significant decrease in the job stress from baseline (46.52) to the post-intervention measurement (35.61) in the experimental group (P<0.001). There was a statistically significant difference between the two groups in the mean of job stress after the intervention (P=0.014).

Conclusion: Stress management education declined work-family conflict and job stress among nurses. This education should be used in nursing clinical and educational training programs.

Background & Aim: Job stress can interfere with endocrine function and result in dysfunctional menstrual bleeding patterns. The aim of this study was to assess the relationship between job stress with menstrual bleeding pattern among midwives.

Methods & Materials: In this cross-sectional study, we recruited 150 midwives working in hospitals and health centers of Mashhad using two-stage sampling. Data were collected using a questionnaire including demographic characteristics, Karazek Job Content, a daily diary for menstrual periods to record duration and interval of periods, and the Higham Chart for recording the bleeding amount. The diary was completed for three menstrual periods. Collected data were analyzed using independent t-student, one way ANOVA, Mann-Whitney U, Chi-squared test, correlation test and linear regression in the SPSS-14.

Results: The findings showed that 21.3% of the midwives reported mild job stress, 19.3% had moderate stress and 59.3% reported severe job stress. Mean of the duration of the periods was 7.06 days, the mean interval of the periods was 27.9 days and the mean amount of bleeding was 79.72 cc. There was a significant relationship between job stress and the duration and interval of periods (P<0.001). There was not any significant relationship between job stress with the amount of bleeding.

Conclusion: Our study showed that job stress was related to menstrual bleeding patterns among midwives. It is necessary introduce strategies to decrease job stress and provide professional support for midwives.

Background & Aim: Recognizing and modifying organizational commitment and its related factors is important. It seems that nurses&apos attitudes towards learning organizations influence their organizational commitment. This study aimed to determine the relationship between nurses&apos attitudes towards learning organizations and organizational commitment.

Methods & Materials: In this descriptive-correlative study, 719 nurses working in Rasht educational hospitals were recruited to the study. We gathered data using the Porter organizational commitment questionnaire and the Jeong learning organization questionnaire. Data were analyzed using descriptive statistics and the Spearman and t-tests in the SPSS-18.

Results: Most of the nurses were female (94.7%) and registered (35.3%). The mean (SD) age of the nurses was 32.13 (6.98). The mean (SD) of the organizational commitment was 27.10 (42.50). The mean (SD) of the learning organization was 92.72 (10.04). The relationship between the organizational commitment and nurses&apos attitudes towards learning organizations was statistically significant (r=0.482 P<0.0001).

Conclusion: It seems improving nurses&apos attitudes towards learning organizations may result in better organizational commitments.

Background & Aim: Maternal-fetal attachment plays an important role in maternal identity forming. The attachment behavior is different between mothers and most of the reported studies are from Western countries. The aim of this study was to assess maternal-fetal attachment behavior and some related factors among Iranian mothers.

Methods & Materials: This cross-sectional study was carried out in 12 health and medical centers, affiliated to Tehran University of Medical Sciences. Four hundred pregnant women were selected for the study. Data were gathered using two questionnaires. The first one was a self-structured questionnaire and the second one was the maternal-fetal attachment scale. Data were analyzed using the Pearson, Anova and t-test statistical tests. The P<0.05 denoted statistical significance.

Results: Findings showed that the mothers had good attachment toward their fetuses (M=84.72). The race, higher maternal age, higher education, gestational age, planned pregnancy, sex of fetus, and assessing health of fetus had positive effects on prenatal attachment (P<0.05). Tobacco use, multiparity, and high risk pregnancy had negative effects on attachment. There were no relationships between attachment and previous marriage, infertility, abortion, number/type of ultrasound, participation in prenatal classes and healthy baby (P>0.05).

Conclusion: Understanding maternal-fetal attachment behavior could play an important role in quality of prenatal care. Midwives can assess and promote attachment behavior as well as recognize factors influencing maternal-fetal attachment.

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

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

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

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

  Background & Aim: Reducing maternal anxiety has a critical role in maternal and fetal mental and physical health. This study aimed to assess the effect of two anxiety reducing techniques including relaxation and maternal-fetal attachment training on anxiety in third trimester and postpartum depression among primipara women.

  Methods & Materials: In this clinical trial, 126 pregnant women were randomly selected and divided into three groups including relaxation training, maternal-fetal attachment skills training, and control group. The participants completed a demographic questionnaire, the Spillberger and Beck questionnaires and written consents at baseline. The participants completed the questionnaires after the intervention too. The one way ANOVA and paired t-test were used to analyze the data. 

  Results: At baseline, the mean total anxiety, state and trait anxiety and depression scores were not significantly different between the groups. The ANOVA showed differences in the mean score of anxiety after the intervention (P=0.03) in the intervention groups. There were statistically significant differences between the attachment and control groups (P=0.01) and the relaxation and control groups (P<0.001) in terms of the mean score of state anxiety. The ANOVA showed a reduction in the mean score of state anxiety after intervention in the attachment (P=0.02) and relaxation groups (P=0.01). There was significant difference after the intervention in the mean score of maternal depression (P=0.002) between the attachment and relaxation groups with the control group (P=0.01, P=0.01 respectively). 

  Conclusion: A ttachment and relaxation trainings can reduce maternal anxiety and post-partum depression. Pregnancy visit is an important opportunity to screen maternal anxiety and prevent post-partum depression using simple and non-expensive training programs.

  Background & Aim: Limitation of fluid intake in parturient can affect uterine contractions. Several studies have been conducted on the effect of hydration in labor progress and reported different results. In the present study, we evaluated the effect of over IV hydration on duration of labor and outcome of pregnancy in parturient women .

  Methods & Materials: In this randomized clinical trial, 120 nulliparous women admitted to Ilam Mustafa Hospital were selected from February 2010 to December 2010. All participants had non-complicated singleton pregnancies and were randomly assigned in four groups. The first group received usual care while the second to fourth groups received lactated ringers at 60, 120 and 240 ml per hour (IV fluid groups), respectively throughout active labor phase. All women had unrestrictedly access to oral fluids. The analysis was done using the ANOVA and Chi-squared tests in the SPSS-16. The p-value less than 0.05 were considered to be statistically significant . 

  Results: Key variables known to affect labor outcomes were statistically similar in all groups. The mean duration of active phase of labor was lower in the intervention groups in comparison with the control group. All groups had significant differences in the duration of second stage of labor, Oxytocin augmentation, and prolonged labor. There was a trend toward a lower frequency of the Cesarean deliveries in the 240 ml group however it was not significant. There was no significant difference in the Apgar scores between groups .

  Conclusion: Over IV hydration reduced duration of labor. There were no reports of poor outcomes for mother and infants .

  Background & Aim: Body image flexibility is defined as the capacity to experience the ongoing perceptions, sensations, feelings, thoughts, and beliefs associated with one's body fully and intentionally while pursuing chosen values. This study was aimed to translate Body Image flexibility Questionnaire (BI-AAQ ) into Persian language and assess the validity and reliability of the translated version as an instrument to measure body image resilience .

  Methods & Materials: In this cross-sectional study, 354 students (130 males and 224 females) studying in an academic year (2012-2013) at Tehran University of Medical Sciences were selected through convenience sampling method . Students filled out demographic questionnaires, "body image flexibility questionnaires", "acceptance and action questionnaire edition 2", and "depression, anxiety and stress scale". For data analysis, IBM SPSS 21 and IBM SPSS Amos 21 software were used . 

  Results: The test-retest coefficient was 0.72. The correlation of the scale with the weight consent, psychological flexibility, stress, depression and anxiety was -0.54, 0.33, 0.33, 0.45, and 0.37, respectively which represented the concurrent validity of the scale. Confirmatory factor analysis results also showed that single-factor model of body image flexibility questionnaire has good fitting the Iran' community. Internal consistency reliability was estimated with Cronbach ’s alpha (α=0.87) .

  Conclusion: Psychometric characteristics of the body image flexibility questionnaires showed that the questionnaire seems to be acceptable in Iranian society. It is a useful tool for research in the psychological and psychiatric clinics .

  Background & Aim: Coronary artery bypass graft is a critical intervention for patients with coronary artery disease. This surgery is associated with significant changes and unique experiences in lives of patients. This study was conducted to understand the experiences of patients with coronary artery bypass graft.

  Methods & Materials: This qualitative study was conducted using an interpretive phenomenological approach. Eleven patients were selected from outpatient cardiology clinics of Tehran Heart Center using purposive sampling method. Data were gathered through semi-structured in-depth interviews lasting 55-70 minutes. The van Manen six steps analysis was used to analyze the data . 

  Results: During the data analysis, the main themes of e xperiences of living with coronary artery bypass and rebirth were extracted. These themes contained living with healthy heart, feeling back to the young and attempts for health maintenance .

  Conclusion: According to the study, participants were inclined to maintain the new lifestyle, dietary changes and also adhere to medications prescription. Nurses can help patients with properly designed educational program based on experiences of the patients.

  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 .

  Background & Aim: Falling is common among elderly due to changes in sensory–motor function. Falling causes physical, emotional and financial problems and decreases the quality of life in elderly. Since the causes of falling are multifactorial, multi-dimensional approaches should be considered to prevent it. This study aimed to investigate the effect of a multidimensional fall prevention program on the incidence of falling and quality of life among old people living in nursing homes.

  Methods & Materials: This before-after quasi-experimental study was conducted on 60 old people living in nursing homes who met the inclusion criteria. Multidimensional fall prevention program was focused on: 1- exercise (stretching, balance, and strength) 2-training classes for caregivers and elderly and 3-environmental modification. Data were collected before and six months after the intervention using demographic and illness form, fall frequency form and the LEIPAD questionnaire. Collected data were analyzed using the paired t-test, one-way ANOVA, Mann-Whitney and Wilcoxon tests in the SPSS-16 . 

  Results: Before and six months after the intervention, the mean frequencies of falling were 2.00 (±0.70) and 0.20 (±0.55), respectively. The mean scores of quality of life before and six months after the intervention w ere 56.48 (±10.45) and 77.43 (±10.45), respectively. Results indicated that there were statistically significant difference between the study participants before and six months after the intervention regarding falling frequency (P<0.001) and quality of life score (P<0.001).

  Conclusion: The multi-dimensional fall prevention program decreased the fall frequency and increased quality of life of participants. Health care providers, particularly nurses can use the prevention program to diminish falling incidence among elderly and improve their quality of life.

  Background & Aim: The HIV infection is a serious health problem with major effects on various aspects of life. It is essential to understand the lived experiences of patients living with HIV/AIDS. The present study was conducted to investigate affected patients' lived experiences .

  Methods & Materials: This qualitative study was carried out using an interpretative, phenomenological approach. Nineteen patients with HIV/AIDS were selected using purposive sampling method. Field notes, in-depth and semi-structured interviews were used to collect data. The interviews were transcribed verbatim and were analyzed using the hermeneutic approach developed by Diekelmann (1989) . 

  Results: From 19 participants, 57.9% were males. Mean age was 39 years 42.1% were single 47.4% had CD4 counts less than 200 cells/mm3. The main emerged themes were as follows: 1) death way 2) halo of worries 3) hope to cure. Based on the final step of the Diekelmann approach, "being in state of hope and fear" was emerged as a constitutive pattern in patients living with HIV/AIDS .

  Conclusion: Patients with HIV/AIDS experienced fears, doubts, worries, hopes and many emotional challenges in different aspects of their lives. Caregivers should understand and comprehend the emotional states of the patients. Health care providers should design effective interventions to help individuals to cope with HIV/AIDS .